Dan's blog

When medicine fails

2012-01-26T05:52:00.000-08:00

I've been a mess lately....emotionally speaking mostly. Since I first was treated for thyroid cancer back in 2005 until now, I've had 2 friends with whom I've been close or connected with basically the same age as me, go through their own experiences with cancer treatment. Now they're both gone...both in their twenties or early-thirties and both after having gone through 'cures'.

The first died of a relapse of his cancer in 2008, 3 or 4 years after he was first diagnosed. I think he was 25 or 26.

The second is gone because of a complication associated with the treatment of his leukemia, a process that began soon after he was in remission and continued and worsened for years. And over those years, this friend and I have both gotten married, moved on with our lives in many ways, and essentially both of us stopped climbing, so we didn't have that common shared activity any longer which originally brought us together. I had no idea what was going on and how bad his condition had become. After talking to his wife yesterday, it sounds like hardly anyone knew how much pain he has been in (lesson-stoicism can be extremely stupid). I'm not sure how appropriate it is too tell the story of this friend here. But, his death, like my other friend in 2008, hits incredibly close to home.

Leukemia is a cancer of white blood cells. When someone has leukemia, there are multiple cellular and genetic events which define the precise type of leukemia, but in almost all cases, treatment involves ensuring that the source of white blood cells, which is the bone marrow in adults, stops producing the cells which constitute the cellular component of our blood and most of the cells of the immune system. Of course the mutation or abnormal cellular event is only in one particular type of cell, and that cell basically makes clones of itself over and over again until the person's bone marrow, blood, etc are filled with a clone of that original cell. Without addressing the bone marrow, there's no way to ensure that the original cell (or at least the most stem-like cell of the cancer) is killed. So, patients get chemotherapy and radiation to kill of the rapidly dividing cells, then their bone marrow is ablated and they're given a transplant of stem cells that should go to the bone marrow, re-populate it, and rejuvenate the production of new platelets, red blood cells, and white blood cells. Sometimes the stem cells that are given come from another person, other times they are one's own stem cells.

A potential consequence of receiving white blood cells from another person is that some of these cells may have the potential to recognize the patient or recipients body as foreign, and begin an immune response against it. This process is the outline (although many details are left out for the purpose of simplicity) of a disease process called Graft vs host disease, or GVHD.

My friend that just passed away died from complications associated with GVHD. He died in the hospital after having been there for a month completely sedated and on a ventilator because he could no longer breath under his own power. The disease process of GVHD was causing an immune response that incited a genetic program associated with wound healing, where fibrotic tissue was being rampantly deposited all over his body. For him, the space surrounding his lungs were incased in this restrictive, fibrous mass and essentially this tissue inhibited him from breathing. He was slowly suffocating to death and as far as I can understand, that was part of the reason why he needed to be on a ventilator. The other reason for the ventilator was that in order to treat his GVHD, he had his bone marrow ablated again and received another stem cell transplant, essentially hoping that they could treat the GVHD like a cancer. The process where the transplant engrafts back into the marrow is incredibly painful, so the sedation and ventilator were also meant to help with that.

After a few weeks on the ventilator, it became pretty clear that he would not be able to breath on his own again. I don't know how the decision took place, but when I spoke with his wife on the phone yesterday, the decision had been made to take him off the ventilator and to let him pass.

If you want to read about his experience, he and his wife kept a blog here. The first time I read through the blog, I was crying and literally shaking, so be warned. The mix of anger that this happens, with guilt for not being able to do anything, and an incredible amount of sorrow for his wife is all culminating into this incapacitating dark place or uncertainty and fear.

Climbing was our original shared interest and allowed us to make our acquaintance. But when he was treated originally for his leukemia back in 2006-2007, I was working in a lab at Wash U, the year prior to going to medical school. My lab was pretty close to his hospital room and I went and visited quite often. I recently received my 2nd neck surgery and at that point had 4 radiation treatments, so even though his leukemia was considerably more severe than my cancer, we were brothers of sorts. He was one of the only people in my life besides my wife who I really talked to about having cancer.

Now I'm in this state of shock and hurt and anger. My mind can be so self-centered and of course, always wants to use fear to project a similar situation for me and Maggie one day. Fear, projection, hatred, anger...these are what currently summarize my feelings that summarize the devastation associated with this story.

To this day after my first friend died back in 2008, I talk to him, usually when I'm on my bike. Maybe this would all be easier if I had a clear ethos about what the hell happens when we die. But even if I did, I'm haunted by the thought that both of these two friends were relieved when it finally came. Of course we can never really know, but from some of the writings on the blog, it was clear that sometimes a desire for the release of death is the plan B for when medicine fails.

Nationals

2012-01-10T05:42:00.000-08:00

I wish I had a great story too tell about the last cross race of the season. But instead, it was something of a blur and also a disappointment.

Dwayne Goscinski and I both showed up to Madison around 2pm on friday. He drove from St Louis and I came from South Bend, IN where I had been working the prior week.

The course wasn't particularly complicated, but on friday it was wet, loose, and messy mud. The temperature had a lot to do with how the course would feel. If cold enough, the frozen ruts would be like ice...you'd hop into one and hope that it doesn't collapse underneath you or lead you into the tape. But if warm enough, it would be a standard mud course with lots of power sections. During the pre-laps a little before 3pm on friday, almost no one was riding the steepest section of the first hill. People were loosing their rear tire and running.

I hoped it would freeze and be fast. It turned out that was a hope based on poor assumptions and inexperience, as indeed my race was slightly frozen and the mud much more firm than in the pre-lap riding I had done. This turned out to prove very challenging. My race wasn't really very exciting. It is almost a standard story for me; I was riding well and fast, then I crashed towards the end of the lap, dropped my chain, lost 10 spots, hopped back on and lost my cool, so crashed again in the sand a few hundred feet later. And that was the end of my confidence.

I wish life were less complicated sometime. I had a bunch of time to reflect on the almost 8-hr drive home on sunday. I think I'm scared for 2012. Maggie has some big decisions to make in terms of what kind of doctor she's going to be. Balance in my life between work, passion, and health seems tenuous at the moment and I just generally feel scared for my health again. I'm not really sure why as I have no tangible signs of a change or decline. But it feels somewhat inevitable I guess and for some reason more looming at the moment.

There is a very interesting article over on Outside magazine about Livestrong and Lance. Anyway, I have a ton of thoughts about this article. At the moment, I'm feeling extremely worn-out and tired from the holidays and travels associated with bike racing. The spring semester starts next week so I'm trying to rest up, do some reading, and just generally have some meditation/prayer/quiet time.

First week of 2012

2012-01-05T08:28:00.000-08:00

I've been in South Bend Indiana this week as a visiting scientist working in my PhD menor's lab. There's a bunch of snow on the ground and I've been resting a bunch after the racing this past weekend, so I've only been out on my bike once.

However I have had some time to think abou this next year.

This was/is extremely helpful in the whole new years resolution assessment: http://www.prana.com/blog/2012/01/01/handbook-for-life-2012/

Of all the things on that list, as a 32-year-old father living with cancer, you'd think I'd be thinking most about the 'health category'. But it is actually the following list which strikes me as the most important at this particular time in my life:

PERSONALITY:
11. Comparing our lives to others is fruitless. We have no idea what their journey is about.
12. Replace negative thoughts with positive ones especially about things out of our control. Invest energy in the positive present moment.
13. Try not to over do. Understand limits.
14. Why take ourselves so seriously. No one else does.
15. Gossip drains precious energy.
16. Dream more while we are awake.
17. Envy is a waste of time. We already have all we need.
18. Forget issues of the past. Let go of our partners mistakes of the past. Focus on our present/future happiness.
19. Life is too short to waste time hating anyone.
20. Make peace with our past so it won’t spoil the present.
21. No one is in charge of our happiness except us.
22. Realize that life is a school and we are here to learn. Problems are simply part of the curriculum that appear and fade away like algebra class but the lessons we learn will last a lifetime.
23. Smile and laugh more.
24. We don’t have to win arguments. It’s ok to agree to disagree.

New years week

2012-01-02T07:16:00.000-08:00

Really amazing couple of days to transition between 2011 and 2012. Hectic for sure, but also a really nice travel experience, fantastic racing, and lovely company with my wife and me getting a weekend away from the kiddo to celebrate our anniversary.

Racing-wise, there's a lot too say but I'll try and keep it to the business:

Wednesday night in KC- Got in a group with Steve Tilford and Brady Kappius after the first lap. Felt very good but regretted the last minute choice of putting a file tread in the rear, as I found myself slipping out in some of the corners. Great race with Brady, we were back and forth the whole race and it came down to the last stretch where he jumped the barriers and I ran. I then missed a pedal and he got a gap which he held to the line. I'll take 3rd to Brady and Tilford and ended up with a great USAC point value for that race.

Day 1 @New Years Resolution- drew a starting spot almost dead last. Fought hard and ended up riding around 12th-13th for most of the race but faded towards the end. With 2-to-go I came through the start/finish and got pulled unexpectedly with the guy who ended up 15th, so I finished 16th. I was surprised and disappointed to get pulled when I did, but I rode a clean race despite struggling with the high-end fitness. So, I let it go and planned for day-2.

Day 2- I was stoked. I had a great NYE/annivesary with my wife in downtown chicago and managed to get to bed at a reasonable hour. I woke up feeling good, drew another almost dead-last starting spot, but was ready-to-go. Pretty much all went according to plan. I tried working together with a bunch of the guys riding around me, but it is really hard when the wind is so destructive and the mud, so sucking. Anyway, with 3-to-go, I figured it was our last lap. I worked my way up and came across the line around 13th, only to not get pulled like I expected. So we headed back out for another lap, knowing full well that Trebon and Powers would be lapping us. The guys finishing 13th-17th managed to last until about .25 of the lap, at which point we were summiting mini-Mt Krumpit part 2 and the pain-train was beginning the ascent. I decided to not get in their way prior to the sand pits so pulled over. The guys I was with didn't take the same approach, so I was gapped badly and ended up getting pulled at 16th position, but was scored as 17th. Considering my wife was pitting for me (so I wanted to do her proud) and I felt so good and thought I planned well, I was pretty bummed with the result. But, there isn't much I can do.

At this point I'm having a hard time finding the motivation to summon much enthusiasm for this last week. Sometimes bike racing is just plain frustrating and there isn't anything you can do about it. Sometimes you try and do the right thing, whether it is be nice or get out of the way, and you end up getting ignored, run-over, or just plain taken advantage of. But that isn't just bike racing. That's pretty much life.

I guess the drain on my motivation has to do with what looked like a good plan on paper, not feeling as good in reality. My wife and I planned our anniversary in Chicago around the UCI chicago race. I was then going to spend the next week doing some experiments in my old bosses lab at Notre Dame, and as such, would be away for an additional week. South Bend is currently getting pummeled with snow, so I'm stuck in Chicago alone because my wife flew home today. All I can think about is getting home. Racing next weekend seems like a joke compared to getting home.

How's your health?

2011-12-24T11:06:00.000-08:00

...the inevitable question around the holidays for a person living with cancer. Always has and always will be a difficult question to answer. I usually say something along the lines of "Excellent, but complicated". And then hope I'm not pressed for more.

Generally I feel like I'm being truthful: I do what I love. I feel like I'm making a difference as a dad, husband, and in science. I'm super passionate about riding a bike. I'm riding well and a pretty high level for an amateur. But, of course I literally have lungs full of 2-5mm tumors and a know nodule in my vertebrae that just seems to be hanging out; not growing and not shrinking. And for the time being, causing no problem.

My father-in-law is an oncologist and gave me a great article to read about Steve Jobs and his death from Cancer.

Here is a link

The meat of the article is this:
"This may be unfair, or at least incorrect. The facts are reasonably straightforward, at least as I can piece them together. He was diagnosed with an early stage pancreatic islet cell tumor, the only kind of pancreatic cancer with any sort of cure rate. Despite the entreaties of friends and colleagues he wasted nine months on worthless alternative approaches before finally undergoing pancreatic surgery. He subsequently had a recurrence of his cancer, underwent a liver transplant, received experimental therapies and eventually succumbed to his disease.

Cancer Doesn't Care

But I do know that cancer doesn't care. It doesn't care if you are rich or smart or powerful, it doesn't share your beliefs on nutrition or meditation and it has no desire to ever give you a second chance if you screw up your chance for a cure. It is an agent of entropy. It maximizes disorder, and our short lives are possible only if we try and preserve ourselves from the entropic catastrophes it foments."

Then about his money:
"I (the physician author) have had similar experiences with some (though not all, by any means) high-flyers (mega rich people). Because the normal rules of existence don't seem to apply to them, they sometimes seem to believe that cancer's biologic imperatives are options rather than mandates. They think they can perform, through use of their wealth and position, some Kobayashi Maru maneuver, reprogramming life's computer to alter the outcome of their disease. Curiously, the well off sometimes suffer from lack of access to good medical care. They surround themselves with toadies and yes-men and (viz Michael Jackson and Elvis Presley) the unethical and incompetent. Idiots with medical degrees endorse their magical thinking. Because they can afford concierge doctors they assume that they are receiving better care, when their care is frequently inferior to that received by the average Medicare recipient. This doesn't seem to have been the case with Jobs, however, who received his care at excellent institutions."

And about his liver transplant:
"Leaving aside whether the transplant was medically wise or appropriate, or even if it was performed for his cancer (I lack data sufficient to make a judgment on this), Jobs apparently got the transplant by gaming the system. Because transplants are assigned on a state-by-state basis, there are inequities in distribution that have a geographic basis. Californian Jobs got his replacement liver in Tennessee by getting his name on their state registry, as well as many others.The Apple addict in me mourns the passing of Steve Jobs. The doctor part of me wonders whom he bumped off the transplant list. There are always more candidates for liver transplant than there are livers, and people die while standing in line for their turn."

Namur- S4it (suffer for it)

2011-12-22T19:25:00.000-08:00

4ème Manche de CDM cyclo-cross from Petitesreines on Vimeo.

Veldrijden Holidays

2011-12-19T18:52:00.000-08:00

On the finishing stretch...

Semester is done. I have a few weeks to focus on my research and get ready for some really cool science next spring.

I rode hard the last 2 weeks. Definitely the hardest weekday riding I've done since September. This week will be the hardest of the fall/winter. Then there will be a couple of hard workouts, family time, and a taper for the last 3 races of the season: 2 UCI races in Chi-town and Master's 30-34 Nat'l championships.

This weekend was a race held by Mark French in Columbia, IL (http://veldrijdencolumbia.blogspot.com/) at definitely one of the best (IMHO, the best) local cross courses this year.

Almost every turn you could rail without braking. There was singletrack, climbing, stairs, sand. And it was awesome weather. Plus podium finishers got belgian beer!

A very happy holidays to all blog readers out there. I wish you love and peace during this awesome time of year and a wonderful 2012. I'm certainly thankful for all the support from friends, family, acquaintances, and random internet-folk. 2011 has been a tuff but good year. Watching Cassidy grow and spending time with her is hands-down the highlight of this past year. I'm pretty stoked to be doing what I'm doing right now...completely focused on; family, science, and bike friends/community/racing/training/surfing

Spanish lake

2011-12-12T06:49:00.000-08:00

It was a stressful week as far as being the end of the semester, maggie being on call a few nights, and starting to train hard again in a final build up to nationals. My bike situation was essentially taken care of for me by Shimano and my new sponsor, Walt's bike shop. Basically all I had to do was choose a new cross frame and where I wanted my old broken frame to get repaired. I knew what I wanted in a cross frame immediately; carbon, shorter wheel base, 2 water bottle mounts, tapered head tube, preferably not BB30, and preferably internal cable routing. The final decision came down to the Trek Cronus and the Felt, with the Trek finally being an easy choice because of excellent tire clearance, positive recommendations, the internal routing, and availability. By friday afternoon, I was spinning around on the new frame with my mechanical shifting and an ad on StL biking for the electronic Ultegra Di2 for sale!

That being said, let me take a moment and give a plug:
I have for sale a 53cm 2011 Carbon Kona Major Jake frameset + Thompson seatpost (internal headset, option for BB adapter cusps to run conventional cranks).
Also, an Ultegra Di2 upgrade group with a brand new warrantied rear derailleur. Included are shifters, wires, battery, mounting hardware, charger, and a 34.9clamp front derailleur.

The last bubba race turned out to be a ton more fun than I had expected. Wonderful weather helped, and for some reason, even though many people dread racing at Spanish lake, the clock-wise course direction made for a really fun, mostly non-technical power course.

I went pretty hard from the gun and basically felt like I had nothing to loose in this one. Josh had already cinched the series, so I might as well forget racing smart and take a Trebon approach to just laying out some power. That worked for about 2 laps. Then my legs hurt. In the last couple of years, my lungs have always been my limiting factor and I hardly ever feel a cross race purely in my legs, but man did I hit a wall of lactic acid earlier than I expected. Josh rode up and quickly dispatched of me. I chased in vein and basically was humbled by his excellent tactics, skill on the cross course, and well-honed power/fitness. I genuinely hope that he can sustain and continue to build for the next month and go crush some souls at Master's worlds.

As for me, it looks like I have a good starting position right now at nationals. According to USA cycling, my point value predicts a top-5 finish given the current registrants, which doesn't really mean anything to me except for the fact that I'll have a good starting position, which has been my number 1 goal for this season- to go into nationals with a legit shot at doing well.

If you click this link, on the right-hand side of the page, there's a grey button called View registrants. Then go down to 1/7 saturday afternoon at 3:45pm (Master's 30-34). You can see the list and click another button called predictor to see how we rank amongst each-other for start relative start position.

December plan

2011-12-07T19:36:00.000-08:00

Got to clear the air after that last post.

Onward.

Motivation remains high for training and riding. In terms of work, I have a good deal of stuff to do in the lab (I'm an MD/PhD student working in an immunology lab) and papers to write, so science will keep me busy throughout December.

I did a hard ride the wednesday before Jingle cross, but besides that only did one other hard training ride and 5.5 races in November. This is all to say that bike time has been 6-8hrs/week with the exception of Jingle CX week with much of that as easy spinning. December however is a whole different ball of wax....back to the training. Yesterday was a hard gym session and then an easy spin, today and tomorrow are bread-and-butter subLT 20minute intervals. Then hopefully race this sunday. The last few percentages of fitness are super demanding and seem to require much more time/pain invested. Since most of my fitness this year came from training in July-September and then racing Oct-Nov, I feel pretty confident that a build will yield benefits.

I'm picking Ryan Trebon for the win this weekend. Home town advantage and rest is huge. Nevermind, Powers and Johnson day 1 and 2 respectively.

MO State Race

2011-12-05T04:37:00.000-08:00

Walt's was able to obtain a replacement Ui2 derailleur after it snapped last weekend. I basically wrote off the incident as a fluke and due to my trust in Shimano and the knowledge that numerous professionals were racing the Di2 at the highest level, that I'd be good to go.

Most of last week was spent working. Most of my bicycle related activities consisted of talking with Maggie and thinking about the next month of our lives, with the question-Is it worth it for a regionally strong amateur racer to continue training through the holidays in order to make a run at the Master's 30-34 national championship in Madison Wisconsin on Jan 7th. Given a number of pluses and minuses, we've ultimately decided that the sacrifices are worth it and that I'm going to work my butt-off over the next month getting ready.

My friend's at Columbia Strength and Conditioning must really believe in me and appreciate the significance of a guy with lungs full of tumors and bone metastases being able to compete at a high level. They've offered too sponsor me and train me in the weight room over the next month! These guys are hands-down the best weight trainers I've ever encountered. They're continually attending national and international seminars and back-up their methods with scientifically proven research. Many of their views are extreme in some ways, but essentially their biggest influence is Charles Poliquin, who is probably one of the most successful strength coaches on the planet. I'm a big believer in the benefits of weight lifting for cycling and CSC is the best I've ever encountered, so I'm incredibly excited to have my first individual sponsor!

So, I got psyched for nationals. Really psyched. The state race this past weekend had been a goal for 2 years. I felt like I was riding well enough to win in almost any conditions on almost any course. I've significantly improved in the mud the last few weeks and basically did everything I could to prepare...I started wearing my contacts lenses again so that I could see without glasses and last wednesday, arranged to have my friends from Walt's (Josh Carrol in particular, HUGE THANK YOU) work the pits so that I was doing bike changes at regular intervals.

The rest of the week was spent recovering from Jingle cross. I did some easy endurance-paced riding, but that was it. Saturday during my opener ride, I knew my legs were good.

Sunday was very thick, heavy mud. Very similar to jingle cross day 3. The course however had considerably more pedaling sections and most of the hard mud sections were not at turns, but were seated-power or even slight downhills. I was stoked with the course. At the start, I had an uncharacteristic bad start, while a Travis Donn and another KC-area rider had fantastic starts. A few others were in front of me including my teamate Devin, Josh Johnson, and maybe one other. But at a big technical 180, I took an inside line while everyone else went wide and next thing I knew, I was chasing down Travis with Devin in tow. By the end of the lap, I Travis had a 5 sec gap and I was alone chasing. It stayed that way for a few laps and I was pretty happy with where everyone was on the race course and how I felt. The pace was solid, but I hadn't gone into the red yet. I eventually caught and passed him on a slight uphill, only to have him reclaim the lead at some point during the following lap.

During those laps, I was doing bike changes at the pits to ensure problems didn't happen. Basically the plan was 2 laps per bike. At some point I gapped Travis and started settling into a solid pace knowing I needed to save a bunch for the last 4. This must have been lap 5 or 6 in the race because I was on my Ui2 bike. It was functioning flawlessly. Really precise, incredible shifting. It was like the mud wasn't there and there was always the option no matter what kind of wattage I was putting out to shift in front.

After the start/finish and before the barriers, I looked back to see Josh had is disel engine firing full gas and even appeared to have a little more kick. He was bridging up to me. Stay calm I thought, no problem. Just ride clean and take deep breaths. My legs weren't burning and I was breathing out of my nose, so I knew this was where the race was beginning. This is the moment I had been waiting for. I started thinking about Wash U, my friend Jason, and my own cancer...I started getting myself psyched and ready to hurt.

Then my bike broke. Catastrophically.

And that was the end of my race.

I ran a very long way, including the long pool of thick-mud with my bike on my shoulder. The rear derailleur had snapped in the exact same fashion as last sunday. I probably should have quit, but honestly that didn't occur to me. Immediately I started thinking about nationals. Johnson passed, Donn passed, and Schottler passed. That was it. And it was a long run. I grabbed my pit bike and kept going...full of rage. Managed to finish 4th. Not the result I was hoping for.

The caveat to intrepretting the following pictures is that n=1 and the conditions were indeed muddy. However, I was definitely doing bike changes, unlike the prior week. The derailleur did not shift into the spokes and the break did not happen during a shift. It was simply under-load and forced the derailleur to fly between the seatstay and spokes. As you can see, the metal surrounding the mounting bolt is extremely thin. In neither this break or last week's did the derailleur hanger break. And in both cases it was actually the metal of the derailleur:

Unfortunately this time, when the derailleur flew into my frame, it must have hit the right chainstay, as it is cracked all the way through:

Right now I hope to race next weekend. Then train for a few weeks and finish off the month by lining up at the UCI race in Chicago over New Years weekend. Maggie is going to come for that one and then I'll head to Notre Dame to do some experiment's in my old bosses lab. From there, I'll drive straight to Madison at the end of the week and hopefully my luck will start to change.

KC-St Louis and Nationals

2011-11-29T05:33:00.001-08:00

I hate the fact that there is hatred/anger/competition/resentment, etc between the cycling communities of KC and St Louis. Seriously, we do the same biggish races, therefore we're essentially part of the same community. Get over yourselves and stop giving people a hard time for where the live/race.

One of my goals for this season was to get connected to some kind of cycling-health advocacy group and use my racing as a means for spreading awareness and educating people about living with the chronic disease of cancer. Despite my best efforts, it feels like no one really cares. High level amateur racing seems to exist in a kind of Ayn-Randian type plane of personal satisfaction. There are a lot of Rand quote's I really like (particularly about rationality) from the perspective of a scientist but mostly, from the perspective of a person who places compassion as the highest moral value, I can't stand what her philosophy suggests about community and personal happiness.

Anyway, at the moment I'm trying to weigh the rest of the season out and decide how to spend the next 6 weeks of my life. Part of me wants to make this next sunday my last cross race. However, I'm well positioned at the moment, at least from a racing perspective, to go race Master's 30-34 cyclocross nationals in Madison, WI on Jan 7th.

