Froze toes 2010

Today was the first road race of the season in Missouri...Feb 28, Froze Toes, just 15 minutes from my house. I learned that road racing on a sunny, warm-ish day looks like a lot of fun. The funny thing is that cyclocross in the worst weather imaginable still looks like much more fun. Oh well.

I couldn't help but wonder how I would have done...and I couldn't escape the feeling like I was letting myself and others down by not racing. Like I said, oh well...there'll be lots of other races.

I went to the race today to volunteer in the first aid station, which was funny because the doctor there is the husband of one of my professors in med school. I also wanted to take lots of pictures and spend time with my daughter, while not racing. Unfortunately, I forgot a spare battery for my camera so ran out of juice for the camera.

But @ 17 months, my daughter is finally at this whole new level in terms of kicking back on a sunday afternoon. First, she can finally communicate besides just whaleing (sp?), pointing, and grunting. I wrote down the number of words that one can understand if you spend a bit of time with her...granted, many of these are only 1 syllable and therefore don't make much sense to anyone else, but in context, they serve the function of 'language' just fine. Second, there was a playground and she can go down the slide by herself and LOVES IT!

She has 38 words as of today. My favorites being:

'Plea' (please, I think her second word ever)
'Toe' (toast or toe, depending on context)
'Ba' (bath)
'Boo-pah' (hilarious website to teach kids to use a mouse)
'Naooooo' (No)
'Doh' (door)
'Tee' (teeth)
'Coh' (cold)
'Dah' (Father dearest to my heat)
'Cah' (coffee) (yes, my child knows how to say coffee and no, we don't give her coffee, she just loves to play with the beans...pronounced 'bea')
'Biiik' (bike)
'OK' (Okay)

On another note, I never actually blogged about this but my insurance company, Anthem Blue Cross Blue Shield of Missouri, had initially rejected my last radioactive iodine treatment, calling it 'experimental'. Which is disturbing because (1) that treatment has been used since the 1950s (2) it really isn't that expensive as far as cancer treatments go and (3) it is the reason why medical students in this country are taught that thyroid cancer isn't 'that bad too have' (b/c the treatment is so good and effective). We appealed their rejection and got them to pay, which felt like a victory given what is happening with insurance in this country.

Picture of the damage from my first ride on the bike again after 2 weeks off yesterday: damn ice.

Back on the bike

After 2 weeks off, some physical therapy, 2 doctors visits, and some bike adjustments I made it out for a ride today. There was no goal and the only rule I laid down for myself was to stay out of the big ring. The ground was frozen so I opted for a mountain bike ride at Rhett's run.

The knee felt fine but it was pretty challenging for me to ride with a high cadence. I don't know how the world class climbers on the road can manage to go so fast and keep such a high cadence. Yesterday I watched some footage of Lance and Ulrich and was amazed at the huge difference in their leg speed. Lance was probably 80-100rpm while Jan was 40-60rpm.

Today was the first day not riding in the snow on the big-wheeled dualie...and man does that thing crush the climbs. I felt like I effortlessly floated over the sections at Rhetts that gave me trouble on my ss.

Camp Mak-A-dream

This is what I'm talking about. (click the word 'this')

Anyone else interested in a 130-mile ride through the mountains of Montana for a great cause?
click this

Details to come...I'll need your help.

My research

This is probably going to be one of those posts that no one comments on. Oh well, I like writing them and I keep getting encouragement to continue (probably from people that don't know how to post!), so here it goes:

I remember my first exposure to the study of biology. In fact, I still keep in contact with my 8th grade science teacher (who, had after teaching us ecology, had us watch Philadelphia (movie about HIV-AIDS)). In college, I ended up studying biology from the perspective of someone interested in human ecology, but when I finally took my required course work during my senior year in organismic bio (note the 'ni')...I knew right then and there, that I wanted to go to medical school.

It is a very exciting time to be interested in both medicine and biology, mainly because of the revolution created by the field of molecular biology.

