tag:blogger.com,1999:blog-65731304556602692962024-03-12T17:38:19.133-07:00Sports and Family Medicine of ColoradoProviding complete family care as well as sports medicine specialty careUnknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-6573130455660269296.post-31330931693702369022011-09-20T12:12:00.001-07:002011-09-20T12:21:31.416-07:00Dr. Tod Sweeney from Sports and Family Medicine of Colorado finishes the Leadville 100 Mountain Bike Race – …”with a little help from my friends”<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">What is the Leadville
100 Mountain Bike race?</b><span style="mso-spacerun: yes;"> </span>The main
website for the race describes it as follows…<o:p></o:p></span></div>
<br />
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<span style="font-family: Calibri;">”This is it. The race of all races. One hundred miles across
the high-altitude, extreme terrain of the Colorado Rockies. Created for only
the most determined athletes. Starting at 10,152 feet and climbing to 12,424
feet, you’ll be challenged to catch your breath — while the views try to take
it away.<span style="mso-spacerun: yes;"> </span>The 100-mile out-and-back
course is in the midst of the Colorado Rockies. Low point, 9,200 feet; high
point is Columbine Mine, 12,424 feet. Majority is on forest trails with some
mountain roads.”<span style="mso-spacerun: yes;"> </span>One little thing that
they don’t market, is that the race is actually 104 miles and the last four
were such a blast!<o:p></o:p></span></div>
<br />
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<span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;">Why would anyone want
to do something like the Leadville 100?</b><span style="mso-spacerun: yes;">
</span>Good question.<span style="mso-spacerun: yes;"> </span>Read on and maybe
you can help me figure out why!!<o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Motivation<o:p></o:p></span></b></div>
<br />
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<span style="font-family: Calibri;"><i style="mso-bidi-font-style: normal;">What motivates people?</i><span style="mso-spacerun: yes;"> </span>Many people will say cash and yes, committing
to the $275 entry fee certainly put this race on a different level.<span style="mso-spacerun: yes;"> </span>You can’t just bag out of it!<span style="mso-spacerun: yes;"> </span>Others might say the reward is in the work
itself and in the process – <i style="mso-bidi-font-style: normal;">the challenge</i>
and I would certainly agree with this. <span style="mso-spacerun: yes;"> </span>For me it was a combination of things.<span style="mso-spacerun: yes;"> </span>The camaraderie of training with friends and
meeting new ones was all part of it.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Training<o:p></o:p></span></b></div>
<br />
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<span style="font-family: Calibri;">Where to begin?<span style="mso-spacerun: yes;"> </span>How
much?<span style="mso-spacerun: yes;"> </span>How frequent?<span style="mso-spacerun: yes;"> </span>All great questions.<span style="mso-spacerun: yes;"> </span>I had never been in a 104 mile mountain bike
race before, so needed some guidance.<span style="mso-spacerun: yes;"> </span>I was
very familiar with the American College of Sports Medicine’s general exercise
recommendations, but to tailor a training plan for an epic event like this was
new to me.<span style="mso-spacerun: yes;"> </span>I searched the internet, read
blogs and consulted friends and professional colleagues.<span style="mso-spacerun: yes;"> </span>My good friend from high school was the third
place finisher in the M4 category from 2010, so he was a wealth of
knowledge.<span style="mso-spacerun: yes;"> </span>I also consulted with another
friend and colleague whom I consider to be a world renowned exercise physiologist.<span style="mso-spacerun: yes;"> </span>He was an elite cyclist in his day and now is
a coach to elite athletes and cyclists, including a Tour de France champion.<span style="mso-spacerun: yes;"> </span>He suggested I get my VO2 max and lactate
threshold tested.<span style="mso-spacerun: yes;"> </span>Having been a baseball
catcher in college, I did not quite have the physiology of the cyclists he was
used to working with, but he said there was hope – though the time before the
race was not on our side.<span style="mso-spacerun: yes;"> </span>I believe that
lactate threshold testing is key for any type of endurance training.<span style="mso-spacerun: yes;"> </span>It provides a barometer to go by and a heart
rate number to stay under so as to avoid going “into the red”.<span style="mso-spacerun: yes;"> </span>As I comment below, going into the red for
too long is a recipe for disaster and almost a guarantee to “bonk”.<o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Nutrition<o:p></o:p></span></b></div>
<br />
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<span style="font-family: Calibri;">This is really an area you have to experiment with – and <i style="mso-bidi-font-style: normal;">not</i> the day of the race!<span style="mso-spacerun: yes;"> </span>I tried various products and really liked