Basically starting position for that race is determined on prior results at national championships and also on the lowest USA-cycling (USAC) point value. As of now, mine is 214...which should be a descent starting spot.
Points per race (a few buba races are missing and also the CoMo Awesomo):

Rankings:

From a material perspective, I have the clothes to stay warm in January in Wisconsin. I always ride that time of year anyway and actually like the cold. I just feel too selfish about committing myself to going right now.

Jingle CX

2011-11-27T20:19:00.000-08:00

This is my 4th season racing cyclocross, and ever since I started there was a mystique and draw to attend the 3 day Jingle Cross event. This year, Maggie was finishing her family medicine rotation on wednesday and beginning her medicine rotation on monday, which gave her the first break >2days since early June. So, we decided to make it a family trip and give it a shot.

The drive was all good with appropriate distractions. Here is a chocolate croissant taking a long time to eat:

The atmosphere of the race is really awesome. I hope to attend again next year for sure. The weather made things pretty intense in terms of racing, but offered some very challenging conditions to continue improving on the cross skills.

In terms of a full race report, the last few weeks have been such a blur that it is hard to keep friday/saturday/sunday straight in my head.

The one thing to say before I attempt a race report, is that I was lucky enough to get an opportunity to pick-up (in the form of purchasing) the coveted new ultegra ui2 groupo. Walt's bike shop really hooked it up and over the last few year's has been incredibly supportive in my families bicycle related endeavors. After last weekend's problems with my Shorty Ultimate's, I also switched my brakes and put the pit bike's CX70s on my 'A' bike and the shorty's on the pit bike. So, I had new digs for the race. And also some crazy conditions to try them out.

Friday night: Mid to low 50s and clear. But the ascent of Mt Krummpet was a long and brutal run-up that I was only able to ride 1x during warm-ups and not at all during the race. I had a great start and found myself around 10th for the 2 laps. I was definitely near my limit, but confident I could hang in the group of 5-or-so riders. On lap 3 someone botched an off camber section and I flew into the tape. From there I was chasing, and simply didn't have the fitness to close the gap. From there on out, it was riding in no-man's land or with one other guy. I came across the line in 18th and was pleased with a top-20 in a UCI race. The next couple of hours were spent trying to wind Cassidy down, who was almost literally bouncing-off-the-walls when we got back to the hotel. Tonight (sunday evening, back in Columbia) we asked her what her 'happy thought' is about the day when we were tucking her in bed and she replied, 'bike racing at the night race'! The Ui2 stopped shifting towards the end. I guess it thought I crashed and went into crash mode, even though I didn't and actually managed to ride a very clean race. A mechanic who used to work for Garmin helped me out and had it functioning flawlessly for day 2.

Saturday: Rain. Mid to low 40s. Mud. Slop. Dead-last starting position. I suck in the mud and want to get better. This was a good opportunity. But I still got lapped by Todd Wells and pulled, and finished a disappointing 23rd out of 24 finishers and 28 starters. Shifting and brakes were amazing, no problems at all. The only bad thing about the day was that my glasses got so covered in mud that I decided to ditch them in the pits. Considering I'm extremely near-sighted, that was pretty dumb. I couldn't see much and literally was asking spectators and Brett Heuring in the pits how close Well's was to lapping me (since I couldn't see).
All smiles after the race:

Sunday: Cold and windy. Low to upper 30s and 15mph winds. Long story short, I had a great start and was riding within the top 15 or so, right on Ben Berden's wheel (who respectively had a lousy start). By lap 2 I settled into a comfortable pace and was riding with Steve Tilford. We were probably around 16th or 17th. He led some sections and I led others. We both talked a bit and clearly weren't gassing ourselves. I was pretty excited with around 3 or 4 to go, until when I was going through a grinding soupy 180 turn, I heard a loud snap and my pedals locked up. I looked down and in horror saw that the rear derailleur had snapped off at it's mounting bolt. Strangely the hanger and bolt were fine, the derailleur seems to have just broken. I was right by the pits and basically walked in and then just stood there dumbfounded. I didn't have anyone helping me in the pits, so I hesitated to even go find my pit bike and continue. After a minute or so, I finally jumped on bike 2 and started riding again. The rest of the race was with Andrew Coe which was nice to see a familiar face and also someone of pretty similar skill/fitness level.
Before:

Anyway, it was painful to clean up my bike and assess the damage.
After:

Then on the way home, we pulled off the highway after about an hour to get some dinner and a deer ran out in front of our car. I slammed on the brakes and swerved and managed to hit it on the left front fender. At first I couldn't open or close the driver's side door, but Maggie popped the sheet metal back with a screw driver and from what we can tell, there is minimal damage.

Wow. What a weekend.

Mid-November

2011-11-20T18:35:00.000-08:00

(Thanks to Mike Dawson for the always amazing pictures)

Oh man that was a crazy week.

Big news is that I had my 6-month check-up and MD Anderson. I was super nervous as there is still no reasonable explanation for why my blood tumor marker went up in July of 2010, i.e. the marker went up but it didn't correlate with the detection of any new tumors. But since then, it has been very stable. Actually, exactly stable. When I go down there, I start the day at 7am with a blood draw, then head over to CT for a head/neck and chest scan. Then I go to ultrasound and have an ultrasound of my neck. Next, MRI for a T-spine and then L-spine magnetic resonance scan. The MRI sucks the most because you lie in a very small tube for about an hour and it is about the loudest, worst-sounding thing you can possibly imagine. If you're a physicist or know a physicist you should get to work or tell them to get to work making those things shorter and quieter. Everytime I go, when I fill out the paper work beforehand, they ask if I've had an MRI before, then "what was your experience". I usually say something annoying like "peachy". Then when asked if there is anything that could make it better, besides stating the obvious like shorter or less-loud, this time I said a waterbed and a massage.

After a full day of scans wednesday I see the doc on thursday morning after they've looked over all the data. Long-story short, there is no progression and the cancer in my neck, lungs, and vertebrae is all the same size. And my blood tumor marker is exactly the same.

Anyway, we got back really late thursday night and then spent friday getting some work done, cleaning up from Louisville, and hanging out with Cassidy (who was extremely attention starved).

Maggie has a shelf-exam for her family medicine clerkship this wednesday, so she wanted to spend the weekend studying. Daddy-daughter-time and racing cyclocross then proceeded to be a juggling act for saturday and sunday as there was a local race here in Columbia saturday and a bubba race in St Louis on sunday. I ended up making it to both and had really good times duking-it-out on both days. Josh is riding really well and with Schottler, we had battle-royale on saturday. The course was really fast and windy. I knew I needed to ride hard from the beginning and do some fitness damage as soon as possible. The plan was coming together pretty well. Then a crash happened and my bars got bent. Josh attacked and I found myself in chase-mode once again.

I don't understand how I have gone 3 season without a pit bike and only 1 DNF and this year, now that I have a pit bike, I think I've used it every race except maybe 3.

After a couple of bike changes, Josh and I battled until the last few feet of the race. I narrowly escaped with the win, but definitely had to work really hard and the legs let me know that last lap. Ouch.

Sunday was a very muddy Mt Pleasant. I was stoked to ride in the mud. And confident going into a hilly course.
Laps 1 and 2:

Unfortunately the quick release of my rear brake kept popping out. It happened 2x while I was off the front early. The second time I got caught soon after. Then it happened a third time and I ended up getting passed by most of the field while trying to get it back on. This time there was too much mud, so I grabbed my pit bike and started chasing. Immediately I started crashing, lost my cool, and subsequently my confidence. Luckily the guys from the Hub fixed my 'A' bike and had it back soon, but I felt totally different.

Not the bike, but riding. Pretty amazing what a lack of confidence does on a course like that.

I moved up some, but there was nothing to do on such a muddy off-camber, technical course, so mostly I just tried to have fun and not freeze. I finished the race without a rear brake as the quick release came out 2 more times. Holy shit was it scary going down one of those hills with only a front brake...but I rode the last 2 laps like that. Salvaged 3rd place, so not too shabby but I never even rode with Josh (winner) or Dwayne (2nd).

Anyway, gotta get some things adjusted before Jingle cross this weekend!

Lua-vuhl

2011-11-14T11:30:00.000-08:00

I need to preface my little race report here with an admission that this weekend was a mixture of:
1. guilt of being away from family,
2. doubt about my abilities as an athlete,
3. skepticism about my financial investment in traveling because of or for a hobby,
4. desire to completely and utterly absorb my mind, psyche, and body in massive amounts of suffering and mental focus, and
5. some solid fun, new friends, and new goals for the future with respect to bike racing.

That last part is key and warrants explanation.

2-3x per year I travel with my wife to MD Anderson in Houston, a refuge for those with weird, aggressive, or otherwise exceptional cancer diagnoses that were less-optimally managed by local health care providers. MD Anderson is known for being very aggressive and similar to Memorial Sloan Kettering, Mayo clinic, Johns Hopkins, UCSF, and Stanford is a go-to for cancer patients who have exhausted or exceeded the normal scope of local medical care. Anyway, when I go down I get a ton of scans and tests the first day, then meet with my doctor the following day. The purpose of the scans and tests is to see if the known disease in my body has either (a) grown, (b) remained stable, or (c) improved. Given my clinical course over the past few years, we generally hope for (b). But unfortunately at a few points have been dealt with an (a) hand, which at this point would have uncomfortable implications: mainly, I've exhausted most standard treatment protocols for thyroid cancer and would need a 'novel' agent, aka fancy-new-chemo drug.

Suffering on a bicycle is a wonderful way to keep my mind off what I have very little power to effect.

So, it was a perfect weekend to travel too a bike race where I could spend almost the entire time absorbed in the activities surrounding pedaling a bicycle. Believe me, thinking about a trip like the one I'm going to take this week does not do much good.

Originally the St Louis UCI race was going to be my first adventure into the highest category of American cyclocross racing. But, that didn't happen, so Louisville was the time to have my proverbial cherry popped by a group of bike riders fully capable of lapping me on a cyclocross course given certain conditions (jeez, I'm making this post sound really negative and myself out to be some kind of masochist. Not sure why...hopefully this is cathartic or something). Alternatively, I could learn that my training is paying off and that the St Louis/Columbia, MO cyclocross scene is capable of producing nationally-competitive riders.

I felt pretty ill driving to the race on friday. Cold symptoms all above the head. But I figured it had been 10 days and I might wake up sat or sun feeling great. That didn't exactly happen either day, but I felt generally OK.

Saturday: I suffered. A lot. Legs were bad, I couldn't recover. The course was painfully hard. But, I didn't fall! I rode clean lines, including the sand almost every lap. Bad legs however made the ride/run-up a definite run-up. I started 64th (dead-last) and suffered almost the entire time to finish 46th. And with a certain degree of pride and thankfulness to people like Josh Johnson and Brian Matter who teach me a ton about cross and training, I finished on the lead lap, i.e. I didn't get lapped! The only thing 'bad' about the day was that on the last lap I was heckled into catching air on a jump and when I landed I rolled a tubular. Rhino down!

Saturday night: I knew I was sick and that I was coughing up nastiness. I knew I should sleep and not do much. But, I was staying with some of the Dogfish crew and couldn't turn-down a chance to go out to a microbrewery for a 7pm dinner. I kind-of had a feeling that getting a table at 7pm on a saturday night in downtown Louisville (bad-ass city btw) would be difficult, but whatever. Anyway, it was in fact a 90min wait. I also knew drinking beer is supposed to be bad before a race, but oh well. I did that too. And it was fun. Then when we finally got back to the hotel and into bed, the hotel's fire-alarm went off and we had to evacuate the building in our pajamas. That sucked.

Sunday: Woke up feeling like I needed more sleep. Legs were stiff. Nose was still stuffy, but I was hopeful that when I registered I would pull a number out of the bag that would at least put me in the middle of the field for starting position. Nope. Dead last, #65. Amazing. But at least I had good legs. I was behind a bunch of crashes the first lap and just couldn't move up at all. Then lap 2 started going to work. I felt like I rode OK. Probably a hard tempo pace, but my lines were pretty descent and I was clearing the run/ride-up 90% of the time. The best heckle of the day came in the second to last lap when I was with another guy on the run/ride-up and he ran and I rode and one of the heckler's yelled at him "Don't let that guy pass you, he's the slowest guy riding the run-up!". Sweet.

Here's a shot Matt Dawson took of me alone on the run/ride-up one lap:

I finished 35th on sunday, which all-things-considered has signs of hope. But, I'm not taking too-much away from it or drawing any conclusions. We'll see what happens over the next few weeks; anything can change.

A huge thanks to Casey and Brett from Dogfish for the help this weekend in the pits! And also to the Kona mechanic who was super nice and friendly! And to Anthony, Matt, and all the dogfish dudes who were a bunch of fun to hang with.

Academia: I would like to quote Gordie LeChance in Stand by Me to Ace at the end.

2011-11-06T18:59:00.000-08:00

Wednesday about mid-day the throat got scratchy, my body seemed way too achey, and I was absolutely exhausted. The salvage process began with as much rest-as-possible, supra hydration, echinacea tea, vit C, and an extra 1000mg of vit D3/day. But, the non-specific viral funkiness already done got me. And by 7pm that night I was hard asleep with a fever...wait a minute, you don't want to hear about my cold?! I was sick. It sucked. I had to miss Iceman. End of story, try again next year. Something really calls to me about that race. I think it is the potential to be done in under 2 hrs...which is bordering on ultra-endurance for me.

Anyway, by friday afternoon, I was feeling a ton better and saturday I rode without feeling too bad...so parsimoniously decided to come to St Louis on sunday for the 6th Bubba race.

To my surprise, I felt ok. I guess of the races I've done this year, 2 were with a splint from a broken wrist (and it kinda-hurt to race). The following involved a possible concussion. Then 2 relatively pain-free races, followed by getting over a cold. I gotta start making my own luck and moving on from Sep/Oct. I love me some holiday-season.

I never know how to say things like this; but, hopefully shit will come together for next week. One of the reasons I love bike racing so much is the incredible complexity that goes into the preparation process. Often it begins months in advance, other times, it doesn't seem too matter how much or little you're riding during the week, as long as sleep is good. Anyway, by "shit coming together" I mean all of those intangible things.

I raced a little angry today. Not sure if readers of this blog are aware exactly of what has been happening academically/professionally with my wife and myself, but I had applied to transfer to the MD/PhD program at Wash U. I'm in the PhD portion of my education and unlike most early graduate students, I wrote a grant and actually got it. Which means, I'm fully funded to do my research, take classes, buy supplies, etc. Getting grants in this country to study health/biology is abysmally hard...the last I read, first time grant-seekers have a 12% success rate while other's get funded at a whopping rate of 8%. So, I don't meant to sound haughty, but it is pretty exciting that my idea got funded. For some reason however, Wash U basically straight-up rejected me even without an interview. Odd given I have 99%-ile board scores, amazing letters of recommendation, and very good academic history while in med school. Maybe they were pissed that I didn't ace chemistry as an 18-year old freshman in college. Nope. I pretty much hated all pre-med classes and immediately began an alternative course of study after only that first semester. Anyway, rant over. The world's unfair and we all know that. Today I made up some emotional ground as I thought about that rejection email almost the entire time.

Rest-up today, easy 45-60minutes tuesday, hard ride wednesday, then recover, and travel to Louisville for the USGP . Anyone have any advice for a punchy-135lb, occasionally smooth cyclocross rider from missouri who will be starting at the back?

Acceptance vs fighting

2011-10-30T19:06:00.001-07:00

This past weekend was race #4 and #5 of the St Louis, Bubba-memorial cyclocross series. I started doing these 4 years ago now after having wanted to race cyclocross for years. I had even lived in St Louis for 2 years prior to medical school and knew my cousin was racing, but something was stopping me. I don't mean to make this post hokey or whatever, but one of my big goals for this season is:

"Connect my cancer story and work experience to my hobby of racing bikes. Not sure how, but I am going to make this happen with the goals of:
a. Helping a larger cancer or health related cause
b. Helping people learn about living with a chronic disease, in my case thyroid cancer that is hanging-out (literally) in my lungs, vertebrae, and neck.
c. Inspiring and being inspired by those who live with the uncertainty of cancer..."fight"; win or loose, including patients, family members, friends, health professionals, or scientists. (I can write a book about how my day-to-day approach is not "fighting" per se, but rather a tender, accepting, loving, and often very painful experience....but in this case, "fight" will do just fine."

The reason I was scared to race is because the radiological description of my lungs is: "innumerable tiny (all considerably less than 5 mm) pulmonary nodules visualized bilaterally. The nodules display a lower lobe predominance, although they are seen in all lung zones". These are small metastases from thyroid cancer. And they're still there to this day and haven't improved despite additional radiation treatments. Luckily, the radiation treatments also don't appear too have significantly damaged my lungs, which has always been a concern. Anyway, for those years before med school, I was scared that I wouldn't be able to breath well. I spent those years climbing a bunch, doing yoga, and lifting weights.

Now that I have a few seasons under my belt, I'm still not completely sure that the lung disease has no affect on my performance. It might. But especially this year, I've made an intention to myself to do everything I can to improve the other areas of my life that contribute too performance; and see how hard I can push it. Basically I trained hard all summer for cross. I cut out some of my beer consumption. I try to sleep enough. Pam told me to eat more carbs. I also have been doing something I never really thought would be helpful, or fun, but has turned out to be one of the best things; get some coaching advice and help planning training/riding. The thing about it is though, that it can't just be a written plan. And I don't think it can just come from anyone. The person has to get your goals, where you are, and offer what you can't really figure out on your own. But who on earth has the cash to pay for upper-level cycling coaching? I ended up getting lucky and started by sending some casual emails and ended up with a friend and supporter out of it...Brian matter.

For the last 2 years, I was doing a hard ride Tues, cross practice Wed, then a long ride or second hard ride thursday, and finally racing sundays or possibly both sat/sun. I'd get going pretty good but couldn't sustain it for more than 4-6 weeks. This year, I'd say I'm doing 25 or 50% of that intensity. However, I spent July and August (and september since I broke my wrist and was confined to the trainer) specifically working on my weakness: steady LT efforts. I also had no clue about openers, warming-up, cooling down, or the importance of treating recovery as part of training. Anyway, it is fun to push myself and see what my lungs and legs can do. I

I've always had a problem with the 'fighting cancer' cliche. It seems to me that, especially when you're living with chronic disease, that acceptance is far more powerful. Sometimes that acceptance dictates significant changes in lifestyle. I have no doubt that I'll continue to change mine year-to-year. I don't know how long racing bicycles will be healthy for me or even if it is at the moment (but I believe it is). If I wouldn't have learned of the vertebral metastasis 2 years ago, I wouldn't be doing research at the moment, which despite being very hard work, I can discipline myself to confine my schedule to set periods and if Cassidy get's sick or Maggie needs something, I can almost always drop what I'm doing to be there. Plus I can take care of myself and sleep 8-9hrs a night...i think the first 2 years of med school I average 5-6.

Next weekend is Iceman Cometh! Super stoked to go ride my mountain bike with almost 4000 other people. I'll ride hard but don't have any serious expectations of myself. The following weekend is Louisville USGP. I'll be starting in the back with a ton of fast dudes and Pros. For that, anything can happen and my goal is much less outcome based, and more an expectation that I ride myself cross-eyed and try not to crash anyone!

Bubba #3

2011-10-25T08:13:00.000-07:00

I'm not quite sure what to think about this race at this point. Between people being reprimanded for speaking their mind on the message board to the possibility that people are talking about this race in Colorado Springs, it just seems like a strange mess. I won't go into the details if you have no idea what I'm talking about, but between facebook and the message board, it just seems like there are positive ways to talk about bike racing and there are negative ways and unfortunately, the latter has prevailed this past weekend.

One thing is for sure though; I'm glad Maggie wasn't there. She probably would forbid me from bike racing ever again if she would have witnessed my fall on lap 2. Mike Weiss described it as just like "Joey's Crash" except "instead of my bike stopping and body flying, my body stopped and bike went flying". Honestly, I don't remember it at all. All I know is, I was leading going into a crazy bumpy downhill; I hit a rut and next thing I knew, I was running with my bike on my shoulder.

I could go on with my account of the race...how I felt, the events of the day and such, but for some reason it doesn't feel right.

A couple of months ago I wrote out my goals for cyclocross season. For whatever reason, pathological or not, I feel super driven and focused this year. The goals have changed, but the enthusiasm is still there. But I do find myself on the edge of getting enough family time. I really love this sport and like the whole atmosphere of fall and cross racing. I love that my friend Matt James helped me out immensely on sunday and fixed my bike for me and did a few hand-offs. I love that families and friend can pretty much see the whole course. I love that there's running. My cross country coach in college always encouraged us to run negative splits. That is what she considered a successful race. It has taken a long time to learn to pace myself in cross, but I'm finally starting to get it a bit.

Anyway, I was able to get the win sunday. It wasn't easy, but I'm excited to keep pushing myself and hopefully will start feeling smoother each week. Mike Dawson took lots of great shots. Being my blog, of course I'll just post the one's about me : )

My life this fall basically revolves around my family, immunology, cancer biology, and cyclocross. I wish there were time to watch the Cardinals, but I've been choosing to read and go to bed early. The gym where I lift has a great piece on the wall by a strength coach called "The Myth of Discipline", by Charles Poliquin.

Basically here is a paraphrase:
"There is no such thing as discipline. There is only love. Love is the most powerful creative force in the universe. You are the result of what you love most. You either love finely etched muscular abs more than donuts or you love donuts more than wash board abs you could do your laundry on (edit: yeah, he's a strength coach, but hopefully you get the point that this isn't just about bodybuilding or whatever). It is as simple as that. Self-esteem is the reflection of self-judgment. One of the best ways to raise self-esteem is to make truly loving choices that lead to increased strength of body and mind. When you are faced with difficult choices, ask yourself, in context of course, what would a loving expert recommend? When people comment on your results and say things like “Wow you have a lot discipline” answer “No, I just make loving choices for myself". Reinforcing your own positive behavior will help you grow in strength. What you appreciate appreciates. Whenever you make a truly loving choice, say to yourself ‘Thank you for taking care of me in a loving way”. The more you talk to yourself like a loving parent, the faster you will grow. Let’s say, for example, you just did a single on the squat with a load you didn’t feel like doing. Say: “Wow! I am impressed with your strength of mind, that’s why you are a champion”. By documenting and rewarding your successes, they will grow in magnitude and frequency. The more you believe in yourself, the more objectively you will be able to take the advice of authority figures."

Finally racing

2011-10-18T04:31:00.000-07:00

First, this past weekend was 5 weeks after breaking my wrist. In a 31 y/o male, it generally takes 8-10weeks for a hairline fracture to lay down hard bone, so at 4-8 weeks, generally a break is held together by softer, unorganized scar-type tissue. So, I knew I would be pushing it by racing the cross bike this weekend. But, I also missed some of the racing that I worked really hard for this past summer, so I was chomping at the bit to get out. Plus, I love the bubba series and really wanted to be there on the course.

I told myself that I'd go and pre-ride. If it hurt, I wouldn't race.

Sat night: arrived for a 10pm start time at about 5pm. I pre-rode from 5-6pm and had no pain. The wrist felt fine, so I was stoked. Fast forward a few hours...managed a solid start and was running second wheel heading into the second ride up and managed to ride myself into the tape. Oops. Man, did I feel unsmooth out there. The barriers were almost a joke for me. I smacked my bike and shins at least a few times and just generally felt uncomfortable. Lap 2: around a swooping, fast right hander, my buddy Schottler laid it down right in front of me. Somehow I managed to not hit him or his bike by riding between the two. From there on, I was even more shaky and less-smooth than before. Later, I went down and lost my chain...which had kinked over itself on the inside of my front chain ring. 1 minute later, I was chasing. Bike change, then a hard chase. Upon catching folks towards the back, my chain popped off and somehow managed to escape the confines of my Paul chain keeper in front, rendering it very difficult to get back on while on the course. So, I ran to the pits for 1/2 lap. Jumped on my other bike and kept going. Now on this bike, I couldn't shift very well...especially in front. Part of this was due to my hand/wrist being super weak, the other part was that my whole drive train seemed off. Then I got lapped. Oh well. Races like that happen.

That night, teamate Devin texted me to meet him at the hub the next morning and he'd help me fix my bikes. Sweet...motivation.