I just read a very interesting piece on the NYtimes called a Roller Coaster Chase for a Cure which explores some of the pertinent aspects of molecular biology. My favorite thing about this kind of reporting/writing is when someone takes complex scientific theories and produces rhetoric of clear, understandable english. The author does a pretty good job describing the article's protagonist and the general nature of cancer cells:

"But he (Penn Oncologist: Keith Flaherty) also chose the field (Oncology) because advances in understanding cancer’s molecular biology convinced him it might finally be possible to cure the disease — and he wanted to have a hand in it.

Healthy cells turned cancerous, biologists knew, when certain genes that control their growth were mutated, either by random accidents or exposure to toxins like tobacco smoke and ultraviolet light. Once altered, like an accelerator stuck to the floor, they constantly signaled cells to grow.

What mattered in terms of treatment was therefore not only where a tumor originated, like the lungs or the colon, but also which set of these “driver” genes was fueling its growth. Drugs that blocked the proteins that carried the genes’ signals, some believed, could defuse a cancer without serious side effects."

One thing that I would add, because it is the topic of my current research is this: it ain't just the genes. In many ways, individual cells are like people, they often group together according to various common factors or activities. Those colonies or communities of cells then interact with other communities of cells, much like when many different ecosytems come together to form the biosphere of the earth. Importantly, it isn't just what comes from the genes of one cancer cell that determines it fate, but actually the environment in which it is placed. For example, when the tissue of the esophagus is irritated by stomach acid, the cells release biochemicals into their local environment, which create inflammation. The soup of biomolecules that the cells are bathed is sort-of like the air we breath or the ocean surrounding fish. However, for some reason, there is an increased chance for cancer to develop in areas of chronic inflammation. The point then, is that the 'microenvironment' surrounding cells can have profound effects on which genes are 'turned-on' and which genes are 'turned-off'.

Once a tumor has formed, there are additional alterations to the micro-environment, sometimes favoring conditions that allow for the tumor cells the ability to dig their way into the circulatory system. Once there, they rarely, but occasionally have the ability to go back out of the circulatory system into some other site, set-up shop, and grow in that 'foregin' area (e.g. breast cancer spread to lungs, colon cancer spread to liver, prostate cancer spread to bone, etc).

I'm currently doing experiments on one particular protein that is characteristically found in elevated concentrations in the micro-environment of tumors which then become metastatic. When I say 'elevated', I mean relative to other tumors which are not metastatic and also relative to normal, healthy controls.

The cool thing is this; in a way, I'm still doing environmental science, just at a very, very tiny level!

ps- This is a pretty cool set-up, definitely up my alley

Friday report

I'll work backwards today, first I'll write about normal life stuff, then cycling, and finally the long awaited treatment plan.

My knee hurts. I've been off the bike since sunday and I'm still having some pain when I walk down stairs. The physical therapist thinks it is due to a muscle imbalance that causes my patella to be pulled to far laterally (to the outside) and then track off of its normal line...which causes inflammation and pain. I usually lift weights throughout the off season and I've found that to be extremely helpful in avoiding problems like this. This year, after I found out about the vertebral met, I stopped lifting due to concerns of unnecessary spinal loading and instead starting riding 12-18hrs/week. It felt great for my mind and for awhile, my body. But over a month, with my tendency to push too big of a gear than what is necessary, I ended up with a muscle imbalance and pain. I'll take next week off as well, which will take me out of Froze Toes :( and see how it feels.

Wait a minute, that was all about cycling not normal life?! Oh well. Onward.

Family life and work are both pretty awesome right now. Maggie has been a hero the last few weeks and Cassidy is a riot. My research is getting ready to ramp-up and my volunteer work with the children's oncology floor is taking form.

As for the volunteer work, I'll be on call to them and available to come in whenever they have a patient who they feel would benefit from talking to me. The classic kid would be a 14 year-old kid who plays a sport and now thinks his life is over due to his diagnosis. I come in and talk to them about the importance of continuing to do what they love and tell them a bit about my story.

Later in the spring, once the H1N1 thing has calmed down, I'll bring some bikes in and lead a program about bike safety, cycling, and physical fitness in the face of chronic disease.

Ok, treatment stuff. Everyone is in agreement that a procedure called steriotactic radiotherapy will be the best thing to treat the 1.5cm x 1.4cm nodule of blood and thyroid cancer in my 5th thoracic vertebrae. Basically they'll stick a needle into the bone and then zap it. Pretty god-damned scary if you ask me.