Gatorade or G2 as my electrolyte drink during exercise as well as Powerbars .<span style="mso-spacerun: yes;"> </span>I needed to consume about 400-500 calories
per hour and this combination in general worked well for me.<span style="mso-spacerun: yes;"> </span>I did a lot of training with Ensure
nutritional shakes, but found on race day that due to the hot conditions, it
did not sit well with me.<span style="mso-spacerun: yes;"> </span>What I also
found very helpful under these arid conditions was fresh fruit e.g. blueberries
and watermelon.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>I am a ‘salty sweater’ so without doing formal
salt loss testing, I knew that I needed to consume additional salt.<span style="mso-spacerun: yes;"> </span>This came in the form of healthy snacks like
pretzels or gorp.<span style="mso-spacerun: yes;"> </span>I also consumed Endurolytes
every hour during long rides and the race.<span style="mso-spacerun: yes;">
</span>For me, this really helped with cramping.<span style="mso-spacerun: yes;"> </span>I typically think about the causes of cramping
in three ways – <i style="mso-bidi-font-style: normal;">dehydration, muscle
fatigue or sodium losses</i> and during my training I learned about all of
these ways to cramp!<span style="mso-spacerun: yes;"> </span>Often it is a
combination of the three.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Hitting the wall,
Going deep into the red zone, Bonking<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">I think you have to do this at some point in your training
prior to an endurance event such as the Leadville 100.<span style="mso-spacerun: yes;"> </span>I did and so did many of the friends I
trained with.<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">If you don’t know your limits, how can you push beyond them?</i><span style="mso-spacerun: yes;"> </span>One caveat and I am biased here – <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">obtain
a formal medical evaluation before embarking on any new exercise regime or
endurance activity.</i></b><span style="mso-spacerun: yes;"> </span>The Wrangle
the Ridge ride in Castle Rock in June was the turning point for me.<span style="mso-spacerun: yes;"> </span>I signed up for the marathon ride which was
60 miles.<span style="mso-spacerun: yes;"> </span>You could see the heat
radiating off the dirt and the wind seemed to stand still – at least around me!<span style="mso-spacerun: yes;"> </span>30 miles in and I was done.<span style="mso-spacerun: yes;"> </span>The nausea, quad cramping and overall fatigue
made me really second guess this whole Leadville thing.<span style="mso-spacerun: yes;"> </span>I was about to throw in the towel and allow
myself more time to spend with my family.<span style="mso-spacerun: yes;">
</span>My thinking at the time was why should I train so hard and spend so much
time away from family when I was just going to hit the wall.<span style="mso-spacerun: yes;"> </span>After a bit of soul searching, I made the commitment
to see this through.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Last minute
preparations before the race<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">The pre-race briefing for new racers was very helpful.<span style="mso-spacerun: yes;"> </span>One suggestion that benefited me the most was
to bring a moist bandana and wear it to avoid the extreme dust on the
course.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Race Day<o:p></o:p></span></b></div>
<br />
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<span style="font-family: Calibri;">Wow – what a spectacle!<span style="mso-spacerun: yes;">
</span>I got up around 4 am and did some last minute checks but was ready having
completed a more extensive check list the day before.<span style="mso-spacerun: yes;"> </span>We (my crew – wife and brother!) arrived
around 5 am and I was able to place my bike in a decent position about mid-way
in the pack.<span style="mso-spacerun: yes;"> </span>I then went back to the warmth
of our car until a little before 6 am.<span style="mso-spacerun: yes;">
</span>Then the pre-race nerves kicked in and had to make a few trips to the
bathroom.<span style="mso-spacerun: yes;"> </span>The opening and closing of
port o potty doors was some of the only sounds in those pre-race minutes.<span style="mso-spacerun: yes;"> </span>By 615am everyone had to be by their bike and
at 630am the shotgun blast signified the start of the race.<span style="mso-spacerun: yes;"> </span>With somewhere around 2,000 people racing out
of Leadville the fun began.<span style="mso-spacerun: yes;"> </span>At around
the 4 mile mark, the pavement turned to dirt and due to the dry conditions – it
was a dust bowl and thankfully I was wearing that moist bandana to avoid the inhalation.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">The course was tight with cyclists and the speed would
fluctuate frequently due to the terrain and the sheer number of cyclists vying
for position.<span style="mso-spacerun: yes;"> </span>My heart rate was supposed
