I stand with HER

Tomorrow I will vote for a major party candidate for first time in over 20yrs. My vote will be cast because I love the women in my life. Because I love my nieces, and the daughters of my friends. Because I love my friends of color. Because I love my Hispanic friends & family(!). Because I love my gay and lesbian friends. Because I believe all religions are equally about love. Because I believe all races are equal. Because I believe in truth, and democracy. Because I don’t believe hate and fear should rule the day. Because I believe we should progress towards equality for all and peace. Because I live for the light, not the dark. Only one candidate supports all of this, and sadly, one is against it all. One candidate has run a positive election, while the other is only about the negative. One candidate is truly prepared and competent, and other not at all. Tomorrow, I stand with HER.

Another reason I will stand by HER tomorrow. She has been preparing for this for decades. I am anti politician, and have voted 3rd party for president for over 20yrs now. She is a politician, but that is all I’ve truly had against her. I did for a while believe in some of the propaganda against her. Hard not to when it has been going on for over a decade. The republican party recognized her potential and the threat to their party long ago and have been trying to smear her since then. Has she been a saint? no. Has she made mistakes? yes. Is she trying to make money? Who isn’t? Fact of the matter is though, after spending millions of tax payer dollars trying to bring her down and discredit her, the republicans came up with nothing. Zilch! Nada! Emails? Give me a frickin’ break. Nothing there. She didn’t do anything that half of our elected officials aren’t doing. Was there some potential security leaks/risk? Yes, but nothing major. Nothing that many other politicians have done and are still doing. You have to remember (or realize) politicians are NOT held to same security standard as military, fbi, etc. The don’t go through years of training and vetting that those in the intelligence community go through. By being elected, they skip over that. You can’t expect them to maintain the same standards. Did she make a mistake or demonstrate bad judgement, possibly. But, I’m confident she learned from it and won’t make same one again. Benghazi? Again, it is mistake others before her have made, and was compounded by republicans cutting security budget. Another thing she most likely has learned from. Bottom line, there is nothing she has truly done wrong. What she has done is a lot of good for women, and minorities. Gained valuable experience with how our government works (and doesn’t work), gained experience in foreign relations. Gained the confidence of allies and friends. She has prepared herself probably better than any president in history. That’s probably why so many fear her, she is showing the men how they should have done it. I don’t agree with all of her ideas and goals, but I do believe she is the one, and only competent and prepare candidate we have. I do believe that she can not only do the job, but that even if I don’t like all that she does, she will do an excellent job as President. Tomorrow, and for the next 4+ years, I stand with HER.

Hillary Clinton for President!

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30+ Hours of Love Up In Smoke… Part II

20141216_201345_resizedAlarm went off on time, but no, getting up wasn’t going to happen. Too many beers the night before and up too late with Jessica and her brother, so I reset and tried again. I finally dragged my weary carcass from bed around 5:45am and got straight to work.

First the turkey was pulled from the truck, and removed from the brine. I rinsed both the turkey and the brine bucket, and the put the turkey back in the bucket with some fresh water. This was recommended to tame the salt some. While the turkey was soaking in fresh water I started to get the smoker ready. Unfortunately I was bit lazy last time I used the smoker and had a lot more work to do than I had expected. I had to empty all the ashes, clean the water pan, and clean the grill. Once the smoker was ready for use, I filled my charcoal chimney and started the first coals.IMG_2792 I then went to fill my water pan with water, and this was when I encountered my second problem of the morning. I forgot the pan had a hole in it. I solved the problem last time by lining it with aluminum foil, unfortunately that foil was no longer usable, and we were out of it (or so I thought).

At this point I decided I needed a little help, and nuked up some leftover coffee from the morning before. This alone wasn’t going to cut it, so I added in some Irish cream liquor (Molly’s). This did the trick, and I was able to focus on the problem with the water pan.

I ended up sticking an old camping cook pot in it, and filling that up with water. I couldn’t just use the cook pot because it was too narrow to rest in the sprockets to hang it, but it worked fine sitting in the old pan. Actually, it worked better because it held more water and meant I wouldn’t have to add any while smoking. This was great because refilling it loses a lot of heat and adds time to the cooking process. I also chopped a couple apples that were rather bruised and getting old and threw them into it. The apples wouldn’t taste good to eat, but they would add some flavor to the steam rising from the pot.