Sun: Whole different ball of wax. Except the smoothness part. That was still pretty bad and running sucked. But, I started further back this time and decided to pace myself. Devin and I did not have a plan at all as I had told him I was really going to try and not crash. A few laps into the race, Devin was off the front, being chased by Casey, then a group with me somewhere in it. At some point I decided to see if I could manage to bridge to Casey and not bring anyone with me. Carefully, it worked. Then after another lap or so, I attacked Casey on a hill and found myself bridging up to Devin. From there, we traded pulls and rode a solid pace. With around 4-to-go, Devin slowed down. I was feeling pretty good and am pretty confident that the last 4 laps were my fastest of the weekend, so I managed my first win at a 'race' in 2011.

Apparently indoor trainers and weightlifting are a good way to spend a month prior to cross season!

Mountain biking in the fall

2011-10-12T12:21:00.000-07:00

It's the best.

This wrist injury has been nice in some ways. I've slowed way down. Focused on work. Drove a ton less and have been saving money on gas, race entries, etc. Actually I don't think we've left Columbia in a month, which is a record for us.

I was out at Rockbridge today and saw 8 turtles. I think the universe is trying to tell me something.

Heading out this weekend for more mountain biking. Then hopefully cross the following weekend. Man, I can't wait for Iceman cometh.

Good riddance september.

2011-10-01T16:13:00.000-07:00

Holy shit. Stuff to look forward too:

-Race support! My Dad and I are taking a man's trip to the great northwoods of Michigan in November. Just me and him, like I'm 10 or something. And I get to race Iceman cometh, a true cyclocrossers mountain bike race!
-More race support! Momma Miller and myself are taking Cassidy and heading to derby city for the USGP de Louisville. I'm registered for the UCI race and can't freakin wait. I hope it is cold.

--That's the registration. SCARY! I wish there were 2 of me there...that'd be sweet.
-Even more race support!!! For my 32nd birthday, Maggie got us 2 nights stay in beautiful Iowa City during thanksgiving weekend...JINGLE CROSS is finally happening. Somehow the stars aligned and Maggie get's to go as well.

-I've been riding outside!!!! I took my 2010 major jake and put a cross top lever on the left side so that I can brake whilst wearing my cast that is actually now a brace. Weekdays have been longish or easy spins with some weight lifting thrown in. Weekends have been 3x20min SubLTs. I love my carbon Major, but man that classic major rides SO nice. Such a comfortable bike. I just can't wait to race either one!

We're unfortunately probably not going to Burnin next week. Cassidy turns 3 and Maggie is on a new rotation, which basically means she has no idea what her days will be like. How bad would it suck to go to your job and have no idea what time you'll be getting home? Thus is Maggie's life for a large portion of this year.

I see the doc wednesday, hopefully the bone is almost done cooking....I have some other wrists to snap.

Practice, practice, practice

2011-09-20T06:13:00.000-07:00

Promises to Yourself By Christian D. Larsen

Promise yourself….
To be so strong that nothing can disturb your peace of mind;
To talk health, happiness, and prosperity to every person you meet;
To make all your friends feel that there is something in them;
To look at the sunny side of everything and make your optimism come true;
To think only the best, to work only for the best, and to expect only the best;
To be just as enthusiastic about the success of others as you are about your own;
To forget the mistakes of the past and press on to the greater achievements of the future;
To wear a cheerful countenance at all times and give every living creature you meet a smile;
To give so much time to the improvement of yourself that you have no time to criticize others;
To be too large for worry, too noble for anger, too strong for fear; and too happy to permit the presence of trouble;
To think well of yourself and to proclaim this fact to the world, not in loud words, but in great deeds;
To live in the faith that the whole world is on your side so long as you are true to the best that is in you.

The wrist is slowing me down and changing plans. Ouch! That hurts quite a bit given the planning and preparation for this fall. But, the fire is burning inside...sometimes there is no other choice, despite even the shrewdest skepticism, to believe that sometimes things happen for a reason.

I see the doctor again on monday 9/26 and will probably get the cast off. He'll also give me a good idea of when I can start racing again. I'm hoping to do Cross our Cancer in KC , but that will probably be too soon. We'll see. If not, Bubba #1.

The agony of amateur athletics

2011-09-12T16:35:00.000-07:00

So I broke my wrist on the friday before my first weekend of cross racing. I wasn't even doing openers or anything cool. I was just spinning around making sure my bike worked when I was passing a runner with a dog on a wet asphalt bike bath. When I passed, the dog lurched at me a bit so I reflexively turned and had my front wheel slip out. I picked myself up and rode another 30 minutes. At the time my wrist hurt, but I went off road and told myself that if bumps didn't hurt it couldn't be broken. At 2am that night, I was thinking about it very differently.

First thing in the morning I ate breakfast and told my 2-yr-old and mom that I needed to go to the ER. I figured I'd decrease my wait time by brining a box of baked goodies...which actually worked, since about an hour after going in, I was walking our with a diagnosis of a broken distal radius.

The funny thing about the first day or so was that I really seemed to take it in stride. Oh well. More beer and cookies and rest and not training. Then monday started.

Let's just say that my work and academic situation at the moment is highly stressful and full of incredibly stupid and frustrating bullshit. By 5pm monday, I was about ready to curl-up in a ball. Tomorrow however, does not hold an hour or two of riding on the trail. Wednesday, I'll be cooking dinner for my family while my BoCoMo buddies are out on the CX practice course. Next saturday, I'll do a trainer ride then eat dinner and watch a movie instead of racing Hermann.

Don't get me wrong about the direction in which my writing is leading me...I really love what I do professionally and I LOVE my family. But shit. Racing and training to race helps me cope! I feel so....normal when I'm pissed off at 5pm and don't want to cook dinner and don't get to ride tomorrow. Normal sucks. And my wrist hurts. Shit my wrist hurts. Maybe if i had cable and could zone out and focus on other people's problems. Maybe reality TV would help? If not, I'm sure Fox news would convince me that I have lots of people to blame besides my own ego-driven desires and the frustrations/suffering we all experience.

The honest assessment of the situation is that cross season in this country is too long anyway. And missing the first 4-6 weeks only means that I don't peak and then have to re-peak again. Instead, I'll have 8-10 weeks of focus, fun, friends, and fall to lead up to the racing that matters for those of us who value the 'glory' of amateur racing...jersey's and bragging rights and maybe , just maybe, beating a bunch of jerks on a sure-to-be-cold day in Wisconsin in January (aka the national championships the first week of January).

Tall Oak 6hr...err 3hr race

2011-08-30T08:39:00.000-07:00

Last week was a bit stressful. MU started classes again and I'm signed up to TA a cancer biology class (fitting right?) and am also taking 2 advanced immunology courses for my PhD. One is super hard, like reading 6-10 papers per week hard. The other is pretty easy and a lot of review.

I had really wanted to race the 6hr team category at Binder lake 6hr race, but various arrangements with 3 different partners all got messed up for various reasons. So, a few years ago I did this race and managed 2nd in the solo category on my SS, so I figured I was in better shape and wouldn't have a problem on gears.

First lap, I was riding with the top 5-6 guys, all of whom were riding on teams. I was still breathing out of my nose and RPE was probably around a 5 or 6, so I thought I'd be all good with a plan to slow down lap 2 and then keep it steady for the following 10 laps. I had looked at Winkler's times from a few years ago when he got 11 laps solo and I even had the necessary splits written down on a note card taped to my top tube.

Lap 2 was interesting. I was cruising at a nice endurance pace, knowing that there were no solo riders in front on me. I had my plan and I think it was a good one. I was eating, drinking, and having a great time. Not to imply that having a good time changed, but half-way through the lap I got passed by the local legend Sam Moore, who was both solo and flat-out hauling. Like XC pace hauling. I decided to follow him and soon realized that we weren't slowing down anytime soon. By lap 4, we were definitely on an 11lap pace. But man was I hurting, not even half-way into the race! My legs weren't the problem at all. Instead, the simple problem of riding my road and CX a ton more than my mountain bike this summer laid the foundation for seriously sore lower back, triceps, shoulders, and neck. Lap 5 I slowed way down, but the pain in those areas didn't feel any better. I ate and drank but no improvement. It started to really suck. I started thinking about the next few weeks and cross and simply decided to pull the plug at the end of lap 5.

I have no major regrets at all.

It was good to see my mountain bike friends again. I miss my buddies on team seagal and genuinely feel like I'm part of the best team around. Even though the Hub and Team Seagal are closely related, sibling teams and I love them both, my heart is always riding in a Seagal kit even when I line up wearing only the socks.

I think my plan for cross will be to ride for the Hub when I have teamates in the race and in my Seagal kit when I don't. My best buddy designed new kits for Seagal and I have to say the templates are the best looking kits around. We haven't ordered yet, but hopefully by the time CX season in in full swing!

Only 11 days til cross! The plan is for 3 hard days and the rest off or easy. I can't wait!

Goals for 2011/12 Cyclocross

2011-08-24T04:28:00.000-07:00

1. Have fun. This isn't my job, and I absolutely love this sport.

2. Connect my cancer story and work experience to my hobby of racing bikes. Not sure how, but I am going to make this happen with the goals of:
a. Helping a larger cancer or health related cause
b. Helping people learn about living with a chronic disease, in my case thyroid cancer that is hanging-out (literally) in my lungs, vertebrae, and neck.
c. Inspiring and being inspired by those who live with the uncertainty of cancer..."fight"; win or loose, including patients, family members, friends, health professionals, or scientists. (I can write a book about how my day-to-day approach is not "fighting" per se, but rather a tender, accepting, loving, and often very painful experience....but in this case, "fight" will do just fine.

3. Keep racing healthy by balancing the stress physical preparation induces with excellent nutrition, meditation/stress management, and love of family and friends.

4. Training hard, learning from my cycling teachers, and giving everything I have on the cross courses of Gateway Cup and Madison USGP. We'll see what happens from there.

5. Defend St Louis (bubba) series first place overall finish from last year, enter the state championship and master's 30+ nationals mentally and physically prepared to stand on the top step of the podium.

6. If goal #5 ever interferes with goal #3, the goal will be letting go.

Cross is almost here!

2011-08-17T13:22:00.000-07:00

I tend too not get bummed out if for some reason or another I can't make a mountain bike race happen. This past weekend were 2 that I would have liked to do, Spoke Pony and the SS-MO Championships. Work called both days in the morning...I'm trying to get a bunch of stuff in the lab done before the University starts up again on Monday. There are tons of students moving in this week and the amount of traffic in Columbia seems to have tripled.

On Saturday, I had a nice 3hr ride with some seated accelerations in preparation fro cross. Then Sunday, spend the morning in the lab and in the afternoon down in Jeff City at the MO state criterium race, which was nice because it started at 4pm. I really wanted to help Devin get the jersey. That was the goal for the race and the plan was too ride near the front, chase down threatening attacks if other's wouldn't and hopefully stay clear of danger. The plan worked great, except when the winning break took off, I had been off the front and got gassed quick. Devin bridged, but then they attacked hard and he was back with the pack.

Ok, field sprint. Well, it turns out Devin didn't need my help. We came out of the last corner in front of the pack with him leading (I think it was supposed to be the other way around, oh well) and then he took off. I went hard and always forget to use the curly things that stick out below my hoods...drops? Lots of fast dudes came around me and I finished somewhere in the middle.

My buddy Derek took some great shots:

Next definite race is finally a mountain bike race, Binder! I don't think I can make it this weekend, 8hrs in the car is just too much. But who knows, maybe I'll change my mind. Or maybe Indiana Jones James will finally come out and we'll be in St Louis anyway.

I do love me some cyclocross. I sure hope I don't take that shit too seriously and get all competitive and bent out of shape with myself. It is just too much of a positive activity to do that. But, it seems like I'm moving in that direction...2 bikes for the year, being selective about when too race, etc! At least both bikes are Konas, it seems that provides an ora of laid-backness to it!

2011-07-29T16:16:00.000-07:00

Summer reflections

2011-07-24T13:46:00.000-07:00

Cross is just around the corner and the dirt crits only have 2 more races! Pretty crazy that the summer has gone by so quickly. I haven't blogged much, mostly because I haven't had too much to say with respect to my cancer...which generally seems to be the more therapeutic and justifiable topic upon which to blorg. I mean blog. Bike racing, riding, and training this year is something I feel is simultaneously a selfish but extremely humbling and gratifying experience. I guess I should try to write more about the humbling and gratifying part.

With respect to dirt bike riding, other riders (namely Pirtle and Chris Ploch), the trails, weather, bike parts flatting or breaking, and training all keep kicking my butt. I'm glad I've been able to pull myself up each time, but there have been some nasty crashes while mountain biking and some close calls on the road. Time spent on the bike this year is around 280hrs and around 4000miles have been ridden. Last wednesday I was out doing 20min intervals and puked in my mouth. Jeez. This is totally and completely all for fun and even upon reflection looking back on the money spent, time taken from other parts of life, and the amount of energy going into riding...I guess I really am an adrenaline junkie. But strangely, probably 90% of my time riding I'm in a very different place with my mind, emotions, and spirit than the fight-or-flight catecholamine induced high of adrenaline pumping through my veins. I love this form of being outside and I love the feeling of crushing a steep hill and then shredding a downhill on my mountain bike. I love the sound and feeling of floating down the local farm roads on a road bike. And I love the solitude and beauty encountered while riding gravel roads that always, eventually, connect to the katy trail along the Missouri river, what an incredible part of this continent!

I'm addicted and I don't think I get addicted easily to things.

The racing is amazing, but I imagine at some point in the next 2-3 years (basically when I'm done with my research and PhD) racing probably won't happen at all. So it goes. This year I'm lucky enough to keep things pretty well balanced. I've found myself the homemaker, a very happy father and supportive husband, and still able to get some good work done as a scientist. And racing has fit in. I'm stoked to give it my all this year and next...keeping things super amateur, ultra-fun, and hopefully safe.

I spent some energy earlier this year trying to somehow unite all of what is above, with some type of cancer-service-based thing. I tried to get a race team involved with Pedal the Cause but things haven't worked out. I don't usually say this particular phrase, but 'it isn't meant to be'. I guess one of the reasons I'm drawn to science and medicine is that I just simply don't understand business. Oh well. It ultimately has just felt like this lofty goal was just some way of justifying an ultimately somewhat selfish activity. But like I said, I'm all good with that. Life is short, you gotta do things you love each and every day if you can.

Presence, Sadness, and smiles.

2011-07-11T05:34:00.000-07:00

My wife has an incredible ability. It has manifest a few times now, but most recently this past friday I was in St Louis and she was working on the burn unit in her surgery rotation here in Columbia. I usually text or talk on the phone at least a few times per day just to check in, ask questions, or make plans. But last friday I hadn't heard a thing. She didn't respond to my emails, texts, or calls. At about 6pm, I started getting freaked out. A little while later, I had worked myself up and was in the process of trying to contact a med student I knew was on the service with her just too see if she'd seen her that day. Then I realized I could page her, so I did and within a few minutes I was relieved to hear her voice on the phone at around 6:30pm. She'd been there since 6am and had no idea what time it was. She thought it was mid-day. She said that she was so focused on what she was doing that she hadn't checked her phone, looked at her email, or even thought about anything else besides patients, doctors, nurses, and surgery. Can you imagine that kind of focus? I know I don't have it. I'd have checked my email a few times, looked up tour results, and generally would have not been fully present for a descent portion of the day. Man, I sure hope I get a doctor like her next time I need surgery.

A friend lost his young child this weekend. I thought a lot about Dwayne and his family this weekend. I thought about suffering and pain. I thought about biology and fairness. It is a very sad time and I hope for peace and healing to the Goscinski's.

It was good to get out on saturday and to do Pfoodman team's Castlewood race. These guys always put on great events and I love racing at Castlewood. Everyone there seems to have the Goscinski's somewhere in their mind that day and it was good to see that there are so many positive and friendly people involved in mountain biking in the St Louis area.

The race went well. It started with a Lone wolf (big wall of a climb). I was 3rd wheel going in and as soon as the grade increased, I passed and put in a good tempo pace...nothing that felt crazy, just a solid pace. Nearing the top, I turned around and has a pretty good gap on the field! After some rocky ridge riding we hit a technical descent with lots of switch backs. I rode pretty well, but got caught by Chris Ploch...who's pretty ridiculous in descending. We rode together for the first lap (of three). I had no problems with the exceptions of the descents...way out of my comfort zone. Starting lap 2, I attacked on the start hill. Got a little gap but he clawed back on the ridge. He was on a dualie and he gapped me on a short rocky straight section where he could pedal very efficiently. That was right before a descent, so the gap stuck and the rest of the race I kept trying to close it but couldn't make it happen. Psyched for 2nd on the day and a great time at an awesome event!

Irish Blessing for the Goscinski's:
Do not stand at my grave and weep,
I am not there... I do not sleep.
I am the thousand winds that blow...
I am the diamond glints on snow...
I am the sunlight on ripened grain...
I am the gentle autumn rain.
When you waken in the morning's hush,
I am the swift uplifting rush
Of gentle birds in circling flight...
I am the soft star that shines at night.
Do not stand at my grave and cry—
I am not there... I did not die...

Webster Crit: Mix of emotion

2011-06-28T05:47:00.001-07:00

Sorrow: Big crash in the cat 5 race. Randy. ICP or intracranial pressure due to trauma is scary stuff. I'm virtually certain that if I would have seen it or been on the scene after, I would not have raced. Not because of anything dangerous about the course, but because of the inherent ambiguity and the potential for shit to happen. I really hope he pulls through and has no deficits because of something relatively random that happened doing something he loved.

Confidence in physical state: Pulling Devin up to break, ~2min: 544w
Avg for the race: 255w
Best 5min power: 330w
Avg Speed: 26mph
Max Speed: 35mph (and I didn't sprint at all, basically I rode as a support rider)

Stoked: I had a ton of fun. Probably the most fun I've had at a crit. The hub is a really fantastic group of people and it was/is cool to be a part of it. Also, it looks like very exciting things are on the horizon for cyclocross. And of course, I was elated that Devin won...I felt like we worked well as a team.

Bummed: Quite simply, I'd rather be mountain bike racing. But, I'm glad I hadn't planned on the scheduled UFD mountain bike race on sunday. I'm sorry for those who had too cancel, I know it isn't easy. But I also wish things were different for growing the series and sport in the state. After so many cancellations I know I'm essentially out for the rest of the season. My friend from Wisconsin didn't even understand what I was talking about when I said so many of our races get cancelled due to pre-race day rain. Obviously the WORS races are pretty entrenched and they have a huge budget compared to ours...but they had to get there somehow. I understand the ethic regarding the trail and riding. And in fact truly support it in general. But for mountain bike races, it seems to me that the situation is different. I don't know what the solution is, but I know a lot of people have been bummed and turned off from racing because so many of the races are cancelled. As I said a few posts ago, I don't see any reason why we can't have a series that competes with DINO in terms of the number of racers. I hope I'm not offending anyone and like I said, I completely support the ethic of not riding on wet trail, but it seems like we need to compare ourselves with some Midwest series that have been super successful and at least consider what they do.

Is it cross season yet?

2011-06-21T12:07:00.000-07:00

Took a nice break from riding after the state road race. The weather was super nice last week so it was nice to get out for some walks but that's about all I did. I ate just about everything in sight and after reading all kinds of stuff on nutrition and cancer in the last year, I'm finally at a point where I can relax and not restrict myself. For awhile I wasn't eating any dairy because of some geeky IGF potentiation issues, but man whole milk yogurt and chocolate milk taste good this summer...and don't make me feel bad.

Maggie spent 2 nights at the hospital (working) last week. That part of this next year is going to be ruff, but sunday we got to spend most of the day together, went out for some awesome dinner...I love me some salmon, and then had icecream.

Last week and this, I'm starting to think a ton about cyclocross. I don't know if I'll have as much time as I do now and next fall anytime in the next few years so this season I'm going to give it all I got. Base building for cross officially began today with some sub-LT intervals. Up next is the Webster crit, Tour of Lawrence, and some dirt crits.

It is pretty crazy how long the season is going to be this year. I'm hoping to come into September with some good roadie form and a solid base. Then take it easy and just enjoy the process being with friends and racing in October. And then in November start building back-up for Jingle-cross and nationals.

If you haven't seen this yet, this is pretty awesome. I wish we had these in the states:

Another view:

My lab

2011-06-16T07:59:00.000-07:00

6am- WakeUp
6:30- Black coffee and emails
7- Breakfast and get Cassidy to school
7:45-8- stain tissue OR if hot outside 8:30-11 Ride trainer
11- ride if not hot
1-5: look at stuff under microscope, read papers, write, plan next day

Then pick up C, cook dinner, have some wine, get to bed.

Repeat.

Big race June

2011-06-14T05:21:00.000-07:00

It's interesting how we arbitrarily assign importance to relatively trivial events and activities. "Sometimes that weight allows us access to deeper meaning. Sometimes it's just bullshit to make us feel better about how we spend our time and energy." (mark twight)

My only goal this year prior to cross season with respect to bike racing was to race well at the state championship mtn bike race. Well, I guess that was a loose goal because when that race had the slightest cast of doubt associated with rain and subsequent cancellation, I began thinking about alternatives. Fitness has been building over the prior months...practicing what works and what doesn't so as to be ready to do the same next fall/winter. I suppose in my mind, the process of building and training is/was more my goal than the actual race. I love training and riding my bike but it is even more fun with something in mind. Unfortunately the execution phase of this particular goal didn't happen...which is certainly the most important part.

The alternate race ended up being the Tour of Ste Genevieve, a race I had wanted to do last year. I was nervous about the almost 90 mile distance....so my goals for that race were real simple: help my buddy and teamate Devin get into a break, try and get into a break myself, and hopefully finish. Thanks to Ron, Alex, Devin, and the sponsors of The Hub I was able to ride on an awesome new Giant TCR advanced road bike.

Goals 1 and 3 were accomplished. And before goal 3, I unfortunately dropped a chain at a very inopportune time, lost contact with the group, and finished by myself...pedaling alone with my thoughts and reflections. Satisfaction came from the process not the end. But a few days later, I'm committing to myself to not let a lack of execution become habit.

A long summer is beginning. Maggie is on the most time intensive rotation of medical school (surgery), I'll be doing a lot of elbow grease work in the lab, trying to publish 2 papers, we both must maintain contact with eachother and our daughter...and strangely, not despite-of, but in concert with all of that, riding will continue.

Onward.

DINO: Brown County

2011-06-06T06:20:00.001-07:00

The 2 girls and I were driving around a beautiful portion of Indianapolis on Saturday and encountered 2 cyclists on the road and Cassidy exclaimed, "Bikes belong in a race, NOT on the ROAD!". I guess she's been to a lot of mountain bike and cyclocross races!

A wedding for Maggie's cousin this past weekend just happened to coincide with a DINO series race in the fabled Mid-western mountain biking mecca of Brown County, IN. With the exception of CX nationals and a SSXCWC 2009, I hadn't raced a bike outside of Missouri or Illinois since 1999, so I was really excited to be a nondescript nobody and test myself in a field that is 3-4x bigger than the expert field at local races.

It turned out that some other Missouri riders thought that the 4.5 hr drive was well worth the effort for the quality of the riding and the race, as there were 5 other St Louis riders getting ready for the 10am start on Sunday including Loraine, Christine, Tom A, John M, and Craig W. I had originally signed up for the cat 1 30-39 race, but last minute decided to see if they'd let me race with the pro/elite men.

It was really amazing to see how many people are attracted to mountain bike racing in Indiana. Even though Brown County is such a treasure and attraction, it seems to me that with 3 metropolitan areas and a few college towns and smaller cities, and certainly overall more mountain bike areas, Missouri should be able to draw larger fields. I thought a bunch about this and don't want to get into it too much here, but racing DINO made me want to invest more in our local trails and racing as opposed to traveling more to other mid-western states even though there are deeper fields and the possibility of significant payouts. I've always tried to be a 'bloom-where-I'm-planted' type of person, so I don't think I'll start traveling more anytime soon.

The race and the competition were off-the-hook. We had a fast start on a mile-long section of road with one super steep hill and another big-ring grinder. I was top-10 into the singletrack but found myself gassed from a hard week of training and at some disadvantage without any pre-ride, so began dropping places in the first lap. The hard-tail 29er Big Unit was the perfect bike and the only mistake I made was locking my fork out a few times when right after climbs there were some technical descents and I'd loose a few seconds if I didn't have time to unlock the fork. With the 20mm thru-axle up front and an all-mountain front wheel, I think locking out the fork is a thing of the past and not worth the effort unless I'm riding on pavement or gravel.

Laps 2 and 3 of the 24mile race I was pretty much in no-man's land but able to keep a pretty stable pace and was neither passing or being passed by expert riders. At the end, I was 17th out of 43 riders and about 10 minutes off pace from the leaders...satisfied with that placing. And I felt very psyched to have raced with so many fast riders on incredible trails.

