Gotta hear that body language

Every since the Tour of Herman last April, I've been cumbered by some knee pain in my left knee. After lots of PT, serious alterations to my riding/training, a few cortisone shots, and even a few weeks of complete rest it seemed like nothing was really helping. So after getting a solid diagnosis to the problem I decided to get a piece of fibrosed (scar) tissue cut out of my knee. I had the procedure on Wednesday August 11th and did great post-op...even walking out of the hospital. The next few days seemed to go very well. I even managed to go mountain biking 11 days afterwords.

Then day 13, something I had a major setback. I wasn't doing much at all when it happened, but all of a sudden my knee swelled up like a balloon, I couldn't bend it, and I was in 8/10 pain. A few hours later, back in the hospital getting 20-30cc of blood drained out. My first response was that I pushed it too hard sunday and that I basically shot myself in the foot. But after talking to a bunch of different people, it actually seems like some of the medicines I was taking are more at fault than anything else. The surgeon had rx'd aspirin for pain and on top of that, I was taking 5-6g of EPA/DHA (omega-3 fatty acids from fish oil) per day. Unfortunately, both of those medicines worked together to produce serious anti-platelet effects and pre-dispose me to a bleed...and of course it happens in the joint that I just exercised nearly 2 weeks after an operation. Dumb luck or dumb behavior? I think a little more of the latter than the former.

The first 5 days after the bleed, I basically sat at home on my butt taking frozen peas on and off my knees. It was pretty depressing. Today is day 7 and I'm feeling a bunch better. I'm able to start my physical therapy again and hopefully will be moving very soon.

What is the lesson in this for me? Honestly, I used to be pretty good at listening to my body but due to a general lack of trust with regards to certain cell growths, it is really hard for me to have real trust for my body. Much less, patience.

For me, I know that I won't race for almost 3/4 of the year next year. It just isn't healthy for me. I love riding a bike but after cyclocross season, I plan on focusing more on health/longevity than racing bikes. The first thing involved in that is health with my family, after that, health in work, then nutrition, and finally exercise.
I'll still ride, but it will be much more frolicking than training. Cyclocross season will of course still be full-on, but everything else will be a lot more chill and probably slow. But who knows?

As for the next few weeks, I'm pulling the plug on any racing labor day weekend and the following. Mas tempo con la familia. Bummer about not racing Herman, but oh well.

After that, I'd like to race my mountain bike 1 or 2 last times this year. Then, cross.

Sep 26: DE STAD CROSS 1
Oct 9: Pedal the cause!
Oct 10: Cross out cancer
Oct 16-Nov 28: Bubba!
Then MO state champs and possibly a trip to Oregon in December for CX nats!

Things that make you go hmmm...

Had my PET scan today. This was the first scan of this variety I've ever had and in order to better understand the results, you've got to understand the scan:

Basically I eat a low-carbohydrate diet for a few days, then go in and they give my an IV bolus of radioactive glucose, wait, then scan me. Cancer cells are known to be highly metabolic and to have mitochondrial defects which (usually) prevent them from utilizing anything but glucose. So in theory, it lights up the cancer cells.

Given my recent increase in my thyroglobulin (or tumor marker), we expected to see ramped up activity in some area or a new ugly looking metastasis somewhere else.

The actual result: completely normal scan. No uptake. Nada. What the does that mean?

-This is a very complicated case, Maude. You know, a lotta ins, lotta outs, lotta what-have-yous. And, uh, lotta strands to keep in my head, man. Lotta strands in old Duder's head. Luckily I'm adhering to a pretty strict, uh, drug regiment to keep my mind limber.

-Well, it could mean that I have a VERY slow growing cancer and that the increase in thyroglobulin was a fluke.

-Or it could be some kind of biochemical mystery, in which case, we don't know what to do.

In either case, my fists were clenched and I was ready for bad news so I don't quite know what to make of the current reality.

In summary, in comforting 'the dude' in the Big Leboskwi in his time of desperation, the words of Walter Solbcheck bring me comfort, if you know what I mean (if you don't then that's the way I meant to write it).

Another big one tomorrow

I can't imagine trying to put myself in my own shoes. If I were me, would I try and keep living my life as normally as possible or would I make changes?

Over the past 6 months, I've worked hard to solidify the opportunity to do a few years of molecular biology and pathology research, in the hopes that it would be less stressful than medical school and allow for greater flexibility in terms of time. Part of my set-up right now is that I'm enrolled in an MD/PhD program so therefore still have a little coursework left in order to complete my PhD. Classes start next week and I can't wait to get something on which to focus. I'll take graduate level cell-bio, molec-bio, and cancer biology classes. Should be very interesting.

