What I do is I walk them out and we just like stay, just stay waist deep in the water and we, I say, look, let's just look around.

Look at this.

Look at where we are.

This is beautiful.

This is what life is all about.

Hello and welcome once again to the Tridoc podcast.

This is the July 11, 2025 edition and I'm your host, Jeff Zankoff.

The Tridoc, an emergency physic athlete, triathlon coach and multiple Ironman finisher coming to you as always from beautiful sunny Denver, Colorado.

The voice you heard at the opening of the program was that of my guest today, Hillary Topper.

She is an endurance coach.

She is an incredibly energetic, enthusiastic woman who brings a history of that kind of spirit and enthusiasm and affability really to everything that she does.

And she talks to me today about several of the books that she's written.

She, she wrote one called From Couch Potato to Endurance Athlete.

And she has an upcoming book coming out, Unlocking Triathlon, the Beginner's Guide to Multi Sport and Triathlon, and that will be coming out, I believe, later this year.

She talks to me about her history being an executive who is burned out looking to find her passion, getting into running and then eventually into multi sport and then how she went to become a very successful coach at both open water swimming and in triathlon as well as running and how she came to be writing the books that she has.

I think you'll enjoy the conversation.

I know I enjoyed very much learning about her and everything that she has done and she brings a lot of excitement and enthusiasm to everything she does and she brings that to our conversation as well.

That's coming up in just a short while.

Before that, of course, I will have the Medical Mailbag in which I am joined by my friend and colleague, Juliet Hockman.

Today we are going to be taking on the subject of a question that was brought to the Try Doc Podcast Facebook group.

If you're not a member of that group, I hope that you will consider becoming one.

It's very easy to do so just look for Tridoc podcast on that platform.

If you're not a member, answer the three very easy questions.

If you listen to the opening of the program, all of the answers are right there.

I will gain you admittance.

You can join the conversation on all of the things we discuss on the program, but you can also submit your questions there.

Just like Justin Rayfield, one of my athletes who I coach and a very vocal contributor on that group.

He asks questions all the time and I'm very grateful that he does because it gives us a lot of things to talk about on the Medical mailbag.

And today one of those questions will be something we will be answering.

He wanted to know about tendonitis.

What is the situation with tendinitis?

Why are we so susceptible to it and what can we do to prevent it and treat it when it comes up on the Medical mailbag, Juliet and I will be looking at the literature on this subject and dispelling the notion that in fact what ails you is tendinitis.

Turns out it's not something entirely different.

So we'll be getting into all of that.

That's coming up in just a few moments.

Before I get to that, though, I want to address the big news that came out in triathlon about 10 days ago now, and that of course is the changes to the qualification standards that are going to take place for the Ironman World Championship and for the 70.3 World Championships.

I'm not going to go into the nitty gritty of the details.

You can find that in my sister podcast, Tempo Talks that came out last week.

I talked to Matt Sharp about that in great detail and I know that there are endless amounts of articles and websites that have gone into all of the different machinations and the whole process of how slots are going to be allocated going forward.

But we saw the first result of this new process come out this past weekend at Muskoka 70.3 and I wanted to just give my initial impressions.

Now, first and foremost, I actually think Ironman has done a really good thing here.

I think that the new looks like a much improved way of allocating slots, at least for 70.3 and I think certainly for Ironman as well.

I do not believe that this is going to address what a lot females are hoping for.

It is not going to allow for parity.

I think that this will allow for an improvement in slot allocation for the faster women in a lot of age groups.

I think that you're going to see a skewing of the slot allocation in some races away from what we currently see, which is somewhere around around 75%, 25%.

We may start to see closer to 65%, 35%, maybe 70, 30, but we're not going to get anywhere close to 50 50.

And if you look at the weighted results that came out this past weekend at Muskoka, I think you'll understand what I'm talking about.

Take away the age group winners in both the men and the women, remembering that all of the age Group winners automatically get a slot.

If you remove those age group winners and you look at the remainder of the results, you will see that even with the weighting and even with the normalizing of results, you still get a lot more men at the top of the performance pool than you do from women.

And so even though you do get more of the second place women coming into that performance pool who will get slots, you're not getting anywhere close to 50.

50.

I do think it's great that the faster women are going to be rewarded and are going to be more likely to get slots.

I also think it's great that you're going to see some of the older age groups be rewarded with more slots as opposed some of the larger age groups that may have given slots in the past.

But I don't know that this is going to accomplish exactly what everybody wants.

But I think all in all this is a really positive step for Ironman.

I'm left though with kind of an overriding question and I don't know if anybody who was at Muskoka might have a partial answer to this.

I'd be very interested in some feedback.

And so if you were there and you happen to know the answer to this, please do let me know either by email or by commenting in the Tridoc podcast Facebook group.

But I don't know how they plan to fill up an entire women's race at 70.3 World Championships.

This obviously is not going to be a problem for Kona where they are reverting to a single day race.

But at the World Championships for 70.3, they have previously been able to address the imbalance of slot allocation through giving away women for try slots.

Now I do not believe that they are continuing with that, although I could be wrong and that's really what I want to understand.

Did they apportion a number of women for tri slots?

Because without that, and if they're just giving 50 slots or 40 slots or whatever it is for a world championship and a majority of those are continuing to go to the male finishers in that performance pool, then how is it that they are going to be able to fill up an entire day race for the women?

I don't know how that's going to work.

I don't know what the plans are to address that imbalance.

And again, are they still continuing with those women for Trisots?

I would like to know.

Those are my thoughts.

I of course would be very interested to know how people feel who are listening to this.

Please do go over to The Tridoc podcast, private Facebook group.

If you're not already a member, I've already given you the idea of how to become one.

I hope that we will hear or hear from you in by virtue of your comments.

Of course, you can always email me privately if you'd prefer.

You can do that@tridocloud.com where you can reach me with questions for the medical mailbag and of course, your thoughts on this or any other subject that you hear on the program.

All right, that's what I've got for you on this subject.

Now let's get to the medical mailbag where we're going to be talking about tendonitis or what is it really going on when something is bothering you in a tendon?

Let's get to that right after this short break.

Hey there, Juliet.

How are you doing?