Next step was to prepare and apply the wet rub to the turkey. Once again, no recipe, just threw it together. I poured about a ½ cup of olive oil into a bowl, added about a handful of celery salt, ground pepper, thyme, basil, oregano, and garlic powder. Everything was mixed thoroughly and let sit for about 10 minutes. While it was sitting, I pulled the turkey out of the water and dried it off. I then slathered the wet rub all over the turkey and put it to the side.

20141216_100105_resizedFirst cup of coffee was wearing thin and I started a fresh press pot. By the time it was ready, and I added some more Molly’s, the charcoal was ready. So I put the coals into the smoker, added some additional charcoal and a couple pieces of the mesquite wood I had been soaking. Water pan was put into place with the camping pot, and then the grill was put in. I put the lid on the smoker so everything could start heating up, and went inside and put meat thermometer probe in the turkey. The previous year, after struggling to smoke my first turkey, I decided to buy a wireless digital thermometer. This was a great buy, it allowed me to spend time with our guests, help prep the rest of the food, etc, while still monitoring the turkey and smoker temperatures. Once the thermometer was in the turkey, it was time to put it in the smoker and install the other probe in the smoker.20141216_095908_resized

7:30am and the turkey was finally on the smoker. I was a bit concerned that i may have gotten it started a bit late to make our goal dinner time of 4pm. Not much I could do about that at this point so I decided to take a short break and sat on the porch with my coffee and Molly’s. It was too cold to sit out there long, but that was ok, because the coffee didn’t last long anyway. I went back in, poured another cup of coffee and Molly’s and started cleaning up my mess. I needed to get the kitchen ready to start making the rest of the dinner.

I then poured another cup of coffee with Molly’s. Before I finished that cup of coffee, my pocket started beeping letting me know that the temperature in the smoker had fallen too low. So I quickly went out and tried stoking it up. Unfortunately, 15 minutes later temp was still dropping so I started another chimney of charcoal. I used only bigger chips in it so that I could more easily put them into the smoker.  I anxiously kept checking the charcoal chimney to see if coals were lit enough to use. The whole time the temperature in the smoker kept slowly sinking. I was starting to think I might have the turkey ready by Christmas at the rate things were going. Finally, the additional coals were ready and I put them in the smoker with some more mesquite, and additional unlit coals. It took a few minutes, but temps started to rise again.

I washed the coal dust from my hands and went back into the kitchen. My next planned step was to make the cranberries. I usually start with the basic 1 cup of water, 1 cup of sugar and add 1 bag of cranberries. From there I add ground cinnamon, nutmeg, allspice, ginger powder, a little ground cloves, cayenne pepper, zest of one orange, and some chopped walnuts. This year I decided, while starting it, to sub in some honey for some of the sugar. I put the water, sugar, and honey into a pot, and put it on the stove with burner on high. While I was waiting for it to come to a boil, I started looking at what else I could get ready, and totally forgot about it. That is until it boiled over. Sugar honey water boiled out of the pan, onto the stove, into the stove etc. I quickly pulled what was left off of the stove, set it aside, and finished my coffee.

After pouring a cup of Molly’s with a dash of coffee, I started cleaning up my mess. About this time Jessica wandered into the kitchen, and informed me that her mom and Tom were bringing the cranberries. This left me with a partial pot of honey sugar water that I didn’t need. But, less work for me, so I celebrated with another Molly’s with a hint of coffee, and then started another pot coffee.

Shortly after I cleaned my sticky mess from the top and insides of the stove, Jessica’s mother, Darla, her mother’s husband, Tom, and her grandmother, Bernie, arrived. We greeted them. Their additions to dinner, and their luggage were brought in. Her brother and Menderes woke up around this time and joined the throng. It was general chaos for a while, and the Molly’s with coffee coloring was going down quickly.

After a while, they all started talking about making breakfast before getting started on dinner. This seemed fine with me, but as with most things, they took a while to get started on it. The smoker temp was doing well, and the turkey was making up for lost time. Temperature of the meat probe showed it cooking quickly. Actually, before anyone got started on breakfast, I started to realize turkey was cooking too quickly. It wasn’t quite 11am yet, and the turkey breast had already reached a temperature of 150deg. It only needed to get to 160!!! Now I was cooking the damn thing too fast! I tried to get them moving on breakfast, but I was the only one that seemed to understand that dinner was coming, and possibly coming soon. If they didn’t get breakfast going, they were going to have turkey for breakfast.

I poured some more Molly’s and went out to try and cool off the smoker.  I cracked open the top, and side door for a while. Once temp was down around 250 (it had been around 390) in the smoker, closed it all up again and went back inside and topped my Molly’s off, and added a little coffee coloring.

