Reading list

This is the stuff that has influenced me more than anything else:

The Moral Equivalent of War- William James
Running&Being- Dr George Sheehan
Catcher in the Rye- Salinger
Hamlet- Shakespeare
Chief Joseph of the Nez Perce- Robert Penn Warren
Comfort in Uncertainty- Pema Chodron
A River Runs Through It- Norman Maclean
Mountains beyond Mountains- Dr Paul Farmer
The River Why- David James Duncan
Wherever You Go, There You Are- Jon Kabat-Zinn
Letting Everything Become Your Teacher: 100 Lessons in Mindfulness- Jon Kabat-Zinn
In Defense of Food- Michael Pollan
All Our Relations- Winona LaDuke

Just about anything by Faulkner, Vonnegut, or Twain.

I read the bible a couple of years ago cover-to-cover. Definitely changed my views on things but I am not a christian.

Friday

Ideas:
1.Please read the comments section on Livestrong's perspective on health care reform and some of their supporters views' on the topic. Link here. I posted a commented on their blog early yeseterday morning after reading the first few entries. As you may, or may not know, I'm deeply saddened by much of the public's outcry regarding this topic. I believe much of it is based on mis-information. Health care in this country is a moral tragedy. The insurance companies don't have a prayer of self-regulating. The government needs a role.

That's about all I have to say at this point regarding this very sad topic.

2. I had coffee yesterday morning with an oncologist and have been receiving advice from a mystery local cyclist-blogger. It feels good to have concrete, thoughtful discussions about my decision of what I want for my future. They basically think that if I'm not having any pain or poor lung function, then I should do what makes me happy and is good for my family. Is it totally fatalistic to think and plan about not leaving my wife and 15month old daughter with 2-4 years of medical school debt? Right now, I have 2 years of debt and if I continue I'll have 4 total years of debt. I can't just quit and do nothing and I also can't quit and volunteer all of my time away (probably my biggest 'temptation' right now). Right now, I think I’d like to stay in medical school or perhaps pursue a PhD but to take some time off and do something different for a year or two.
Anyway, that's one of the things I keep thinking about. I guess in a way I'm planning to die in 10 years, even though I really am trying hard not to do that. I know, I'm strong and all that bullshit, but in the depths of my brain I can't help but thinking in those terms: 1 decade. 30-40% 10-year survival. Yeah, I know...I probably don't fall into those statistics. I really don't want to argue about the fact that the way I am thinking is wrong because of such-and-such a reason. I just want you to hear what I'm thinking. The plan for the worst-case-scenario. Now, do I let it dictate my options or do I ignore it as unreasonable? Of course it is unreasonable on a variety of levels, but if you want to have a conversation, I can make a pretty strong case for why in fact, it is reasonable to at least consider the worst-case-scenario.

Emotions
There's a lot of these. Won't try to write about all of them.

-Oh man, I desperately need to make something good of all this shit! (I think that's probably guilt but maybe also hope.)
-Warmth, peace, and happiness when I'm with maggie (love)
-I want to crush Dave Breslin on a mountain bike at one race this year (definitely anger....sorry dave, its nothing personal only the expression of my anger...seriously, its NOTHING personal)
-Pain about the direction healthcare debate has taken (sadness)

Lots more, but this entry is getting long.

Day 1805

47 miles on gravel with two brothers, 2700ft of climbing, a frozen downtube cable leading to only having a 38x14, sun, and maybe 6 cars.

returning home for: 2 beers, maggie and cassidy, big pasta+bacon+brussel sprout+chicken breast dinner, putting her to bed, and sitting and writing. This is the best part of my day.

Down time

The news from last tuesday is starting to settle. It has been great to be home, back on my thyroid hormone, and trying to live in the present. Oh man, the future holds some amazing opportunities. Speaking of which, check this out.

It has been wonderful to have some time off work. My program/superiors are somewhat expecting me to come back with a plan or at least some idea of what I want to do. Right now, I'm thinking some time away from the hospital is in order. Back to the grassroots, hopefully activism but however I can serve.

Those Jesuits in college sure did a number on me. Well, maybe that sounds bad given the recent catholic priest things...all I'm saying is the world is a cold, hard place. Wealth and power rule. It takes a strong and open heart, open eyes, and a willingness to jump in if we want to change anything. That british kid is amazing.