Next up is the State race, then a few weeks of chilling during the week and racing on the weekends (perhaps a trip to Wisconsin for the Subaru Cup), and then the preparation for cyclocross begins!

I'm hoping to do as much as I can in the next few months for Pedal the Cause ride on Oct 1st and 2nd. Currently the plan is to do some writing for their newsletter from the perspective of a cancer survivor, medical student, PhD cancer researcher, yoga teacher, cyclist, and friend/family member of those who fought-like-hell but still lost their lives to cancer.

I used to have a huge problem in talking about a 'cure to cancer'. But am slowly regaining a less cynical view. Especially after reading reports such as this...the impossible is not always as such.

Brown County

2011-05-31T14:28:00.000-07:00

This weekend, heading for a race here:

Here's somebodies Garmin link (note the climb the I get to ascend 3x on sunday at mile 4.2):
http://connect.garmin.com/activity/7131558

A full mile long!

Hope

2011-05-23T17:32:00.000-07:00

Seems a bit cheezy for a title doesn't it?

Well, you have to comprehend how huge this past week was in order to understand that last monday, I had little and now I have a ton, of hope. And hope, is one of the most important things in life.

Last week: 1.5 years of uncertainty, with a significant possibility that the weird disease I live with had morphed into something more serious.

This monday: Significant evidence that my thyroid cancer is 'stable' in the form of:
1. Stable tumor marker
2. No radiological change in 16 months time
3. No significant physical symptoms

By stable, I mean no growth and no shrinkage.

That is awesome in my mind because:
1. The lifestyle choices I've made with respect to (a) work, (b) family, (c) family, and (d) exercise are having a positive affect. Yes, this is an n=1 experiment and as a future doctor, I couldn't actually Rx what I believe to be beneficial, but I can still feel empowered by it.
2. The fact that my thyroid cancer is stable, 'rules-down' the possibility that there is some kind of weird mutation suggestive of a more aggressive cancer (which was a significant possibility when we learned I had a met in my bone).
3. Because my disease is stable, there is more time for my bad-ass doctors to do trials on people who are really sick and hopefully come up with a cure.

That last part about a cure, well, that represents a HUGE psychological shift for me. My PhD will eventually be in the field of cancer biology. And some combination of being an adult, skeptical thinking, my own experience with cancer, and knowing so many young people who have lost the fight despite living as strong as fucking possible, has made me think that talking about 'cures' to cancer is intellectually and practically a forlorn pursuit.

Call me selfish, but this week I feel a lot more like a hopeful kid...starting over again with a sense that anything is possible. I have every confidence that in my lifetime, we will eclipse our current knowledge regarding the signaling circuitry and intercommunication between cancer cells and all of the other many types of cells in the body connected to these cells. To be sure, cancer is not a single group of cells, but a developed tissue...with perhaps as many different cell types involved in the pathology as is present in the normal physiology of the GI tract.

I now truly believe that in the coming decade, we will see "cancer research as an increasingly logical science, in which myriad phenotypic complexities are manifestations of a small set of underlying organizing principles” (Hanahan and Weinberg, Cell 2011).

This past weekend was a whirlwind. Saturday was a morning with the family at the farmer's market and library. Then a crit in the afternoon where I effectively buried myself and tried too work together with some other folks to bridge up to a break, but could never quite summon the necessary sustained ability to deal with pain.

Sunday was a 6hr team mountain bike race. I rode the new Kona Big Unit (single speed currently) which has a 20mm thru axle up front, and I must say that it is hand's down the best mountain bike I've ever ridden. Fatty TAs are the future.

My teammate and I ended up 2nd on the day. I felt like I'm finally getting some fitness back this year. Thanks so much to Bob Arnold for hooking up the rear wheel. Hopefully things will come together so I can run the Big Unit as a 1x10 for the next few races. The plan is to have another 2 weeks of hard riding, then a little taper, a race, then the long run towards cyclocross next fall.

Big week and race reports

2011-05-15T14:53:00.000-07:00

I'm heading to MD Anderson in houston this week to get checked out by my cancer docs. The anxiety has been very high over the past few months...so many questions unanswered. We fly out Tuesday, get in around dinner on tuesday night, then wake up and have the following schedule:

07:00 AM 1 hour of yoga and meditation
08:15 AM- BLOOD/SPECIMEN COLLECTION
08:40 AM- XRAY CHEST, PA & LAT
08:50 AM- CT CHECKIN-DONT EAT 3 HR PRIOR
09:20 AM- CT SCAN, CHEST/HEAD & NECK
09:50 AM- Eat a shit ton of food from the buffet
11:30 AM- ride the crappy spin bike in the exercise room
01:00 PM- CHECKIN FOR TEST / EXAM
01:15 PM- NEURO US SOFT TISSUE HEAD&NECK
03:30 PM- PREPARATION/CHECK IN FOR MRI
04:00 PM- MRI T-SPINE W & W/O CONTRAST
05:00 PM- MRI L-SPINE
06:30 PM- get loaded with my wife on cheap wine at the hospital bar, then eat, then watch movies (we don't have TV so always go a bit nuts when we do)

If anything needs to be biopsied, it will be during the US (aka ultrasound).

Then I see the doctor the following day at 9:30.

I've been quite depressed over the past few months. For some reason, despite living with cancer for 6 years now, the last year has been hard with the last 6 months being absolutely soul crushing. I just can't see past this incredible sensation of impending doom.

I miss a ton of my friends who are spread across the globe and the bike community here in Columbia has been different this year than in the past. I've been riding a bunch by myself and didn't go hard at all until around early April. From then, I started doing some short intervals and raced mountain bikes a few times. Inertia sucks sometimes because it's inertial...basically I've found it hard to get going.

Last saturday was Greensfelder marathon. I rode hard and pretty well for 45 minutes, then flatted and subsequently felt like poo. I don't think I'm built for marathon, metabolically speaking. My mountain bike season so far has gone something like this:

At least this past week I had a ton of fun and rode in some awesome weather:
Monday was a 2.5hr easy ride on gravel with 2 laps at cosmo.
Tuesday was the Tuesday night crit in St Louis, first road 'race' of the season. Buried myself. I tfelt great.
Wednesday- easy 2 hrs with a hot lap at cosmo
Thursday- trainer ride, mostly easy with a little tempo
Sat- top-secret openers bestowed from Schottler for helping him out last week.
Sun- race mtn bikes

I haven't really felt great about any racing this year. But today was exactly what I needed. Sometimes when your body is fighting something it can alter your emotions which affects your thinking. Other times, you mind affects your emotions which may or may not affect your body. The problem is that it is hard to tell in which direction the flow is moving. Today, I was tired of not feeling good on the bike, so I brought my trainer to the race and warmed up properly for the first time ever. The race went great and I finally feel a sense of inner strength again....the whole reason I ever started in any athletic pursuit.

Random pictures of interesting and strange things:

Does this actually sound appetizing to anyone? You know vitamin D without fat just gets pooped out right?

Mark Twight wrote these words and just posted on his site, please respect them as his (not mine):
"Evolve. Adapt. Grow up.
Be willing to move on from a particular identifying idea or activity or period in your life. When it is time to do so, let it go instead of inhabiting it. Do not become it, or die chained to it.

The first goal need not be the final one
Use physical activity to diagnose and learn oneself
Use physical activity as meditation - become what you are doing
Use physical activity as a developmental tool
Learn the truth of one way and extrapolate to all ways, to self
Do something all the way or don't do it at all
Understand the shallowness of dilettantism
Understand the shallowness amateurism
Also understand the necessity of each
Bite off more than you can chew - deal with indigestion or the tiger on the end of the tail if it becomes an issue
Maybe it won't

Grow
Change
Cause change
Try new things
Don't lose track of the past or the path that led here
Let the past influence the future
Do not dwell in that past
Don't get stuck on a particular rung of the ladder
Try on many shoes
Reject stagnation
Understand the danger of repetition
Understand the value of repetition
Constantly shift focus from big picture to small detail, back and forth, wide angle, zoom
Constantly shift focus from master to student and back in an instant

Be dogmatic when it works
Be open and bending when that works
Hard works, soft also works, each appropriate to a moment
Expect more from yourself
Do not settle for good enough unless the task does not truly matter
Obsession is how one gets things done
Body teaches mind and vice-versa
Learn with the body
Learn with the mind
Allow both to grow
Drive both to improve (according to particular objectives)
Do not coast

I will never arrive
I will never "know"
I will only know how little I know
If and when I know more than others I will wear it on my sleeve, as a badge, as my standard. I will be ego-driven where appropriate and sometimes where it's not. I will be ego-less where it is appropriate, and necessary. I will try not to get in my own way. I will use my talent instead of wasting it.

I won't make excuses when I fall short.
Instead I will make corrections."

MFXC 2011

2011-05-02T05:52:00.001-07:00

The best group of people I've ever been involved with for any sport or activity put on the second annual Middlefork XC (non)race this weekend.

First, if you've never been to Middle fork and live within 4-5 hrs, you owe it to yourself to head down there. Here is a link to some garmin data:

In terms of the day and the people that were involved, I was one that got to reap the benefits of my teams hardwork, without putting much effort into organizing the thing. That must change. Non-races are free events that may or may not be timed and can be taken as seriously as one wants. I'd say most of the people there yesterday let leash the same level of effort towards the ride as they normally would toward a mountain bike race...so for all intents and purposes, it ended up being a race for most of us.

With all the rain recently, many were nervous about making the trip down. I managed to ride Rhett's run last thursday and after seeing how well the ground was draining, I had a lot of confidence that the non-race would indeed happen. In fact, the conditions ended up being close to perfect. There were some serious creek crossings, but this is mountain biking.

There were 3 start waves for the race, my buddies Matt James and Dan Furhman were the first to go, as the 2 first place (geared and single speed) finishers from last year. Next the first 10 registered, then a larger group which is where I started.

Riding in April has been really good for me this year. I've only raced 2x, but have been motivated to ride hard at least 2-3x during the week. So, I wanted to ride hard and smart for the duration of the 32-33 miles.

After the start, I caught Matt and Dan about 2 miles down the single-track, a little before a 7-ish mile section of gravel road riding. Matt and I took off together, leaving Dan and his single gear to spin his brains out. We traded about 90s pulls and kept a steady tempo pace for the entire 7miles. It was the most boring part of the topography, although the scenery was quite awesome.

When we arrived at a concrete section we saw Caleb from Momentum chasing us doing like a mad-man. He eventually caught us right before the 16 miles of singletrack. Matt led in, then Caleb, and I followed. Caleb looked as though he had burned too many matches catching us and I felt really good. So with about 13-14 miles left, I took off.

The riding was fast, flowy, exciting, and absolutely beautiful. I was seriously in bliss pedaling along and felt like I was hauling. At about 19miles, there was a little gravel section and as I was riding it, I noticed a pink flag and a weird trail to my right. At first, I turned thinking it was the trail. Then I stopped, looked around and decided to keep going. A minute or so later, I turned around and rode back too take a look and decided I was a moron, since there were no tire marks. I looked up and saw Matt and Caleb down the road. Time to haul. I didn't want to ride away from Matt, but he was keeping Caleb in check and I thought it would be good to keep up the pace. I established a gap again and tt was more of the same until mile 27, when all of a sudden I pinched and was riding on my rim. It took me awhile to change the tire and during that time, Matt, then Nico, then Dan Furhman passed me (note, always carry 2 C02s). Once I got back on, I started soft pedaling, then figured what-the-hell, and took off in chase knowing I had 3-4miles to catch people. Looking at my garmin, it looks like a 20min threshold effort, but eventually I caught Matt and he and I finished together in a tie for first place.

I'm sitting in a coffee shop writing this up, and an old ancient Columbia cyclist came up to me and just told me that the state mountain bike used to be in the area of middlefork...probably 13-15 years ago. And consisted of a single loop of about the same length as MFXC. Back then, the locals apparently were into the race, but one year, a cat 4 made some big deal about either his placing or maybe his wife's, and almost started a brawl with the officials. Cops had to come and that was the end of that.

Bone bender

2011-04-18T07:38:00.000-07:00

I hadn't raced a bike for 3hrs since Herman road race last year. I'd been thinking of doing a few marathon races this spring/summer, so the 3hr-Bone Bender was a great target to test out the endurance legs.

The plans were somewhat mettled the week prior, with my bike developing an irritating rattle in the front, eventually leading to a diagnosis of a loose inertial valve in the fancy front shock (stupid moving parts), and an inability to fix the problem. But, my buddy green beans came through and offered his incredible 26-in YBB Moots. Since we're almost exactly the same size and weight, it was an easy decision to proceed with the plans.

Maggie came along for a night of camping followed by a day of racing. But since the race was in Lawrence, a stop for BBQ was required in KC:

We managed to get in with enough time to pre-ride the course and were totally surprised to find Clinton lake trails in superb conditions despite the a few a days of rain leading up to the race.

Sunday morning:

The race began with a LeMans start, normally something I enjoy. My plan was to test myself and see if I could keep up with the likes of Schottler, Bill Stolte, John Rines, and many more for the first lap.

I've been riding a ton of base miles this year, so I figured the 3hr race wouldn't be too ridiculous. Man, was I wrong. The hardest part for me was that there was hardly any climbing at all. Around 40-60% of the trail was rocky and technical, but generally the 9-ish mile lap was a hammer fest with almost no recovery. As mostly a single-speeder over the past few years who relies on going really hard for a few minutes, then recovering and spinning really fast, this was not something my body was used too.

We ran up a short hill to start, and then went for our bikes in a huge pile:

Unfortunately for me, there was another Moots a few bikes down from Green bean's bike. I grabbed the wrong one and proceeded to run for 50 yards to get out of the chaos and then realized I had the wrong bike. So much for a good start!

The first lap was slow and full of crashes. I went down once and got the seatpost twisted and forgot my multi-tool, so rode the rest of the race with a crooked seat. At the end of the first lap, John Rines and I ended up together and rode a steady and fast 2nd lap. I felt OK, but my HR was jacked super high the whole time. I just couldn't seem to relax. At the start of lap 3, I crashed again, dropped my chain, and my Garmin fell down a hill. So, I had to stop and collect myself before getting going again. John was gone. The rest of lap 3, my knee and ankle hurt and I started to get sore from the 2hrs of effort. Before heading back out for lap 4, I pulled the plug and decided to get some ice on my knee and call it a day.

Overall, an awesome weekend, with good friends, the wifey, and an amazing but painful day of singletrack!

3laps for the day:

Bumps: part 4

2011-04-07T04:37:00.000-07:00

The biopsy came back benign.

You'd think after 6 years of living with metastatic cancer in my body, that I'd have more control over my fears. I have to say, this last scare with the new bumps (check out those pictures, you'd be scared too!) rivaled the 2 week period this past summer when I thought I might have brain metastases. I don't think I've become a hypochondriac just yet, but as I wrote, there a certain biological phenomena with respect to the observations we can make on my disease which are ambiguous at the moment, but their interpretation suggests that my cancer is currently, or certainly will get, worse.

For example, this is a plot a protein produced by thyroid cells (Tg=thyroglobulin), which in my body are all cancerous. The amount is an excellent correlate to the amount or activity (how active/growing) of the cancer cells in my body (zero is 'remission'):

2x increase isn't good. However, no one has any idea why it went up. I was treated last January with radiation treatment #5. Going in, I had a ton of hope that the treatment would cure me, or at least come really close. I envisioned throwing a massive party with all my friends and family invited...kegs of beer, bikes, music, a true novel of modern medicine. I had both good rationale reasons to support this and also more romantic ones: First (rational), I had surgery number #3 after the first year of medical school in 2008. They removed 17 nodes and only 4 or 5 had cancer in them. I was then prepared for a radiation treatment by giving me a synthetic form of thyroid stimulating hormone (TSH), which serves to help my cancer cells (yes, I called them 'my', I've completely accepted these as a part of me!) absorb the radioactive compound that I drink. Anyway, this was all being done at John Hopkins (romantic hope) by probably the best and most caring doctor I've ever encountered (again, romantic hope). He had the idea that radiation treatment number 5 should be a big one (rational), so when I say 'preparing' for radiation treatment number 5, something different was happening than any other treatment I have had. Normally, I go off my thyroid hormone for 3 weeks, and my TSH get's really high. I then consume the therapeutic dose of the radioactive iodine and a few days later, lie down for a scan which shows where in my body that radiation has been absorbed and therefore, where I have cancer. We then wait 6 months to a year and see if cells die. Well, in the summer of 2008, my John Hopkins doc had a different idea: they would give me a shot of synthetic TSH in me bum, then a tiny diagnostic dose of the radioactive iodine and over the following few days see how much me pee glowed and how quickly my body dealt with the radiation. That study, called dosimetry, would allow for a calculation of the highest tolerable dose of radioactive iodine. All of that went fine and they figured out my dose to be very high. However, before they gave it to me, I had a full body scan to see where the radiation had been absorbed. Something amazing, hopeful, and wonderful happened: that scan was completely negative! It looked like those 4 lymph nodes they had removed a few weeks earlier could be the source of my stable tumor marker and that over time, it would significantly decrease. It looked like my lungs were free of disease because they didn't take-up any radiation. So, I did not receive my 5th therapeutic dose of radiation in the summer of 2008.

Over the next year, Cassidy was born, med school was amazing, and I started racing my bike again for the first time in awhile. It was awesome. But over time, it became clear that my tumor marker wasn't budging. Bummer. So, we waited.

Fast-forward to fall of 2009. Tumor marker is still stable but elevated. John Hopkins doc suggests that at some point, I'll need that 5th dose so I could either do it now or wait. After almost 5 years of living with this, I was anxious to get cured, so I choose to get the treatment. In January of 2010, I went back to Hopkins and was dosed with a therapetic level of radioactive iodine:

Then we waited a few days. For the post-treatment scan, I was hopeful that it would show very minimal disease. But that's not what happened. Instead, we saw this:

-extensive disease in both lungs, spread throughout all lung fields.
-multiple areas in my neck
-newly developed vertebral metastasis in T5

Shit. Everything changed. Again, I had been walking around for over a year thinking I was nearly cured and that this treatment would do it. That diagnostic scan came back negative...how could that be? What the fuck was happening to my body and why? I had just won the cat 3 state cyclocross championship! What on earth would happened to me now? Bone disease? Really?

That next summer, when the effects of the treatment would first become observable, I went to MD Anderson. I was scanned from head to toe many different times (although, my insurance wouldn't pay for a PET scan or an MRI of my brain) and everything looked the same as it did the prior winter/spring...not much change. The crazy and further dis-heartening thing was that my tumor marker doubled in the interval between the radiation treatment and the following July. Again, if the treatment worked, it should have decreased, not increased. Moreover, it fucking doubled! Not just went up slightly, but fully doubled. And, we didn't know why. A PET would tell us if the cells in my lungs, neck, and vertebrae were more 'active' and a brain scan would tell us if I had new mets in my brain. But, insurance wouldn't pre-cert those studies, so I had to go back to Missouri and wait for 2 weeks with those possibilities floating around my psyche until I could have the scans at Wash U. Luckily, there were no brain mets and the PET scan was unremarkable. So, we are yet to be able to explain why my Tg doubled.

So, I'm definitely take the results of this last biopsy with a great deal of equanimity. Who knows, it could be good or it could be bad.

Not waiting around

2011-04-03T15:20:00.000-07:00

Friday night, Maggie and I went out with some friends and met some new ones for a couple of drinks. Our esteemed Kona rep was one of the new ones. He introduced me to one of the best blogs I've read in awhile: http://www.fastboycycles.com/teachingcancertocry/

Plus, he was a super fun dude with similar taste/choices in reading, bikes, lifestyle, and religion (or lack thereof).

Anyway, when I was in college I read the book Portrait of the Artist as a Young Man. For a really long time, it was my favorite book. One of the things I took away, was the emphasis on making one's life a work of art in-and-of-itself. My older brother Lucas Miller has always embodied that for me...a father and husband who loves what he does:

yet at the same time has honestly grappled with some hard stuff.

The last year has brought me the challenge of frequently struggling with not feeling like my life's purpose is anywhere near completion. I've basically been on plan B from medical school (I'm doing research/PhD work at the moment) and have very mixed feelings about it, but remain convinced that given the state of my health where it stands, the journey is not worth the destination. And, one thing that I'm keenly aware of as a 31-year-old with a family and a disease that will likely one-day kill me, life is all about the journey. I feel off-track and I hate it.

Despite the stress of not knowing the results of the biopsy, this weekend actually ended up being quite excellent. I even got to race my mountain bike for the first time this year and ended up taking third place! That has got to be a good sign, right?

This is the way I feel,
A bit out of place:
and like whatever is going on in my body, I feel full of biological irony:

My weekend finished with me practicing my manicure skills:

New bumps: part 3

2011-04-01T16:00:00.000-07:00

The schedule went something like this:

Wake up, drink coffee, eat, then head to the hospital.

I had the biopsy under ultrasound guidance around 10:30. Basically they stuck 6 needles into each of the two nodes and moved them around a bunch. This was after they numbed me sufficiently with lidocaine. The funny thing was the docs kept asking me yes/no questions while the needles were in my neck, a situation where I'm not supposed to move or talk. Anyway, they got lots of tissue.

Unfortunately we still don't have a definitive answer as to what is going on. But, the absolute great news is that the thing causing the lymph nodes to be big is definitely NOT what I feared most (anaplastic thyroid cancer, aka poorly-differentiated). Again, what I have in these nodes is NOT that. Yeah!!!

Now the weird news:
-If it were the same kind of thyroid cancer as I've had this entire time, they would have been able to tell that easily. But, they couldn't.
-One of the things prominent in the biopsied tissues is a lot of lymphocytes. Some of them are atypical (normal english translation= white blood cells responded to an infection or inflammation). But, there were a lot of lymphocytes and a cancer of the lymphocytes, aka lymphoma, could not be ruled out. That being said, they need to put a bunch of stains on the tissue to see if the cells are all the same (clonal). If so, then I have lymphoma. Then they need to figure out what kind. If not clonal, then I have some kind of weird viral infection with no other obvious symptoms.

But, there still is a chance that this could be inflammation due to my old friend, papillary thyroid cancer...and that those particular cancer cells are in those swollen lymph nodes.

So, more waiting.

New bumps: part 2

2011-03-30T11:32:00.000-07:00

Biopsy is scheduled for friday. One thing we were taught in medical school is; order tests only when the result would affect the 'management', aka treatment, of the patient.

Just so that people are on the same page in terms of the information this biopsy will provide, here's the deal: Given the size and character of these nodes and the fact that they're in my neck (I've have 80-ish lymph nodes plucked out over the course of 3 surgeries and around 60 of them have had cancer in them), it is highly likely (maybe 95-98% certainty) that these two 'new' nodes will have some kind of cancer. The diagnosis I've lived with for the past 6 years, is a thyroid cancer sub-type called papillary. There's a few things important with respect to that subtype; it is typically a disease of females or those exposed to radiation, i.e. Chernobyl. Papillary has an excellent prognosis, however the following features each worsens the prognosis: being male, extensive metastases, poor health, or certain mutations beyond the scope of this post. Unfortunately, we know I have mets in my bone, lungs, and neck. And of course, I'm male.

That all being said, my own hope for this biopsy is for it to come back saying 'well-differentiated papillary thyroid carcinoma'. The other possibilities are considerably less pleasant to think about and the worst would be 'poorly-differentiated thyroid carcinoma'...which carries a very poor prognosis. So, the differentiation status is very important. The other kinds of cancers aren't very likely, but again, I don't believe this biopsy is being performed to ask the question: "Is there cancer?", instead the question is "What kind of cancer is this?".

The last thing I want to say that I've tried to make exceedingly clear in other posts, but some friends still don't seem to pick-up on this: I have never been in remission form thryoid cancer. It has been inside of me since sometime before I was diagnosed in 2005. And honestly, given what has happened in the last year, new bone lesion and increasing blood tumor-marker, I've been waiting for this too happen. Again, the question isn't 'if?' but 'when?'.

In the meantime, today's Wednesday and I've logged 10hrs and 45min on the bike this week. I feel OK, but definitely have very limited race-type fitness as all of my activities have been base-miles, yoga/stretching, and lifting weights.

New bumps

2011-03-28T05:12:00.000-07:00

note: If you ever get cancer and decide to blog about it, don't ever write something on your blog before you tell your parents or spouse. Just trust me on that one...it'll save you some headaches.