IMG_2773Fortunately, breakfast was now underway. I was a bit grumpy (a lot grumpy if you ask my wife), and didn’t want to breakfast with everyone. I just wanted to get them started on dinner. Wasn’t sure how long I could nurse the turkey along without drying it out too much. Fortunately, the water pot still had plenty of water steaming away in it. In retrospect, maybe a morning long breakfast of Molly’s and coffee wasn’t the best idea, but at the time I thought it was working well.

Not soon enough for my liking, breakfast was done and I helped clean it up, while drinking another mug of Molly’s. I then helped get started on the rest of Thanksgiving dinner. I was continually in and out of the house though, as smoker temperature kept getting too high. I would go out, partially open top and door again, and then when temp dropped low enough shut them again. The good thing was that Jessica, Darla, and Bernie were all into IMG_2776dinner prep mode and things were going well in the kitchen. At least until we got to the dressing. Jessica wanted to do it one way, her mom a slightly different, I chimed in with another variation and got ignored. Eventually I had enough, or Molly had enough, and I left the rest of the dinner prep to the three of them, which they handled quite skillfully. I instead decided to quit pretending, drained my Molly’s and went down to the basement and poured myself a pint of Southern Tier IPA.20141216_203218_resized

I had to keep sneaking through the kitchen to cool off the smoker, and then back through again, but managed to not interfere with the work going on there. At some point though I did end up with a knife in my hand, but merely used it to chop some onions and celery for the dressing. I also finally found the right amount to crack open top of smoker to keep it at a steady 250deg, so I didn’t have to keep going out. The turkey temp actually dropped back down to 140 and stayed there.

Finally, after I don’t know how much Molly’s and about 3 pints of IPA, dinner was approaching completion. I went out, closed up the smoker, stirred up the coals, and got the turkey going again. It took about 45 minutes, but the turkey hit 160, and dinner was ready. I just needed to let it rest 15 minutes and then carve it up.IMG_2791 IMG_2790

Around 2pm we all sat down to eat. We had initially planned for around 4pm, and the way things started with the turkey, I was thinking I’d be lucky first for 10pm, then noon, but it all worked out well in the end. I was feeling no pain, the turkey was tasty, as were the dressing, mashed purple potatoes, mashed turnips, candied sweet potatoes, cranberries, apple pie, pumpkin pie (made with real pumpkin that Jessica cooked up), and cranberry bread. I wish we could have had all of our family and friends with us, but we’re grateful for those that were.

After dinner I had to finish carving up the turkey. The carcass was put in a freezer bag and stuck in the freezer for Jessica to use to make soup. I then had over an hour of clean up for my all of my smoking gear, including the smoker itself. By the time I was done, over 30hrs had been invested in smoking the turkey. A lot of time, but well worth the effort. Good news is, we still have a turkey in the freezer so I can do it all again next summer…


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30+ Hours of Love Up In Smoke…

IMG_2730For the second time in my life, I played host for Thanksgiving. The first was long ago in a galaxy far, far away, or Texas, which is pretty much the same thing. It seems like a lifetime ago, but I haven’t forgotten it, or any of the wonderful people that I met while I was down there, though only a couple of them were at that dinner. It was long enough ago, it was almost like I was doing it for the first time.

We originally were supposed to have a much larger group, but due to foreign bureaucracy, our group was a bit smaller. When we were expecting the bigger group we weren’t sure if one turkey would be enough, and there was no way our small oven could make two, so I had volunteered to smoke a turkey to compliment the oven roasted one. However, after we found out about the smaller gathering, it was decided that we would drop the oven roasted turkey, and I would smoke one anyway. This would give us more room in kitchen and allow the oven to be used for other things. I have smoked a turkey before, not for Thanksgiving though. Thus putting a little more pressure on this one since it would be the center piece of the meal and had to be ready to go when all the rest of the days delicacies were. Also, even though my last smoked turkey was good, I felt I needed to elevate it a bit so that it did the day proper justice.

The easiest way that I could come up with to knock this turkey out of the ball park was to give it a good brining. Brining is commonly used in smoking meats, but I’d never done it before. Thank goodness for the good old internet, where everything on it 100% accurate and true. Well, at least occasionally, but it is a good source for things like this. I googled a few brine recipes, glanced at them, thought simple enough, and then totally disregarded them and went at it Douglas style, which means I winged the mother…

I did see and remember enough to know that generally you put some salt in water, boil with some aromatic seasonings until all of the salt is dissolved. I also saw that some of the aromatics can be added in after the boiling before you add in the remaining water. Simple enough!