On the medical/physiology front, one of the people I ride with has her PhD in Nutritional and Exercise Science. She does research on bone density and how to strengthen bone, particularly in cyclists. With my vertebrae as it is and with one of the well known side effects of my primary anti-cancer med, thyroid hormone, being low bone density I started taking her recommendations yesterday. Her research has shown that plyometrics; as few as ~40 to ~100 jumping exercises 3 times per week, is one of the best ways to improve bone density, even compared to lifting weights! So its riding (40 miles on gravel today at 18 degrees! with a couple of cadence drills), plyos, and yoga for me for awhile!

Here's a video Dave Henderson made of how we roll when it is 7 degrees (and hypothyroid) in Columbia, MO: Jan 2, 2010

In today's edition of the NYtimes, there is an article about the use of radiation therapy in treating various cancers. The title, "Radiation Offers New Cures, and Ways to Do Harm" itself is interesting on so many levels. Psychological dichotomies are very strange, I'm often able to see things from different perspectives; in this case, that of a training physician but also that of a patient. I say strange because I don't think there's actually a division or dichotomy actually present. Our minds constantly try to divide and categorize into black and white, good and bad, reason and emotion, etc but in my own experience truth is more of a bowl of chili as opposed to steak and potatoes. Regarding the perspectives of physicians and patients, the views are certainly different. One of the important things the article brings up from the doctors point-of-view is the idea of taking responsibility and apologizing. I would argue that today's medical students are being taught differently than the physicians of the past. Reading through the article, other important themes were running through my mind.

The first is one that is the source of so much pain in this country; patient's feeling as though they have been wronged in some way and doctors not being upfront about the issue. In medical school today, we are shown data to back up the notion that when doctors screw-up, they need to tell the patient about it. (How do I emphasize that period more?). We are taught to take responsibility for not just our actions but for the actions of the entire care delivery team. We are taught to apologize. It sounds so normal and humane, but it is actually a departure from the way my parents were taught as medical students.

The second theme that ran through my mind reading the article, is how incredibly dangerous radiation can be. In pathology, when we see slides of a patient's biopsy tissue who has a known history of cancer and the tissue looks 'ugly or disrupted', the first question is always whether or not the patient has received radiation. I wish I knew more about physics or was as smart as a nuclear physicist with regards to the balance of harm and benefit from radiation. In some cases radiation reduces the incidence of cancer. Solar radiation allows life to exist as we know it. In other times, cancers come from radiation. Many people with my type of thyroid cancer have a history of radiation exposure. As far as we know, I've never had such an exposure.

The most amazing and inspirational aspect of the article was the story of Scott Jerome-Parks and Alexandra Jn-Charles. Their experiences, as incredibly painful as they may be, serve us. They embody one of my favorite Einstein quotes: “Three Rules of Work: Out of clutter find simplicity; From discord find harmony; In the middle of difficulty lies opportunity.” They made cancer their work. "As Scott Jerome-Parks lay dying, he clung to this wish...that his fatal radiation overdose be studied and talked about publicly so that others might not have to live his nightmare."(nytimes)

A few days ago, I wrote about how as I lay on the table being scanned this past Tuesday a new kinship became apparent to me that I've never been able to either intellectually or emotionally accept. The kinship is created by cancer. Indeed, the molecular pathology, underpinnings, biological behaviors, and the causes of the various forms of cancer that affect human beings are vast and diverse. But, there's still a connection in the lives of those affected by cancer. And the connection goes beyond personally experiencing a diagnosis to include the family and friends of those who must face their own cellular biology going awry.

I am at a point in my life where I have a number of choices ahead of me. I've been through 2 years of medical school and 6 months of advanced training in pathology. I've read some of the best textbooks in the world, cover-to-cover, actually multiple times on the cellular biology of cancer. I have also continued to ride my bicycle and this year will be well beyond where I ever thought I'd be racing. I also have an incredible wife and 15-month old daughter whom I live for, care for, and who walk beside me through these recent developments in my own journey.

I've also just been given the news of a bone metastasis. And I still am not quite sure what it means. I've spoken with 2 doctors who care for me and who's opinions I trust but I still haven't spoken with my main doctor. Right now, the consensus seems to be that we'll probably wait a year and see how this past radiation treatment has worked.

Ok, one last quote from Einstein before I end and go for a ride. I had never read this before, but really like it: “Strange is our situation here upon earth. Each of us comes for a short visit, not knowing why, yet sometimes seeming to a divine purpose. From the standpoint of daily life, however, there is one thing we do know: That we are here for the sake of others...for the countless unknown souls with whose fate we are connected by a bond of sympathy. Many times a day, I realize how much my outer and inner life is built upon the labors of people, both living and dead, and how earnestly I must exert myself in order to give in return as much as I have received.”