On saturday, I was driving and noticed my neck felt a little weird...stiff or something, similar to last fall. Because there are still known lymph nodes with thyroid cancer in my neck, I try not to feel around myself, all it does is provoke anxiety. Sometimes knowledge is not power. But, despite that, I poked around a bit myself and felt these two little buggers (about an inch in front of my scar and just behind my jaw line).

The upper one is the size of an almost and the lower a peanut. Neither are tender, both are firm and relatively immobile. I'd much prefer tender, soft, and mobile as each of those qualities would support a 'reactive process' where white blood cells are mobilizing in my lymph system in order to process antigens from infectious entities. But instead, I'm probably bound for a biopsy later this week.

Of course they're probably thyroid cancer, but because of the amount of radiation I've received since 2005, lymphomas and salivary gland tumors are unfortunate possibilities.

Late March

2011-03-21T05:04:00.000-07:00

The build-up to my wife's headshave reached it's inevitable culmination on saturday night. Cassidy and I were there to support and cheer for what was and is Maggie's journey into the depths of herself...fears, hopes, constructed images, real images, and all. Of course, Cassidy just saw her momma getting a big hair cut. But I knew how deep we have gone with this one.

It is very cool and inspiring being around people doing that internal work that isn't fun or even necessary but always changes us....going deep, as they say.

Saw this quote copied and pasted by Mark Twight, not sure who said it:

I'm racing the dirt bike next sunday and don't have the focus as depicted in the above quote, but I will come May...when the racing get's frequent. After that, the plan is to do the state mtn bike race, take a break, and then start base miles again to get ready for cross next fall/winter.

Sunday was an awesome small-group ride on a regular-old BoCoMo route. Funny that I don't think of this (and I don't think others do either) as having a lot of climbing:

I still say cyclists who rag on Columbia, don't have a clue.

On the health-front, I go back to MD-Anderson in May for a full round of scans and tests. I still have a hard time believing that the course of my disease randomly veered off-the-road to produce a bone metastasis and increased tumor marker while not progressing in other ways. Unfortunately, cancer biology is a logical science despite it's complexities. And it doesn't take a genius to observe a pattern. I'm scared that the down-ward slope will continue in May and that there will be some other indication of shit getting worse. But, that's what meditation, bike rides, red wine, good food, coffee, family, friends, and graduate school are for...providing positivity in uncertain times.

St Baldrick's and bikes

2011-03-13T11:29:00.000-07:00

After cyclocross nationals at Bend this past year, I spent sometime evaluating my relationship with bicycles, bike racing, and my friends surrounding those activities. My intention was to make some changes for 2011 including racing less throughout the year but still focusing on cross. The past few months, I've been riding a bunch but mostly intentionally keeping things very easy, going as far as to ride with a HR monitor to ensure that I'm staying aerobic in my efforts.

For this post, I'm going to try and include all three areas of my target blogging audience:
1. Biochem/science geeks
2. cyclists
3. curious family and people interested in my cancer story

First, aerobic base isn't just something for old-school endurance athletes. Developing a solid base as an endurance athlete basically means that you adapt your body for the metabolic pathways that utilize oxygen, mainly burning fat to fuel cardiac and skeletal muscle at alactic, oxygen rich efforts. No matter how many threshold intervals you do, nothing substitutes for base building in terms of the biochemical mechanism. For cyclists, the best way to do this is to ride at somewhere between 70-75% of max-heart rate (zone 2) for a large percentage of riding volume. Doing this while fasting or while eating a diet pretty high in fat and low in crappy carbs also helps (although this can be debated, I remain pretty convinced that a relatively high-fat diet during base-building is where the money is in terms of aerobic progress).

Anyway, after cross season I decided I'd try and spend as much time as possible in 2011 building base prior to the 2011 cross season. I sold my road bike and told myself I wouldn't race on the road. Instead, I'm logging the miles on this beauty:

(please ignore the naked 2-year-old doing yoga in the background)

The nice thing about base building is that I don't feel as burnt-out and have time to climb a bit, eat well, hang out with the family, and and also to work.

This next week is a pretty big one for the Miller's. My wife Maggie is taking a stand towards something which is almost too-hard for the parents of a two-year-old to think about: childhood cancer.

Before I go on, I must re-iterate what I've said on other occasions of blogging, I really am not a t-shirt wearing, lance-worshiping, support-group kind-of cancer guy. In fact, the more I read mission statements along the lines of 'eradicating cancer from the planet' the more I want to crawl into a hole (what I mean by that, is that from a biological perspective, cancer represents the pinnacle of Darwinian evolution, and I don't think it will be eradicated basically ever). In other words, I often find cancer advocacy fund-raising to be slightly dubious.

Despite all that, I'm proudly standing by my wife next weekend when she takes part in a fundraiser for St Baldrick's foundation. Next saturday, she'll shave her head to raise money and to stand in solidarity with those affected by childhood cancer.

127hrs

2011-03-09T05:38:00.000-08:00

One of my best friends in Columbia has been trying to get me to see 127hrs. It had been high on my list for awhile and I couldn't wait til it finally came out on itunes (when you have a 2 year old and your wife is a med student, netflix and itunes are the lifelines to pop culture).

The story is well known and the while idea is something that both medical and out-doorsy adventurous types talk about all the time: mostly the logistics and the decision. For me, the story was interesting from those perspectives but really hit home as a humanistic story. And for me, the cancer experience is the path by which my qualities and resources as a human being are most challenged.

Living with chronic disease has brought me face to face with many of the same questions in the movie:
-How bad do I want to live?
-What are the consequences of my actions on a daily basis, both with others and within myself with respect to psychology, biochemistry, physiology, and pathology?
-How far will I go to preserve the chance, opportunity, and true gift of my life?

David Brooks wrote a great piece today where he discusses qualities that really help make us more grounded as people. He suggests that the following qualities trump I.Q., professional merit, and academic achievement:

Equipoise: the ability to serenely monitor the movements of one’s own mind and correct for biases and shortcomings.

Metis: the ability to see patterns in the world and derive a gist from complex situations.

Sympathy: the ability to fall into a rhythm with those around you and thrive in groups.

Limerence: This isn’t a talent as much as a motivation. The conscious mind hungers for money and success, but the unconscious mind hungers for those moments of transcendence when the skull line falls away and we are lost in love for another, the challenge of a task or the love of God. Some people seem to experience this drive more powerfully than others.

Attunement: the ability to enter other minds and learn what they have to offer.

Very cool movie and article. Pass them on!

A night for valium

2011-02-28T19:22:00.000-08:00

I haven't written much lately about my own cancer. I guess I'm trying to find a little niche in the blog-o-sphere and am hoping to write more about science-related and cycling-related topics. But sometime, I just need to vent:

There's this little spot on my neck, pretty high up...basically over my larynx, where there is a palpable non-tender, oblong nodule, which is not freely movable. Basically, a lump right on top of my larynx, aka voice box. My doctors know about it and the last 3 neck ultrasounds I've had, they spend a bunch of time taking dimensions. Last time I asked the radiologist if that nodule definitely represented metastatic disease, and they answered yes, but that it has been 'stable'...so nothing to worry about.

That's well and good, except for the fact that it is on top of my larynx. If any one cell in that lump of over 10^10 cells (10^9 in the least number of cells present in a clinically palpable or detectable tumor...and this is bigger than that, so probably a log-scale difference) acquires the ability to overcome senescence and express genes required for invasion of soft-tissue, I'd basically loose my larnyx (to surgery).

Today I was listening to NPR and heard a story about a PhD student from Germany who invented a computer program that assimilates data gathered from cutaneous electrodes placed on the face of someone who is lip-talking...moving their face like they were talking without actually using their voice; and the computer is about 90% accurate at producing a reasonably well sounding voice that speaks the words that the person with the electrodes stuck to their face is mouthing. Crazy. I wonder if I could ride a bike with one of those things?

Anyway, scary stuff. As I wrote about last fall, I do have some pain and stiffness in my neck but other than that, don't have any bone pain or breathing problems. Therefore, my psyche tends to gravitate towards my neck and treak things...making me not trust my body.

When I was a little kid, the one recurring nightmare I had was me fighting in some kind of ancient japanese samari battle...swords, spears, crazy looking body armor, the whole bit. The dream always ended with someone grabbing me and from behind, without me ever seeing who it was or being able to fight back, taking a sword, and slowly slitting my neck. Then I'd wake up.

Man, it has been awhile since I've written this way. Everything I've typed or written lately has been academic. I wish I could do it more often, but honestly I don't really know what to do with this whole blog thing anymore. I'm a but disillusioned with anything related to cancer support groups or advocacy things...and I try pretty hard to live my life without thinking about my own situation. But every once in awhile, stories like the one I heard today on NPR come on, and I freak out. Let's just say that I didn't get much work done today. Instead, I cooked a bunch of food, went to the gym and stretched, washed 4 loads of laundry, and cleaned my bike. Then I drank a bunch of wine, had dinner, and am getting ready to pop some valium before bed. What else can I do?

Will.

2011-02-23T06:42:00.000-08:00

Strong people are harder to kill

2011-02-12T11:11:00.000-08:00

A friend and teacher of mine is a dedicated coach, nutritionist, and writer. He and I have been corresponding about lifestyle choices that help people with cancer and how diet and training play into the equation. My thoughts have definitely evolved over the past year-one year after finding out that thyroid cancer had spread to my bones. These days, I make significantly different choices, then I did in 2009

In 2006, I developed a nasty case of elbow tendonitis that never really went away until about a month ago. In January, I started what I was told was an "anti-inflammatory diet". I was incredulous and skeptical, but after reading lots of biochemistry over the past few years and corresponding with a guy name Mat Lalonde (PhD chemist at Harvard) and Robb Wolff (pretty much the man when it comes to dietary research), I gave it a shot. Chronic inflammation and associated neo-vascularization are extremely important for cancer, so that was another motivating factor to be fastidious with the experiment. Within 30 days, I could rock climb a few times per week for the first time in 5 years. I don't get anything associated with my cancer checked until May, so we'll see if there is any effect. The bad scenario would be progression or growth of tumors while stable disease or improvement would be excellent.

The whole concept of an anti-inflammatory diet is something that I've been interested in, but never really bought into when it comes to the science. Moreover, my attempts at following the recommendations were always de-railed by my skepticism. But after being disciplined and making sure that I'm sleeping enough and training smart, I'm convinced.

As for bike racing (I haven't written much about this lately), I'm going to spend the year taking more camping and mountain biking trips. A few mountain bike races are on my radar, but mostly I'm thinking about and looking forward to cyclocross again next fall. Last year and perhaps every year since I was a teenager, my play/sport/training has had too much emphasis on threshold level training, too much time spent in the anaerobic (or lactate) threshold zone in either cycling, climbing, or running. This year, the plan is to dedicate 8-12 weeks of the year to hard training and racing. The other 40-44 weeks minimizing stress, building strength, and aerobic base is the intention.

In terms of the specifics of healthy eating and cancer, I don't believe in a one-size fits all solution. However, I think there are common principles, the mechanisms of which I can now understand and won't get into here...but to not be elusive about what I mean by an "anti-inflammatory" diet, here's what I think is true:
-Saturated fat is my friend
-Vegetables are my main food group by volume
-Serum vit D concentrations should be in the upper range of normal
-Grass-fed beef and lamb have lots of CLA and an evolutionarily appropriate ratio of n-3 to n-6 fatty acids. CLA is excellent for people with cancer.
-Fructose can be problematic in large amounts, probably best to minimize
-Chronically spiked blood sugar is a huge problem
-Gut irritation can lead to systemic inflammation, don't eat things that irritate your gut (this is more subtle then you'd want). For me, gluten, once removed for 30 days and subsequently re-introduced is indeed a problem.
-Balancing n-3 to n-6 ratio of fats in the diet leads to better overall health and significantly lower levels of inflammation (that's a strong statement, but if I were writing a true academic piece I'd back it up. Right now, I'm just stating what I've learned and my beliefs).

I dare ya

2011-02-01T10:33:00.001-08:00

click

Crossroads

2011-01-15T15:09:00.000-08:00

I posted an academic piece I wrote on cancer biology recently...and despite intentions of transitioning the blog to a more critical look at biology with a sprinkle of my own life, it isn't there yet.

I got a great ride in today. Columbia is really a fantastic place to live. With that in mind, last weekend while Maggie and I were trying to make a final decision about whether we're moving or not, I had a bit of an epiphany: what I do on a daily basis has profound effects on my health and I need to do everything I can to protect my health.

With that said, I'll continue with my PhD and graduate school here at MU. No move. Possibly no MD and no med school for the time being. As crazy as it sounds, but proper sleep, time with family, good nutriton, time spent outside, and riding my bike are something I just won't compromise right now. Returning to medical school in June and then starting a residency in 2 years, too high of a portion of my day will be at work. It isn't that a PhD is any easier, but I can get my stuff done and be serious about it in a confined period of time.

My thoughts on cancer biology

2011-01-07T07:10:00.000-08:00

Cancer is a global challenge. An overwhelming amount of scientific, medical, and social progress has been achieved in the last 30 years with respect to cancer. However, cancer remains a vexing economic, health, and community challenge around the world. It is estimated that 1,529,560 Americans (789,620 men and 739,940 women) will be diagnosed with and 569,490 men and women will die of cancer of all sites in 2010.(1) Indeed, the lifetime risk of being faced with a cancer diagnosis is ~1 out of 2 for every man and women, i.e. 40.77% of men and women born today will be diagnosed with cancer of all sites at some time during their lifetime. On January 1, 2007 there were 11,713,736 living US citizens, 5,353,054 men and 6,360,682 women, who had a history of cancer of any site.1 Globally, the statistics are staggering. It is estimated that 12.9 million new cancer cases were diagnosed in 2009 and this number is expected to rise to 16.8 million by 2020.(3) It is the second leading cause of death and disability both in the US and worldwide.
The global burden of cancer, based on the incidence of new cases and deaths, has doubled within the last 30 years.2 The costs associated with this burden include medical spending such as costs of diagnosis, in-patient treatment and care, and out-patient treatment, in addition to productivity losses such as lost income due to cancer morbidity associated with new cancer cases. The worldwide cancer costs, excluding research expenditures have been estimated to be at least $286 billion in 2009 alone.(3) That sum does not include the topic of this document; the amount spent on cancer research, which totals at least $19 billion worldwide.(3) Lastly, it should be emphasized that although the disease is indiscriminate with respect to socio-economic boundaries, the global funding for cancer research is almost entirely accounted for by developed nations.

The infrastructure of the scientific and research communities of the US and the personel have contributed immensely to our current understanding of cancer biology.

This post will follow an outline format to provide an overview of the following:
I. Our understanding of cancer biology in 2010
II. Major accomplishments of academic, biotechnology, and pharmaceutical research on cancer
III. Remaining problems for scientists and physicians working in cancer biology
IV. Specific areas of high priority research
V. Concluding remarks and overall progress report

I . Cancer is the common term for all malignant tumors. There are >100 types of cancer, each classified according to the types of cells from which they develop. We understand cancer to be an abnormal mass of tissue, compromised of cells, the growth of which exceeds and is uncoordinated with that of the normal tissues.4 Most affect solid tissues, but some such as leukemias and lymphomas can be distributed throughout the circulatory system.
The mechanism of disease is incredibly complex and not fully understood. The growth of cancers is often described as occurring without restraint because of, when left to their own natural history, the ability to colonize and invade foreign tissues. This persistence of growth and inability to undergo normal processes of restraint results from somatic genes (although occasional germline mutations are present) inside the tumor cells that are heritable elements passed down to the progeny of the tumor cells. Often, the genes of tumor cells are in fact the driving force that allows for autonomous, excessive, and unregulated growth. Despite the knowledge that cancer is a genetic disease, we also know that only a minority of cancer syndromes are heritable.
Fundamental to cancer biology is the notion that the entire population of cells forming a tumor arises from a microevolutionary process whereby a single cell experiences an initial insult, often genetic damage acquired by the action of environmental agents, such as chemicals, radiation, or viruses, or inherited in the germ line. This damage leads to dysregulation of the cellular machinery controlling replication, the integrity or fidelity of the genomes, adherence to surrounding cells, and the biochemical/physical communication with the organism at large. This event is termed transformation.(5, 6)

The progeny of the transformed cell has the same or similar alterations and therefore are known to be clonal.11 As tumors grow, local invasion of a tissue can occur. In a process that is now understood to be multi-step, as time passes (depending on the context the scale ranges from days to up to years or decades), tumor progression occurs where further alterations and mutations accumulate and may lead to the ability of some cells within the tumor to enter into the circulatory system and eventually invade distant areas of the body, i.e. metastasize. This process is the subject of intense scientific scrutiny. And there is substantial evidence to support that there are steps leading to the phenomena of metastasis and that these steps reflect accumulating genetic alterations.7, 8, 9, 10 In other words, the temporal progression of a cell from a normal differentiated epithelial cell to a life threatening carcinoma requires multiple and successive mutations and/or alterations working under the selective pressures of a permissive microenvironment, each of which conferring growth advantage and laying the foundation for metastatic potential.16
Metastatic cancer represents the major cause of cancer-related morbidity and mortality. Metastatic disease can be thought of as monoclonal, because at any point in time, one sick cell gave rise to all subsequent cells, in addition to being heterogeneous, because progeny cells can undergo further alterations. This is to say that cancer is a disease with dynamic changes to its genome and behavior, and that each case of cancer is characterized by its own array of genetic lesions, e.g. recently completed genome-wide sequencing analysis of breast and colon cancers has revealed that individual tumors accumulate an average of 90 mutant genes.10
To summarize the above, the behavior of malignant tumors can be divided into four phases: (1) transformation; (2) local growth; (3) local invasion; and (4) distant metastases. Each of these phases is now better understood because of rigorous study in multiple fields of scientific inquiry at the level of molecular mechanisms. This growing understanding holds incredible promise for the future in reducing disease burden and mortality from cancer because the scientific body of knowledge is the source upon which medical advances are drawn. Indeed, the rational design of drugs and treatment of cancer at all levels, including diagnosis, surgery, chemotherapy, radiation, recovery, and remission demands an understanding of the properties that cancer cells acquire as they grow, evolve, and spread.

II. The major accomplishments in cancer research include the discovery of the critical genes involved in cancer and the development of effective treatment strategies for some patients with metastatic disease. Both of these broad categories of advancement were made possible by the inquiry into the molecular basis of cancer cell behavior, i.e. cellular and molecular biology and the tools that those fields of study have developed. The technologic progress accomplished in these fields is massive. To name a few; we can now amplify, copy, and read gene sequences in a matter of hours with incredible fidelity; We can query proteins expressed by cells accurately and with confidence; Cells can be sorted on the basis of specific expression markers; human cell lines can be used to test drug efficacy; and many other revolutionary technologies. Through the techniques of molecular biology, in the 1970s, scientists became aware of two families of genes that are predominately involved in transformation:
(1) Oncogenes, which are genes involved in growth and when mutated or altered cause normal cells to proliferate. No single oncogene can fully transform cells in vitro, but cells can be transformed by combinations of oncogenes. Such cooperation is required because each oncogene is specialized to induce part of the phenotype necessary for full transformation.7
(2) Tumor suppressor genes, which are regulatory elements within cells to oversee and coordinate cell division, repair mistakes in DNA replication, and to initiate programmed cell death or apoptosis if needed. We now know that the emergence of malignant tumors requires mutational loss of many genes, including those that regulate apoptosis and senescence.8
We also now know DNA repair genes can be mutated but do not directly transform cells by affecting proliferation or apoptosis. Instead, they affect cell proliferation or survival indirectly by influencing the ability of the organism to repair nonlethal damage in other genes.14, 15 Additionally, a new class of regulatory molecules, called microRNAs has recently been discovered. Although they do not encode proteins, different families have been shown to act as either oncogenes or tumor suppressors.12, 13
Another area of accomplishment, made possible by cell cultures is the discovery that mutations that cause cancer are often induced by carcinogens acting as mutagens. The mechanism can vary from viral insertional mutagenesis (about 1/5 of the worlds cancers are caused by viruses), to carcinogenic chemicals causing DNA adducts, and ionizing radiation acting to induce breaks in DNA strands.
The model that has been produced from research proposes a set of rules, including 6 hallmarks listed below, helping us understand how cancer cells differ from normal. This knowledge can lead to targeting therapies, such as the development of Gleevec to treat the specific oncogenic event in chronic myelogenous leukemia.17 These physiologic changes of cancer cells include:6, 9
• Self-sufficient growth signals or constitutively activated growth factor signaling.7, 9, 18, 19
• Resistance to anti-growth signals or inactivated cell cycle checkpoint20, 21
• Immortality or limitless replicative potential22, 23
• Resistance to cell death via activated anti-cell death signaling24, 25, 26
• Sustained angiogenesis via activated VEGF signalling27, 28
• Tissue invasion and metastasis by multiple mechanisms including loss of cell-to-cell interactions29

III. The principles above provide a foundation of strength in moving forward and working on cures for various cancers. However, a major challenge stems from the diversity of the >100 cancers known and because of this diversity, progress in the clinic has been slow. Although there are unifying principles, there will almost certainly never be a single cure. The spectrum of cellular pathophysiology is too broad. Moreover, as living cells with remarkable growth advantage, the microevolutionary process creates a difficult problem, e.g. a patient with breast cancer can have their original tumor tested for a specific oncogenic aberration and can be found to be negative in their primary tumor but positive in a distant metastasis. The current targeted drug for this mutation is also known to make the disease worse in people who lack the mutation, so what should be done in that scenario? It is also known that tumors can become treatment resistant and that even some of the new targeted agents such as VEGF inhibitors, over time, select for even more aggressive disease.
Cancer is indeed a terrible disease and although there have been successes with hematologic malignancies (especially amongst children) and germ cell tumors, many carcinomas are still very difficult to treat. The oncology literature generally proclaims statistical victories with P<.05 despite only weeks of survival gains. Indeed, it has been said that the clinical research efficacy bar is currently set too low, therefore hindering progress and that the “objectives, methods, and regulation of clinical trials need to change so that we can rapidly move drugs from the lab into the clinic, and then define those drugs that are effective and those patients who are most likely to benefit”.30
IV. Future areas of research ought to lead to substantial improvements in patient care and be conducted with that purpose in mind. Although many unanswered biological questions remain and represent missing links in a comprehensive understanding, with limited funding, the eventual contribution to patient care should at least be considered in deciding which questions to pursue. Promising areas include:
• Using viruses to treat cancer
• Gene therapy
• Helping the bodies immune system destroy cancer cells
• Designing drugs that target malignant cells
• Starving tumors of their blood supply and taking advantage of cancers’ altered metabolism
• Improving diagnostic tests
• Improving/reducing costs of care
• Helping the developing world with their cancer burden

V. Despite the complexities involved in understanding cancer, there is a concept amongst the experts of the cancer biology community, that cancer research is a logical science, “where the complexities of the disease, described in the laboratory and clinic, will become understandable in terms of a small number of underlying principles”.6 There is a notion that various aspects of tumor biology, although diverse and complex in scope, are supported in the literature to be “acquired capabilities-shared by most and perhaps all types of human cancer”.6 This guiding principle is the conclusion drawn from the observations made by the field of cellular biology and indeed fundamental to biology itself, that virtually all mammalian cells share similar processes and machinery which regulates proliferation, death, and differentiation.6

Figure references:
Table page 1- Reference #3
Figure 1, 2, 3- Reference #5
Table page 5- Reference #30

Text References:
1. Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Cronin K, Chen HS, Feuer EJ, Stinchcomb DG, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2007, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2007/ based on November 2009 SEER data submission, posted to the SEER web site, 2010.
2. Boyle P, Levin B (eds.) World Cancer Report 2008, Lyon: International Agency for Research on Cancer. 2008.
3. The Economist. “Breakaway: The Global Burden of Cancer-challenges and opportunities”, a report from the Economist Intelligence Unit 2009. Sponsored by LiveStrong. http://www.livestrong.org/What-We-Do/Our-Approach/Reports-Findings/Economic-Impact-Report
4. Willis R: The Spread of Tumors in the Human Body, London, Butterworth, 1952.
5. Kumar et al. Robbins Pathological basis of Disease. 7th Edition. Elsevier Saunders
6. Weinberg RA, Hanahan D: The hallmarks of cancer. Cell 2000; 100:57.
7. Halazonetis TD, et al: An oncogene-induced DNA damage model for cancer. Science 2008; 319:1352.
8. Knudson A: Two genetic hits (more or less) to cancer. Nat Rev Cancer 2001; 1:157.
9. Hahn W, Weinberg R: Rules for making human tumor cells. N Engl J Med 2002; 347:1593.
10. Wood LD, et al: The genomic landscapes of human breast and colorectal cancers. Science 2007; 318(5853):1108.
11. Gale RE: Evaluation of clonality in myeloid stem-cell disorders. Semin Hematol 1999; 36:361.
12. Zhang W, et al: MicroRNAs in tumorigenesis: a primer. Am J Pathol 2007; 171:728
13. Rana TM: Illuminating the silence: understanding the structure and function of small RNAs. Nat Rev Mol Cell Biol 2007; 8:23.
14. Jiricny J, Marra G: DNA repair defects in colon cancer. Curr Opin Genet Dev 2003; 13:61.
15. Friedberg EC: How nucleotide excision repair protects against cancer. Nat Rev Cancer 2001; 1:22.
16. Loeb LA, et al: Multiple mutations and cancer. Proc Natl Acad Sci U S A 2003; 100:776.
17. Kurzrock R, et al: Philadelphia chromosome-positive leukemias: from basic mechanisms to molecular therapeutics. Ann Intern Med 2003; 138:819.
18. Sharma SV, Settleman J: Oncogene addiction: setting the stage for molecularly targeted cancer therapy. Genes and Development 2007; 21:3214.
19. Polakis P: The many ways of Wnt in cancer. Curr Opin Genet Dev 2007; 17:45.
20. Kastan MB, Bartek J: Cell cycle checkpoints and cancer. Nature 2004; 432:316.
21. Sherr CJ, McCormick F: The RB and p53 pathways in cancer. Cancer Cell 2002; 2:103.
22. Deng Y, et al: Telomere dysfunction and tumor suppression: the senescence connection. Nature Rev. Cancer 2008; 8:450.
23. Sharpless N, DePinho R: Telomeres, stem cells, senescence, and cancer. J Clin Invest 2004; 113:160.
24. Danial NN, Korsmeyer SJ: Cell death: critical control points. Cell 2004; 116:205.
25. Korsmeyer SJ: Programmed cell death and the regulation of homeostasis. Harvey Lect 1999; 95:21.
26. Igney FH, Krammer PH: Death and anti-death: tumour resistance to apoptosis. Nat Rev Cancer 2002; 2:277.
27. Nagy J, et al: VEGF-A and the induction of pathological angiogenesis. Annu Rev Pathol 2007; 2:251.
28. Bergers G, Benjamin L: Tumorigenesis and the angiogenic switch. Nat Rev Cancer 2003; 3:401.
29. Fidler IJ: The pathogenesis of cancer metastasis: the “seed and soil” hypothesis revisited. Nat Rev Cancer 2003; 3:453.
30. Stewart DJ, Kurzrock R.Cancer: The Road to Amiens. J Clin Oncol. 2009 Jan 20;27(3):328-33.

o ¡por fin!