IMG_2722Brining day was Wednesday, the day before Thanksgiving. We kicked off the day with an early swim, and I do mean early. Then a quick breakfast and it was brining time! I started with about 1 ½ cups of salt and 4 cups of water, but quickly learned that that wasn’t enough water to fully dissolve the salt, so I added in a couple more cups. To this I added: a handful of black peppercorns, a handful of dry thyme, a handful dry of oregano, and a handful of dry basil. Yeah, that’s about as accurate a measurement as I ever use, usually I just eyeball things, or add to taste, which is probably why I can’t bake. Anyway, I let this simmer for a while to fully release all of the flavors. I also wanted to add a handful of coriander seed, and a handful of dry bay leaves, but I didn’t have any.

IMG_2725Once the brine was pretty well cooked I made the bad decision that I was going to go get the coriander and bay leaves and add them in. I had my mind set on it, and couldn’t let it go, so needed to make a store run. Besides, I needed more charcoal.  I told Jessica what I was doing, and my quick trip quickly became the full shopping trip for all of Thanksgiving. It was the day before Thanksgiving, it was snowing heavily, so roads were in bad shape, and therefore I was going to be fighting the last minute Thanksgiving shoppers and blizzard panic shoppers, what fun. To top it off, I went to the wrong store, the one that didn’t carry my brand of charcoal (Royal Oak. I used to be a Kingsford person, but decided I didn’t want the chemicals in my food), and had to go to a second store during my outing.

IMG_2728Over an hour later I was back home, and ready to continue brining. I added in the coriander and bay leaves, and set them to simmering. While the brine was cooking, I chopped some onions and garlic and threw them into my brining bucket (5 gallon bucket I bought at hardware store for $3). I added the brine to the bucket and let it soften the onion and garlic and start to draw out their flavors. Next I added what I thought was the crowning touch, the king of my aromatics, a pint of Southern Tier IPA! I felt this would really get things hopping…


Once my brine mixture was complete I added my IMG_2732turkey to the bucket and started adding enough water to completely submerge it. Jessica quickly noticed a problem, the turkey was starting to float, but I had anticipated it and already had a fix in mind. I took the pot I had started the brine in, put it in the bucket on IMG_2733the turkey and added water until the turkey sank again. I then finished adding water until the turkey was completely submerged. A quick stir and it was all set.

It was around noon when I finished and the plan was to let it brine until the next morning when it would go into the smoker. We did have a bit of a problem in regards to how to refrigerate it overnight. Our fridge was too full, and I didn’t want to remove my keg of Southern Tier IPA from the kegerator and let it get warm. There were a couple of suggestions that since it was so cold out that we could leave it out on the back porch, but I didn’t want the raccoons and neighborhood cats to feast without us. Eventually it was decided that inside my truck would be the perfect spot, so there it went for the night.

Thanksgiving morning I knew I needed to get going on things early if we were going to eat dinner at a reasonable time. I have an old charcoal smoker, and it was going to be a cold, windy day so controlling temperature was going to be a challenge. With that in mind I set my alarm for 4:30am.

The rest of this post, the actual smoking of the turkey, will follow soon in Part II…

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Time to Celebrate and Promote Athletic Training: March is National Athletic Training Month – We Got Your Back #NATM2014

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Every March is National Athletic Training Month. For some it is a time to celebrate athletic training, and thank their athletic trainers for all the hard work they do. To show appreciation for keeping their athletes safe, and for helping active bodies of all ages prevent, and rehabilitate injury. But for me, and for many others, it is a time to educate our communities about what athletic trainers are, and what they can do for them. It is also a time to help further and improve the profession of athletic training, which helps out every active person around us.

I was, and still am an athlete, in addition to being an athletic trainer. Over the years I suffered many an injury myself and needed help. Part of that is why I decided years ago to become an athletic trainer, and over the years have come to know many athletic trainers that I have to thank for helping me get to where I am now.

For those of you that don’t know, athletic trainers are sports medicine professionals. We are not trainers, but rather highly trained medical professionals specializing in prevention, emergency care, concussion evaluation and return to play, rehabilitation of injury, education, and so much more. They don’t just care for athletes they care for everyone that is active.