Let's just get a few things straight

If you want to watch the video, before you start reading this post, here's some instructions: First hit play on the video, then fast forward to 2:33. Now hit pause and let the video load whilst reading blog. Then after reading blog watch the video. It was taken in late November, I'm the guy in the black jersey and gray shorts climbing up the hill at 2:33. You can keep watching to watch a great race unfold, where I eventually placed 2nd against some people I never, ever, thought I'd beat in a bicycle race. Now, to be clear: my 'disease' has not progressed at all since then. On that day, a scan of my body would have looked the same as the scan posted yesterday. Strange, yes, but true. This is the point of this post. 3 posts in a row of sullen, difficult to swallow news is enough. It is time now to put things in perspective. Ok, now follow above instructions and read on.



A couple of facts before we move on:
1. The scan shown in my prior post is a 'post-treatment' scan. Meaning, many of those cells which are showing up as black, are doomed to die.
2. This has been my 5th radioactive iodine treatment. The first 4 were within the first year and a half after my February 2005 diagnosis.
3. I have known, all to well, that I've never been in 'remission'. That is to say that since my last post-treatment scan in August 2006 (a couple of weeks before taking the MCAT) I've have known there are multiple (countless), 1-3mm nodules in my lungs. However, in the past, they had been mostly in the lower lobes, now, mostly upper lobes. I've also known that there is random disease throughout my neck.
4. Fact number 3 has been dealt with, medically speaking, in two ways. The first has been a blood test every 2-3 months measuring a protein that my cancer cells release. The second has been removing the signal for those cells to grow by taking a large dose of thyroid hormone every day. For the medical minds: high T4/3-->ultra-low-TSH-->suppression of thyroid cancer.
5. My blood marker has been present but very stable since August of 2006. A big change in that marker or a decline in my own 'function' were the things we worry about.

Point number 5 is important. My own biology is co-existing with a rather smart parasite. We have the parasite on a leash via the TSH suppression but my tumor biology is co-existing quite well with my biology. We've adapted to each other. Clearly my lung function is good (maybe you want to take a break and go watch that video now) and luckily, thankfully, I don't have any back pain (I'm speaking here about the nodule in my vertebrae). I've even taken some pretty nasty falls recently. Actually, 2 weeks ago I was walking down some steps at our apartment and fell really hard after slipping on some ice. I had a headache the whole next day and definitely didn't feel a vertebrae break. Make no mistake about it however, I do have an ugly and atypical form of thyroid cancer and it is definitely true for me that the statistics, both positive or negative statistics, don't apply.

Yesterday it was around 40 degrees and raining here in Columbia, MO. I had woken up with Cassidy around 5:30, made pancakes for all of us, wrote a bit on the blog, and then went for a ride on the road. I was riding past the big tree, see pics below:



and right then, looked up and saw an incredible, soaring bald eagle. As I rode by that tree I said, "Big tree, teach me. I can't do it without you". To surrender is a powerful thing, no matter whether you're an atheist, a spiritual person, or religious. Almost immediately, I felt empowered.

At breakfast this morning, I was telling Cassidy about where milk comes from and we thanked the cows, farmers, truck drivers, grocery store employees, and dada (me. I poured the milk!). It reminded me of my wife's favorite thing her yoga teacher says and now I'm about to write to you. Maybe after you read it you should stop and think about it or just say it (I don't mean to command anything or anyone, just sharing my experience): "Before we go on, let's take a minute to offer up some gratitude for the good, great fortune that is our lives".

Thanks and gratitude to everyone who has been reading, writing, callin, etc. I can't tell you how much it means.

This post is getting long, so I'm going to end it soon. But before I do, I need to say that I have been given 2 weeks off from my fellowship to process the news of the bony met, to make a treatment plan, and to reflect a bit on what I really want to be doing. I have no answers yet to those questions.

Lastly, you can stop reading now if you're not a cyclist. To all BoCoMo riders, teammates, and friends with whom I ride: One of my doctors told me bike riding, as long as it isn't to 'jarring' is a fantastic activity for me right now. So don't kid yourself thinking I'm not going to be pulling into the wind anytime soon. Mountain bikers out there, I'm not quite sure about that situation yet. The whole concern is the vertebral nodule. I'm thinking maybe full suspension.

Information to process

Sorry for not posting yesterday. I was hoping to get a little more information on how this will be affecting my life before I post. I spent my first day back in Columbia talking to various people at work about the findings, crying a bunch, feeling helpless, getting Maggie out of class and going out for a Thai-food lunch (mmm, curry), and of course a road ride with someone who's turning into a great friend.