2010-12-30T11:27:00.000-08:00

I'm really glad this year is over.

We still haven't made a final decision regarding accompanying my mentor to Notre Dame, but at this point we're leaning towards staying in Columbia. The unfortunate consequence of that decision is that I'll probably discontinue my graduate school (abandon the PhD) and head back to finish med school...which although that won't be good for competitive cycling, I'm actually super motivated to get back to medicine!

I just read my friend's blog about his awesome accomplishments in bike racing this year and felt like writing my own version of a 2010 reflection. However as I sat down, I don't think I have enough to say about bike racing to write much. I had 2 goals for racing: 1. To win a bubba A race and 2. Top 5 in the state race

Other than that, here is a year in pictures:

Next year, more camping and more mountain biking are my goals. The end. Thanks for reading.

Huge life decision ahead and winter training

2010-12-22T05:34:00.000-08:00

After returning from Oregon, my PhD mentor with whom I've worked for this last year sat me down and told me that she got an incredible job offer as the director of a new cancer research institute at Notre Dame.

Now, the question of British punk band The Clash is on our mind.

There are lots of incredible career advancing and debt reliving benefits to accompanying her. But, it ain't so bad around here either. Anyway, big decision.

In terms of winter time and physical activity, I always hit the weight room this time of year. When I played Lacrosse in college, I learned how to squat, deadlift, press, and clean and IMHO those are about all you need in terms of lifting weight. One thing I learned early, is that even if I'm eating 4000-6000cal/day, I don't build ridiculous amounts of muscle...I just get stronger. Which for a power-endurance athlete is great.

Over the last year I have gotten much better at assessing weaknesses and understanding what I need to do to correct them. In general, I find that the key to a cyclist's lifting program is mobilizing the tissues which limit range of motion, e.g. hips (mostly stretching flexors and strengthening/activating extensors and rotators), ankles, and shoulders.

My sessions consists of about 10 minutes of foam rolling and digging into any tight areas with a lacrosse ball...see here. Then some dynamic exercises like high knee walks, lunging around, push-ups, etc. Next lifting. Right now my goal is to strengthen just about everything and stretch/mobilize the hell out of my hip flexors and quads.

My plan is 6-8 weeks of a 4 day per week split. 2 days will be 'full-body' days, one dedicated upper body, and one lower body only. Here's a sample for those that care:
Full day 1:
A) Front Squat for Speed: 6x2 at 60-70% of 1RM, 45s rest between sets
B) Stiff leg romanian deadlift: 3x10/side, 40X0 tempo (time for: eccentric, bottom, concentric, top)
C1) Alternating Low Incline DB Bench Press: 3x6/side, 31X4
C2) Chest-Supported Row, Pronated Grip: 4x6, 40X0

Lower Day:
A) Snatch-Grip Deadlift on Podium- Initially perform 10 sets of 3 reps on a 50X0 tempo, resting 3 minutes between sets. Keep the weight constant until able to perform 10 sets of 5 reps; then add 5 to 10 kilos (11 to 22 pounds) to the bar so back to 10 sets of 3.
B) Barbell Reverse Lunge — Front Squat Grip: 3x8/side
C1) Pallof Press Isometric Hold: 3x3/side (10s hold at lockout)
C2) Glute-Ham Raise (un-assisted: 3x8

Upper:
A1) Bench Press: 5x5
A2) Neutral Grip Pull-up: 5x3
B1) 1-arm DB Push Press: 3x8/side
B2) Seated Cable Row — Neutral Grip: 3x8
C1) Ab Wheel Rollout: 3x8
C2) Side-Lying External Rotation: 3x10/side

Full:
A1) Back Squat: 4x6 (form just like that video, but slower eccentrics)
A2) Feet-Elevated Push-up: 3x12
B1) Standing 1-arm Cable Row: 3x12/side
B2) Walking DB Lunge: 3x6/side
C1) Landmines: 3x5/side
C2) Supine No Money w/Band: 3x4 (10s hold on each rep)
D) Farmer's Walk: 3x40yds

Since the role of abs/core in cycling is stabilization this program emphasizes that. Actually, I challenge you to find any sport or real life activity in which a crunch or sit-up actually leads to better performance. The anti-rotational and stabilization function of the 'core' absolutely trumps trunk flexion for injury prevention, low-back health, and performance.

Bend and Cross nationals

2010-12-12T07:02:00.000-08:00

A lot of time, money, and energy has been spent to get me and my wife to Bend, OR along with our friends Matt and Lizz James. When we first started talking about the trip back in August, we've gone back-and-forth about the affordability, feasibility, and utilitarian aspects of this undertaking. With a 2-year-old at home, a limited budget, demanding jobs, and having already spent a few months with bicycle racing dominating virtually every weekend from Sep-Dec, there were many reasons not to make this trip.

In September and October, it looked like it wasn't a good idea to make the trip. It would be too much to fly and then ship bikes, then requiring a rental car big enough to transport the bikes. Leaving out daughter also seemed like a terrible idea since she is every bit of a 'needy' 2-year-old right now (not sure if needy is the right word, but if you have kids or know many 2 year olds, you probably know what I mean).

Slowly however, we began coming up with solutions.
-First and foremost, grandparents offered to take time off work and come to our house too keep our daughter on her own turf. Unbelievably kind. Best christmas/bday present to us ever!
-Maggie and I got to use her parents frequent flyer miles for our plane tickets, again, an incredible bday/xmas present. Thank you SO much.
-We'd find the cheapest rental house possible and split it with Matt and Lizz. We can cook, do laundry, and relax in our own space!
-Bikes would be provided for us by the Specialized demo truck! These were full sram force equipped Cruxes with Zipp 303s and Dugast Rhino tubulars! All, because Specialized is an amazing company with a ton of great people working for them.
-Because we'd have bikes waiting for us, we could split a cheaper and smaller rental car with Matt and Lizz! Amazors!

The lingering issue was the question Maggie and I had about the trips' selfishness with respect to our family and our jobs. Was it worth it? Should we devote so much time and energy to a weekend away at a huge bike race? I'm not a pro cyclist and have no intentions of ever being one. The chance of doing well in the race was realistically the chance of a top-20 finish in the Master's 30-34 category. If we're going to take a vacation, why not just a cozy weekend away at a B&B in Missouri?

At this point, the cyclocross aspects of the trip have made every ounce of energy poured into bike racing completely worth it. The race is over and now it is time to just enjoy this incredible state and town of Bend.

The race yesterday was unreal. Matt and I started in the 5th and 4th rows respectively and both battled our way to middle of the pack finishes (41st and 31st place out of 74 racers) and easily had one of the coolest cycling experiences I've ever had. There were 6in deep water puddles, long quick-sand mud sections, a drum core marching band, hundreds of cheering fans, tons of cow bell, and every person I raced with seemed to be very positive about it.

Plus, our biggest fans were there to support us and put up with our silly passion for riding curly bar road bikes around a small loop in the grass, cold, rain/snow, and mud. My stress level right now is zero. In my own crazy mind, that makes me better as a husband, father, scientist, and person.

MO state champs! Cat 1/2!

2010-12-07T17:16:00.000-08:00

A year ago in Herman, Matt James and I crossed the line in the cat 3 race second and first respectively. This year, the race was in the birth place of Charlie Parker, home of Arthur Bryants, and after reading on wikipedia, apparently a large enclave of Irish Americans...KC, MO. Although we were only a stones throw away from Kansas, it was still the MO state championship.

I didn't know what to expect going into the race and was a bit disappointed that half of the KC cat1/2 field wasn't in attendance. Devin was sick, Jeff Yielding had already raced (and won) earlier, and Schottler resting. Plus, the race was on saturday so many folks, had to work. So it left Josh and I battling for the jersey. In addition, Andrew Coe was in attendance and proved to be a very worthy competitor as he pretty much crushed everyone there.

The race went something like this:
-1/2 lap in, Josh was at the front and I was on his wheel. Coming into the first set of barriers, there was a sidewalk crossing and unfortunately I slipped and scraped my knee pretty good but managed to recover and chase back onto Josh's wheel.

-Josh fell in the sandpit, just like in October ;) I passed and soon it was Andrew and me at the front. I haven't ridden with such a strong rider this year. He was attacking out of every corner and really riding well. A week ago, I think I could have ridden with him longer but this week, I just didn't feel on. It was a struggle and the hurt began early.

-After a few laps, I smacked the back of my knee with my pedal coming out of the sand and Andrew was gone. I hobbled around until Josh caught me and then tried to recover on his wheel for a few laps.

You can actually see the blood soaking through my right knee warmer here along with a cut on my shin. At this point, I'm not exactly sure what happened. Josh is my friend and I have a ton of respect for him but for some reason he and I have a hard time communicating non-verbally. I wasn't sure if we were working together to bring back Andrew or if he was trying to shake me off his wheel. All I knew was that I was hurting and wished my legs felt like the week before.

With 2 to go, Josh yelled at me to pull. So, I put in a big effort to try and catch Andrew. I guess my adrenaline got the best of me and I rode myself into a hole. With 1 to go, Josh came around me and I just couldn't match his pace. It was painful watching him ride away. Especially given the crappy week that preceded the race (had to travel to Houston to get another bump on my neck looked at).

This week I've come down with a nasty cold and am really hoping to feel better before leaving for Bend on Thursday. Maggie, Matt James, and his wife Lizz are coming with. Cassidy is staying with GaGa...very nervous about leaving her for so long, but we're also really looking forward to the trip.

Congrats to Andrew, Josh, Jeff Yielding, and as always T-tocs and storm for some impressive races and superior attitudes and states of mind.

Last bubba and what I learned this year in CX

2010-11-28T19:05:00.000-08:00

This weekend's race was a flat venue, with the potential for some mud. I was a bit nervous about being in good standing in the series and tried not to think about the point situation. Competition is fun for me, but in the end it is just about a healthy race environment and keeping perspective on things.

Last week I managed to get the week off from school/research and so spent it in St Louis with just Cassidy (my 2 year old) and me hanging out with the grandparents.
It was really what I needed to be away from cancer biology for a week. We did normal stuff like cook, go to the zoo, coffee shop, playground, and of course I found some time to ride. Specifically, Tuesday was an easy 2hr mtn bike ride at Castlewood with my good buddy Matt James and Justin Neely. Wednesday, the weather was rainy and upper-30s. Really quite miserable for biking. But over the past season I didn't do much structured training with the exception of wednesday's in November...which were 2min, 1min, or 30sec intervals each until I felt like I was loosing it a bit. My goal was to increase the number of intervals each week and land at 6 of each (6x2min, 6x1min, 6x:30). On wednesday, I went out in the morning and got drenched and cold, finishing only a few of the 2 min intervals. So, I went and got a rain jacket/change of clothes only to head back out for the remainder of the workout.

It is for that reason that I've decided that 'training' isn't how I want to approach bike riding and racing. I'm too intense about it. Too much of a type-A personality. Too scientific. I've always used movement/exercise as a kind of escape and work hard at whatever it is, but over the past year I've learned a ton from riding my bike and find that I'm a lot happier just riding as opposed to training. Sunday morning I woke feeling great despite having done some serious beer drinking the night before (and all the preceding evenings the entire week).

During the race I was glad to have a little ring (39t), as I spent the majority of the race trying to keep my cadence and pace high. Devin, Jeff, and I got a gap early and I ended up going off the front for about 6 laps to take the win.
Race started out like this:

Honestly it feels kind-of crazy as I didn't expect to do as well as I have during the bubba series. I guess I just didn't have any expectations for myself and I came in with a solid base of road riding from last winter/spring, some short track mtn bike racing in July, then nothing but the weight room during August and most of September. I'm convinced that the weight room and time off the bike has been a tremendous benefit to this cross season. A little bit ironic that I say I don't train, but still lift I suppose. I think lifting heavy things is a part of our ancestral-past and helps keep us healthy. If I had to design a longevity exercise routine, it'd consist of lifting 2-4 days per week, one or two hard 'interval' type days at whatever modality enjoyable, and then 1-2 long meandering type days (endurance riding, long hikes, long walks, etc).

Every other year for cross, I didn't have time to do long rides whereas this year, every Tuesday I managed gravel loop before work (~3hrs). More than anything else, I rode this year because I loved it and found so much peace of mind, especially on my Tuesday long rides (Josh Johnson actually encouraged me to sell the power meter and ride in this way). Wednesday's were cross practice or intervals in November. Thursday was either rest or an easy ride, then race as much as possible as long as it is fun.

Gratitude

2010-11-26T12:17:00.000-08:00

This past week has been a good reminder of why I'm happy to be doing what I'm doing.

There are a couple of swollen lymph nodes in my neck, which have been making it a little hard to swallow and have been giving me some discomfort. In combination with the increase in my thyroglobulin, it has been very hard to remain focused on my research. With all of that said, after the race last sunday, I decided to stay in St Louis with Cassidy while Maggie went back to Columbia to work until Wednesday. It has been really nice to spend some days off with her doing totally normal but exceptional stuff; the zoo, playing dollhouse, eating waffles, and hanging out at the playground.

2 of the days I wanted to ride this week were drowned in rain and cold but given my neck symptoms, I really needed the psychological space created by being out on my bike regardless of the weather. Sometimes I wish I could still rock climb, because the climbing gym would have been a much more hospitable environment to spend a few hours tweaking my body and getting my heart pumping...but the elbows scream at me every time I try to climb so it is rarely worth it. Biking just feels too good.

I also had some time to think about the Pedal the Cause ride that I was involved with last October. The donations from that ride were recently presented to Wash U/Barnes/Children's hospital of St Louis and totaled 1 million dollars. What an amazing contribution for the first year! Moreover, having written a few grants this past year I feel like that money will truly fund positive research.

This has been a week where the things I'm grateful for are at the forefront.

Mt Pleasant: Bubba #9

2010-11-22T05:20:00.000-08:00

Pride Inc, Alton Illi-noise on saturday:

Mt Pleasant, Bubba #9 on Sunday:

It had been a year since my first top 5 result in the bubba race, which had happened at Mt Pleasant. Now, I find myself in the hot seat (leading the series?!) with one regular bubba to go, the state championship on Dec 4th, then nationals!

Bubba #7 and 8

2010-11-14T19:14:00.000-08:00

I really don't know anymore how to begin a race report on a pulp blog such as this, which is increasingly aimed to be more about my experience as a young adult with cancer and less about pedaling a bicycle in a race. Certainly the former deserves more attention and psychological work than the latter, especially given that I pretty much only do the latter to help with the former.

As I wrote last week, Maggie and I feel strongly that things will soon be changing in our lives. I'll see my doctor at MD Anderson on Jan 3rd and think it likely that I'll need more treatment. From the perspective of thyroid cancer, it has been clear for the last year that things are getting worse and it now looks like the radiation treatment last January acted as Darwinian selective mechanism for a population of cells which are no longer responsive to TSH suppression (english translation: continue to grow despite the thyroid hormone pill which I take on a daily basis, which in theory keeps them from growing). Just to put it into perspective, at no point before last week did we ever talk about me dieing (is that spelled right?) within the next 5 years. It just wasn't possible. Not a part of our reality. Now it may be and we actually talk about financial, social, and very practical implications of that.

Of course, I still feel quite healthy and am in better shape than I ever was for college sports, climbing, or anything else. Given the amount of time I trained in college for cross country, LaCrosse, climbing, and mountain biking it seems amazing that now that I'm 30 almost 31 with a family and a very real life, that somehow I get more out of doing less.

This article touches on so much that I've been thinking about and obviously living in the past year. My pedal the cause team was actually named after the First Descents organization and if you buy any of the bubba merchandise a portion of the proceeds will go towards helping this wonderful charity (thanks Mike Weiss!). Please read the article for more about First Descents.

On to the weekend racing:

This weekend=two pretty epic battles with Josh, eating and drinking (too much) with a bunch of friends saturday night, and mind over thyroid cancer.

When I was in college, a really good friend of mine taught me the art of making a really good music mix. The transition from song to song and the overall emotional ambiance created by sitting down to listen to everysong on the album was the guiding principle of making another person's art into your own....kind-of like DJ'ing I suppose. Anyway, I was thinking today that a musical mix of Sunday's bubba race would probably rank amongst the greatest mixes of all time (that was hyperbole in case you couldn't tell).

Saturday's race was on a very diverse course with a little bit of everything thrown in. The huge sweeping turns and the road section leading to the stair run-up were my favorite. I ended up second after not being able to ride with Josh up a long and technical off-camber climb during the penultimate lap. He got about a 5-10s gap and held it to the line. As someone who has been mountain biking since the 7th grade, my background in cross country running in college and bicycle messaging in Boulder/Denver after college created a great background for the pursuit of cyclocross 3 years ago. But, I never thought I’d be saying that I like the road section the most! I guess that is what living in Columbia, MO has done to me!

Sunday was the race that needs a soundtrack. It would probably begin with an intense song, which sucks you in and gets your attention, because for the first time in my 3 year St Louis cyclocross memory, Josh took the holeshot! I wasn't about to watch him ride away, so I jumped on his wheel and the pain began very early in the 9 lap race. Maybe the them song for Pirate of the Caribbean would be appropriate to begin?
He's stronger and smoother than me on techy turns but I can climb better. We're very evenly matched at the moment in terms of straightaway threshold power so because the course had a nice balance of all of the above, neither of us were able to drop the other. And we both tried like hell and made it very hard on the other.

Bubba number 6

2010-11-08T16:41:00.000-08:00

I think November is having an identity crisis, isn't it supposed to be cold now?

Fun day at Queeny last sunday. Maggie raced again but was intimidated by the plethora of single-track mountain-bikey goodness and the 90s-2min hill climb at the end of the lap...all of which, got me psyched!

I'll defer to my buddy Jeff Yieldings description here for the first part of the race. Devin and I were on the verge of attacking when Devin bobbled in front of me on one section and Josh attacked and got a gap. I chased back on using the big hill at the end of the lap, this was with 4-to-go. Then I tried to recover for a lap (it was only a 5minute lap). Then I held Josh's wheel for another lap and fought the ridiculously steady JDE (Johnson Diesel Engine)....then attacked on the hill with 2 to go. I couldn't drop him. Then on the last lap, I attacked again on the barriers and got in front. I then cruise controlled it to the hill and attacked. I couldn't ride away, which left the uphill finish where I gave it my all and ended up with a win.

In other news, I posted a few weeks ago about the certain ambiguity in which my family and I have been living with over the past year. Recall that the story goes like this:
January 2010- radiation treatment which takes about a year to have an affect
July 2010- blood test showed that my tumor marker went up, uncertain about the validity of the test

Now in November 2010, the actual trend of my tumor marker looks as though it has gone up about 60% in a year. What's that mean? What is my tumor marker? How accurate is it? Well, I used to think I could answer those questions but now I really don't know. In July, it seemed as though the rise of my thyroglobuilin, aka tumor marker, was in contrast to all the scans I had which revealed stable or improved disease status (present in vertebrae, lungs, and neck). The blood test is supposed to be very accurate for increases or decreases in the size or amount of cancer in my body, so the knee jerk reaction is to scan me head-to-toe again to and compare with other pictures. Right now, I'm told to not worry too much about it and live my life normally over the next 2 months until I see my doctor on January 3rd at MD Anderson.

It is so incredibly hard too not attribute some kind of behavior or lifestyle trait to this change. But I'm no more or less active than I have been in the past 5 years. Stress-wise, my life is abound in it but is it contributing to the change? Basic science research is hard. I don't feel like I'm making significant contributions to society, etc. Is it the coffee? Adrenal fatigue? Too much protein? Fat? Carbohydrate? Beer? Bike riding? Pesticides? Bike racing? Is it some household cleaner we're using or laundry detergent? Maybe my renal or hepatic function has changed and I'm actually clearing the thyroglobulin at a slower rate? Maybe antibodies were masking it this entire time and we've had falsely low test values over the past few years? Maybe the test is like PSA and not as reliable as we thought. Fuck, I have no idea what I should do. More surgery and probably a fancy new chemo drug (like this) is probably in my future. At least for my cycling life there's this possible side effect.

November already!

2010-11-01T11:20:00.000-07:00

Times flies. Maggie left for work early monday morning and texted me around 7:45 asking me to bring some chain lube and a water bottle so she can ride after work (after 2 weekends of 2 day racing!). I think the conversion is near completion...she's a bike geek.

Racing is serving as a wonderful distraction this fall. I've been riding more than I have any other fall and given this amazing weather, it has really felt great. I've tried to do one day of hard riding during the week (usually Wednesday) then just ride for run, peace-of-mind, etc on other days.

This past weekend was Bubba #4 and 5 CX races at Creve Coeur lake park in St Louis. Racing there is particularly meaningful for me because a good friend of mine, who I've written about before, Jason Brightfield, helped organize a cancer charity walk there a few years ago (about 1.5 years before he died). I think of Jason a lot and although I'm not a believer in an afterlife, sometimes I catch myself having a 'mental cigarette' with him. Anyway, those thoughts set the stage for a weekend of racing that ended up being a ton of fun.

Saturday night was weird. Besides the 10pm start, which is at least an hour after my bedtime, I somehow found myself chasing an ex-local named Sam off the start line at a start pace which was both silly and atypical for bubba races. I found myself off the front pretty early and decided not to race smart but to race hard...so I gave it a go for a few laps, knowing that the inevitable swallow would come. Looking back, I don't regret it at all. After a few laps, I got caught and settled into the group to recover. I was feeling OK and still smooth on the bike but responded too aggressively after Jay rode past me in the sand. I tried to match his pace and I bobbled the little berm run-up exiting the sand pit. Somehow I managed to endo and bend my brake cable over itself in my front canti. It took a minute to get going again and even then I couldn't seem to get rid of the rubbing. I chased for the next few laps and came across the line in 6th, tired but satisfied.