In the meantime, I'll have my long awaited PET scan tomorrow. I've been reading a bunch of what the results may mean and honestly am pretty scared because the strength of the radiotracer uptake is pretty high correlated with prognosis in some studies (in other words, how much glucose these cells take up in a short period of time is correlated to long-term survival). Plus, the PET scan should be able to detect if there are any additional sites of metastasis besides what we already know (both lungs, various spots in my neck, and probably still some left in my 5th thoracic vertebrae).

I'll post ASAP once I hear something, but just to remind everyone of reality: The tumor marker that we follow went up when it 'should' have gone down or at least stayed the same. I'm not feeling very hopeful at the moment.

If you've any interest in a great and simple read, I highly recommend the following:

The workings of my mind

The question that plagues me from an intellectual standpoint: what the hell has changed in the last 2-3 years that would make what is supposed to be a very slow-growing cancer into something that seems to be resisting conventional treatment.

First, let me admit a slight change in the way I think:

A few months ago, I wrote a blog entry on the environment and cancer. I think I came off as saying that since we don't definitely know many of the dietary and lifestyle factors that contribute to the ability to survive and enter remission that they're not important. That is not what I believe.

In the past few weeks/months, I have come to terms with my strong belief that although we will NEVER have a world free of cancer, we CAN reduce the incidence and prolong survival for many people. I recently re-read a piece written by Robb Wolf where he discusses the possible benefit of a ketogenic diet on cancer and during which he cites a paper that says "our understanding of the molecular underpinning of cancer has exploded; yet this has translated into few advances in treatment or survivability. The authors also make the point we have plenty of information to make lifestyle and environmental changes that will dramatically reduce the OCCURANCE of cancers. Aside from smoking little effort has been placed in the prevention category."

In my life, when things began to change (get harder) with regards to my thyroid cancer the following changes were taking place:
1. More stress (medical school, newly married, new child)

That's about it. My activity level has stayed about the same since I was about 8 weeks gestational age, so cycling doesn't seem to be a culprit. Although I am now having VERY SERIOUS questions about the high carbohydrate diet that fuels high performance cycling and its affect on cancer cells. I never actually blogged about this, but at some point after my January treatment I underwent a self-induced experiment of a vegan diet where 60-90% of my calories came from low-glycemic grains, legumes, vegetables, and fruits. I'm not calling causation or even correlation, but during this same period my tumor marker went up. There is abundant data to support the the high need for glucose of cancer cells. Hell, this is the entire principle of the PET scan which I'll have in a couple of weeks at Wash U. Maybe Robb Wolff is right and the ideas in this article from Time magazine have more basis in truth than the epidemiological observational studies supporting that a low-fat, high Cho diet is the way to live a healthy life. Who knows.

Anyway, these are the things I think about.

Next steps

This weekend was a sigh of relief. On thursday morning I had a brain MRI to assess the possibility that the increase in my blood tumor marker could be due to brain metastasis. The scan was completely normal.

Although we don't yet understand the blood test, at least the worst possibility imaginable is not a reality.

I spent my weekend hanging out with the fam, reading about cycling anatomy and bike fit, and cooking these:


Memphis style, fall-off-the-bone, didn't even need sauce. Yum.

Then eating cookies with her:

Sometimes I think about how I've ended up being a person who thrives on competition (NCAA lacrosse and cross country, competitive climbing, bike racing, med school) yet hates all analogies of living with cancer where it is compared to a 'fight'. It just doesn't make sense to me that I'm 'fighting' cancer. Maybe it helps some people feel like they're taking an active role in their treatment, but I honestly don't feel like my actions have much effect on the disease process.

Anyway, I'm currently starting week 2 of my forced time off the bike. It is getting easier but I'm really starting to get psyched for cyclocross this fall. There's a sweet new frameset from Kona that I'm seriously considering:
although, I'd definitely have to sell a bike (possibilities include the Tarmac and the 2010 Major Jake), but I also don't know if I have the time or energy to deal with all that.

Racing-wise, here is the current schedule:
Aug 22: Mtn bike: Single-Speed race, Jeff City
Sep 4: Mtn bike: Tall Oak Challenge- 6hr team (Teamate is Schottler)
Sep 18: Herman Under the lights
Sep 19: Herman #2
Sep 26: ?DE STAD CROSS 1(KS)? or rest or train
Oct 3: Boss Cross (KS)
Oct 10: DE STAD CROSS 2 (KS)
Oct 16: Bubba #1
Oct 17: Bubba #2
Oct 24: Bubba #3
Oct 30: Bubba #4
Oct 31: Bubba #5
Nov 7: Bubba #6
Nov 14: Bubba #7
Nov 21: Bubba #8
Nov 28: Bubba #9
Dec 4: Mo St CX Champs (KS)