I'm reluctantly, posting some images of the radio-iodine scan. I say reluctant b/c they're hard to interpret and are normally correlated with a CT-scan. In other words, to figure out some of the anatomy, you look at these images and know that not all of the black is cancer. You can't really tell how much cancer is in there based on these images, the important data these images portray is the location of cancer cells in my body, minus the salivary glands, which normally take up the radiation.





1. Salivary gland tissue (not cancer, it is normal for this tissue to uptake the radiation)

The following dark areas, all represent cancer but I'll say it again: The purpose of these images is to show that they take up radiation, NOT TO DEFINE HOW BIG THEY ARE or HOW MUCH DISEASE IS THERE
2. Place where my thyroid used to be (removed March 2005, the black represents residual, microscopic disease)
3. Tumor in 5th thoracic vertebrae
4. Right Lung w/ tumor
5. Left Lung w/ tumor

Disclaimer: I read the following in a peer reviewed article published in 2008 and more knowledgeable people would probably have a number of caveats so don't take this as written in stone. I'm only sharing the information because it is having a large emotional challenge to me right now. Right now, the only thing that I have learned about how the finding of the bone (vertebrae) metastasis changes things is this: Before the finding of the bone nodule, 85-95% of people with my condition are alive in 10 years. After the finding of the bone nodule, ~40% of people with my condition are alive in 10 years.

Now, statistics when you have cancer, especially ones involving prognosis are very complicated both from an epidemiological view-point and ESPECIALLY a psychological view-point from the perspective of the patient. Ultimately, they are mental hurdles that easily tie the mind into knots and make one feel doomed or not. To an individual, they do mean something, but shouldn't dictate everything. I've really thought quite a bit about statistics like these and would like to take some time to better articulate my perspective on them but right now, my purpose is to help friends and family understand that first, I'm not doomed. And second, I feel a bit doomed and am having a hard time not planning my life around that sort of statistic. Beginning with the process of hearing that statistic and leading up to where I am now, writing, represents a dynamic process; a mental and emotional journey of sorts. I need to feel it. Cry about it. And think about it, but not too much.

The process will continue to evolve in the coming days, weeks, and years. The goal, is to be able to still live my life, truly, from who I am, and just put one foot in front of the other each day. Right now, I'm focusing on the words of Mr Henley and in my reality, hope is not yet here. Right now, I'm in the process of accepting.

Day 6 (Part 2 of 2, read second)

On the flight home, everything got quiet. The sea of clouds below mesmerized and reminded me that in this moment, everything is OK. My lungs look like shit on a nuclear medicine scan, in my opinion, full of cancer. But right now, everything is quiet.

An interesting philosophical issue came to mind, if you’re reading this, you’re welcome to come over sometime and discuss over some good food and wine. Is it possible to come face to face with your mortality? What does it mean to say “I’ve come face-to-face with my mortality” or “I believe or know that I’m truly going to die someday”. To me, we must always be weary of delusions and try to the best of our ability to use our minds and hearts to discover what is true. At this point, besides the fact that it is an interesting question, I’m more interested in what happens after the sense of stillness, after the time when the mind quiets down. Looking out at the clouds I begin to hear my endocrinologists assurances that people “live up to 20 years” with lung nodules like mine. Sometimes, they don’t exactly quantify the 20 year thing, but it has certainly been mentioned on multiple occasions and I have to say that it is pretty uncomfortable this whole “up to 20 years” comment. Maybe uncomfortable isn’t the right word, but it certainly makes me want to plan a bit for that 20 years.

Do I really want to spend 2 more years in med school then 3-5 in residency? Is it worth it? Would I rather commit myself to being a full-time father and husband and part-time cancer researcher? What about full-time father and husband and part-time writer or activist? But then again, two things seem to be true in this situation. 1. No one can say that I will die from thyroid cancer and 2. I may never get better, ie, my lungs may always have tumor in which case, we can try and make reasonable predictions for my life expectancy.

===================================================
I wrote the above on the airplane. When I got off I had a message with the results of the scan (you should read part one first). The nodule is in my 5th thoracic vertebrae. In addition, multiple, diffuse nodules throughout both lungs, multiple mediastinal lymph nodes, and a few lymph nodes under my jaw. These all have cancer in them. Right now, I'm home and am coping. I should know more tomorrow.

Day 6 in Baltimore (part 1 of 2, read first)

Short story: 2 scans today, the first was planned the second was not…it was the results of the first scan which required a 3 dimensional perspective of an area discovered in the first scan.

Results: There’s a newly discovered nodule in my upper chest and diffuse disease in my lungs. I still haven’t spoken to the attending physician yet about the plan, but there’s no doubt that there’s still thyroid cancer in my body.