The 'when?' of the treatment is the big question right now. In January, the nodule received a hefty dose of radioactive iodine, a known cytotoxin to all cells thyroid. So there's some reason to think that if we wait a little while, the thing will at least decrease in size. Therefore, allotting a smaller dose of the big-bad needle radiotherapy. 3 months (April) has been the time thrown out there. But in the past, I've always heard it takes around 6 months for the affects of radioactive iodine to become apparent, so I don't quite understand why, if we're going to wait, we don't just wait 6 months (July).

The 'where?' is at least a bit comforting. I'll for sure get that treatment in St Louis at Wash U...so at least they'll be friends and family around (and I'll be right across the street from Forest Park so it'll be easy to dis-obey any doctors' instructions about not riding my bike, although I probably won't actually have many restrictions at all). Maybe I'll commute to the hospital.

In summary:
-needle in back in either April or July @ Wash U
-Knee hurts, I want it to stop
-Family and work rock

5 years from my 10/2

Nike makes a LiveStrong shirt with 10/2 on the front. I'm actually, quite unintentionally, wearing it as I type. That date represents the date in which Mr. Armstrong's life changed forever. The date when he got diagnosed with testicular cancer.

February 17, 2005 in my 10/2.

I remember first reading one of the biographies written on Armstrong. I had always been a fan of him, and even had a US postal service hat when I was 19 way back in 1999. I think that hat blew off my head when I was sea kayaking in Patagonia in December 1999...anyway, back to the subject. When I read the book on Armstrong, I think it was 2006, almost a year after my diagnosis. At that time I had, moved from Boulder back to St Louis, underwent 2 total neck dissections with something like 70 lymph nodes and my thyroid plucked from my neck, and had 4 radioactive iodine treatments. When I read that Mr Armstrong had his last treatment in December of the same year as his diagnosis, I laughed and declared (in complete sarcasm and in jest) that "Lance is a wuss".

Now it is 5 years later and I have my health but have still never been in remission. We could talk all day about the importance of health and that 'remission' doesn't actually mean much...but then I'd just keep coming back with the cold, hard truth that there's a metastasis in my vertebrae. Not having ever been 'in remission", I've never had the feeling that I 'beat cancer'. However, for that matter, I've also never really felt like I was 'fighting' cancer. Maybe I'm just playing semantics and over-thinking the issue, but my experience has felt as though I'm being watched or stalked, not in a fight. Most of the time, I'm able to ignore being watched, other times, it feels as though I'm alone in one of those police interrogation rooms knowing that behind the tinted glass, are eerie sets of eyes (my cancer even has histological nuclear features of 'orphan annie nuclei' under the scope! that was a joke). What a mental game this experience has been. The only time I've ever felt sick has been when I've underwent treatment. Otherwise, I feel fine.

This Friday, after exactly 1 month from initially learning about the vertebral met, I'll find out my doctors' plan. I imagine that it will involve either a different (and much more serious) kind of radiation treatment or surgery (which would suck, because they'd be cutting out a piece of my vertebrae). Until then, at least the Olympics are on!

Bicycle-wise, I'm having to take some time off the bike. There's a couple of reasons, the most immediate of which, is a nagging bit of pain in my right knee that I want to nip in the butt before the weather gets nice. In the meantime, I'm dreaming of warm places and mountains (I just registered this morning for the Firecracker 50!!!!).

Judge your success by what you had to give up in order to get it

A few days ago, when I was at the reception desk for the MRI, I was handed a health questionnaire about how I'm feeling and the state of my health. One question asked if I felt as though my health was poor, average, good, or exceptional. I choose exceptional. For some reason however, some dark corner of my mind keeps tweaking the information we've learned in the past month (cancer still present in lungs, mediastinum, neck, maybe jaw bone, and 5th thoracic vertebrae) and using it against me.

Nothing has changed since December, when I was preparing for the 2010 cycling season with high-hopes and dreams of: 350-watt 20 minute time trials, a busy mountain bike racing schedule (and associated friends, beer, and time in the woods), massive w/kg numbers, and dethroning butthead (with the help of fellow BoCoMo resident Shottler) as top cyclocross dog. However, psychologically, everything seems to have changed. Now I feel like a real cancer patient. And it sucks.