I'm doing great.

How about you?

We are T minus two weeks until I get to see your sweet.

Oh, my.

Yes, it's true.

It's true.

And the panic training again is full swing.

I've just been dealing with all kinds of aches and pains.

It's really frustrating being 58.

Like, I gotta tell you, I'm right.

There with you, baby.

I've noticed that the stress dream started last.

I woke up this morning and I had a kind of a stiff jaw when you've been clenching in your sleep.

And they were completely unrelated to racing, but I just know that they're related to racing.

The stress creams have started already.

We still have two weeks.

I'm not there yet just because I've got like a bunch of other stuff going on.

But I will say I was going great after Boulder.

I've really been back in the pool.

I've been running, I've been biking.

And then it was just one thing after the other.

And so I've been sidelined from running off and on, and now I'm on the off.

But I will say that as I've been sidelined from one, I've been able to really hammer on the other.

So I've not been.

I've.

My running has been really inconsistent because I've had issues with my back and now I have issues with the hamstring and a glute.

But I've been biking really hard.

I've been swimming a lot.

Not that matters for Oregon, but I'm hopeful.

I'm hopeful that the bike fitness and the run fitness will somehow carry through.

And yeah, I'm looking forward to it.

I'm looking forward, of course, to seeing you and all of our life sport athletes who will be there.

And my whole family's going to be there this time.

So that's going to be fun to see the team.

Yep.

My daughter Sam is on her way back from Asia right now, so she is going to be coming out as well for the race.

Yeah, it's going to be a big, big family reunion and it's going to be fun in Salem.

Yep, that's very cool.

And as I've been talking to all of our life sport athletes in the couple of weeks leading up to this and doing pre race meetings and all of those bits and pieces, of course, everyone right now is pretty much like we're ready for.

We just want it to come at this point.

It's very typical reaction to sort of emotional state of being.

And I'll never forget, I still have this sentence in my brain from 40 years ago.

My college roommate, two weeks out from the Olympics.

I was complaining about how I was exhausted and she's a college swimmer.

I was at that point training for the Olympic Games.

And she wrote back, she wrote me this wonderful card I still have in my brain.

And she said, the taper is coming and your coach can't slow down time.

I keep look at my training, I'm like, okay, after Tuesday, baby, that's when the taper starts because I am ready.

So, yeah, I, my taper is going to be a bit delayed because I'm going to try and push through and maximize what I can this week.

But I'll have a good week of rest leading into the race.

I would be remiss since you mentioned Olympics.

I would be remiss not to mention that we are recording this the.

Oh, by the way, we are recording the medical mailbag.

That's why, of course, Juliet and I are bantering so much.

I would be remiss if I did not mention we are recording this Monday, July 7, which happens to be my twins, Adam and Lauren.

It's their birthday today.

And so yeah, and the reason that I and Lauren, of course my pole vaulter, she won the regional qualifying meet for pole vault on the weekend.

So she will be going to the national finals for the Junior Olympics for both the USA Track and Field association and for the au, the American Amateur Union.

American.

No.

Amateur Athletic Union.

Amateur Athletic Union.

So she's qualified for the national finals for the Junior Olympics.

In both of those, my son Adam continues to just absolutely drop me on everybody.

I heard he grilled you on one of your rides last week.

Oh, he did it again.

To me yesterday as we were riding up for his pre birthday ride, I took him out for another 50 mile, 5,000ft of climbing and he just absolutely shelled me.

It's just, it's a pleasure.

It's a pleasure.

And at the same time somewhat humiliating.

In fact, at one point I did gap him on a bit of a climb.

And I got to a stoplight and I stopped and I turned around and he wasn't there.

And I was like, wow, he pulls up and he pulls up.

And I said, I looked at him and I looked at him and he's not even like out of breath.

He comes up this like 8% grade and he's totally fine.

And I was like, so what happened?

He's oh, you got ahead of me on the descent and I couldn't bridge the gap and so I just.

Oh, I thought you were going to say you stopped.

And I was like, yeah.

I was like, oh my gosh, you cut me to the quick.

Couldn't you have just told me I gapped you on the climb?

And he's, I'm just telling the truth.

And I was like, oh my God.

Anyways, this is, this is what I'm doing.

My children are older than yours and I'll never forget the day that my younger son and I did a lot of hiking when he was younger and he was a really good hiker.

He can move really fast.

And at about age 10, he left me in the dust and I'm literally.

Like, can you wait up, Louis Vuitton?

Can you wait up?

What's your problem?

Oh my God, it's so great and it's so humiliating.

Yeah, yeah, yeah.

I also want to mention Lauren has been doing the editing of the podcast now since the beginning of the summer.

So thank you, Lauren, you're doing a fantastic job.

And yeah, Happy birthday to the twins.

Okay, medical mailbag.

Before we get into this week's question, I do want to revisit our topic from the last episode, which was the cold plunges.

Because I did hear from Dr. Bobby Robert Dubois, who was a guest on a previous episode.

I interviewed him.

He does a podcast that is very similar to this one in that he does evidence based reviews of different topics.

And he reached out to me because while he agreed with everything that we said about cold plunges and their limited real efficacy and truthfully their detrimental potential for recovery, as was really the main focus of our conversation, he did want to emphasize the benefits that cold plunges have on well being, psychological well being.

And we mentioned when we talked about it.

That wasn't going to be our focus.

That we were really just looking at the physical.

Whether or not cold plunges really did all that they were advertising in terms of helping you get better, to be able to go back to working out again.

And if they were really all they were cracked up to be.

I did mention quickly that there is science that shows that cold plunges are beneficial for psychology.

And.

And Bobby wanted to really emphasize that, hey, there's studies out there that show that using a cold plunge really boosts your dopamine in your brain.

And he's absolutely correct.

And so I did want to call that out, that if you are using cold plunges for that reason, there is good evidence to show that cold plunges can benefit your wellbeing psychologically.

Just as we said last week, or sorry two weeks ago, when this episode comes out, we don't want you to be thinking that cold plunges therapy is.

Is useful for recovery, because clearly the evidence shows that it is not.

Yeah.

So we wanted to go there.

And then the second thing that he pointed out was you and I had a conversation where you asked me about the use of cold for acute injury.