The profession of athletic training is continually growing, and as athletic trainers it is our responsibility to step forward, help the growth, and grow with it. It is our responsibility to do what we can to help protect our athletes and encourage parents, doctors, administrators, and everyone else to help us do this. One way to do this is to help support and push for legislation that allows athletic trainers to fully use their training and expertise. In New York the New York State Athletic Trainers’ Association is currently working with legislators, physicians, and more, to update our practice act. Our practice act is the legal guidelines that determine the education and training required to be an athletic trainer and the limits of what they can do to help their athletes and patients. Our new practice act, if passed, will tremendously improve the care we give our athletes, and ensure that only those with the proper training, education, and certification can perform the job of athletic trainer.

For the rest of March, and beyond, please thank your local athletic trainer, and help support our profession, and in doing so, help us protect and care for our athletes. Thank you and happy National Athletic Training Month!

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Looking to Improve

Resolve: to make firm decision about.

Resolution: a course of action determined or decided on.

Goal: the result or achievement toward which an effort is directed.

I’m not of these New Year’s resolution kind of people. That doesn’t mean I don’t set goals for improvement, I just don’t make a yearly determination for them. I always have jessthem, and as one is achieved, a new one is set. In my opinion, if you aren’t looking to improve, you’ve given up and are just sorting floating to the end. I’m all about improving, I’m just not resolute about it, merely have a goal of it. However, I am deciding to follow my wife’s example and publish some of my current goals. They range from athletic, to work, to professional, and to personal.

So, here they are, and in no particular order:

1 – I want to start posting in my blog more often. I’ve been very sporadic since I first started it, and this bothers me. I love writing, and sharing my thoughts, and adventures. I have dozens of posts partially written, I just haven’t gotten around to finishing them. Last year for National Athletic Training Month (NATM) I had a goal to write a post a day NATM 2014 logo colorrelated to athletic training. I only missed 2 or 3 days. I thought this would get me started again, but no, I went several months without another post.

2 – I want to continue to improve the care I give my athletes at work. I’ve been an athletic trainer at my current school for over 13 years, and each year I’ve tried to make some improvements. This involves not just improving the facility, equipment, and event and practice coverage, but also improving my knowledge and skills. There is always something that can be improved, new techniques, and technology to learn and acquire. Always room to improve.

3 – I’m still looking for my sub 11 hour Ironman, and do another sub 5 hour ½ Ironman. I also want to qualify for my 3rd age group national championships in triathlon and finish in top 20% of my age group.

4 – I want to improve my swimming. Part of this is for my triathlon goals, part of this is just because in over 7 years of triathlon I have improved in both running and cycling, but my swim is unchanged. I want to get stronger, and faster. I want to return to Swim Ocean City and not only finish the full 9 miles, but I want to do so in less than 5 hours. If I’m the lastopen_swim_ocean_city_maryland_1-300x252 finisher again, that is fine, I just don’t want to look like I’m on deaths doorstep this year.

5 – I want to continue to become more involved in my profession. Several years ago I took on the task of being the LinkedIn account manager for the National Athletic Trainers’ Association District 2 (NATAD2). About a year later I took on the responsibility for handling the Section One Athletic Trainers’ Society (SOATS) Facebook, and Twitter accounts, and later took over their LinkedIn account, basically becoming their social media coordinator. From there I started becoming more and more vocal in supporting and promoting our profession on social media, and everywhere else I could. Including the blogging I mentioned about during NATM above. Back in October, 2013, I became the New York State Athletic Trainers’ Association’s (NYSATA) Newsletter Chair and Editor. I’m not sure what the next step will be: larger role in promoting NATM, being very active in helping find support in getting our (NYSATA) new practice act passed, or other. But, I’m sure I’ll find something.

6 – I want to become a better husband. I feel I already do a lot for my wonderful wife, but wedding picI’m sure that there is more I can do, ways I can better show my love for her, and ways I can improve our relationship. I’ve put this late in the list, but it is the most important one. I’ve got some ideas, but it is just a matter of actually implementing them. No, I’m not sharing them on here though.

7 – I want to do a better job checking things off of our home improvement to do list, which is quite extensive. We’ve done a lot, but there are a lot of little projects that have I’ve been putting off and a few projects that I’ve never quite finished. This would also help with goal #6, but only a little bit.