Every little back-ache I experience, a waterfall of worse-case scenarios fills my monkey-mind. For some reason now, with the knowledge of continued pulmonary (aka lung) disease, I can't seem to get as much oxygen into my blood.

The present is still a time for waiting...no plan yet as to what to do. Somebody might want to stick a needle in my back to biopsy that vertebral nodule, so of course, I'm trying to think of a time in which that would be least inconvenient. Maggie takes her boards in May, we'd like to have some time to chill in June (perhaps head to Colorado for a few weeks just to ride and relax), then of course, there's work, med school continuing in August, and taking care of Cassidy.

Froze toes is coming up, and I'm still a little unsure about the whole treatment plan in addition to feeling a bit freaked out with everything going on. Ethan and Dave Henderson have been teaching me good road riding skills and I'm enjoying it, but I'm definitely ready to go crush some single track.

Le Professeur's 29in chariot of fire

I'd like to introduce you to a serious bicycle. When I found out about my vertebrae, I got some advice and talked with a bunch of people. Through much help, I ended up deciding that in order to minimize risk, I'd have to sell my hand-built dream bike and move towards a heavier choice: Full suspension with 29inch wheels.

Then came some incredible support. Cory at Kona and Karl at Klunk helped me put it together, plan it out, and make it happen. The old mountain bike was around 22lbs, with only one gear. This one has 2x10 gears and weighs in at 24.1lbs. Rider plus bike weight will be 164.1lbs. Truly amazing for a bike that is going to roll over anything in its path. You might as well expose your wrists to its wrath now...

Keep trying no matter how hard it seems

I'm getting pretty tired of trying to make the best out of what, for all intents and purposes isn't good news. I think this is what I've been trying to do, not always successfully, since 2005.

The latest health-front news, is basically more neutral to bad news. Now, I'm in the process of making the subsequent mental adjustments to try and feel better about it. The MRI today ultimately told us nothing more than we already knew. But, it also confirmed what is still so hard to believe; there's thyroid cancer in my 5th thoracic vertebrae.

Getting an MRI is a pretty crazy experience. It is kind of like being stuck in a really bad crowded techno dance club; they're awfully loud, there's weird computer sounds, your arms are tucked up against you, and you can't see a thing. The MRI however, pales in comparison to the 'gamma camera' scan that I get after radioactive iodine treatments. Talk about big machines being right up against your nose for long durations. The time for the MRI was about a third of what it takes for the gamma camera.

After the scan, I got to experience one of the benefits of being a part of the medical establishment; straight back to the radiologist's lounge to see the picture they took of my spine (sometimes I feel really sad considering how hard it is for me to get information and comprehend all this stuff especially when I think of how many people don't have medical backgrounds who deal with the same stuff).

It was a pretty terrifying image. Even though I knew it was there, it was a whole different experience seeing it in the high resolution of an MR scan. My stomach sank and began to hurt. The radiologist was a hero and after seeing the 'lesion' in my vertebrae proclaimed (DISCLAIMER, those under the age of 18, I am about to use bad language, prepare yourself or look the other way and skip to the next paragraph) "Man, I hate me some fucking cancer". My thoughts exactly.

I drove myself home and went out to dinner with Maggie to our favorite restaurant. I found myself thinking that 'well, at least there's only 1 nodule in my vertebrae, because there very well could be more'. And there you have it: "trying to make the best out of what isn't good news".

It is good for me to write on this blog and share these bad times with people. I'm amazed if you actually read through all this melodramatic, crappy writing, full of mis-spelled words and sappy thoughts. Its funny, I don't actually feel like I'm writing for an audience, but somehow feel more connected through this form of communication.

If opportunity doesn’t knock, build a door

A couple of weeks ago, I wrote "These connections seemed to reach out to me reminding me of a common experience that I’m quick to overlook (connections, referring to memories and emotions that connect me to friends and strangers who also have had a serious cancer diagnosis) . Cancer is intrinsically an experience with uncertainty and everyone who has had cancer is confronted with that uncertainty."

I've be quite restless since having the realization that, I do have a common experience and that I desperately want to be doing something positive about it.