Because there's this whole thing, cold's no good for recovery, but we're constantly using cold when we have an acute injury to help us swallow.

And I mentioned that, yes, that's still the current sort of mantra.

And Bobby pointed out, rightly again, that there is a growing body of evidence that actually suggests that might be something we need to revisit.

So you and I were talking before we started the acronym rice, Right.

So when you have an acute injury, and this was something that I used in my medicine career all the time, I used to tell people all the time, rest, ice, compression, compression, elevation.

Yep.

For any acute injury.

And there's a growing body of research that suggests that some of those things are not actually good.

Rest for sure, but not rest to the point of immobility.

Because like, for example, if you twist an ankle and you can weight bear on it, you should continue to weight bear on it.

You should not just lie around and not do anything.

Because we know that if you lie around and don't do anything, you're actually, that ankle's gonna become stiffer.

It's actually gonna prolong the duration of rehabilitation for that ankle.

So you want to actually mo early and you want to weight bearing, you want to get back to activity as tolerated as quickly as possible.

So the rest thing has been modified.

The ice thing is also beginning to be questioned.

And it's for a lot of the same reasons we talked about in that last episode.

Cold plunges are not so good because they inhibit blood flow to the area and they can delay healing.

They can delay the washing out of all of these evil humors.

The inflammatory molecules.

Ice, in these situations, it looks like, can do the same thing.

And while ice can decrease swelling, which we think is probably still beneficial, we are now learning that there may be some negative offset.

Now, this science is still in its early phases.

There is some evidence that heat application for an acute injury is actually better than ice.

And I talked about this in a podcast.

I will link to the episode in the show notes.

I can't remember which episode it was off top of my head, but I will link to it in the show notes.

And I do want to note that I still am.

Maybe I'm getting to that point in my career where I'm too old, Right, Juliet?

Yeah.

And then we don't want to change our weight.

I can't change totally on a dime the way I used to be able to.

But I'm not totally ready to give up on ice for an acute injury.

And partly that's because I know when I have an acute injury, ice does feel better.

I was about to say that you roll your ankle, your knee blows up, whatever it is, it just feels good to put an ice pack on it.

Yeah.

But at the same time, you and I were talking before.

If you have a muscle strain or something like that, we know the heat really feels better.

Yeah.

So I'm not sure where it's all going to shake out.

I do want to acknowledge.

Thank you so much, Dr. Bobby, for sending that email to me because I count on you guys, my listeners, to hold us accountable.

If you hear something that doesn't sound right, please do let us know.

And in this case, I'm not going to say that we were wrong, but I definitely do think that it's worth pointing out that there is evidence coming out that maybe suggests that ice for an acute injury not necessarily the right thing to do.

Okay, with all of that said, Juliet, we have a question for today, so let's move into that.

Who's it from and what's it about?

This question comes from our avid supporter and maybe say verbose or perhaps loquacious.

Yeah, I think loquacious is good.

Loquacious contributor to all of our related socials, Justin, who is writing and asking about tendonitis.

And I think he's probably like many of us have experienced frustration with various tendinitis over our years of triathlon training.

And he just, he wanted to know on a generalized view, like, how do you avoid tendonitis?

What is tendonitis?

On all of these treatments that are out there for tendonitis, all the modalities you can get when you go to pt, the ice, the rest, the strengthening, the don't strengthen, all of the different pieces of advice that we get when it comes to tendonitis.

What really works and what is the current thinking on this malady which often sidelines triathletes and athletes of all different stripes?

Yeah, it's a really good question, and it actually was one that I had fun researching.

I want to call out.

Cosette Rhodes is the intern who was going to be doing the research for this.

And Cosette had a mishap.

She ended up with a concussion.

She is on the mend.

She, I understand, is back to her usual self.

But at the time that she was going to do the research for this, she was unable.

So I got to do the research on this and read through all the papers.

And if you're not a subscriber to the supplement that comes out for this podcast in the form of a newsletter that comes out every two weeks, this would be a really good opportunity to sign up because I'm going to include all the references and the summaries of the references in the newsletter.

I think it's a really good one to look over because the references are excellent.

They're written very much, not just for physicians, but really for laypeople.

So if you want to get a really good overview of these tendon problems, I would highly recommend you take a look and subscribe to the supplement.

I will again put the link for that in the show notes so you can find it there.

At any rate, tendon injuries, and I want to be careful to call it that because I think you and I were talking before, we've always referred to this ourselves, and I include myself here.

Tendinitis.

And whenever a word is finishing with that itis that suggests that the problem is based on inflammation.

And you and I have both had tendon issues.

What have your issues been?

I had Achilles tendon issues for so many years, 12, 14 years.

I finally had surgery a couple of years ago, and I also have an ongoing issue with proximal hamstring.

Tendinopathy, another tendon word which really limits my run training.

So those are just two of probably many.

And our friend Kelly also was really hamstrung by tendon issues with her hamstring to the point that it actually ruptured on her.

And that is the devastating complication of this.

So let's define the three words that you're gonna hear for the rest of this segment.

So tendonitis.

Tendinitis is an inflammatory problem.

It does occur.

It is essentially an acute issue, but it is exceedingly uncommon.

If you have a tendon problem, it is very rarely tendinitis.

I could tell you when it will be tendinitis.

So for example, when I first moved to Colorado, Sandra, my wife and I, we went on these hikes and we would climb these like ridiculous mountains and we would come home and my Achilles would flare up and it would be really painful, but it would go away after 48 to 72 hours of rest.

Ice, ice and some anti inflammatory medications, because that was an acute reaction to an acute stress and it was truly an inflammatory process.

This can also happen in the knee.

You will sometimes have an acute injury to your patellar tendon and it just swells up and you'll see it.

You will physically see that one patellar tendon looks more swollen than the other.

That is the hallmark of an acute inflammatory process.

And this is tendonitis.

And you can ice it, you can take some anti inflammatories, you can rest it over a couple of days and it will get better rather quickly.

This is the minority.

And those two tendons, the Achilles and the patellar tendon, are the ones where inflammation tends to be most common.

