QANDrA - Episode 2

Thanks for all the questions this month, which I’ve picked mainly travel focussed queries. I’ve just done a Tour of Duty to Seattle and San Fransisco for work, and the vagaries of time zone shifting really brings training and performance into sharp focus. I’d forgotten just how tough it can be to feel settled in a new city, let alone get the best out of your body on the track.

Make sure you shoot any questions to me by the contacts provided below- no question is too silly! There’s no names attached, so feel free to share something you’ve always wanted to know…

First up, some general advice before we get to specific medical stuff. Preparations for any exotic location need to start well before booking a ticket or packing your bag. Have a look at DFAT online for any warnings about where you’re going to (hopefully no RD is setting up a transition in a war-zone…but you never know!) Then which vaccinations may be required which you can search for online ( or ask your local GP. They’ll probably just google it too, so you may as well head along there informed.

Lastly, don’t forget you’ll need health/travel insurance. If you break a leg in the US, things can get expensive. Or worse still, if you break it at the Timbuktoo 70.3 they may lop off your leg while you’re unconscious…so always have the option of first-world helivac care!

Question one:
Will Melatonin work to drop me into a new time zone?

No strict answer to this one. Maybe it will…or maybe it won’t work for you. But for starters, what is Melatonin? It’s a hormone that is available at pharmacies on prescription from your general practioner. A bottle of two milligram tablets (30 tabs) will cost you around forty dollars. It’s not subsidised under the PBS, making it quite expensive. There are over the counter versions marketed as homeopathic, but I’m almost certain these are derivatives of melatonin and not the actual hormone. Ninety percent of the tablet will be cleared by your liver after you absorb the tablet, but you only need 0.2-0.3 active to do the job. Take it seriously- this is a hormone whose primary function is to regulate your sleep-wake cycle. Get some clear advice from your GP on how much to take and when. As an adjunct, use a smart phone application like Jetlag Genie. I’ve had a number of medico’s use this app with good success.

Aside from advising about melatonin, it also touches on all the natural behavioural ways to drop efficiently into a new zone. Simple common sense things like: sleep and wake times; when to get some sunshine and when to avoid light; or even taking a nap. Exercise also plays a role in ‘training’ your circadian cycle, so always get out for a session when you wake. Meal timing is also important, so snack when you’re hungry, but try to eat your main meals in the new zoned times. Just like training, acclimation to time zone requires diligence and adherence to basic principles for success!

Question two:
What basic medical kit should I carry with me on a triathlon trip?

If you think about all the things that can go wrong on an international trip, and the vagaries of what may/may not be available from the local pharmacy…this list can get a bit extensive! But there’s a great principle in medicine: “When you hear hoof beats, think horses…not zebras.” That is, common things happen commonly. You only really need to prepare for the common happenings, which are (in my mind) as follows.

1.     Chafe/blisters: Almost a guarantee to happen before, during or after a race! Have some papaya ointment, it’s a great barrier and lubricant for all of the above. The blister blocks/donuts can take the pressure off these areas of friction (undercarriage, neck, under ams, nipples). As always, apply liberally to potential area’s pre-race!

2.     Crashes: Have a supply of compression bandages, tape, gauze and disinfectant. A triangular bandage can double for a sling or a wrap for an injured limb. Fixomull is a hypoallergic tape that covers road rash and sticks extremely well- providing a great barrier. Alcohol swabs around the area will help it to stick at it’s best. Panadol and anti-inflammatories.

3.     Infection: Could happen with all the stress of training, tapering and going away. Usually this will be an upper respiratory illness. If you have a friendly GP, a script for broad spectrum anti is a good thing for your kit bag. Make sure you ask for specific instructions about the utility of what to take and when. Have these instructions written on/in the box. Don’t take it if you don’t understand what its for…

4.     Clots: a simple prophylaxis prior to departure is to take three to five days of half an aspirin daily, then continue throughout your trip until the same period after you have arrived home. This dose makes your platelets less sticky, reducing you risk of a clot.

5.     Food poisoning/Gastro distress: Bugs are everywhere, whether you’re third world or first. Shoot for frequent and thorough hand washing. Gastrolyte sachets and water are the best place to start. An anti-nausea drug (again on script from your GP) is a perfect companion with panadol as a first line treatment.

6.     Stings. Stingose is a great panacea for an itch, but there are a number of preparations that do the same job. Even better, take your favorite insect repellent to avoid the bite in the first place. Stay sensible and have malaria prophylaxis if you need it (do your research). The DFAT website is a good start.

7.     Bandaids. Of all shapes and sizes. You’ll always use one. Especially when you start losing toenails after the race.

8.     Your regular medications. Toiletries. Just saying- they’re easy to forget! And they’re the things you actually need. Put the daily medications in your hand luggage with a letter from your GP, so that if your luggage is lost, you won’t be without them.

9.     Sex: prophylactics. Herpes and Tinder are a world-wide phenomenon. Ural.

10.  Scissors. Nail scissors. You need to prepare your feet for a race.