Sorry, nothing exciting here. Unfortunately, I’m off to a poor start on it too. This post was supposed to have been written, and was actually started, at the beginning of January, and here it is February and I’m making my first blog post. Fortunately I have been doing better with projects around the house, you can find some here, and here, I edited my first NYSATA newsletter, and I have done some nice things for my wife, but still got ways to go there too…

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Spreading Christmas Cheer, One Run at a Time…

me and kahluaI wish I could take credit for the start of this, but two years ago I was invited to a challenge on DailyMile (sort of a Facebook for endurance athletes of all abilities). One of the members on the site, Chris N., has been running with a Santa hat every Christmas Eve since 1998. He started a challenge on the site to try and get more people to join in the fun and help spread the Christmas cheer. I’m not sure when he first started the challenge on DailyMile, but each year it grows in popularity.

I did it for the first time in 2011, and was completely amazed at what happened on my Christmas Eve run. I bought a cheapo Santa hat for $1, put on a red wind breaker, whiteIMG_20131224_134937_278 gloves, white socks and my red Vibram Five Fingers. Normally, drivers of cars ignore and/or are completely unaware of runners or treat them with downright avarice, but not on this run. It started with one smile and friendly wave, but continued to grow from there. By the end I had received dozens of thumbs up, waves, smiles, and friendly honks, that my Christmas spirit grew 3 sizes that day… I had so much fun in fact, that I donned my Santa hat, and went for another run Christmas Day, and received and spread even more Christmas cheer than I had on Christmas Eve.

Santa hat run 2012I put the hat away after the Christmas Day run, and didn’t bring it out again until the next year’s challenge came around. Christmas Eve 2012 I again donned my Santa hat and set out for another run, but in a new location. This year was in a much more rural location than the one in 2011, so I wasn’t expecting much from it. I had a long run planned for the day before Christmas Eve (Christmas Eve Eve?) and so decided to start the run a day early figuring that longer I was out, the more cheer I could spread. With the thinner population, I thought this might equal out with last year. Cars were few, and far between, but I was met with even more enthusiasm and cheer than the previous year. There may still have been fewer people, despite running over 4 times as far, but the percentage of people cheered was much higher (though I failed to post about it).  I ran with the Santa hat again Christmas Eve and again on Christmas Day. I saw 2012HuffUltra50K684almost no one those two runs, but still had lots of fun.

Several days later I donned it one last time for the Huff 50k. With my full beard, redjacket, white gloves and Santa hat, I was definitely a hit out on the course. I had a lot of fun with the other racers and volunteers throughout the race. Entertained myself the last few miles asking the volunteers if they had seen a team of reindeer run by, and exclaiming I was getting sick of these reindeer games ditching the old guy in the woods…

893043_10201719952055457_195386921_oThis year, I’m at it again. But, I decided to expand the time frame. I actually did my first Santa Hat run 4 days before Christmas, another run 3 days before, and another 2 days before. I will also do a run today, Christmas Day, and plan on running with the Santa hat all the way to New Year’s Eve (and New Year’s Day if possible). Again this year, it has been a blast so far, and the response has been great. I’m in a more populated area again this year, and the response so far has been great. I looking forward to the rest of my planned Santa hat runs.

I’m hoping that by sharing this that I can encourage some of you to come out and join in the fun. If you are on DailyMile then join the challenge. If you’re not, then don’t let that stop you. Grab your Santa hat and go out for a run anyway. The distance and pace aren’t important, just go out with your hat, smile, have fun, and help spread a little Christmas cheer…IMG_20131224_134651_229


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My Concussion Return to Play Protocol Based on Heart Rates

Concussion is obviously a major buzz word, and if you’re in a medical profession and or working with athletes it is more than that, it is something we have to work with. Unfortunately, it is something that we still don’t know a lot about. We are steadily learning more and adjusting how we treat and handle them on a regular basis. There are many good guidelines out there for coaches, PE teachers, athletic trainers, nurses, doctors, etc. to use, and they are good, but they could be better.

In June of 2012 New York State passed The Concussion Management Awareness Act which went into effect on July 1st, 2012. This law led to the development of The Guidelines for Concussion Management in the School Setting. These guidelines were based on the 2008 Zurich Consensus Statement on Concussion in Sport. A new consensus statement came out in November of 2012, with no significant changes in regards to the graduated return to play protocol (RTPP) (Zurich 08 page 4/758, Zurich 12, NY page 11). It is this RTPP and its implementation and monitoring that is my concern.

As an athletic trainer I have found the new law to be a great. So much of it is clearly defined, and there is no argument. If player, parent, coach (fortunately none of mine) question any decisions in regards to pulling an athlete from activity and restricting them it is very easy to point to the law as the reason. My hands are tied, not my decision dad, little Johnny has to sit. Unfortunately, when it comes to implementing and monitoring the RTPP, things become a little more difficult.