The other ones, the gluteal tendon, the hamstring tendon, shoulder tendons, rotator cuff, the elbow tendons, which we see with tennis elbow, golfer's elbow, these ones do not tend to get inflammatory problems.

Instead they get a degenerative problems, which is called tendinosis.

And tendinosis and tendinitis are dramatically different.

They should be managed very different and they have very different outcomes.

And that really is a crux of the matter and really is the big problem here.

So tendinosis looks very different surgically.

So if you actually look at the tissue, a normal tendon is nice and glossy white.

It looks very robust.

And just also to define one more thing, the tendon is the fibrous collagenous tissue that attaches the muscle to the body bone.

And this is distinguished from a ligament.

A ligament is the fibrous tissue that attaches bone to bone.

So if ever you've gotten a sprain, or if you've heard of somebody getting a sprain, is an injury to one of those ligaments that attaches a bone to a Bone.

If you have a minor tear of a ligament, that's a sprain.

If you rupture the ligament, that's a more severe sprain, a tendon injury.

Tendons can tear, but it's very unusual for them to just tear out of nothing.

They usually have to have some disease first in the form of a tendinopathy, which is the third word.

So tendinitis is inflammation.

Tendinosis is the degenerative process that occurs over time.

And tendinopathy is what is established as you have tendinosis over time.

It's the chronic result of tendinosis.

And tendinopathy tend to be used interchangeably.

And you will likely have heard of tendinopathy but not of tendinosis before today, I'm guessing.

So I want to dispense with tendonitis because we are not really dealing with tendonitis most of the time when we deal with these injuries.

Instead we're dealing with this destruction of tendon.

And if you look at these things under a microscope, what you would see in the form, in the case of tendinitis, this acute injury, you'll see inflammatory cells, you'll see all kinds of signs and signs and microscopic debris that are associated with truly an inflammatory.

But in tendinosis, which is the vast majority of tendon based injury, you don't see any of that.

You don't see any inflammatory cells.

Instead what you tend to see is a breakage in collagen with gaps in the collagen.

So the tendon is looking like it's truly breaking down.

A destruct or not a destruction, but an absence of the normal fibroblasts of the normal cells, sorry, the normal collagen forming cells and a replacement with fibroblasts.

So you have these scars are forming cells instead of these normal healthy cells that would deposit collagen in a normal fashion.

And then you also get neovascularization.

So you get all of these blood vessels forming within the tendon, which ostensibly would be to help repair but actually contribute to further damage.

And so all of this together results in a destruction of the tendon, a breakdown of the tendon.

And if you look in under when you and surgically and you look, the tendon looks boggy and brownish and it just does not look healthy at all.

So really a lot going on there that explains why tendinosis and tendinitis have nothing to do with each other.

Completely separate processes.

And this is something that has only really been accepted in the last, I would say five to 10 years and has really radically changed the way we approach these processes.

And so, again, tendonitis, very rare.

Tendinosis, much more common.

The outcomes are dramatically different with tendonitis.

Tendonitis, you can get better very quickly, a couple days to a week or two.

Whereas tendinosis, you're.

Or tendinosis and tendinopathy, you are looking at weeks to months, sometimes even years.

And that's why you had your issue with your Achilles tendon for as long as you did and eventually needed to have surgery.

That is not uncommon with people who have tendinopathy.

That gets well established.

It can take a very long time and eventually result in needing surgery because those gaps in the tendon just never heal up.

The tendon never gets restored to its usual strength.

Strength and can rupture.

Or if it doesn't rupture, it becomes to a point that it's just continuously painful.

And the only thing to do is to go in there and to surgically reinforce it so that it's no longer painful.

And your experience was.

So with the Achilles, again, I think it started back in 2010 or 2009.

And over the course of many years, I kept having doctors look at it and evaluate it.

And some years were great racing years, and some years, our sideline completely.

Completely.

And eventually someone once said to me along the line, oh, you'll know because you just can't take it anymore.

And I got to that point about a year and a half ago where I thought, I'm not gonna be able to hike with my grandkids whenever they appear on this earth.

I'm not gonna be able to walk in 10 years.

And so that was a tipping point.

I said, okay, this is it.

We gotta do it.

And, yeah, surgeon went in, removed a piece of bony tissue, debrided the underside of the tendon, and it didn't have a great outcome.

But I got really lucky and worked really hard, hard, and it's fine.

So I consider myself very lucky.

And the hamstring.

The hamstring is a.

It is a continued.

It isn't really.

There isn't really a surgical option for that.

It's all about strengthening.

I know we're going to talk about that.

Some of the newer evidence in the last five years has suggested that we're not babying these things anymore.

The best approach for trying to address these imbalances which create a tendinopathy are heavy lifting.

So for that hamstring, it's deadlift all day, baby.

And that was the issue for our friend Kelly, who.

Whose hamstring tendinopathy got so bad that her tendon ruptured.

And unfortunately at that point, it's too late.

And as you mentioned, surgical options for the hamstring tendon are limited and she was not really a good candidate for that.

And so she just had to wait.

And it took almost a year for her to get back to the point where the tendon had reinforced and strengthened enough so that she could start doing weights.

And weights was the big thing for her to heal up.

And now she's finally back running, nowhere close to where she was at her peak, but getting there slowly.

But it's been a long process.

And another friend of ours, Benny, she had, excuse me, a Achilles rupture.

Yeah, she had one too.

Yep.

So these tendinopathies are quite common.

Fortunately, they can be recovered from, but it does take time.

So let's talk about what the science has showed in terms of how to fix these, because that's recommended really what Justin was asking about and really what we need to.

First of all, all of the supplements in the world, all of the potions that are being promoted to prevent this or to fix this, they are completely useless.

So there is no science whatsoever that suggests that anything that you can take is gonna prevent any of these things or fix any of these things.

So please save your hard earned cash dollars and let's not go there.

Instead, the most important thing is to get the right diagnosis.

Sometimes imaging can help with this.

An ultrasound can actually show gaps within the tendon.

An is very helpful as well, but you often don't even need that.

Often you just need a good physical exam and a good history taken by a good provider who will be able to provide you with that diagnosis.

And once a diagnosis is established, you have to take a deep breath.

You have to be sad because you have to understand that this is not going to be a quick fix and this is going to take time.