Maggie raced great and will probably start her own racing blog soon with a huge list of sponsors ;) It was cool to see so many women come out to race. Given the somewhat more meager A-race turnout, it is good to see signs of growth in cyclocross. I think it is funny I've only been doing this 3 years and I'm already blabbing about growing the sport...I guess I've never really been pulled into something like cross before. I've had passions in the past, even obsessions, but I don't think I've ever loved an activity as much as I do cyclocross. With that said, I'm excited to say that Maggie hooked up some plane tickets for Bend this December and we'll be joining our good friend's Matt and Lizz James on a weekend adventure to cross nats! Matt was even able to arrange for us to borrow some Specialized demo bikes for the weekend so as to avoid the hassle of packing and traveling bikes! Part of me wants to make a training plan for the next few weeks...but I'd rather just keep doing what I'm doing and just see how it all goes.

Sunday's race went well. I felt tired and sore while getting ready and thought I was barely holding on for the first few laps in the lead group. Jay and out-of-town Sam were doing all the work and setting a solid pace. With about 5 to go (right after getting caught on video picking my nose), Jeff had been pulling for a solid lap and I came around to pull on a bumpy section with a headwind. My intention wasn't to attack at that point, but I ended up gapping Jeff and bringing Jay up with me. I slowed a bit so as to work with them but Jay yelled to keep the pace high. Next thing I knew, I was by myself with I think 4 to go. Cruise control was on until I saw Schottler chasing me down. At each of the 180 turns, Josh was close enough to us that I could hear him yelling commands to Schottler. It was pretty awesome. I tried to make it hard on Jon, but he inevitably passed me and I kept the chase up over the last few laps to finish 2nd. Even though the field isn't as deep as last year, the top 6 or 7 racers are definitely each stronger and makes for a lot of fun.

PICX and Bubba #3

2010-10-25T09:34:00.001-07:00

Sometimes it is good to race pissed-off.

Maggie and I decided to bail on Columbia for the homecoming madness this weekend and head to St Louis. I had been planning on racing all the bubba races, so had sunday's race number 3 on the schedule. But, last weekend I felt great on day 2 of racing so decided to head to Alton for the Pride Inc Cross race on Saturday. Maggie was also keen to race both days as she's just recently learned to dis-mount/mount her bike on the fly.

The Pride race was at a beautiful park that was set up pretty close to perfect for a cross race. Honestly, it would have been hard to set up the course poorly in such a nice park. The turnout for the A race was a meager:

But, it was still a chance to race, plus there was a perfect playground for Cassidy right next to the race course. The race went well. I sprinted off the line, got in front and stayed there for the rest of the relatively shortish race.

Sunday was bubba number 3. We got there super early to pre-ride and for Maggie to get a warm-up for her noon race (my race was at 3). After a lap of pre-riding my motivation plummeted as the course was bumpy with lots of straight-aways (my absolute weakness last year). The few things I can bank on, in terms of strengths, are barriers and hills. Turns are sometimes good, but I seem to fall a lot this year...so are a definite double edge sword.

After a little nap in the car at around 1:45, I got suited up and started spinning around. My legs felt very stiff and sore. Somehow, I convinced myself to just ignore them and went to the line without many expectations.

The race wasn't as fast as I expected and I felt good in the lead group...knowing that the inevitable attack from Josh would be coming at some point. When it did, I warned my break-mates Jay and Jeff...oh man, I just lost my train of thought (we're watching this show on the food network where they're talking about bacon wrapped lambchops). Anyway, at some point after Josh joined the group, I attacked on the only thing resembling a hill on the course.

I held the lead for most of the lap, until a turn where, I hit a pothole that I knew was there and endoed over my bike, jamming my wrist and knee/shin. I layeded on the ground, stunned and in some serious pain, I thought I broke a bone. But, next thing I knew Josh was yelling at me to get up and catch back on.

As a BoCoMo resident, I'm privileged to know the positive competitive camaraderie that exists at all levels of Columbia cycling. Anyway, I couldn't have caught back on if Josh didn't yell and slow down for me. Jay and Jeff also slowed, but Josh pulled my sorry-butt back. I rode for awhile, unsure if my proximal fibula was broke or not. All I could think about was Aldon Smith and holding Josh's wheel.

At some point Josh and I broke away. The pace was high and we both attacked a few times, although I decided to hold off on the barriers until the last lap. I guess I stopped thinking about whether or not it was the right thing to do to attack the guy that lent a hand when I was face down in the muck. Whether that was the right thing to do or not, I layed it down coming through the barriers with 1/4 of a lap left, then got a gap and came across the line winning my first bubba race.

Today I woke up with my leg hurting enough to get an xray. Nothing is broken, but I've got mixed feelings about the racing and racing pissed-off.

The workings of my mind Part 2

2010-10-21T17:28:00.000-07:00

My wife and I have been considering buying a house over the past month. In the context of being graduate students, this is a major decision.

The fact that 2010 has been chronicled on this blog in a way that is pretty close to my reality (trying to balance serious changes to my health, loving my family, and having a ton of fun riding/racing bicycles) serves as a kind of reality check. The fact of the matter in my life is quite painful when it comes down to it: in January, I went into a medical category that most people don't ever come back from, ie most people don't survive thyroid cancer metastatic to bones. Typically it indicates an aggressive form of disease that is or will be, non-responsive to treatment.

On a weekly basis, someone who I love and want to be honest with, asks me how I'm doing...mostly from the perspective of my thyroid cancer. I really hate being melo-dramatic and truly don't mean to write in such a manner...but I also attempt to use this form of self-expression (blog) as a way to cleanse my psyche. And also, to help people understand the situation that my wife and I are dealing with. With respect to the question, I never know how to answer because my feelings and thoughts about it are so complex.

The scrupulous answer, from the perspective of a 3rd year medical student, is that I feel like I don't have a full life ahead of me. I don't think I'll get to see Cassidy graduate high school or grow up. In the short-term, I often wonder if it is worth-it to even be in school. If my tumor marker continues to trend upwards, then I don't think I'll be living anything resembling my current life. In fact, I'll probably begin a novel chemo-therapy drug that may or may-not work. That drug, will almost certainly carry numerous and rather dramatic side effects ranging from nausea, to fatigue, to hypertension, and probably to the inhibition to new capillary formation (which wouldn't be so good for a cyclist). Alternatively, I'll have surgery number 4 on my neck, which won't be much fun. I guess the other alternative is that one of the best hospitals on earth (MD Anderson), botched my last blood test.

Why am I writing this now? Thursday night at almost 8pm? I don't know. Certainly not for sympathy for me. But, I also don't want people to assume that because we're trying to live a normal life that everything is a-okay. Ever hear the expression that 'fine' stands for; f'ed up, insecure, neurotic, and emotional? Well, in the fall of 2010, my family and I are just fucking fine.

Bubba #1 and #2

2010-10-18T18:18:00.001-07:00

The first 2 bubba cross races in St Louis were this weekend, the first was a 10pm start on saturday and the second an afternoon on sunday. Right now it is monday at 8:20pm and I feel like I've been going non-stop since saturday.

What to say about the bike racing this weekend?

Overall, I felt really good and had a great time. I was definitely in the mix near the front for both races, but things didn't quite go as I would have hoped in the middle to end of each.

Saturday night, I was in a chase group going after an incredibly dominating performance by Schottler, who apparently was riding pain-free for the first time in forever. The course was flat and a bit roadie biased, so I was in the pain cave with what I still feel is limited fitness. However, with 3 to go, I started to wake-up a bit. There was a single section with multiple turns and I decided to attack there with 2 to go. To soon. Got caught, then bobbled. Got gapped, then finished 5th (I think).

Sunday had a big hill. I like hills. Plus, my legs felt great and I ended up in a good spot off the line. Things were going along quite nicely until half-way through the race when I must have hit a stick so my rear derailleur and hanger were forced to snap. Oh well. Butthead was fixin to dish-out a bunch of pain at that point, so I got a nice excuse to avoid said suffering. Hopefully next week.

PTC part 3 and Cross out cancer

2010-10-10T16:13:00.001-07:00

The thing I learned this weekend: cancer survivorship isn’t an honor. No matter what society, Nike, or others tell us about being strong ‘fighters’, we’re nothing compared to people like my friend Jason Brightfield; those who know they’re going to die, especially young. We’re also nothing compared to millions others who struggle against injustice be it political, social, sexual, gender-based, monetary, racial, or anything else. Cancer is often an injustice and may help grow us as people, but it doesn't intrinsically make us better people.

"Cancer" is a clonal population of cells that are no longer responsive to normal homeostatic controls from the organism at large. It isn't facing death. Cancer may cause one to face death....and the reaction to that experience of confronting one's mortality may in practice lead to making me or you a better person. But, what is the difference between me (got cancer, went to medical school, doing cancer research, etc), my grandpa who got cancer at an old-age and lived a long caring life, and Jason Brightfield who died in his mid-twenties from a childhood brain cancer (medulloblastoma for you medical geeks out there)? It isn't courage. It isn't how hard we fight. It is the time, circumstance, and nature of those cancer cells.

PTC #2

2010-10-09T15:30:00.000-07:00

The ride was awesome. The course got sketchy after mile 23-24-ish. But overall, it was a great time.

Bob Roll and CVV thought Team Seagal is amazing.

Pedal the Cause

2010-10-08T20:03:00.000-07:00

The last few posts on the blog have been about racing bikes. This post, is something that I hesitate to write, and even as I sit down to begin, I'll probably end up revising a few times over the weekend.

Ever since February of 2005, I've been walking around knowing that I have metastatic thyroid cancer in my neck and lungs. Since January, I've known it is in my vertebrae. When I applied to medical school in the summer of 2006, a decision which was significantly influenced by my cancer, I had to decide what I would talk about in my interviews and write in my personal statement. I'll never forget the advice I received from a family friend, that living through difficult, even horrible experiences, despite the stigma placed by society, is not a badge of honor. The advice I received was too let it influence me from the inside out. When I started this blog about 1.5years ago, it took me a long time to even write about thyroid cancer.

After last January, my life seemed on the line and my situation much more immediate. I tried to reach out. I basically begged livestrong to let me be involved (which still hasn't happened at all beyond sending me some goodies) and tried to seek out community organizations to help connect to others living with cancer. The opportunity to participate in Pedal the Cause came and after a few months of procrastinating, I admitted to myself that this was something I really truly believed in...down to my heart and soul. I signed up, raised money, volunteered to help in anyway that I could, and feel like I made a good contribution.

Friday night (the night I'm sitting down to write about this), was the kick-off celebration. Honestly, I left feeling quite depressed and I've spent a bunch of time reflecting about how and why.

I'm an idealist. I believe that scientific medical research leads to improvements in peoples lives. However, I begin to feel very uncomfortable when people start talking about a world without cancer. I don't know...can't we just work really hard and try to improve survival? Why does it have to be such a melodramatic goal?

Anyway, that isn't the reason I'm blogging. I think tonight, I felt really shut-out and bummed that I wasn't hanging out with all of my friends at Council Bluff.

Upon our arrival, I saw one of the organizers who I've gotten to know pretty well. Maggie, Cassidy, my mom, and I approached him and soon we found ourselves shooting the breeze with Mr and Mrs Vande Velde about spain, having kids, mud babies...etc. The night seemed like it was off to a great start, they were super nice and we were just having a good time. All of a sudden, Christian inquired about the the scar on my neck (a question that I've been directly asked maybe 5 times in the last 5 years). So, I told him the story..blah, blah, blah...Next thing we knew, he went off to sign autographs and me and the fam went off to walk around. A little while later, we were all called to dinner, so Maggie and Cassidy went to find a table and my mom and I went to grab food. It took awhile, but eventually we met up again at a table that had a little sign that said 'Vande Velde'. I was psyched, since they seemed like such nice people and I was eager to hear more about Spain, racing, etc.

People started filling up the tables around us and as soon as we started eating, we were told that the Vande Velde table was reserved for VIPs, so we had to find someplace else and unfortunately at that point, there wasn't room for 3 adults and a 2 year old at any of the tables. So, we ended up sitting outside on the curb, but still within earshot of the speakers that were beginning their speeches.

That is when the night took a turn for the worse.

Let's just say that one of the speakers really rubbed me the wrong way. I felt like the cancer story was like some kind of Dateline, made for TV event, only from a very in-articulate perspective. It honestly felt like the people that were asked to speak were just friends with the guy organizing the whole thing and didn't have much thoughtful to say. On top of that, they honored and mentioned only the teams that raised tons of money, which were almost exclusively teams with a ton of people on them. I guess it just felt as though it was more about image. The individual above the many. And to me, that isn't what events like this are supposed to be about. I wanted to feel like I was coming together with people, not getting ticked off.

It then felt like I was on the edge of the whole thing.

I don't know...I'm not sure how I feel about these kind of events. Hopefully the ride turns out better tomorrow, but right now, I'm tired and wish I was at Burnin.

Boss cross #1

2010-10-04T07:39:00.000-07:00

I knew I was in for a hard race when I saw BH line up on the front (as opposed to the back of the pack at Bubba) of the 28-man field. This past week was the completion of week 3 back on the bike after surgery and a long break from training. My legs are starting to come back, so right now I'm focused on training and getting my attitude lined up. This was a 'training race' in the sense that I try to pick a specific aspect to focus on during the entire race and not let myself get caught up in anything except that goal. For Boss cross #1, the goal was to lay down a really hard effort during the last lap and hopefully pass/catch people. In order to do this, I needed to not burn my matches too early and race smart.

Here's a video of the barriers the last lap:

I grew a gap and managed to pass Bill Marshall the last lap, but couldn't quite catch Yielding. Who, you'll see I followed during the first lap here:

There was no way I could mix it up in the top 5 of this race, especially at this point in time...but as long as I can keep focused I see no reason why November/December shouldn't be different.

Here are the top 15:
1 7 CX 1-2-3-4 M 42 WINKLER Jeff Blue Springs MO Unattached
2 11 CX 1-2-3-4 M 34 JENSEN Brian Lawrence KS Unattached
3 14 CX 1-2-3-4 M 34 JOHNSON Joshua Columbia MO Michelob Ultra - Big Shark Rac
4 23 CX 1-2-3-4 M 25 SCHOTTLER Jonathan Columbia MO Columbia Bike Club Race Team
5 21 CX 1-2-3-4 M 50 PRICE Thomas Overland Park KS KCCX
6 8 CX 1-2-3-4 M 30 COE Andrew Mission KS SKC Racing
7 12 CX 1-2-3-4 M 40 STOLTE William Topeka KS TradeWind Energy / Trek Stores
8 4 CX 1-2-3-4 M 41 YIELDING Jeff Hermann MO Revolution Cycles
9 15 CX 1-2-3-4 M 31 MILLER Daniel Columbia MO Columbia Bike Club Race Team
10 2 CX 1-2-3-4 M 40 MARSHALL Bill
11 27 CX 1-2-3-4 M 27 COIL Nicholas Prairie Village KS TradeWind Energy / Trek Stores
12 16 CX 1-2-3-4 M 47 FROESE Ethan Columbia MO Columbia Bike Club Race Team
13 19 CX 1-2-3-4 M 18 LININGER Luke Greenwood MO Bicycle Shack Racing
14 22 CX 1-2-3-4 M 30 OGILVIE Scott St. Louis MO Dogfish Racing Team
15 9 CX 1-2-3-4 M 36 BAUGHER Matthew St. Joseph MO Epic Cycling Team

Kansas City: Maniions Cross

2010-09-26T17:55:00.000-07:00

First real cross race of the season today and man, was it fun. Maggie and Cassidy came along and we had a perfect day on the side of a hill somewhat resembling the Augusta winery course of the bubba series last November. Much of the BoCoMo peloton was in attendance and it got me really psyched to get back to riding more frequently and doing some solid training over the next 2 months with some fun-loving strong-as-hell bike riders.

I did the cat 2/3 race and lined up with Jeff Yielding, Cale Mc, and about 13 or 14 other riders I knew nothing about. Starting about a minute ahead of us, was the 1/2 (open) race and looked like a good but small throw down, featuring butthead, Schottler, Shadd Smith, Steve Tilford, Ethan Froese, and others (see...KC racing rocks!).

Like I said, the course was very, very similar to the Augusta winery last except it was slightly more technical and the climb was full of switchbacks, instead of just a wall.

I still don't know what to expect from myself, as June was the last month in which I was able to consistently ride and train. But the last few weeks have been good on the bike in terms of consistency and I've been reminded that much of my own attraction to cyclocross is because there's a huge need to ride technically and endure an onslaught of pain and suffering. Yeah there's a need for high lactic threshold and training, but a huge piece of it is mental. That being said, I knew it was going to hurt and I was excited.

I rode about 6th or 7th wheel coming off the start and beginning a series of mostly flat or down hill, off camber turns descending towards the bottom of the hill. During most of the turns, I passed people and made my way to to 4th wheel. On the backside of the course, there was a short, very steep 10ft-ish 'run-up' that most people were riding but also botching the very top. After that 'wall' there was about a 90sec hill climb with a bunch of switchbacks, that lead to the start/finish straightaway. By the top of that climb, I was in second with about a 20-30 sec gap between me and a rider from Tradewinds. I gained a little on him during the descent and turns but at the bottom of the hill, there was a long, flat straightaway and my buddy Mr Ethan Froese kindly let me hang on to his wheel as he drilled it across the flats. Next thing I knew, I was on the 1st place wheel and the game was on.

It was a ton of fun and with 2 to go, I got a little gap after riding up the 'run-up'. I started to plan an attach when about 1/4 of the way up the big climb my left foot popped off the pedal and at first I thought my cleat had broken. After stopping and taking a look I realized the spring on my pedal (crankbros eggbeater) had snapped. I tried to pedal, but my foot just kept slipping out of the pedal.

I ended up borrowing a bike from Green beans and finishing the race in last place. Oh well...the only thing irritating about the situation is the long and convoluted relationship between me and pedals over the past 10 months. Ever since age 15, I've used Shimano SPD...never broke a pair and never had a problem. After last CX season, I wanted to try something that offered better mud clearance, as they tend to clog on very muddy courses. So, I went to eggbeaters. After a few months, they seemed to be causing or at least bare association with some knee pain, so I switched back to my SPDs. Then, after my knee surgery I couldn't ride at all in the SPDs and really needed the non-resisted float of the CBs...so I switched back. Since then, my original set wore out and need to be re-built and a pair that only has 100 or so miles on them snapped, under the torque of a 140lb guy. I'm not impressed. I'd love to try the Time pedals, but really, really can't afford any new bike toys (our rent went up so we're really stressing what to do and our finances). So, probably back to the trusty shimanos!

More cyclocross please!

2010-09-19T18:14:00.000-07:00

This was a big weekend bike, friend, and family-wise. First, there was a night in St Louis without the toddler...just the wifey, myself, 2 great friends, beer, and a couple of pizzas from Pi.

I guess the point of this particular blog post is to communicate some of my opinions regarding things I like, some potential areas of excitement, and a few predictions for the coming cyclocross season.

Things I like:
1. Lots of jalepeno's on pizza
2. IPA
3. New bike parts that work really well
4. Happy, stoked, and motivated people (i.e. most of the people I conversed with at the cyclocross race before about 8pm on saturday night and all of the people on the Pedal the Cause 'training' ride saturday morning).
5. My wife's new pumpkin bread recipe.

Potential areas of excitement:
- We had 30-40 people show up for the Pedal the Cause training ride and flat clinic sponsored by Mesa on saturday morning. We took a nice mellow ride around the park and I got the opportunity to talk to some people about why they're doing the ride. One guy's wife has HPV positive head and neck cancer, which coincidentally is the area of my PhD research. It is very nice to be reminded of real life reality (dare I say suffering?) when it is so easy to be self-absorbed in esoteric molecular biology.

-I raced my bike in a race for the first time since July 15th after having taken 6 weeks completely off the bike and done almost zero hard riding. I choose to race my mountain bike in the single speed category of the Hermann Cyclocross race because it was only a 35 minute race and I just wanted to see how I felt. Somehow my mojo, seems to have not gone completely to hell and now I'm super psyched for the next 12 weeks of progression. Right now the plan is to race my cross bike as much as my health, family, and work balance can allow. My season goals are now: have fun, give the fast kids a hard time come November/December, and go to nationals in Bend and represent well. I'll definitely race collegiate as a grad student for Mizzou then probably the Master's 30-34, but maybe the B-race instead of masters.

Predictions for the coming cyclocross season in Missouri:
-Big Shark (Schottler and butthead) will be hard to beat, but there are potential challengers.
-We will learn that flat-barred 29er's can hang in most CX races
-My idea of racing on a 1x10 will constantly be a source of reconsideration.
-The following quote will hold true:

I'm psyched to learn more about these folks from the western part of the state. I have to say, they looked intimidating in their black and orange skin suits and gorgeous carbon bikes.

I'd be remiss not to mention the unfortunate situation with the storm at Hermann on Saturday night. There was serious lightening and eventual torrential rain fall. Due less to luck and more too pro-active, considerate leadership and disaster response on behalf of race organizers, park officials, public workers, and alert citizens no one was hurt (I don't really believe much in luck). Although, it sounds like there was a lot of damage to equipment and the park, I'm really glad that there were no serious injuries.

Gotta hear that body language

2010-08-29T08:46:00.000-07:00

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...

2010-08-17T12:56:00.001-07:00

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

2010-08-16T09:28:00.000-07:00

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

2010-08-09T09:30:00.000-07:00

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

2010-08-01T18:02:00.000-07:00

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)

Diazepam and rollerblading

2010-07-28T05:02:00.000-07:00

Right now, nothing is worse than waiting and not knowing why my tumor marker increased. Medical knowledge and having read quite a bit of the literature on thyroid cancer outcomes isn't helping either.

For now, I'm waiting until Thursday morning at 7:30 to have an MRI of my brain, then probably the rest of the day until we get the results. In the meantime, I'm carrying around a bottle of valium and taking them as needed.

After knowing the MRI results, I'll either start spending a lot more time at a hospital as a patient (Wash U, Hopkins, or MD Anderson) or we'll keep looking via a PET scan for a potential source of the increased thyroglobulin.

I'm taking a few weeks off my bike, which is something good to do in between the bulk of the mountain bike season and cyclocross. I'm hoping I can finally fully get my knee healed, which although improved has continued to bother me off and on since April. Basically, every time I've gone on long rides it hurts. We finally decided that despite a very good fit on my bike, that my cranks are probably a bit too long, so will be going through the annoying process of removing cranks, selling them on ebay, and getting new, shorter cranks for at least 2 of my 3 bikes.

If the results of all this cancer stuff turn out to be OK, then after this break from the bike, some very serious motivation and jedi skills will be released upon the fall cyclocross season.

MD Anderson July 2010

2010-07-22T12:57:00.000-07:00

Today I met with my Dr at MD Anderson to discuss the results of a series of studies I had yesterday. The intent of the scans and blood draws was to gauge the response of my January radiation treatment. As has been the case over the past few years, my situation continues to challenge and baffle me, my family, and my doctors. There are basically 3 areas that were measured on Tuesday:
1. Radiologic measures of tumor size and appearance including MRI, CT, X-rays, and ultrasound of my neck, lungs, and back.

2. Blood tests for a protein secreted by the cancer cells in my body that is a pretty accurate measurement of how much disease is present

3. Blood tests for side-effects of the radiation treatment including red and white blood cell counts

The results are as follows:
1. No major change either bigger or smaller of the disease in my neck or lungs. And evidence of improvement of the single known bone metastasis in my 5th thoracic vertebrae
2. Increased by 40%
3. Both down, with one of my white blood cell counts (neutrophils) pretty low.

So, there are both good and bad signs. First, we’re really happy that the treatment had a positive effect on the bone met. The bad news is that it didn’t seem to do much for my lungs or neck and for the first time ever, my tumor marker really went up. The latter is super scary because we don’t know the details associated with that increase, like whether or not I have disease in areas we didn’t look (e.g. brain, pelvis) or if the neck or lung disease is growing more quickly and no longer responsive to the treatment I received in January.

Maggie was with me to meet with the doctor today. My mom also came to stay with Cassidy at the hotel. My mom seems to be doing pretty well but Maggie and I are both scared, confused, and very angry. One of the things most annoying is that one of my scans that had been scheduled for me yesterday got canceled because insurance didn't approve it. The purpose of that scan was to answer some of the questions we're left with. Unfortunately, insurance now doesn't have a choice...I have to get a PET scan, but will have to do so back in St Louis in a few weeks. More waiting.