Discussion: 5 years ago, a ton of bricks fell on me. I was told something that changed my life forever, my thyroid had papillary carcinoma and it had spread to many lymph nodes throughout my neck and mediastinum in addition to my lungs. During the time since, the experience of living with cancer has been a conduit through which, I have adapted something that my mom calls (she’s a shrink, so it must be legit) emotional resiliency.

With that in mind, I expected the news today to bounce a bit…no matter what the news, I would want to collect myself and make a plan and deal.

As I lay on the table for my second scan, I had already been on the table for a full hour. The large metal blocks rotated centimeters from my face and chest at a rate of a few inches per minute. It was a full hour of laying there thinking. First I thought about the differential diagnosis for mediastinal masses (the 4Ts, but you probably don’t care about that). Then I started thinking about the real question at hand: was the nodule mediastinal (between my lungs) or not (in my lung)? If not, then bad news bears. If so, then it is probably just a lymph node filled with cancer and could be plucked out surgically.

Then I started to get scared for the possibility of having a lung nodule. As a fellow in pathology this year, I have seen and helped participate in the diagnosis of many different sorts of cancer. Since 2005, when I was initially diagnosed I’ve always felt strangely alone going through this experience, even though many friends and family have been so close. Up until today, I had never really been able to connect the dots between myself and other people with cancer. I’ve known many people in the last few years, with whom I’ve connected but as the years have passed I wonder whether or not what I’d like to think of as resiliency, isn’t more of a numbing or hardening of my heart. During my first summer in the first few months, I was emotionally very raw and tender. I’ll never forget breaking down in tears as I was driving to work one hot summer morning when I heard the news that Peter Jennings had died from lung cancer. I hadn’t even watched the news and hardly knew anything about him.

Within those first two years I knew many people who dealt with cancer. During the second summer, my grandfather, rather suddenly got diagnosed then ultimately died from malignant melanoma. A few weeks later, my Mom’s partner/boyfriend died from prostate cancer. Later, I watched my buddy Tony, fresh back from Iraq, get diagnosed with leukemia and subsequently get treated ultimately to remission.

Then there was my friend Jason from high school. He was two years behind me in school and when he graduated from college in 2004 found out he had medulloblastoma (brain cancer). Over the following 4 years, he went in and out of remission a few times, then ultimately passed away during my second year of medical school in 2008. We had coffee together a few times and tried to call each other when we could. I hesitate to say whether or not we were close. In some ways, very much so but I’m not sure how good of a friend I was in the end. I couldn’t even bring myself to go to his funeral. It hurt so incredibly bad to see his repeated triumphs and subsequent returns to the hospital. I don’t know if I’ll ever forgive myself for not being there to honor him.

All of this starting flowing through me as I lay there on the table. These connections seemed to reach out to me reminding me of a common experience that I’m quick to overlook. Cancer is intrinsically an experience with uncertainty and everyone who has had cancer is confronted with that uncertainty. When I started this blog, I was 3 years into living with cancer and after a successful surgery in the summer of 2008, things seemed to be well, so it became a bicycle racing blog. During that time a ton has happened. Other, ultimately much more important events occurred, the bricks that were dropped began to be built and organized. I got into medical school, married an incredible woman, and despite being told that it would not be possible had our daughter.

This is all to say that I’m having a hard time seeing myself as resilient at the moment. Definitely more along the lines of freaked-out, insecure, neurotic, and emotional. The reality of the situation is that it is probably not a lung mass and that when I get off the plane I’m getting ready to board, there will be a voicemail from the attending physician telling me so.

Day 5

Not much to write about today. It was gorgeous here in Baltimore and my energy is starting to finally return. Tomorrow, I get my scan, which will tell us where there are still cancer cells in my body. It had been hard not to think too much regarding the possibilities and not get to hung up on my wife and baby who got to go to Miami this weekend. So with that scenario in mind; having more energy and wanting to focus on something, can you guess what I did?

60+ mile group road-ride on some killer, country-style roads leaving just 20 minutes from downtown Baltimore (a universe described on one of the prior blogs but just to summarize, lots of poverty, many real people doing cool things, and a few chique over-the-top urban-cool areas). The ride consisted of many hills, some quite steep. Nothing too long, so overall it reminded me a lot of riding in Missouri. 4000ft of climbing on the day. Total ride time: 3 hours and 30 minutes. I was pretty worked and tired after 2.5hours, but was super motivated given the 50 degree temperatures, beautiful roads, and AMAZING Lemond Maillot Jaune. What a great bicycle: made in the USA with Reynolds 853, dura ace components and with the way the bike fits, it is hands-down my favorite road bike I've ever ridden. It provides such a sense of stability balanced with a suppleness that I've never felt on a road bike before without neglecting stiffness.