As I mentioned, for many of these tendinopathies, you are looking at at three to six months, if not longer.

And so you need to be prepared for that and understand that during that three to six months, anti inflammatories are not the answer.

So steroids, NSAIDs, ice, ice we'll talk about in a second, because ICE is actually supported.

But NSAIDs, corticosteroids, those things, they may actually be harmful because they can inhibit tendon healing.

So you want to stay away from those things.

Tylenol is okay for pain management, but you want to stay away from the ns, aids, support devices and oh, before I get to support devices, identifying what it was that led to this.

So if you have a specific imbalance in movement, if you were wearing the wrong shoes, if you had something with your anatomy that was leading to this, you need to identify what it was that got you into trouble and fix it right away so that as you're healing, you know that you're not going to get a recurrence of this for whatever the reason was initially.

So very important there.

Support devices, braces, orthotics to a degree, heel lift, all of those things that can offload the tendon and give you some degree of relief while you're healing.

Very important.

And then it's time, once you get on the road to healing, exactly what you were talking about, Juliet.

Heavy lifting.

Now, at first you're not going to go right to heavy, right, because you want that tendon to.

To heal a little bit, you want your body to recover.

But once you have gotten there, it's really important to lift because lifting actually promotes those cells within the tendon to secrete more collagen and to reinforce the tendon in a way that it is structurally sound and reverses the process by which you develop this tendinosis in the first place.

So what kind of lifting?

And you mentioned deadlifts, but are there other lifting that you were doing as well?

As you say at the beginning, you just want to create the right movement pattern, right?

Because if you haven't done lifting before, you especially something like a deadlift where your lower back is in play, etc.

You want to make sure you're creating the right movement pattern.

And you can do this double sided, single sided, etc.

But for, yeah, that hamstring, it's a whole lot of deadlifts.

If you have, if you have access to a universal machine, the one where you lie on your back on your belly and you pull your, your ankles towards your bum, that's another really good one.

But there's so many different ways to do deadlifts that you can actually stop yourself from being bored stupid by doing them, by changing up the pattern in which you do them.

But yeah, two or three times a week, lead with the warmup, and then do the deadlifts and then whatever other strength you've got to do.

But I know for me, I do a lot of work around hamstring health via various forms of deadlifts, as well as just a whole lot of calf strengthening.

Because calf, if you're strengthening your calves, you're also mobilizing that Achilles, which has.

Been a problem area, and sometimes stretching and foam rolling of muscles that are a little bit removed from the area, like for example, plantar fasciitis, which is considered a form of tendinopathy.

Stretching out and rolling the calves has actually been shown to be very beneficial.

So there's.

Working with the PT to find out exactly what you should be doing can be really a good idea here.

I want to get back to the ice because we mentioned ice in different ways, different ways throughout this segment.

But there is evidence to suggest that ice for tendinopathy is actually helpful.

And the reason goes back to what I mentioned before about these neovascularization.

So the fact that there's these blood vessels within a diseased tendon that aren't supposed to be there, applying ice to the tendon causes those vessels to vasoconstrict and eventually to potentially regress.

And so icing a tendon with tendinopathy can actually be helpful in the long run.

Now it's not easy to do that with tendons like in the gluteal area or in the hamstring because they're quite deep.

But for the Achilles tendon, for tendons in the elbow, it's quite easy to do and it is recommended and has been shown to be beneficial both in terms of reducing pain and also less.

Strong evidence here, but still some evidence to suggest that it does help in terms of healing.

So I.

Makes a lot of sense.

Yeah, yeah, yeah, yeah.

All right.

Any other comments to finish this one out?

I don't think so.

So I was just thinking about Voltaren and I guess that's an end stage, right?

It is another thing that can has been prescribed for example, Achilles because your Achilles is so close to your skin surface that you there's this idea that the Voltaren will penetrate the skin enough to get to the Achilles.

That sounds and I remember using that after, before and after my surgery on that Achilles to try to bring swell going down.

But you're saying probably not a good.

Idea because NSAIDs definitely inhibit the healing processes for tendinosis.

And now after surgery is a different situation, right?

Yeah, it could be different.

If you've had surgery, you do have an inflammatory process going on there and there is some benefit to using an anti inflammatory in a post surgical state.

So I don't want to extend the broad sort of idea that shouldn't use NSAIDs to a post surgical state because I think there's different pathophysiology there.

But in general, if you have a tendinopathy, volturn cream or any of these NSAIDs not going to be advised because of the problem related to inhibiting these cells that are so important for healing and tendinopathy.

Yeah, so there we go.

I feel like I got a lot out of this and I hope our listeners did as well.

I know Justin well.

He's always acutely learning about.

Yeah, exactly.

Definitely.

If you're not a subscriber to the newsletter, please have a look and see where you can subscribe.

And you will get these references with the concise summaries of what was in those articles.

And if you want to find the articles and read them, they're actually an easy read and I think quite interesting.

So well worth your time.

All right, Juliet, this was another great medical mailbag.

Thank you so much for joining me here.

I two weeks from now we'll publish, of course on the Friday, but oh no, it'll be after that.

So I'll see you before the next one comes out.

That's probably right.

Yeah.

Looking forward to it.

It'll be great.

All right, until the next time then.

Thanks for listening everybody and we'll be back with another one soon.

Take care, Juliet.

Thanks, Jeffrey.

My guest on the podcast today is Hillary Topper.

That's likely a name you're not familiar with.

It's certainly one I wasn't familiar with.

But when I read her biography I knew that I had to have her on the show because she is really interesting and she's done a lot in multi speaker sport and a lot in endurance sport.

She is the author of a book called From Couch Potato to Endurance Athlete which is a memoir, a self help book where she shares her 10 plus year journey from being a workaholic to an endurance athlete.

And if you think that was the end of her being a workaholic, no, I'm here to tell you that's not the case because she continues to do a lot.

She currently has a book coming out in January of 2026 called Unlike Unlocking the Triathlon, A Beginner's Guide to Triathlon Training.

Following that, she has yet another book coming out next year on swimming in the open water.

She is a USA Triathlon coach, a USMS swim coach, RRCA run coach and a WOWZA swim coach, which I think is probably the best acronym of all of them.