How do you explain to an athlete, coach, parent, etc. what low level activity is? How do you control it to make sure that the athlete is complying? Performance standards don’t really work. For most of my high school athletes a 6 minute mile is either very hard or impossible, but I’ve known cross country runners that can whip one out so casually that it is barely a warm up for them. And, no matter how well you know the kid, how can you truly tell how they are pushing themselves? It is just as important to know that the kid isn’t pushing too hard during their RTPP as it is to know they are pushing hard enough. Don’t want a kid to be released for full return and go into a game without having properly tested themselves beforehand.

In the first year of the law I tried to describe to the athlete what level I was looking for. For example, in step 1 I would say that they should peddle hard enough on the exercise bike that they felt like they were putting out some effort, but they should still be able to talk very comfortably and easily. In step 2 talking while running should be able to talk easily, but it should take a little more effort. Each step it would get a little harder for them to talk, breathe, etc. but this could easily be faked for whoever was monitoring them. The intent of the RTPP is to start with a low level of physical stress, make sure the athlete can handle it without return of symptoms or any difficulty, and then step it up. Each step should increase, but limit stress making sure the athlete can safely handle it before increasing to the next step. No matter what I did though, I wasn’t sure whether the goals were truly being achieved.

I don’t remember exactly what it was that prompted the thought, but sometime during a series of lectures on concussions at EATA symposia last January (2013), I came up with the idea to use heart rate to monitor and control my athletes as they went through RTPP. I spoke with a number of other athletic trainers that weekend and all agreed that it seemed like a great idea. The only problem was buying the heart rate monitors, which could eat up a lot of budget, and designing the heart rate parameters for each step of the RTPP. Especially since I had to keep within the existing protocol from the state and not allow something that would possibly range outside of their parameters.

Over the next couple months I didn’t think about it too much because I knew it wouldn’t be until the following school year that I could attempt to work the monitors into my budget. I didn’t table it totally and kept it percolating in the back of my mind. That summer I started putting some of my ideas down onto paper. I did some research to see if I could find anything relating to it, but there wasn’t much out there. There was plenty on heart rates, zones, effort levels, but nothing that tied into concussions and return to play protocols. The only thing I could find was in both the ’08 and ’12 Zurich statements they referred in the first step to aerobic activity at or below 70% of maximal heart rate. So I made that my starting point.

Just before the start of the school year I had several heart rate monitors donated to me. The Polar FT1’s I was given were very simple and easy to use. They had no fancy functions, but they provided heart rate that the athlete could see and try to control, as well as a record of the time of work out, average heart rate, and max heart rate for the workout, and I could set their target heart rate zone. I was now in a position to start using heart rate in my RTPP. Just two final steps remained, creating a working protocol, and getting permission to use it.

I went through several drafts before coming up with one that I submitted to my AD and our team doctor. New York States protocol had one more step then Zurich’s, and I ended up using the 70% HR for step 2, and so lowered step 1 and created a range of 60-65%, and step 2 65-70%, and each step increased by 5%. Everything looked good and I was ready to try it.

Unfortunately, I had athletes all too soon that had concussions and therefore needed to go through the RTPP. Everything worked well for the first couple of steps. The athletes were instructed to keep their heart rate in the correct zone. I told them the number range and programed the watch to beep at them when they were out of it. They were told that failure to remain in the proper zone could either have the workout stopped, and therefore nullified, if they went to high and they would have to try again the next day, and if they were too low, the workout would not count and they would also try again the next day.

The first step the athletes were initially limited to exercise bike and on second step running (treadmill or outside monitored), but I quickly opened up step one to a couple of other low impact aerobic machine we had (UBE, and rowing machine) and step two I included a couple of more and changed workout to at least 10min of running and then the rest of the workout could be on any of the machines (also have stepper and elliptical machines).

The heart rate monitors worked great for the first two steps. We caught one athlete pushing too hard and stopped them before any they could do themselves any harm and all others managed to keep themselves in the correct range. Problems didn’t start to arise until the remaining steps.

In step 3 the athletes return to sport specific activity. Unfortunately it is rare that this results in a consistent heart rate, so I had to amend protocol again. The athletes were instructed to keep their heart rates within prescribed range as much as possible, and to not go over it, but that they could drop below the zone as practice dictated. This wasn’t a big deal, but it meant my monitors were no longer as effective. I could check to make sure that the athletes didn’t push too hard, but there averages were now well below the zone and I had no way to judge how much time was spent at the effort level that they needed to test themselves at. I had no choice but to once again work somewhat in the blind. I used the max heart rate to keep the athletes under control and had to trust coaches and athletes that they were pushing hard enough.