Now I'm feeling mellow. Not too worked, just satisfied. It is wonderful what fresh air and an activity you love can do. However, I miss Mags, Cassidy, and friends so much and can't wait to get back home.

Day 4

I already know what I'm writing about today and I'm still sipping coffee #1. First, thanks to everyone that has been reading. Thanks to everyone that wrote something. Seriously, it means a lot.

I just read an op-ed piece in the NYtimes about happiness. I'm hoping that article and my recent discovery of the poem Invictus serve as new guides for the next few years in walking on this planet.

I have some med school friends who are all freaked out about changing health care, that doctors are going to get the short end of the stick. I genuinely believe, that unless you're also doing some type of research, be it molecular biology, drug/therapeutic trials, epidemiology, etc, that doctors should receive a salary. How high that salary should be, I don't think is anywhere close to what many doctors currently bring home. In my eyes, a doctor is a public servant, more educated sometimes, but no less dedicated than teachers, firefighters, police, etc. During residency, most physicians make 45-52k/year. The whole ideal that our society has where doctors and lawyers, because of their long educational process and often large knowledge base I think needs critical examination. What if the people who went into medicine were smart and did it because they wanted to serve others? Isn't that the whole point anyway? So then, why is it that many private practicing blank physicans make 400-500k while primary care doctors 90-150k. Skill? Time? Injustice in the system? Hard work?

Would I work the rest of my life at a resident's salary (currently the reality is that I'll at least work 3-6 years at that salary)? I would if my loans are forgiven and there was also additional incentive to contribute in other ways, in my case perhaps studies in molecular biology. I suppose also, that there needs to be some increase in the salary over time, just to keep people in the system...such and such percent increase per year over baseline. If we did that and also launched a serious health campaign against diabetes (which costs our country $123 billion+ per year in largely preventable complications) our health care problem would be better. I don't claim to know very much about the insurance side of things (universal vs government run vs private etc), all I know is what I'm willing to do from my own abilities.

Back to the present. I finally got to start taking my thyroid hormone again today and over the next few days should start feeling normal again. Phew. I get scanned at Hopkins on Tuesday and will get to take a look at the image before leaving to head back to Missouri. I except that I'll see some uptake in the lower lobes of my lungs and in some discrete areas in my neck. We won't know how well the radiation worked for another 3 to 6 months. Basically this stuff keeps doing its job over time, because it has caused DNA damage and in combination with lack of growth signal (no TSH secondary to very high doses of thyroid hormone) cells should start dyeing. We'll know the extent to which via a fancy blood test at 3 months and 6 months.

As far as the altruism article goes, I still want to create/find a way to bring together something from this cancer experience, bicycles (which to me mean community, low-energy lifestyle, greenspace conservation, meditation, exercise, and racing), and doing good. The Livestrong thing is great but it has always seemed to abstract and big for me. Maybe if Lance sent me an email and went on a ride with me I'd get it!

I still don't really understand what a war on cancer means...how about a war on diabetes? That will save this country many more lives and billions of dollars. But again, I want to do something with cancer.

Day 3

I woke up very tired this morning. It was painful to get out of bed, I felt hung-over despite not really drinking last night. I decided to try a local group ride, leaving from the burbs @10am.

I was immediately concerned when I saw that there was a guy on a recumbant (sp?). But ended up having a great ride. 45ish miles through some very pretty country roads. The dude on the recumbant was a hero. I'm pretty sure he could hang in the BoCoMo peloton as long as there wasn't a ton of climbing.

The Mailot Jaune was unbelievable. Easily, one of the best handling and most comfortable fast road bikes I've ever ridden.

I keep going back and forth about how to approach equipment choices in mountain biking the season. Right now, I have my lynskey and 2 Kona cross bikes (1 geared, the other ss). I feel about the same with regard to the lynskey and the Major Jake as I do wih the Mailot Jaune. The folks I want to be competing with all are choosing different options and it is making it kind of interesting: dual suspension 26in, dualie 29er, hardtail 29er. I'm tempted to change something. I love single speed mountain biking; bought my first ss from Gino when he still worked at TC back in 2006 and my only experience with geared mountain bikes since then resulted in an irreparably (although questionably so) damaged derailleur hanger.