Two incredible opportunities have come up in the last couple of weeks:

1. I will represent LiveStrong, at a grassroots level, and go to the children's oncology floor at our local hospital to talk with them about how they're doing, living with cancer, exercise, bicycles, and bicycle racing. I'll bring a couple of bikes with me including the new dual-suspension 29er mountain bike (pictures soon). I'm also trying to talk with some local bike people to see if they'd be interested in lending me a demo bike (preferably a light, race-ready road bike). If the day goes well, then I plan on (a) making it a regular event and (b) doing the same thing at hospitals in St Louis and Kansas City.

2. Med school will continue next August! In the meantime, I have an incredible research project. I'll look at a specific protein called lipocalin 2 or LCN2, which has been shown to be involved in a bunch of different processes including (I'll try and make this stuff as simple as possible, let me know if you're following):

-the ability of certain tumors to metastasize (when looking at different cancers, some seem to be populated by cells which have the ability to leave their original location in order to travel to a different site in the body and nestle themselves in that distant site).

-In order for cancer cells from a particular tissue, say for example, breast tissue, to leave their original location, they need to turn on a set of genes which transforms the cell into a more primitive and mobile entity. Way back in our momma's womb, when our tissues were organizing, cells went from primitive and mobile to 'differentiated' organs. The protein I'm looking at seems to be involved in the reverse process, 'differentiated' to primitive and mobile.

-The ability of some cancer cells to make room for themselves by digging holes in normal tissue and killing normal, non-cancerous cells.

There's a couple of important aspects of this protein, including the fact that its levels in the pee of people with nasty, aggressive cancers is higher than those with more 'well-behaved' cancers. We can also look at biopsy tissue to see if the protein is over-expressed and therefore have an idea of the patient currently has, or may develop, metastatic disease. And lastly, researchers and drug companies can develop therapies which target this protein and in theory, decrease the ability of cancer cells to pick-up and move to distant tissues.

Monday news

Monday morning on my blog, I intend to post a bit of news concerning research that interests me at a professional (and personal) level.

Most of it will be concerned with the identification of novel techniques to understand metastatic behavior of various cancer. I'll write more about my own research which I'll be working on this year later today or next Monday. In the meantime, this is the face of modern medicine today:

MedWire (2/8, Grasmo) reported that research conducted by a team in Italy "shows that in women aged 35 years or older, human papilloma virus (HPV)-based screening is more effective than cytology in preventing invasive cervical cancer through earlier detection of persistent high-grade lesions." Investigators reached that conclusion after randomizing study participants to "conventional cytology only or to HPV testing plus liquid-based cytology (first phase) or HPV testing alone (second phase)."

MedWire (2/8, Dean) reports, "Gene expression profiling has identified fibronectin 1 and chemokine ligand (CXCL)9 as candidate biomarkers for breast cancer screening," According to the French paper in the British Journal of Cancer, the proteins were initially "identified as candidate biomarkers for blood-based screening" because "they both had more than two-fold increased expression in the cancer compared with the benign lesion, were proteins that are released in the extracellular medium and stable in serum, and had a commercially available and accurate enzyme-linked immunosorbent assay."

MedWire (2/5, Guy) reported that, according to a paper in the Proceedings of the National Academy of Sciences, "the loss of a single nucleotide polymorphism located in the gene encoding the disabled homolog 2 interacting protein (DAB2IP) in prostate cancer cells may be responsible for cancer progression to other organs." In other words, "removing DAB2IP from human prostate carcinoma cells initiates epithelial-to-mesenchymal transition which is a characteristic of metastatic cancer." Thus, researchers at the University of Texas concluded, "DAB2IP in these cancer cells can be a valuable prognostic biomarker for risk of the aggressiveness of certain prostate cancers."

Zealot

I was at my friend Karl's shop yesterday and Jacuie Phelan called. She just wanted to say 'hi' and that she liked the Klunk patch she had picked up a few months earlier during her 4200mile cross-country ride.

I knew who she was and remembered an amazing picture of her caked in mud but hadn't ever read any of her writing. Man, have I been missing out.