to be below 150 bpm to avoid exceeding my lactate threshold, but unfortunately
to keep pace and to make the first time cut off at 4 hours – I had to push
pretty hard and exceeded this rate most of the time.<span style="mso-spacerun: yes;"> </span>I knew I would likely pay for this, but I
really had no choice if I wanted to keep racing <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">(Mistake #1 – but no way to fix
this other than getting a better base earlier in the season)</i></b>.<span style="mso-spacerun: yes;"> </span>I made the first cut off by about 10 minutes
and pushed on towards Columbine Mine at 12,600 feet.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>I
refueled (<i style="mso-bidi-font-style: normal;">sort of</i>) at Twin Lakes and was
off.<span style="mso-spacerun: yes;"> </span>About 4 miles into this next stretch,
I began to feel a bit nauseous and my Gatorade and GU were not sitting well
with me.<span style="mso-spacerun: yes;"> </span>Unfortunately, I did not bring
any plain water (had plenty of Gatorade and Ensure) – <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Mistake #2</i></b>.<span style="mso-spacerun: yes;"> </span>I had to get off my bike and walk at least
3-4 miles until I felt better.<span style="mso-spacerun: yes;"> </span>Nearly 2
hours later (no food or water during this time – ouch! – not a recipe for
success), I was near the top and was able to ride to the Columbine Mine Aid
Station – where unfortunately <i style="mso-bidi-font-style: normal;">they had
run out of water</i>.<span style="mso-spacerun: yes;"> </span>They did have
watermelon and I was able to stomach this and then made my way back down to
Twin Lakes.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">I made it back to Twin Lakes under the time cut off – now at
the 8 hour mark and had to get to the Pipeline Aid Station before the 9 hour
mark.<span style="mso-spacerun: yes;"> </span>To do this, I had to dig deep and
make it in just over 1 hour.<span style="mso-spacerun: yes;"> </span>Still not
feeling great, I pushed on and was able to get down some blueberries and a
peanut butter and banana sandwich.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">As I approached the Pipeline Aid Station, fans were yelling
“2 minutes” – so I basically sprinted and made it just under the time cut off
for the third time.<span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Mistake # 3 – not really!</i></b><span style="mso-spacerun: yes;"> </span>What this allowed me to do was to suffer for
another 4 hours and 25 minutes.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Climbing Powerline at around 4 pm in the heat of the day was
pure joy (Oh, did I mention this was one of the hottest and driest races in
recent history – with temperatures over 80 degrees and no wind!).<span style="mso-spacerun: yes;"> </span>This is where I saw grown men crying with their
head in their laps and riders standing and vomiting over the seats of their
bikes.<span style="mso-spacerun: yes;"> </span>No, not me – I just suffered
quietly.<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">I had already done my vomiting and crying earlier in the race! </i><span style="mso-spacerun: yes;"> </span>As I raced down Hagerman pass, I knew there
was no belt buckle for me.<span style="mso-spacerun: yes;"> </span>Sadness was
certainly one of my many emotions at the time, but I thought I might have a
chance to finish under 13 hours – so I pressed on.<span style="mso-spacerun: yes;"> </span>Well, the nausea and cramps resurfaced on the
way back up to the last Aid station, but there was no way I could stop
now.<span style="mso-spacerun: yes;"> </span>Pushing hard over the last 10 miles
only to miss the 13 hour cut off by about 25 minutes.<span style="mso-spacerun: yes;"> </span>The worst gut wrenching cramp came with just
over a mile to go and I had to get off my bike one last time.<span style="mso-spacerun: yes;"> </span>After walking for about a quarter mile, I got
back on the saddle and pushed onto the home stretch where I saw my family cheering
me on and realized that <i style="mso-bidi-font-style: normal;">this is what it
is all about</i>.<span style="mso-spacerun: yes;"> </span>Their support and
cheering brought tears to my eyes and the volunteers at the finish line were so
kind to put a Finisher medal around my neck to validate the entire event.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">Crew<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">No way, no how!<span style="mso-spacerun: yes;"> </span>Could
not have finished this event without my supportive crew including my wife
brother, mom and kids.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">What would I do differently,
were I to do it again?<o:p></o:p></span></b></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;">Start training 3-6 months earlier i.e. 9-12
months out<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;">Train more in extreme conditions – i.e. heat and