One gear got me strong last summer. It was also a ton of fun. But after this past cross season and some late-summer mountain bike races, it is partially that I have something to prove to myself, but also a desire to keep pushing it with regards to competition. I've always been intensely competitive with myself and one great thing about the small racing scene in Missouri is that the intention can be self-competition but also focused on pushing other racers. Making them less comfortable or just raising the bar. I hate to say it, but here it goes: beating butthead up that climb at the Mt Pleasant cx race flipped a switch. I want to see how hard I can push myself in relation to others.

I'm planning on sitting down with Karl @ Klunk and talking to him about ideas in terms of changing things up. I actually don't know if I want another bike. I love my lynskey and I've also come to appreciate how important it is to actually ride a bike before thinking that it would be good for me. Money is the biggest limiting factor in this decision but some ideas I've had are:

1. Only riding my single speed and changing the gear according to the course...basically hoping for that magic moment when I'm just as fast as the local hard-men

2. Getting a group for the lynskey: 1x9 or 2x10 for sure...but probably just 1x9 and then going back and forth a couple of times throughout the season between one or multiple gears and maybe also having the option of fully rigid vs front shock (I can't tell you the number of times I lock my fork out and love it)

3. Having a second mountain bike, maybe a dual suspension (which I've read are pretty well proven to be faster and a bunch of fast dudes will be riding them...but one, I've never even ridden a dualie and two, I lock my fork out so much as it is and am pretty well a full 29er convert...and a light 29er dual suspension is DEFINITELY not in the deck of cards at this point).

4. Selling the lynskey frame and then doing some combo for option 2.

I wish #3 were an option, but I really don't think reality is such at this point in my life to make it happen.

Day 2

I was standing in the 'travel' aisle of the drug store last evening and had finally determined the cheapest of the small toothpaste tubes and was in the process of reaching forward when 300-lb guy walks right in between me and said-chosen toothpaste. Then he just stood there trying to decide which to buy. Anyway, it was really weird and very rude, so I not-so-quietly muttered 'dip-shit', reached around him and grabbed my toothpaste. I don't think I've said anything like that out loud to a stranger while not on a bicycle. But, a) it was really annoying and b) being hypothyroid makes patience very short, especially in the evening.

Then as I was walking out, realized that I had just exposed the dude to a miniature Chernobyl. Quite literally; Chernobyl (look it up, I-131). A couple of the things I'm supposed to do over the next few days are stay at least an arm's distance away from people, pee sitting down (yeah, that one really hurts the man-hood ego and is very hard to remember), and flush the toilet 2x. There's definitely other things, but those are the only ones I can think of.

It was hard to get out of bed this morning. I felt some nausea and a case of the feel-bads as we almost-doctor folk like to say. I pulled myself up around 7:30 had some coffee and then went out to breakfast. I'm finally allowed to eat a normal diet again. Today for breakfast were scrambled eggs (I thought about requesting only egg yolks) cooked in butter, toast with butter, and some hash browns, all salted generously with regular iodized salt.

Around 10am I headed out on a ride to what I had heard was a paved, flat, car-free trail connecting Baltymoar to Annapolis. The interweb said it was a 15ish mile trail one-way and feeling a bit ambitious I decided to give 'er a shot. Truly an awesome trail running through some pretty woods but it certainly felt like I was in the suburbs the whole time. The whole east coast seems like it would require either a little imagination or a lot of time in order to truly find some solitude. There's so many people here. On the way back from Annapolis I began to pay for having a bike that was too large and not a good fit at all. Everything started to hurt: knees first, then wrists, then shoulders. Yikes. I had seen one bike shop on the way out so I stopped there to at least move the seat forward. The guy was stoked to see my Kona jacket and we shot the shit for a little while and talked about how sweet of a company Kona is (seriously, I'm not putting a plug in...he did most the talking cus I was starting to feel really tired and shitty and wanted him to STFU).

The last few miles were pretty painful both because of the bike fit and just b/c I'm still hypothyroid. I stopped to grab a 1/2 gallon of chocolate milk and chugged the whole thing in about a minute. Well, that's exaggerating, but I drank it fast and it was good cus I hadn't had dairy since before christmas. Can you believe that? Not christmas cookies b/c the butter!

Anyway, the milk helped but I was still really tired. I did manage to head back to light street cycles and see what could be done. The owner took one look at me and said that I should take a different bike:

Can't wait to ride it tomorrow!

As a city, Baltimore is a lot like St Louis. There's tons of really poor out-of-work folks, a few dip shits who drive way to fast in nice cars, and people who are trying really hard to be cool and revitalize the downtown area. The poverty however, is totally in your face here. I keep reading about how much money is being given to Hati (a very just and noble cause) and can't help but wonder if there's money to give, why can't we have more jobs?