Here's a sample:
"The Bicycle Bond, one of the strongest known, derives its power from the inescapable fact that riding turns the rider into a Zealot. If the rider is already a Zealot, then they become a Major Pain In The Butt Zealot, the kind of person that attempts to create links from cycling to any other subject of conversation that might come up among a group of uncyclists, to rope the discussion back under control.

I am one of them. With much help, I have learned to rein in this urge, but I have to admit it to the world, here in my little blog.
Zealots know that

–bicycling, whether on skinny tires or fat, is a low-impact activity that alleviates the ills of mostpodern humanity.

–bicycling does not abide the mental yo-yo game between past and future that we allow to pass for reality. The bicycle obliges you to be precisely here, at this moment…Poised in perfect balance between the dime-sized oval blobs that connect the tire to the ground. Oh, all right, then : on a road bike you can often get away with the yo-yo game more easily than on a mountain bike because concrete, asphalt, pavements promise a smooth surface.
Whether they keep that promise is another thing entirely.

And lastly, bicycling is cheap bliss—the celebrated endorphins eliminate the middle man (‘big Pharm” or shady illegal pharm/ag) and put you in full control of your dose."

Her blog: http://jacquiephelan.wordpress.com/

I went for a 3 hour hammer-fest with Fish, Shot, ProPam, and Alejo yesterday. Ethan said he was putting out 350-400w while holding Shot's wheel for the last 10-15 miles at the end of the ride! Today will be more of the same, although probably longer.

Food and cancer, a complex topic.

To all those making claims that all "cancer" is a preventable disease,

Shame on you. I am sorry to say that this is one myth floating around health-food grocery stores and the internet that is sorely, and dangerously mis-informed. I would refer you first to the textbook, The Biology of Cancer by Robert A. Weinberg to explore the incredible complexity of the nature of cancer. The first thing you need to understand is a theory called 'Multistep Tumorigenesis' (which I'll post about on another day).

The following comment was posted on the LiveStrong blog in response to a report from the Union Against Cancer (UICC) that states 40% of cancers could be prevented with vaccines and a healthy lifestyle:

"Sorry but this report is bogus . Vaccines are not the answer – they cause more problems than anything, as do anything we ingest which is not made from food. As far as the statistics, that number is way off. I would venture to say 100% of cancers can be prevented. That’s right, 100%. 1 0 0. 100% preventable, 100% curable (if caught early enough)."

My response to people who hold such a viewpoint:
1. Please don't ever talk to parents of anyone who has a child with cancer. Pediatric cancers are different, much different.

2. You are putting too much blame on people who, to absolutely no fault of their own, have ended up with various cancers. You need to educate yourself before you make such vast and appallingly incorrect generalities.

3. You need to read about tumor viruses and you need to get some facts regarding disease prevention and vaccines. Until you have done either, you should keep your dangerous and terribly mis-informed statements to yourself. Editors of the Livestrong blog, you should be ashamed to have published such statements.

There is no doubt that the environment (food, toxins, radiation etc) are involved in the incidences of some cancers. From Weinberg's text:

"Although the incidence of some cancers (e.g., some pediatric ones) is comparable worldwide, many vary dramatically by country and therefore cannot be due simply to a normal biologic process gone awry by chance. Differences in heredity or environment might well explain these differences; in fact, epidemiologic studies have shown that environment is the dominant determinant of the country-by-country variations in cancer incidence." It is also true that Seventy-Day Adevntists, whose religion discourages smoking, heavy drinking, and the consumption of meat, die from cancer at a rate that is only about half that of the general population.

The conclusion is inescapable: "the great majority of the commonly occurring cancers are caused by factors or agents that are external to the body, enter the body, and somehow attack and corrupt its tissues". These agents are often viruses. Vaccines help prevent viral infections (e.g., Smallpox eradication and huge decreases in polio). Environmental toxins (aflatoxin B2, sterigmatocystin, benzo[a]pyrene, 4-aminobiophenyl, 2-naphthylamine, etc) can be mutagenic and therefore carcinogenic. Radiation is no doubt, a culprit. Food is another, very complex matter. From Weinberg:

"A diverse set of discoveries led to the model, which remains unproven in many of its aspects to this day, that a significant proportion of human cancer is attributed directly to the consumption of foodstuffs that are mutagenic and hence carcinogenic. Included among these foodstuffs is, for example, red meat, which upon cooking at high temperatures generates compounds such as heterocyclic amines, which are potently mutagenic. The difficulties in proving this model derive from several sources. Each of the plant and animal foodstuffs in our diets is composed of thousands of diverse chemical species present in vastly differing concentrations. Almost all of these compounds undergo metabolic conversions once they are inside our bodies, first in the GI tract and often thereafter in the liver. Accordingly, the number of distinct chemical species that are introduced into our bodies is incalculable. Each of these introduced compounds, once it is present in the body, may then be concentrated in some cells or quickly metabolized and excreted. This creates a further dimension of complexity."

"In sum, the ability to relate the mutagenicity of foodstuffs to actual rates of mutagenesis and carcinogenesis in the human body is far beyond our reach at the present-a problem of intractable complexity".

Should we then ignore food because we can't define the exact culprits? I would argue no. I believe Michael Pollan and his book "In defense of food" best summarizes the health consequences of a modern industrialized diet as well as modern 'nutritionism' as we know it. In my view, one should ignore much of what nutritional science tells us (macronutrient obsessions) and practice the following:
-Don’t eat things that your great-grandmother wouldn’t recognize.
-Avoid anything that trumpets the word “healthy.”
-Be as vitamin-conscious as the person who takes supplements, but don’t actually take them.
-"Eat food. Not too much. Mostly plants.”

BIKES!!!

That MRI that I was supposed to have (if you read my last post, you'll know what I'm talking about) couldn't be scheduled until next Wednesday for 'insurance reasons'. Oy vey.

On another note, I'm feeling well on the bike and have somehow managed to get some good riding in the last few weeks. Base building is the goal so I'm trying to keep the intensity low and the volume high. I've done maybe 2 or 3 tempo workouts with my powertap, which has been good and has produced an interesting set of numbers/personal bests. Being a big fan of CX and mountain biking, I would have expected to have good 5sec, 1 minute, and 5 minute power outputs. To my surprise, my 20 minute and 30 minute are much better than those other shorter intervals. According to some fancy power/kg charts (that are actually probably total BS) I'm supposed to race as a cat 2. Perfect, because that's what Mike Weiss is making me do!

My 2010 cycling plan that I imagined back in December is looking quite different than what I'm thinking now. Being a true Team Seagalian, I was focused on mountain biking and cx only and my bicycle choices reflected that: 2 Kona CX bikes (one with multiple gears and extra road wheels, the other ss) and my sweet Lynskey SS-hardtail). 3 bikes is a good number. The wife didn't think that was too ridiculous and she knew I loved each of the bikes on account of careful part selection, good sale/pro-deal prices, and awesome fits.

Now things are different. That damn vertebral nodule is causing me much trouble. Stupid-ass insurance...sorry, I get pretty worked up about the health care situation in this country. Back to the topic: one of my docs raced bikes for awhile and even the ones who know nothing about bikes have told me that I should keep riding, as hard as I want. The bike-savy doc however suggested a bit more road versus mountain biking because of the bumpiness of mountain biking. Basically the concern is that cancer in bone may lead to weak bone and weak bones lead to broken bones and broken vertebrae (the bones that surround the spinal cord) lead to bad news (I'm getting so good at not cussing anymore now that I'm trying to establish a wider audience for this blog! cus before I would have not said 'bad news' and instead inserted some kind of expletive).

Anyway, the Lynskey has sold on ebay (frame went for more than I paid!!!).

Karma has brought me a sweet, 9-speed dura-ace equipped, Lemond. It is 17.8lbs with these wheels...with some race wheels, probably 17 even.




As for mountain bike, I can't give that stuff up. So, the plan is to take as many precautions as I reasonably can. I spoke to many local experts (thanks matt j, karl, shot, beans, casey ryback, gino, mason storm, justin neely, andy davis, and nico toscani) and have decided to ride a dual suspension 29er. After much debate and consideration for the Fisher and Specialized bikes, Kona had a bike from last year in my size and made me an offer I couldn't refuse. It should be here next week, but I'm going to have to switch a bunch of parts and get weight-weeny with it before she's ready.