WOWZA is the World Open Water Swimming Association.

She blogs and her blog is called A Triathlete's Diary where she reviews products, something that is near and dear to my heart, of course.

And she writes about her experiences.

She also blogs for Hillarytopper.com a New York Lifestyle blog.

She has a podcast called Hillary Topper on Air.

She's an adjunct professor at a local university teaching digital marketing.

I swear she sounds almost as busy, if not busier than I am.

We're going to all of this, Hillary.

Welcome to the Tridoc podcast.

Thank you so much, Jeff, for having having me.

I want to hear a little bit about co being a couch potato and ending up as an endurance athlete.

So tell us please, about what that story was.

Just.

I know you've written a book about it, but maybe you could synthesize it for us.

Sure.

So in the book and I'll show you the book cover.

That's me.

It was about over 10 years ago.

I was working 60, 70, 80, 90 hour weeks.

I know you are familiar with that.

And I just, I was, I wanted a change and I decided that I was going to join a gym and try to lose weight.

I was just gaining a lot of weight, going to all these cocktail parties and drinking a lot, just eating crappy foods and all that kind of stuff.

Anyway, so I joined a gym and the trainer says to me, go warm up on the trainer on the treadmill.

And I'm like, okay.

And I look at the treadmill and I have absolutely, absolutely no idea how to turn this thing on.

So I see some woman next to me and she's running and the sweat is dripping off of her.

And I said, excuse me, I felt bad interrupting.

I was like, I had no idea how to do this.

So she stopped what she was doing.

She was very gracious about it and she turned it on for me and I started to walk.

And eventually through time, I started to continue to train with this person and I started to run a little, little bit.

And then eventually I took it outside and I met a per.

This woman from one of these women's groups that I was involved with the kids, My kids were young at the time.

And so anyway, so we became friends and we started running on the Long beach boardwalk.

Long beach is on Long island in New York, as you could tell from my accent.

And anyway, so we would run on the board boardwalk.

And then I guess it was about three or four times we ran.

And she said to me, let's sign up for a half marathon.

And I said, what, are you kidding me?

I never even did a 5k, let alone marathon.

13 miles.

Really?

So it's a Disney, it's no big deal.

It's Mickey Mouse, Donald Duck.

So out of it.

We had no idea.

Anyway, so we end up doing all of these races together.

And wait, you don't get to.

You don't get to skip over the first half marathon.

How did it go?

Oh, okay.

So the first half marathon was a disaster.

Okay, we didn't train properly.

We get in at 11 o' clock at night into Florida, into Orlando.

They didn't have our room ready.

The two of us were like nauseous from.

We were eating, eating like Shake Shack or something.

Like, it was just.

We were.

It was a disaster.

So we end up.

We ended up blowing off the half marathon, but I did do another one after that.

I did the hair.

So anyway, so we did a.

But we started doing a bunch of these half marathons.

We do these race cations together.

And then we did.

We signed up for the Brooklyn half.

And at the Brooklyn half we were really like, I guess about 10 miles in.

And my friend looks at me and she says, I never want to do another one of these running races ever again.

They're horrible, they're brutal.

My back is killing me.

I don't want it.

And I said, now this just like a little sidebar.

I was in Fort Myers Sanibel about a month before that Brooklyn half race.

And I was one of the original Google Glass Explorers.

And I don't know if you remember that, but for your audience, they were augmented reality glasses and you could actually see your stats.

You could interpret things, you could post on social media, you could take videotapes, whatever.

So I was invited with four other people down to Fort Myers Sanibel to do a whole project for their tourism board.

And while I was there, the tourism director says to me, there's this great triathlon.

You know how to run?

Run.

You're a runner.

Oh, you would love this triathlon.

I didn't even know what a triathlon was.

Okay.

I said to her, oh, that sounds so cool.

So fast forward now I'm running with my friend at the Brooklyn half and she says, I don't want to do these anymore.

And I said to her, why don't we try a triathlon?

And did she.

Did you or her know how to swim?

Neither one of us knew.

She knew a little bit more than, than I did.

I did not know how to swim at all.

I thought I did.

I knew how to doggy paddle.

I mean, that first 25 yards getting acro.

We went to Long Beach.

We sign up for this race and we go to the Long Beach Recreation Center.

I don't have goggle.

I didn't even know that they work.

I, at the time that I swam, I didn't really swim.

When I was in camp, we didn't wear goggles.

Goggles.

There was, this is all like new stuff.

The lifeguard looks at me and she said, where's your goggles?

I said, I don't have a pair of goggles.

So it was just like a series of unfortunate events.

And trying to get across that 25 yard pool.

Oh my God, I think I threw up three times.

It was, I kept gagging on the water.

There was no, there was.

So then my friend says to me, we have to hire coaches.

And I said, what do we need a coach for?

This kind of ridiculous, right?

So she said, no, we have to hire a coach.

This isn't like running.

You have to hire a coach for a triathlon.

I said, okay, fine.

So she actually goes with one coach.

I go with a different coach.

I go with this coach that thinks I'm like preparing for the Olympics.

He says, my first workout was a 1600 yard yard swim.

Now mind you, I had just tried to do 25 yards and I couldn't do it.

So 1600 yards was like, this is impossible for me.

But anyway, I ended up, I, I ended up going to a master swim group and at the master swim group, just like really hot looking master swim instructor.

He was the head of the, the group.

Now he's, he must have been like 20 years than me.

I'm trying to get across the pool.

I can't get across the pool.

I'm just like gagging.

I'm throw.

Oh my joy.

He, it was just a disaster.

He jumps in the pool with me and says, okay Hillary, we've got to start from the basics.

Let's start with blowing bubbles.

Now you can imagine how embarrassed I was.

Like all these other triathletes are in the other lanes and they're, they're just, just killing it across the pool.

And here I am with the, with the master swim coach blowing bubbles.

But he actually taught me how to swim there.

There are a few things I'm taking from all of this.

Number one, you are obviously a very joyous person and you need to be able to go into all of these things with as little information as you had and yet still be willing to do it and succeed.

Which is I think, fantastic.

Fantastic.