Rage and self-love

2010-07-16T10:26:00.000-07:00

Racing attitude yesterday: Breath. Chill. Don't compare to others, only compare myself to myself with past accomplishments and future potential. Go out and give it 100% and wherever the chips fall...

It was a constant mantra during the race yesterday and it felt good. Real good. I ended up getting second and missing the win by just a wheel or so. I also didn't fall or ride outside of myself too much...finally.

Next week, yikes. Don't have much of a mantra for that. There's really 3 possibilities:
-Tumor marker lower and scans show less or smaller tumor, i.e. the treatment in January worked.
-tumor marker the same and scans show no change, i.e. still don't know if the treatment worked or not.
-Tumor marker increased, tumors spread to either more bone or brain.

Every once in awhile, I get scared about what is going to happen but generally, I really don't know what to expect and don't really believe that positive intentions or a good attitude will affect the outcome, only my existence in the meantime. The cold hard reality of nature, in this case malignant cells unresponsive to the normal homeostatic mechanisms of the body, is something beyond my control and I've accepted that. I just wish that this situation didn't have to hurt my family.

Here I am blogging away about racing bikes in-spite of a bad hand I've been dealt and sometimes I wonder if it is doing any good. Honestly, it often feels a bit narcissistic (you should read this op-ed btw).

Life in July

2010-07-11T16:15:00.000-07:00

This is a weird month. In 2 weeks I'll have probably one of the biggest and most important doctors visits of my life. The basic story with my cancer situation, which I'm intentionally trying really hard not to think about and therefore not write about, is this: In January, I got my 5th radiation treatment in 5 years and there are 3 big important things for you the reader to know about that treatment:
1. Due to the fact that I've had 5 of these treatments, I'm approaching a generally accepted 'limit' for the amount of radiation I can safely receive. It was already a bit of a miracle that I was even still able to express me gametes (yes I meant to write 'me'...just seemed funny), but with 5 treatments there's risk of leukemias and other bad things. Plus, depending on what happens with item #3, I probably won't ever get another treatment.

2. The scan post-treatment, which showed where there is still thyroid cancer in my body revealed a new metastasis in my 5th thoracic vertebrae in addition to previously known metastases in both lungs and a few areas of my neck.

3. It takes 6-12 months for treatment I had in January to have any effect. So, even though we knew about the vertebrae and all that, we had to wait and live life as normally as possible in the intervening 6 months. If there's significant improvement, then I may have another radiation treatment. If there isn't, then I won't. The latter is associated with a great deal of ambiguity and fear...no one really knows what the hell to do.

Ok, enough about that...on to bikes. I'm proud to announce to the world that my 21month-old daughter consistently knows the difference between a wheel and a tire. Hells yeah.

Racing-wise:
-Thursday was dirt crit #2, I was all stoked cus I got second the first race and felt physically much better thursday. But, 3 pedal strokes after the official yelled 'Go', my chain fell off. I had pulled my wheel forward in my horizontal drops and therefore no longer had chain tension. Of course I wasn't carrying a multi-tool for a 40 minute race, so I had to run around to find a wrench before I could fix it. Damn. There went any chance of doing well in the series.

-Today (Sunday) was the MWFTS race in Springfield. I really will try hard to not say anything negative about the course, but generally I was not stoked and certainly won't ever race there again on a rigid single speed. I had never ridden there before but was told that a bunch of new trails had been built and all those rocks and roots sticking up out of the ground seriously kicked my butt. I just couldn't seem to carry any momentum or flow during any of the course. Oh well, certainly no one's fault but mine...but if you ever go ride Sac river, bring a bike with suspension if you want to go fast. The race was well-run and there were definitely a lot of strong guys there, but it was a serious suffer fest for my upper body and back...both of which have never really been issues in many bike races for me. I quit after completing 2 of my 3 laps in around 4th or 5th place.

Loads of fun

2010-07-02T08:10:00.000-07:00

Thursday night was the first race in a July Short track series in Castlewood. Last year I went and watched Maggie race only to commit to myself to try and make every effort possible to be there for some racing this season.

Short track mountain bike racing consists of a shorter total amount of time than the typical cross country races. This series is similar to road crits, where races mass start and a clock begins ticking. Depending on what category, races will last either 40, 30, or 20minutes then there will be a bell which signals 1 lap left. My race was 40+ 1 lap.

I put a 36x16 and rigid fork on my bike (pictures to come) and set off to give it my all and have a blast.

Bob Arnold of DRJ racing posted a really great video of the race. I'm the guy in the black Team Seagal kit coming by at ~2:30.

2010 Dirt Crits - Race #1 from bob arnold on Vimeo.

Ralph and his crew have done an incredible job with this event. It was a ton of fun and very well organized. Thanks so much to everyone who helped! I can't wait to do more!

Broemmelsiek race

2010-06-27T16:59:00.000-07:00

Sunday's race was an epic battle. Although the race had a pretty small turn out, with many notables, who would have seriously altered the race, not present. I've had a goal since last season of being competitive on my singlespeed in the expert category and today was good step towards that goal...missed the podium by just over 15 seconds. There's always some kind of afterthought post-race about how to do better and messing up such-and-such a situation, but that's all just water under the bridge. The important thing in my mind and for me in my life right now, is just getting out there and competing. Some days I may feel great, like today, and others I may feel awful and either quit or come extremely close to quitting.

I rode a 36x18 on what was a pretty perfect single speed course. I usually like more climbing, but today's course was almost like a cross race with never ending quick, sharp turns, little dips, and a very undulating gradient. I didn't pre-ride the course and honestly, I don't think a couple of more laps on a course makes that big of a difference, especially in a 6 lap race. Home field advantage on a trail that one rides a few times a week is a totally different story...huge advantage, but on a day like sunday, I'd rather try and ride 3rd or 4th wheel behind some really good riders and see what happens.

That's exactly what happened. Here are some cliff notes, laps were 20-25min and total race time for me was ~2:05:00 or something:
lap 1- 4th wheel following Bob Arnold, who was behind Ploch who was behind TK. Felt great. Gearing was perfect...HR was pretty mellow and legs felt very good after a solid week of training last week.
lap 2- Pass Bob, ride behind Ploch or TK
lap 3- Ploch drops chain, ride behind TK.
lap 4- don't know what happened but I still felt good at this point but I slipped in 3 corners riding behind TK. I think I just got super excited that I was in front of Ploch. Those falls hurt my ego and I actually got pretty pissed at myself because the slips seemed so silly and happened each time I caught back on to TK's wheel after prior fall. Mental slippage seemed to occur at that point. Doubt plus and 1:20 of pushing a big gear convinced me my legs were getting tired. At some point, Ploch caught back on a went around me.
lap 5- Got caught by Mark Gullet. See mindset as stated at the end of lap 4. He passed me.
lap 6- climb hill, see ploch stopped on side? He said he was cramping and we rode together for most of the last lap. I was hurting. Then almost at the end, he decided he wanted to see if he could catch Mark. I couldn't follow. The end.

Goal? Accomplished. Fun? hells yeah. Wifey? Present and rode her butt off in marathon! Teamates? TTM had 50% bad luck, Storve did his first race of the year and came out top 10, and there's talk of a new teamate ; )

Up next are the dirt crits! I love short racing.

July is a HUGE month for me. I have a massive piece of writing due and the month marks the 6month interval from my January treatment. Very crazy, but we still have no idea whatsoever if that treatment had any effect....it takes 6 months. 3rd week of July I head to MD-Anderson and will find out.

2010-06-22T19:24:00.000-07:00

"You also will want to make sure that being extra uncomfortable is something you’re into because 60 minutes against the fastest geared guys around isn’t going to feel very good until it’s over."

http://www.cxmagazine.com/travis-book-cowbell-singlespeed

"The most important thing, though, is your mental state. That’s where it’s at when you have gears too, (clearly if you’re thinking of going SS you KNOW the bike doesn’t really matter that much) but it’s even more important without them. When you pull up on the starting line, remember: your opponents think you’re dumb, crazy, and possibly tough as nails. You want to encourage this thinking. I wear a Camelbak during warmup because you won’t be drinking for 60 minutes once it starts, no one else does it, everyone should, and because it makes me look like I have no clue."

Lost Valley race and some thoughts on training

2010-06-21T11:35:00.000-07:00

Riding and training for riding over the past few years has been an awesome lesson in physiology and psychology. Progress has been elusive the last few months...basically ever since the Tour or Hermann. But that's completely understandable and totally natural: sometimes training 15hours a week is what is needed to be better, while other times 3-6hrs/week is all I can possibly handle physically, practically, and even emotionally. The past few months I've started to learn more from my sleep patterns, food cravings, and general hunger then I've ever been able to pay attention to in the past. For the first time, I've been interpreting the signs of consistently poor sleep and intense sugar cravings too mean; take a few extra days off, skip the ride or workout, and/or focus on eating better. My thoughts on nutrition have evolved significantly this past year, as I deviated from my normal diet for a period of time and attempted an experiment of absolutely no animal products for 6 weeks. The reason for the trial, was mostly based on curiosity for the sports-performance effects and as a long shot attempt to see if eating a 'anti-cancer' diet would have any effect on my tumor markers. After the 6 week trial, I resumed my normal diet with a few tweaks and now feel like I have a pretty good grasp on what I need for good energy, focus, etc. In terms of the effect on cancer, I'm not convinced and in fact, I felt like my insulin/blood sugar was all over the place eating such an intensely Cho-rich diet. I much prefer eating more meat, nuts, seeds, vegetables, and fruit...blood sugar stays much more stable and I feel overall more focused, recovery quicker, and generally feel better.

Training-wise, the last month I've only been putting in 3-7hrs total a week. But my intensity has been there in the form of short, crazy-hard stength/cardio work in the gym with these guys. Rides have been down to 1-3/week and have mostly been for mental clarity and fun.

With all of that said, I really haven't known what to expect in June as far as racing. Last weekend I felt really strong on the bike. Yesterday was the Lost Valley race that was put on by my friend Matt James and many of his co-workers at Mesa. I had been at a family re-union in Louisiana Thurs-sunday morning...so traveling the morning of the race and not riding for a few days prior felt pretty weird.

I had never ridden the course before, but knew that there were multiple sections of fire roads, with very little total elevation change. I also knew that I wanted to race Cat 1 and would be doing 3 laps on an 11-ish mile course. Gear choice for the week was the highest I've ever ridden on a mountain bike: 36/18. Gino from Team Seagal was there and gave me the advice to hold wheels like I was in a road race and hope I was geared high enough to hold on.

At the start, I felt pretty good. From the line until the first turn was probably about a mile of flat fire road. I managed to hover somewhere between 3rd and 8th wheel, but man was I spinning like crazy. My cardio system took a pretty big beating and the whole time I was thinking about the proprioceptors I learned about in med school which are located in extremities and cause the body to activate the fight/flight response...cus man was my heart racing. I think I must have been going 120rpm or greater (note: rpm= revolutions per minute, as in pedal speed...not heart rate).

After we turned, I descended and then started up the big gravel climb. I ended up making a little break and riding right behind a lead group of Ploch, Breslin, Shottler, Devin Clark, fast DRJ guys, and ultra-hella-fast-for-an-old-guy TK. But then we hit the flats up top and I got dropped. Quick. I just couldn't transition from the climb to the flats quickly on a single speed.

The rest of the race was pretty similar to the first few minutes. The gear choice was good, but I definitely need to ride the big geared SS some more. Adaptation will take place...I can feel it. It was definitely a sign of progress and a positive experience.

Despite the heat, it was an awesome race. Matt did an awesome job. Shottler crushed it again and good races were had by many (Drew Black and Nate Means looked super strong!).

Thanks to TTM for the hand-off and the post-race refreshment! You guys rock. Hope the bike turns out well for ya.

2010 MO state mtn bike championships

2010-06-12T17:44:00.000-07:00

Although I appear to be shorter than those around, I am in fact on the top step.

Maybe next time I won't wear a blindfold and will try and beat Shottler.

Strongest single speed field that I've ever raced in Missouri today. Pro mountain biker and recent (don't know the year?) singlespeed national champion Dejay Birtch was there, as well as Garrett, Dan Fuhrmann, Nico Toscani, and many others. In addition the day was hot, humid, and I don't think I had pedaled a bike for more than an hour in about a month. Given all of that, my goals were not based on any particular outcome, only the the process of getting to the race and seeing how I felt.

The first 'separation' climb felt great at the beginning of the race. At the top, it was Fuhrmann, Dejay, and then me and i felt like I was well within my comfort zone. My gear choice for the day was a 34x18 which was hard but about perfect for the 3 lap, 90-ish minute race. If I would have needed to do another lap, I definitely could not have pushed that gear. At the top of the hill, Fuhrman got off and ran a section and Dejay and I sped around him. A few minutes into the race I felt well within my comfort zone holding Dejay's wheel and we slowly started pulling away. On the second climb we started passing some of the expert riders, which was interesting riding with such an experienced racer, as he was much more aggressive in passing than I normally am...but I didn't want to let him get a gap on me so I just tried to apologize and keep moving. 10-15 or so minutes into the race, at the start of the 'rollercoaster' section, he fell. Don't exactly know how or why and after talking with him after the race, neither does he. So, I just kept my pace and kept pedaling. Next thing I knew, I was by myself. I hammered it up the climbs and just kept it steady and smooth on the single track.

The heat was really hard to deal with. I opted for the camelbak today and was really glad I had it, as I went through all of a 100oz bag except for just a few sips.

The last lap felt great until climb #3, when my quads locked up in searing pain anytime I fully extended my knees.

It was definitely a suffer fest with the heat and the cramps at the end...but for some reason I've got an appetite for that these days.

Jersey #2 and third state title in a year (last year's ss race at the state championships only had 2 riders, so no jersey!).

ps- Very unfortunate thread on stlbiking regarding bitterness. I read this quote last week from Mark Twight and really dig what it says about our personal responsibility to be respectful and to work hard. Although he is talking about road racing and people that sit-in I think the general idea about just putting it all out-there is one of the reasons I love racing:
"I just don't get it. We're amateurs. It's a hobby. The sport is tough. That difficulty makes the feeling of finishing well after having utterly smashed yourself so satisfying. I know that feeling. I wonder what it feels like to finish after having sat in, after having done the bare minimum for 99% of the race, and then shooting to the line on reasonably fresh legs ahead of the chasing, faltering pack. Is it a good feeling, that win? It must be.

Still, why wouldn't you work hard enough to break and redefine yourself? Afraid of what you might find?"

This is not to say ANYTHING about sandbagging or getting second place, or whatever. The only thing I mean by it is that we do this for fun. Winning isn't everything. In 10 years and beyond my daughter won't give a rats ass that I won this race today or even that I raced bikes. She will care however if I live my life with balance, take responsibility, and treat others well.

Cosmic Irony

2010-06-04T18:39:00.000-07:00

Well, there's a new bike in the Miller family. It really is getting ridiculous, the whole buying and selling of two-wheeled pedaling machines. Honestly, I've given the pursuit a great deal of thought lately and have come down to this:

When I have the ability to effect change, I do so. Often with very little patience. Looking back, the notion of selling my single speed lynskey, the idea of which had been a dream for years, was motivated by a great deal of haste and fear. I thought I needed a change, so after about a month of looking around, when Team Seagal's sponsor contact came up with a great deal on a geared, cushy full-suspension bike that would fit, I jumped on it.

Maggie and I have both toyed with the idea of me and control issues...especially in relation to things that I don't have any control over (i.e. cancer). Maybe that is why training, science, and bicycle materialism have been so attractive in the past few years. It is funny, because in college I was one of those gandhi-reading, world bank-protesting, hippy, live-out-of-my car types. Now I own 2 carbon bicycles and a third that is pretty close to carbon.

I do still hold on to many of my ideals, but clearly the materialism associated with light, fast, and stiff bicycles in something that I've 'compromised' on. The drivetrain on the Kona sold in a day and through good-fortune and friends ended up getting a Specialized (which is actually the bike sponsor of CBC, so I didn't feel all that bad) single speed. I've ridden it once so far and am very happy.

I suppose the whole idea of 'single-speed' has gone a bit over-the-top on this thing. Yes, it is made of plastic. And yes, it is incredibly light for a mountain bike. Complete, the bike weighs a scanty 19.09lbs. Rock on.

Awesome perspective on intensity (completely applicable to cycling)

2010-05-26T18:10:00.001-07:00

Click here

Mommy wow! I'm a big kid now.

2010-05-23T09:38:00.000-07:00

One of the things I love most about riding a bicycle is how it makes me feel like a kid. Racing has been a convenient extension of that over the past few years but commuting to work/school, bar hopping, baby towing, my first few dates with my wife (now we always seem to drive when we go on dates), and of course romping around in the woods on my mountain bike breaths life in to an otherwise dreary and occasionally forlorn modern landscape of concrete, strips malls, and buildings disconnected from nature. As a mode of transportation and as a recreational tool, the bicycle adds a sense of liberation, exhilaration, and connection to the environment.

This blog entry is hopefully going to be circuitous, where after a bit of rambling I come down to explaining the title and ultimately process my thoughts about how I'm riding very little at the moment (1-2hrs/week)...which may or may not be a source of distress in my life.

Last weekend, Maggie and I went to a wedding of one of her friends from college. It was the third wedding in a year of one her friends in an absolutely beautiful location. This most recent was on the coast of eastern Connecticut, the other 2 were in Mendicino, Ca and northern Vermont/New Hampshire, all places I had never been. In each place I found myself wishing I had a bike to go pedal around on, but in all situations allowed that to be just a passing thought and ended up being quite content having weekends away from normal life in Missouri. Just being in those places with Maggie and Cassidy was amazing. One of my favorite artists on the planet, David Byrne, wrote a great book on traveling in foreign cities via bicycles. Sometimes it seems as though the bulk of my traveling days are long gone, but I still really connected to some of the writing in this book. Here is a great except, with my thoughts in parentheses:

"Lots of folks have jobs that take them all over the world. I found that biking around for just a few hours a day-or even just to and from work-helps keep me sane. People can lose their bearings when they travel (or deal with illness, life circumstances, etc), unmoored from their familiar physical surroundings, and that somehow loosens some psychic connections as well. Sometimes that's a good thing- it can open the mind, offer new insights- but frequently it's also traumatic in a not-so-good way. Some people retreat into themselves or their hotel rooms if a place (or feeling) is unfamiliar, or lash out in an attempt to gain some control. I myself find that the physical sensation of self-powered transport coupled with the feeling of self-control endemic to this two-wheeled situation is nicely empowering and reassuring, even if temporary, and it is enough to center me for the rest of the day...

...Performing a familiar task, like driving a car or riding a bicycle, puts one into a zone that is not too deep or involving. The activity is repetitive, mechanical, and it distracts and occupies the conscious mind, or at least part of it, in a way that is just engaging enough but not too much-it doesn't cause you to be caught off guard. It facilitates a state of mind that allows some but not too much of the unconscious to bubble up. As someone who believes that much of the source of his work and creativity is to be gleaned from those bubbles, it's a reliable place to find that connection. In the same way that perplexing problems sometimes get resolved in one's sleep, when the conscious mind is distracted the unconscious works things out."

All high-brow stuff aside, all kinds of events and situations have demanded my attention as of late and I just haven't been riding (including not commuting to work/school). Cassidy starts daycare soon so I'll have to drive her there everyday. This past week, she and I spent a few hours each day in the mornings just getting her used to the situation. I haven't figure out how to get from my place to West Broadway via bike and trailer, so it is looking like commuting to work/school will be on hold for awhile. Plus, to my intense frustration and chagrin, I've had some knee pain again, this time in my left knee. The dx is an irritated Plica, which is particularly annoying because the only thing I can do is wait til it stops being irritated. Next, Maggie takes her board exam June 8th and is studying 6:30am until 5 or 6pm everyday including weekends, so my day has been based around the following priorities: 1. Cassidy and her care, 2. Anything I can do to help Maggie, 3. Getting work done and figuring how to get some preliminary data on what will end up being my dissertation research 4. everything else

I've made it to the gym more frequently and have been running a bit (meaning 1x), both of which don't hurt my knee and strengthen/loosen structures which contribute to my angry plica. But man, I'm a bike junkie and am bummed to have missed a couple of really fun events this past weekend (Crit saturday, amazing mountain bike ride with a ton of friends sunday, and even the state road race).

So, adult responsibilities come first and to tell you the truth, I'm actually pretty happy and content right now!

CBC video

2010-05-12T06:24:00.000-07:00

My friend Justin Craig made a video on the Columbia Bike Club, which has been my road team this year. Great message on this video: bike racing is for everyone!

Greensfelder

2010-05-07T04:04:00.000-07:00

Mtn bike race at Greensfelder park in St Louis today! Much love for this park, although I wasn't sure about the course as it had much hype on the message boards. "A true mtn bikers course" and sections of "pushville" (getting of the bike and pushing are often required) were some of the words on the street…sounded interesting!

This past week was intentionally mellow as April consisted of 4 hard races and a good deal of intensity on the road bike. My body just felt like riding less and heading to the gym a bit. I felt like a little taper was a a good thing and even managed to get a ride in friday with a few 'openers'.

Day prior-prep: Did everything right. No booze, good food, lots of sleep

Race day prep: Perfect morning, good coffee, nice breakfast, fun with Cassidy, and a good warm-up

Race: Big field today with lots of strong guys (both Pirtles, the whole DRJ crew, Shottler, Piepert, a few Mesa guys, Mike Best, lots of people I didn't know). The start was really important as the hole shot order would determine the order for the first long and technical down hill. E Pirtle and Ploch were 1 and 2 (I think), then Big Shark guy, Bob Arnold, someone else, R Pirtle, then me. I held R Pirtles wheel pretty tight as we watched E Pirtle and Ploch ride away. We were more or less stuck in traffic, but figured it would be a long race therefore no big deal. Probably mistake one.

As soon as we hit the rolling single track, I knew I was off. Although my bike was amazing on the terrain, I just felt a little shaky. I looked down to see my HR hovering in 185-190...very high for me and also uncommon for what wasn't very hard pedaling. 30 minutes into the race, the same was true. My legs opened up a bit and I was able to hold my own on the climb, but no where near what I knew I was capable of. I also managed to go over the bars on a silly little loose section during the first lap, which seriously shook me up and made me much more conservative on the downhills and techy parts. So that about summarizes my experience: shaky with a sky high heart rate.

Soon after my little fall, my rear shifting went to hell.

Reason for poor shifting?:

But I still had the magic of my front shifting which kept me close to R Pirtle and rolling in 6th or 7th for most of the race. Still though, I was just having a bad day physically...my body was just not doing what it has been over the last few weeks. Then halfway through lap 3, my front shifting stopped working and unfortunately I was stuck in my little ring for the rest of the race.

Oh well, a little bit of humble pie was dished out to the 'ol professor (Lt Dan) at Greensfelder today.
Post-race cinco-de-mayo deliciousness:

ps- I miss my single speed.

Fluorodeoxyglucose

2010-04-30T06:17:00.000-07:00

I haven't been writing much about the cancer situation, mostly in preference for the topic bicycle adventures and balancing family time. Reality however, is catching up. As I wrote in my last post, I'm in stand-by mode until July, when I'll go back to MD-Anderson for a bunch of scans.

Yesterday I received my appointment information informing me of when I'll be seen (no choice, kind of like being called to the principles office or something). Check out my schedule for July 21st:
6:30am Blood sample collection
7:30am PET scan prep (do not eat for 6 hours prior)
8:00am PET/CT Injection/localization
9:30am PET/CT Skull to mid-thigh
10:30am Check-in for CT exam
11:00am CT scan, chest/head and neck
12:00pm chest x-ray
2:30pm Ultrasound of neck
4:30pm Prep for MRI
5:00pm MRI T-spine w/ and w/o contrast
6:00pm MRI Lumbar-spine

Then at 1pm the following day, I see my doctor.

This weekend I'll be in Columbia. Over the next few weeks, my wife Maggie will be studying for her first medical licensing 'board exam', which is unfortunately the hardest of them all and the most important. I took mine last June and will never forget my ridiculous study schedule (usually 6:30am-noon, then 1 to 1.5 hour ride, then study until 5, eat with family, study until 9 or 10pm, sleep, wake-up, and repeat).

With her board exam in mind and some changes to our income, I probably won't be racing my bike as much as I thought. It is even looking like our planned trip to Colorado at the end of June for vacation and coinciding with Marathon Mountain bike national championships in Brekenridge, for which I'm registered, is probably not going to happen. Racing bikes is really expensive and often beyond the means of a couple of graduate students...but traveling to race bikes is even more expensive.