Training for the 1500/1650: Suggestions?

Ditto congratulations on an excellent 1650. In terms of item #2 on your list, what do you--as a cardiologist--think about the following: Vioxx's link to heart problems (knowingly suppressed for four years) that damaged Merck's once admirable reputation the idea that plain old generic ibuprofen and naprosen are Cox-2 Inhibitors, though not selectively so--why would Vioxx be any better? Just an individual response on your part? the idea that shoulder overuse problems (including rotator cuff "impingement" problems) are increasingly viewed by orthopedic researchers as tendonosis rather than tendinitis, and that kiboshing inflammation is exactly the opposite of what you want to do that most of these problems, unless there is traumatic damage (SLAP lesion, rotator cuff tear, and so forth) are self-limited, and that you might have healed over time without VIOXX, perhaps even faster and that the RC exercises (and ice) may have been the most valuable elements here by 1. tightening an overly lax capsule, keeping the humeral head stabilized, and 2. providing some pain relief and increased blood flow? The reason I ask is that it seems to me there really has been a sea change in how swimmers shoulder is being viewed--and yesteryear's idea of attacking inflammation (via NSAIDS or cortisone injections) is more and more emerging as counterproductive (there is no evidence of inflammation, for one thing) and injurious (retarded healing rates and, with cortisone injections especially, evidence of weakened connective tissues.) Excellent points. Vioxx and related drugs are selective Cox-2 inhibitors, unlike Ibuprofen which is nonselective, inhibiting both Cox-2 and Cox-1. I personally found it to be the most effective of the Cox-2 inhibitors and far more effective than any of the other nonsteroidal anti-inflammatory agents. Every drug has potential side effects, including aspirin, which in a large study from Harvard actually increased the risk of intracranial hemorrhage in healthy physicians. Selective Cox-2 inhibition does come at a price which for some reason was not anticipated. Inhibition of Cox-2 without Cox-1 inhibition increased the risk of thrombosis in patients with coronary artery disease; whether a daily aspirin is sufficient to negate this effect is unclear to me. Other Cox-2 inhibitors, like Celebrex, remain on the market but should be used with caution by individuals with CAD. I am well aware of the concept of tendinosis and the rationale for not treating inflammation. I tried that for awhile and continued to experience pain. I discussed this with my orthopedist who shared my view that pain = inflammation and recommended anti-inflammatory treatment along with PT. Interestingly, while I was taking Vioxx my migraines completely disappeared. They recurred when I stopped. It was later learned that the drug was very good at migraine prophylaxis.

Ditto congratulations on an excellent 1650. In terms of item #2 on your list, what do you--as a cardiologist--think about the following: Vioxx's link to heart problems (knowingly suppressed for four years) that damaged Merck's once admirable reputation the idea that plain old generic ibuprofen and naprosen are Cox-2 Inhibitors, though not selectively so--why would Vioxx be any better? Just an individual response on your part? the idea that shoulder overuse problems (including rotator cuff "impingement" problems) are increasingly viewed by orthopedic researchers as tendonosis rather than tendinitis, and that kiboshing inflammation is exactly the opposite of what you want to do that most of these problems, unless there is traumatic damage (SLAP lesion, rotator cuff tear, and so forth) are self-limited, and that you might have healed over time without VIOXX, perhaps even faster and that the RC exercises (and ice) may have been the most valuable elements here by 1. tightening an overly lax capsule, keeping the humeral head stabilized, and 2. providing some pain relief and increased blood flow? The reason I ask is that it seems to me there really has been a sea change in how swimmers shoulder is being viewed--and yesteryear's idea of attacking inflammation (via NSAIDS or cortisone injections) is more and more emerging as counterproductive (there is no evidence of inflammation, for one thing) and injurious (retarded healing rates and, with cortisone injections especially, evidence of weakened connective tissues.) Excellent points. Vioxx and related drugs are selective Cox-2 inhibitors, unlike Ibuprofen which is nonselective, inhibiting both Cox-2 and Cox-1. I personally found it to be the most effective of the Cox-2 inhibitors and far more effective than any of the other nonsteroidal anti-inflammatory agents. Every drug has potential side effects, including aspirin, which in a large study from Harvard actually increased the risk of intracranial hemorrhage in healthy physicians. Selective Cox-2 inhibition does come at a price which for some reason was not anticipated. Inhibition of Cox-2 without Cox-1 inhibition increased the risk of thrombosis in patients with coronary artery disease; whether a daily aspirin is sufficient to negate this effect is unclear to me. Other Cox-2 inhibitors, like Celebrex, remain on the market but should be used with caution by individuals with CAD. I am well aware of the concept of tendinosis and the rationale for not treating inflammation. I tried that for awhile and continued to experience pain. I discussed this with my orthopedist who shared my view that pain = inflammation and recommended anti-inflammatory treatment along with PT. Interestingly, while I was taking Vioxx my migraines completely disappeared. They recurred when I stopped. It was later learned that the drug was very good at migraine prophylaxis.