Day 1

The travel day concluded with my Mom and I successfully arriving at our hotel in Baltimore. 5th trip here in 2 years. Thankfully, we stay for free through an organization called the Livingston Foundation. The Livingston’s set up a suite at a nice downtown Baltimore hotel for cancer patient’s needing treatment at Hopkins. Their young son had died with leukemia and this was one of the ways they honor him.

After getting settled, I headed to Light cycles to rent a bike for the 6 day that I’ll be here (if you click the link, notice their description of where they’re located). That bike shop was great. Reminded me of many back home…more like Klunk than anything else except they had tons of really nice carbon road bikes. After looking around a bit, I saw what I was looking for:
There’s a sweet spot in my heart for steel bikes and this one was gorgeous. I always really liked LeMond bikes.

Anyway, the owner of the shop Penny, was amazing. She was just getting back from the state capital, having spent the day lobbying for a 3-foot law for cyclists in Maryland. She said her other big issue has been health care reform over the past few years. Needless to say, we had a lot to talk about. What a hero; total shirt-off-her back small business owner.

I woke up early today and found myself disappointed to learn that the ground coffee I had might not work in the tea-maker disguised as a coffee maker in the hotel. Bollocks. Oh well, I jumped on the LeMond and cruised around downtown Baltimore at 5:30am looking for a French press. Yes, that’s what I just said; 5:30am, looking for a French press. Maybe it was just an excuse to go ride the bike around on empty, dark city streets at 20 degrees? After riding to all the little artsy coffee shops I knew of, I finally found one at Caribou coffee…returned back to the hotel and enjoyed a wonderful cup of the black. Next, one of my 2 breakfasts that I’ve been having over the past month, while on a low-iodine diet:
My appointment at Hopkins was for 1pm. Basically I showed up and took a pill. In the past, I've drank it with a straw, so this was a little less fun but certainly painless. I wonder if I'll set off any detectors at the airport next Tuesday.

Early January

I'm still in my staring match with the impending radiation treatment. It was originally scheduled for Jan 7th, but at the beginning of last week a blood test indicated that a hormone (TSH) that my body is producing in prodigious quantities since I'm off of my daily thyroid-pill, isn't high enough.

The last couple weeks have been a bit of a struggle. Thyroid hormone basically sets your metabolic rate and is important for general energy as well. Most people gain a bunch of water weight in addition to real weight while hypothyroid (low on thyroid hormone). I tend to feel depressed. I hesitate to qualify the depression at all, since 'very' depressed is so subjective and a stupid term. But let's just say that if I don't get some time to relax everyday and ride my bike, then I feel like jumping off a bridge.

I've always used movement and activity as a sort of meditation, through which I somehow change my mind in some weird way and without which; my mind doesn't work as well. Sounds like an addiction doesn't it? Probably is. But the sports/activities I've chosen in my life every since I was a kid are always so much more than exercise. If all I needed was exercise then I'm sure the gym and those bloody cardio machines would suffice. But I usually won't be caught dead on the hamster machines. My sports have always enabled and empowered me as a person...much more so than just exercise might do for some people. My progression of sports from about 2nd grade onwards went something like this:

Speed skater--> Rollerbladder/Skateboarding (mostly in skate parks)-->mountain biking-->High school and then college LaCrosse, which also made me a runner-->college cross country-->mountain biking--> sport climbing (clipping bolts)-->bouldering-->trad climbing--> cycling in all forms, but preferably off-road

Skiing, sailing, and yoga are intermixed throughout that timescape, but were never central.

All of those activities, with the exception of Lacrosse have a certain culture or community about them, so that each became more of a lifestyle than anything else (never really dug the 'Lacrosse lifestyle'). I've always felt that if I lived near the ocean, surfing would be what I'd do, mostly because I love being connected to the natural world and being able to talk to others about it.

So when I feel like shit, even right now, a ride is just how I change my mind. Hopefully there'll be some temps above single digits this weekend, which is pretty much my line in the sand for riding.

Right now the radiation treatment is scheduled for Jan 21, so I have a couple of more weeks of feeling tired. Can't wait to get it done but for now, the staring match with cancer continues. I think it might blink soon. In the meantime, I've pretty much nailed down my race schedule for next year. Primary goal: have fun, meet moar friends, stay sane, get outside amap. Secondary goal: Build it all up for 2010 cx season and represent my team/sponsors and the StL/BoCoMo well at the Trek Big Ring Classic and Jingle Cross.