The other thing is obviously a lot of dedication because truly neophyte at all of these things and somehow persisted and were able to get through obviously very little in the way of self awareness.

Like not at all concerned with what other people think because you are going to do this for you and you are.

And I just think that is wonderful in every way.

I think it's amazing.

Now give me a.

A sense of how long did it take?

Because I know for myself, I did not know how to swim.

It took me a year to learn how to swim.

How long did it take you from that first time learning to blow bubbles to being able to actually do your first race?

See, the game changer for me was once he saw that I was struggling with.

I was getting, like, water up my nose.

Like, it just kept going into my sinus.

I was getting really bad addict.

And he said to me, you know what, Hillary?

I think you should start wearing nose plugs.

And once I started wearing nose plugs, I was a little, again, a little embarrassed wearing them here.

I'm like, I started at 53, so it wasn't like I was a kid and I felt a little bit, like, weird about wearing them, but once I started wearing them, it was a game changer for me and I was able to start to do.

To swim, and I would.

I started in June, and the triathlon was in September.

So I actually caught on pretty quick.

That's amazing.

It was weird because it just came very natural to me.

Like, once I was able to get that breathing down, it all just clicked to me.

It was like a weird.

So today, it's actually probably my strongest.

Discipline, certainly as a swim coach and a wowza swim coach.

It is also, I think, a lesson for all of us to stop concerning ourselves with what other people are thinking and do what we need to do to be able to succeed.

Because too often I hear people say, oh, I can't do a triathlon with this bike, or I can't swim with masters because I'm xyz and I'm like, you know what?

You need to think more about yourself and less about others.

But it's really hard in this.

It is really hard.

It's really hard.

It's hard enough for my kids.

It's hard for adults, too.

And I think you are the poster child for just doing and not worrying so much about what other people think.

I think that's great.

What lessons do you have for people who might be listening, who might be thinking, gosh, I would love to do what she did and be brave and try a challenge like that.

Something that I have absolutely no idea what I'm doing, and yet I'm just going to embrace it full on.

What are some of the lessons you've learned from and that you would tell other people to do?

Yeah, I would Definitely say it's if it's something that intrigues you.

And it did intrigue me.

It intrigued me to do three different sports in three different disciplines in one sport.

Like that was something that I thought, oh, this is interesting, this could be really fun.

Just do it.

I think Nike has the best tech line.

Just do it.

Get out of your head.

If you believe that you can't do something, you can't do something.

But if you really believe that you can get it done.

I'm going to Mackinac island, which is in Michigan.

It's an 8.2 mile swim.

I'm doing this in August.

It's going to be hard.

It's going to be really hard.

And I do have doubts about, about it because I'm doing another swim before that that's even harder.

It's a little shorter.

But I'm doing it and I'm going to just focus and I'm going to visualize on getting it done and accomplishing it.

And that's what I would say is the biggest obstacle is your mind.

Because you could really do anything.

If you want to do an ironman, you could do an ironman.

You just have have to believe that you could do this and just trust the training.

I think it's pretty interesting that you've gone from being a non swimmer to doing these really long endurance swims.

I know for me as a non swimmer, like I still struggle.

I don't love the swim.

The swim to me is the means of getting to my bike.

I've become, or I, until my most recent race I had become a reasonably good swimming swimmer.

I kind of lost that, but hopefully it will come back.

At any rate, what is it about the swim now that intrigues you to do these really long distance?

Is it because it's a challenge?

Is it?

Or have you just found that you love swimming?

It's that I absolutely love open water swimming.

There's something to me when I'm out there and I'm looking at the sun.

I usually swim early in the morning.

I can go out like quarter to five, five o' clock when it's first light and the sun is just rising above the horizon.

It is magnificent.

And I'm watching the birds flying around me and just seeing everything.

The beauty of it, it's just, it just makes me feel like I'm in my happy place.

And when I'm gliding through the stroke, I just feel like I'm part of it.

I'm like, I'm in tune with the water.

It's a really weird thing.

But when I teach beginners, when I work with people, and there's most people, most triathletes in particular are really nervous about the water.

There's something about the open water that.

It'S an innate fear.

It's an innate.

Deep water is an innate fear.

I think for most animals it definitely is.

And I think that what I do is I walk them out and we just float, like stay, just stay waist deep in the water.

And we, I say, look, just look around, look at this, look at where we are.

This is beautiful.

This is what life is all about.

And they, they get comfortable and they start getting comfortable.

And there's this one woman who I interviewed for my swimming book.

In my new triathlon book, I have some really funny stories.

Every, I have have about, oh, 20 or 25 different stories.

I interviewed people on their first triathlon and they're hysterical, like talking about the bike and talking about how you were saying, you know, that some people, you know, are afraid because they don't have the right bike.

My friend did his first triathlon.

I talked him into it.

He borrowed a bike from somebody.

The seat was chewed off by the dog.

Like half of part of the seat was chewed off.

It was a mountain bike.

And he still kicked my butt in the triathlon.

So I was like, you know what?

See that your, your affinity for open water swimming reminds me of another famous New Yorker.

I don't know if you are familiar with who Robert Moses was.

Well, yeah, he did most of the.

Yeah, so he was.

So there's a very famous book about him.

And anyways, there's a lot of talk about how he was a very avid open water swimmer.

And anyway, so hearing you talk about swimming reminds me of his passion for open water swimming.

Yeah.

Anyways, tell me about your triathlon book.

But you just alluded to it a little bit with the discussion of your interviews.

What else is in that book?

And I told Hillary I should just tell my listeners I really try to read the books of the guests that I'm having on, but my life this year has gotten just crazy.

And I told.

When Hillary approached me about being on the the show, I just told her there was just no way I was going to get to read her book.

And so I hope to be able to read it at some point.

But please do share with us what's in the book and what can people get from it.

So the triathlon book is, it's called Unlocking the Triathlon, A Beginner's Guide to Competing In a triathlon, it's basically it takes you from everything from the world.

Why?

Like why do you want to do this?

You have to come up with a why to it talks.

I have so much information about the swim, the bike, the run, nutrition, hydration, supplements.

Should you take them?

Shouldn't you take them to zones?

What's yours?