cold – especially heat for me – long rides<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;">More training at altitude – over 10,000 feet<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;">Always bring enough plain water on your rides –
you can always bring electrolyte powder to mix, but you can’t go the other way!<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin: 0in 0in 10pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-family: Calibri;">-</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;">Experiment more with natural foods during
training e.g. fruits <b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri;">What next?<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: Calibri;">Stay tuned…</span><br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6573130455660269296.post-81453763539199244642011-04-14T09:16:00.000-07:002011-09-20T12:10:28.363-07:00Training for Leadville Continues: Up Belcher Hill Trail yesterday after work. 1600' climb in a little over 3 miles. Snowing at top and dry below. Gotta love having White Ranch just 15min away!Dr Mainohttp://www.blogger.com/profile/03868635917559223130noreply@blogger.com0tag:blogger.com,1999:blog-6573130455660269296.post-12906553759310087542011-04-10T17:00:00.000-07:002011-04-11T14:58:41.044-07:00NCQA recognizes physician at Sports and Family Medicine of Colorado<div class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="color: #333333;">The National Center for Quality Assurance (NCQA) recognizes Dr. Tod Sweeney of Sports and Family Medicine of Colorado for his care of diabetic patients.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="color: #333333;">NCQA developed the Diabetes Recognition Program (DRP) to provide clinicians with tools to support the delivery and recognition of consistent high quality care.<span style="mso-spacerun: yes;"> </span>This voluntary program is designed to recognize physicians and other clinicians, who use evidence-based measures and provide excellent care to their patients with diabetes. </span></div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="color: #333333;">The physicians at Sports and Family Medicine of Colorado are board certified in <i style="mso-bidi-font-style: normal;">both</i> family medicine and sports medicine and continue to strive to provide high quality, comprehensive care.</span><b style="mso-bidi-font-weight: normal;"></b></div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 0pt;">* <span lang="EN" style="mso-ansi-language: EN;">The information contained in these blogs is purely informational and may not pertain to your specific condition.<span style="mso-spacerun: yes;"> </span><strong>Moreover, it should not replace a formal physician evaluation.</strong></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6573130455660269296.post-80937407272566483222011-04-10T16:24:00.000-07:002011-04-11T14:59:14.397-07:00Tod Sweeney, MD recently published in the Encyclopedia of Sports Medicine<div class="MsoNormal" style="margin: 0in 0in 0pt; tab-stops: 276.0pt;">Dr. Tod Sweeney of Sports and Family Medicine of Colorado in <place w:st="on"><city w:st="on">Arvada</city>, <state w:st="on">Colorado</state></place> was recently published in the <i style="mso-bidi-font-style: normal;">Encyclopedia of Sports Medicine</i>.<span style="mso-spacerun: yes;"> </span>Dr. Sweeney’s chapter on ‘Risk Factors for Sports Injuries’ highlights what are <i style="mso-bidi-font-style: normal;">intrinsic</i> and <i style="mso-bidi-font-style: normal;">extrinsic</i> risk factors, as well as looking at risk factors for specifics sports such as baseball, football, soccer and ice hockey.<span style="mso-spacerun: yes;"> </span>Overuse injuries, playing technique and prevention of sports injuries are also reviewed in the chapter.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal" style="margin: 0in 0in 0pt; tab-stops: 276.0pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 0pt; tab-stops: 276.0pt;">The physicians at Sports and Family Medicine of Colorado in <city w:st="on"><place w:st="on">Arvada</place></city> are board certified in <i style="mso-bidi-font-style: normal;">both</i> Sports and Family Medicine and really emphasize the importance of prevention of injuries and other preventive health techniques.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal" style="margin: 0in 0in 0pt; tab-stops: 276.0pt;"><br />
</div><div class="MsoNormal" style="margin: 0in 0in 0pt; tab-stops: 276.0pt;">To pick up a free copy of the above chapter, please contact us through our website at <a href="http://www.sfmcolorado.com/">http://www.sfmcolorado.com/</a> and then stop by our office at 6390 Gardenia Street, Suite #140</street>, <city w:st="on">Arvada</city>, <state w:st="on">CO</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><br />
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</div>* <span lang="EN" style="mso-ansi-language: EN;">The information contained in these blogs is purely informational and may not pertain to your specific condition.<span style="mso-spacerun: yes;"> </span><strong>Moreover, it should not replace a formal physician evaluation.</strong></span>Unknownnoreply@blogger.com0