I am in the process of ordering an upgraded heart rate monitor that will correct this problem. I’ve done some research and got a few recommendations and I am looking at getting the Polar RS300X. It has programmable zones and records how much time is spent in each zone. This is a bit of a bump up in cost, and will take more of a chunk of my budget, but from the results I’ve had so far with the FT1’s I think it will be worth it.

I also started finding that some of the athletes were having trouble staying within the heart rate parameters on step 2. Once they started going fast enough on treadmill to actually run they were over the top end of the limit and once they slowed heart rate down to proper range, it was too slow to run anymore. Upon further review of the Zurich consensus statement I decided that step 2 could be bumped up a notch, and every step thereafter, and still stay within their limited heart rate recommendations. So I increased every step by 5% and expanded the range on the last 2 steps.

Another problem that has very recently arisen is with wrestling. We have had some difficulty with the watches on step 5 being accidently stopped during wrestling, and they have caught on clothing. As a result, we are currently not using them with the wrestlers during contact activities on day 5 (also worried about athlete safety). I have found a couple of possible solutions to the problem, but need to research them further. One is that Polar makes a transmitter, wearlink+, which links with a device that can be plugged into a pc or laptop and record the data from a distance up to about 20 meters. They also make a Bluetooth transmitter that is compatible with newer iPads and iPhones. They even make an app for them that looks like it could open up interesting possibilities. Unfortunately I don’t have an iPhone or compatible iPad, so won’t be looking into that route for a while.

All of that being said, our RTPP is currently as follows:

Concussion Return to Play Protocol

Athlete must be symptom free for 24+ hours, fully return to ALL academic activities, pass ImPACT test and be cleared by School Medical Director before beginning this progression. No more than one (1) step may be done a day. If there is any return of symptoms, athlete must stop activity immediately, and be seen by school medical personnel, and after symptom free 24+ hours, may return to last symptom free step that they had done. The athletic trainers will monitor and control the athlete through the entire return to play protocol. Athlete must be seen by athletic trainer daily, before and after all activity including prior to start of Step/Day 6. Athletes will wear a heart rate monitor programmed by the athletic trainer for all five steps of the progression.

Step/Day #1:  Low impact, non-strenuous, light activity – 20-25min on exercise bike (may also use rowing machine, or UBE) at 65-70% Maximum Heart Rate (HRmax).

Step/Day #2:  Higher impact, higher exertion, moderate aerobic activity (running, stair stepper, elliptical, rowing machine, bike, &/or UBE), no resistance training – 25-35min (at least 10 minutes of which must be on treadmill or running) at 70-75% HRmax.

Step/Day #3:  Sport specific non-contact activity. Low resistance weight training (must be able to do 12-15+ reps) with a spotter – 35-45min at 75-80% HRmax. HR may drop below 75% due to nature of practice, but can never be more than 80% and should spend part of practice in correct zone.

Step/Day #4:  Sport specific activity, non-contact drill, higher resistance weight training (6-10 reps) with a spotter – 45-80min at 75-85% HRmax. HR may drop below 75% due to nature of practice, but can never be more than 85% and should spend part of practice in correct zone.

Step/Day #5:  Full contact training drills and intense aerobic activity – 60-120min at 85+% HRmax. HR may drop below 85% due to nature of practice, but should spend part of practice in correct zone and must incorporate some maximal efforts such as repeat full speed sprints (4+ sprints of 50+ yards).

Step/Day #6:  Return to full activities with clearance from School Medical Director.

As you can see, this progression stays right in line with the NYS protocol; it just adds a heart range for monitoring and control purposes. Notice I’ve also added in number of reps for weight training. I’m sure that this is something that will continue to be adjusted and changed with time and experience and as new research comes out. For now though, it is working well, but I’d love to get feedback on the RTPP from others. What are your thoughts on what I’m doing, good or bad? What are you doing to monitor and control your athletes through your RTPP? Do you know of any research that counters, or supports what I am doing? Thank you in advance. I’m looking forward to what everyone has to say.

I know that budgets can be tight, and heart rate monitors are an expensive luxury. However, when we are talking about the safety of our athletes, especially when dealing with concussions, the money is well spent. If the money doesn’t exist in the athletic training budget, athletic directors usually have discretionary money, as do principals and headmasters. If all else fails, parents associations are for the safety of their kids and can always find money for something as important as safety…

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