How do you figure out your training zones to it's.

It runs the gamut.

It has pretty much everything that you, you need to be successful in a triathlon in this book and it's specifically for beginners and I also have some training plans as well.

I also what's interesting about the book in terms of first triathlons, I had that but I also have, I put a question out to the pathetic triathletes group on Facebook and I asked the them just to give a funny something that happened to them, something that kooky or whatever.

So that's in the beginning of each chapter and you'll see that as well.

So I tried to get my community involved in it and not just be serious, but it's serious and funny and it's got a lot of really good information in it.

That's great.

And when is it coming out?

So it's coming out January 2026.

I'm hoping that I'll be doing a couple of book tours.

I'm definitely going to obviously be doing it in New York.

I'm definitely going to be doing it in Colorado because I just love coming out to see you guys.

And Florida, South Florida, I've already booked with Miami and I'm hoping to book a tour with in Fort Lauderdale.

Fail as well.

So you went from being a workaholic, doing whatever it was you were doing before to being a workaholic and endurance sport now.

Do you find this more rewarding?

Is this less taxing on your life?

Like, you know what it's.

You get to a point in your life where I was, I had my public relations business for 30 plus years and you get to a point in your life where you say you, you know what I want to do what makes me happy.

And I love endurance sports.

I love getting up early in the morning, going for a bike ride or a swim or a run.

I just, I love it.

It's just something that it drives me, makes me happy.

And yeah, it just all that stuff that you go that you have going on your head, the things that tell you, oh, you're not good enough, you're not this, you're not that, you, you can just let it Go.

When you're doing these sports and it's just, you're just so focused on what you're doing.

I just, it's just something that, that I'm passionate about and I love.

I'm getting a sense for the answer of this question, but I'm going to ask it anyways because I'd like you to share it.

So what is your why?

Because you said yourself, everybody brings a different why.

I know that my why has changed over the years.

I'm curious about what yours is.

My why originally was because my friend didn't want to do a half marathon, but now it's always just to show myself really that I can outdo myself, that I could do things, that I could do hard things, that I could dig deep, that it's not going to scare me to, to do a half hour man or an 8.2 mile or a 5.5 mile swim in the ocean.

I'm going to do this and I'm going to get it done.

And even if it does scare me, I need to get out of my comfort zone.

And that's what I strive to do, is always get out of my comfort zone.

That's great.

With the time we have left, I'd love to hear a little bit about what you do on Hillary Topper on air.

Sure.

So I also do.

I also interview people in the endurance sports.

I interviewers, authors, lifestyle.

It runs the gamut.

And I've been doing this since 20, 2011.

It's a long time.

That's.

Yeah.

I, I've written a couple of other books on social media marketing back in the day, like back in 20 2008, 2009.

And that at that time I started getting into podcasting and yeah, so it's been going a long time and it's on Apple podcasts and all the places just like yours, you know, where you can you listen to.

Yeah.

We'll put the links in the show notes and you've been doing it obviously for a very long time.

Are there some guests that kind of stand out as really memorable?

And if so, what did they impart to you there?

A lot of the guests that I have either have new products or do everybody add something?

There's always something that, that I walk away with and think, wow, that's interesting.

I don't think I've ever had a guess most of the.

I think the one time when with guess is that sometimes they don't let you get a word in edgewise and it's like but.

Or you get A you get a guess that like they'll answer the question and then there's like silence and it's.

Wait a second.

That's all you have to say.

It's like a one word answer or something.

That becomes a little bit of a challenge.

But I've had some really interesting.

There's this one woman who's going to be on soon.

She is a triathlete and she travels around the world like just doing like bike tours and different types of tours that include running or cycling.

And I interviewed her because I thought, wow, she's got some really cool stories about different places like Vietnam and like wherever.

Like she's just been all over the place.

So, yeah, so I've got like really very eclectic guests.

That's great.

That's great.

So what is next?

You mentioned your open water swim that you're doing in Mackinac Island.

Do you have any triathlons that you're doing this year?

Yeah, so I had a bit of a knee injury.

Yeah.

Last year and I had surgery.

I had this really weird new implants put into my knee.

It's called a missha knee system and it's supposed to take the pressure off of your.

The arthritis in your knee.

So it's not bone on bone.

Anyway, the hundred that they put in were all defective.

Lucky me.

I've been struggling to get back to running.

That's been a challenge.

But I'm determined to get back to it.

I'm scheduled to do it tomorrow, so let's keep going.

Yeah.

So I have a couple of aqua bikes I'm doing in June.

Next week I'm doing a 5.5 mile swim across from Fire island to Bayshore, which is across the great South Bay.

It's really the ocean.

It's going to be very challenging and I actually write about that the first time I did it in my book From Couch Potato to Endurance Athlete.

I did it with my son and we went way off course, so hopefully that won't happen.

But who knows knows it's the.

You're really in the.

There's no land, it's just ocean and Mackinaw.

And then I'm doing two Olympic sprint, Olympic aqua bikes.

One in Montauk and one in the Hamptons with Ven Power Long Island.

Yeah.

That's great.

That's awesome.

Yeah.

Hilary, it is truly a pleasure to speak to you because you bring a lot of joie de vivre to the.

To everything you do, obviously, and it comes through in your conversation and I really enjoyed hearing about it.

The book comes out in January.

It will be available I imagine in on Amazon and everywhere else.

Barnes and Noble everywhere.

Yeah.

Awesome.

All right, you make sure to send me a note that it's out and I will make sure to remind my listeners that they can find it on bookshelves when it comes out.

Hillary Topper is a podcaster.

She's a coach, she's, she's a author.

She is just ubiquitous across endurance sport and multi sport.

And today thankfully, she was my guest on the Tridog Podcast.

Thank you so much for joining me.

It was a real pleasure having a conversation with you.

Thank you so much for having me.

Hi, my name is Denise Haslik and I'm a teacher, teammate of the Tridoc and a proud Patreon supporter of the Tridoc Podcast.

The Tridoc Podcast is produced and edited by Jeff Sankoff along with his amazing interns Cosette Rose, Anita Takashima.

You can find the show notes for everything discussed on today's episode as well as archives of previous episodes@www.tridoc podcast.

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