So, I'm back to 4 bikes with the following race plan:
Feb 28: Road- Froze Toes, Columbia MO road race
Mar 21: Dogwood Road Race Road Race Bradleyville, MO Road Race
March 28: Mtb-Mesa Lost Valley Luau (marathon)

Apr-10: Hillsboro Roubaix Road Race Road Race Hillsboro, IL
April 18: Mtb Bone Bender 3hr MTB Odyssey. Smithville Lake. Smithville, MO

May 1: Mtb- 50 mile race: Syallmo’s revenge
May 8: Mtb- Greensfelder
May 23:Tour de Ste. Genevieve - MO State Road Race Road Race Ste. Genevieve, MO Road Race

June 12: Mtb Missouri State Championship. Castlewood
June 25-27 MSC #4 Wildflower Rush, Crested Butte, CO
July 4th- Firecracker 50, Brekenridge CO

July 25-31 Ragbrai

Long awaited day

Sorry about the lack of theme in the past few posts. I've been trying to decide whether I should keep the blog cycling, cancer, or just a general journal.

It has been a struggle the last 2 weeks waiting to hear from my endocrinologist at Hopkins. Today however, we finally spoke and there's now a plan. I'm scheduled for an MRI later this week with the intention of taking a closer look at the newly discovered nodule. We're still not 100% sure where it is and what it is doing. We know it is cancer, of the papillary thyroid variety but the radiologists think it is in my bone and the endocrinologist isn't so sure.

Otherwise, the plan is to wait. Wait to see how this recent radiation treatment affects things. We'll have some idea in 6 months but the real test will be 1 year from now. We are hoping for a reduction in tumor burden, not a complete cure. As I've said in other posts, I will probably never truly be in remission at the level of cells. But that doesn't really matter, since my quality of life is high and I can still be healthy, so the process now is to find some degree of psychological or holistic (that ones for you Matt James) remission. If the results of the test are not what we hope, then I'll either get another radiation treatment or we'll wait and see longer (maybe years or decades), then I'll get some other kind of treatment such as a tyrosine-kinase-inhibitor or maybe a VEGF inhibitor or maybe even solid tumor chemo.

Things are looking up at work. I've decided to continue with medical school but that won't begin again until August. Until then, I will have some cool research projects:

Multiple kallikrein (KLK 5, 7, 8, and 10) expression in squamous cell carcinoma of the oral cavity. Pettus JR et al. Histol Histopathol. 2009 Feb;24(2):197-207.

Urinary-type plasminogen activator (uPA) and its receptor (uPAR) in squamous cell carcinoma of the oral cavity. Biochem J. 2007 Oct 15;407(2):153-9. Review.

Exciting stuff. Basically, I'll look at the expression of specific genes in really nasty cancers versus not so nasty cancers. I'll do that by using prior research to select some genes, then cut up some tumors really thin, put them on slides, stain them with specific antibodies that turn different colors, and finally look and see if they're present in either the really ugly tumors or the not-so-bad ones.

For the last few weeks I've been all worked up about doing something with bikes and cancer. Livestrong and fatcyclist.com were the obvious choices. At this point, I haven't gotten very far pursuing either of those resources.

The LiveStrong thing has always eluded me a bit. I've never been sure if it was just a Nike Ploy or an actual non-for-profit that did good things. After reading everything I can get my hands on over the past few weeks, I am quite convinced that the latter is true.

Examples:
Grants for physical activity and nutrition programs for cancer survivors
Money to underserved folks with cancer
Funding high quality basic science research

Then of course, there's the symbolism behind the black and yellow. The lance story. Love him or hate him, he is still an inspiration to millions of people. I'm not afraid to admit that he's an inspiration to me as well. Cancer made him more focused, stronger, compassionate, and more connected to people. I hope that it continues to do the same for me.

You may see me wearing some LiveStrong stuff this season. I'm down for talking more about it if you'd like. The leader of the 'TeamLivestrong' told me this today about their stuff: "Our brand is built on people being open and honest about their cancer experience. The more we can encourage these simple conversations the less we’ll have to combat stigma. As a grassroots movement, we really rely on storytelling to help us raise awareness and spread our mission." Sounds good to me.