Cross season

Over the last few years, I transitioned from a minimalist commuter on a surly showing up at my first cyclocross race in a Tshirt, to a dedicated competitor with multiple skinsuits, tires for every condition, and identical carbon race bikes. My wife has been more-or-less supportive of this change. I really do have fun racing my bike and try to keep it real and not make things to serious. The only problem with the cyclocross season (from both of our perspectives) is that it is a period of time of weekly racing (requiring 4+ hrs in the car every single weekend), during a time of the year when so many awesome things are going on. The training has always been the easy part for me. Riding 1 to 2 hrs Tue-Thurs isn't work and I really don't care what the weather is like; it keeps me sane and I do it regardless of whether or not I was racing. But seriously, do you know how many amazing beers come out in the fall? Yes, they can all wait til January, and I can practice moderation now, but I really don't want too.

All things in moderation, including moderation.

I really want to be a good dad. And husband. And also friend, son, brother, mountain bike racer, and cross racer. And on top of those things, I really, really care about being a good scientist. And doctor. And unfortunately, I kind of give a shit about this election tomorrow. And reading. Plus, there's a bunch of good food too cook, vegetables too grow, beer to drink, house projects too complete, and maybe there'll be some time to watch some sports on TV. Or maybe a movie.

So much for voluntary simplicity.

Two Sunday's ago, I raced in KC and ended up having some really nasty calf pain towards the end of the race. It seemed like a cramp and therefore ignorable, but it actually got worse once I stopped racing. And by the time I drove home, it was totally debilitating, leaving me hopping around and needing crutches at first. I saw a couple of sports docs on Monday, who both thought I tore a muscle in my calf and that it would take 6-8weeks too fully heal. Luckily I was scheduled to fly down to Florida on Wednesday morning for a few days on the beach at this medical conference my wife's family attends every year, so I had the opportunity to be away from bikes and to relax.

After talking things over with my wife, I decided that it'd be better to 'let-go' and re-focus for the remainder of the fall. Time to get into the gym, start riding my mountain bike more, and planning for next mountain bike season.

Florida was awesome.

Movember

Sometimes I catch myself being a crotchety-old-grouch when it comes to certain cancer related things. For example, when I read about 'X' cancer awareness campaign, I find myself thinking, 'what exactly are we supposed to be aware of'?

The statistics? Yes, the figures are staggering; just about everyone knows someone who's died from cancer. Residents of the US have about a 1 in 5 chance of dying of cancer. In 2008, ~5-600,000 people in the US died from cancer (23% of all mortality), which is a frequency surpassed only by heart/vascular disease.

That people do research and that private/donor money is important for research? Well, that's a huge area that does need more awareness.

Recently I was riding by some outdoor University tennis courts. There were a ton of construction workers putting some kind of pipes and electrical stuff under the courts. I don't know this for sure, but it seemed like they were installing equipment that will help keep the outdoor courts warm during the cold months of the year. I counted the construction workers; there were 46 of them. Oh yeah, and these courts are right next to an indoor tennis facility.  But, I guess now that we're in the SEC, we need to keep up with Georgia, Florida, et al.

Meanwhile, researchers and students pinch pennies and pray for miracles.

Sometimes I think I'm crazy for taking the MD/PhD educational route at my particular University. But when I examine my value system and my motivation, deep down I believe that research is important for society and that my voice in research (as someone with cancer) is important. It's a little sad, but there was a facebook conversation/debate I recently witnessed where someone was basically saying that research is really only funded by the private sector and that basic science research does little for the economy. Unfortunately, after really thinking about the economics of things and reading this, I can't really disprove that point of view. But, I BELIEVE that it is wrong. And I choose to BELIEVE that discoveries made on the bench-top do lead to improvements in patient care and that these discoveries, no matter how obscure or strange sounding, often do spur economic growth (both because Universities create jobs and because discoveries are often open sourced and can be built upon by a poor grad student in Cambodia or Genentech).

Anyway, my point in all of this: we need to examine our beliefs, our priorities, and realize that gestures like growing a mustache or wearing pink also need to be backed up with tangible substance. It's not just the thought that counts. Wearing pink in October is fine and dandy, but it doesn't make anyone a better person for doing so, and ultimately it doesn't mean much unless it really inspires people to work for change...maybe it's figuring out WHY the breast cancer statistics are as they are or any number of other questions. Or maybe someone interested in doing something positive would donate to the University of Missouri MD/PhD program? Clearly our University is more interested in things in the same ballpark as the football coaches incredible salary.

Mid-October Cyclocross

Official cyclocross racing season runs from September through December in this country. Although now it is a bit longer because beginning last year, the national championships was moved from mid-December too early January. Further, the Master's world championships is in the US for 2012 and 2013 and this year (well, actually early Feb 2013), the elite World Championships is going to be in the US. So now you can race in the US from September through early February. That get's to be a pretty long season, and similar to baseball, different riders (teams) ratchet things up at different times.

This past weekend was an exciting one for cyclocross fans because the American hero of our sport, Jeremy Powers, got his best ever finish in a world cup...which bodes extremely well for the rest of his season and the possibility to see him on the podium at the world championships.

Locally, there was a big race weekend down in Tulsa, OK, which originally looked extremely attractive. But seeing that the friday and saturday races started at 9:30pm, I decided that I'm too much of an old man, and that it'd be better too stay in Missouri.

This is a point in the season where you can still build some high-end fitness too last through the winter, so I've been hitting it pretty hard during the week and also on Saturday's. So, like all self-centered cyclists, I'm trying to rationalize why my legs didn't feel super hot on race day this past Sunday. One of my favorite racers in cyclocross wrote a great blog piece about those days/times when you're legs don't show up to a race:
"Dear legs,

I regret having to send this letter, but enough is enough. Maybe you never got the memo. Or maybe you just forgot because it doesn't feel like autumn yet and in your defense, it has been quite a while. So let me take this opportunity to remind you that we are supposed to be a bike racer now. Actually, it was supposed to be a week ago and due to your absense, beard and hands were hung out to dry. I have to wonder how you failed to notice how hands were out practicing for bike driving and beard was filling out in preparation for the coming season. What have you been doing? I have supplied you with all the tools you should need to succeed. Hard training, long rest, but you don't seem to take the hint. Well, moving forward, we have a long job ahead of us and it's going to be much longer if you continue to fail at your part of the bargain. Unfortunately I have to put you on the spot. If you don't get it together I am going to have to reconsider your involvement at this facility.

Sincerely your's
Bike Racer Dan"

I think Josh must have sent a similar memo to his legs after last week, because he brought some heat and put me into a serious pain cave yesterday. It was like old times and honestly, really fun to suffer at the hands of the butthead. Well, let me re-phrase, it was really fun too race off the front with Josh from laps 4-10 yesterday. We traded leading and thus, attacking each other and had a solid dual. Which lasted until the finish line and concluded in pats-on-the-back and my comment to him, "thank you sir, may I have another". 

As far as the race report, I've been pretty bad at writing these lately and need to get my day started...but, Kenda/Felt pro-mountain biker and super nice dude, Drew Edsall recently moved to St Louis. He was there and put in a blistering 2nd lap...which almost shattered all of us. Devin Clark was also riding really strong and at one point, it seemed like he and I were going to repeat the shenanigans of Hermann. However, an untimely miscalculated corner would prevent that from being the case. 

Next up for me...well, it's Monday. Time to go cut some cancer cells with a laser (cancer research is awesome). 

Bike-stuff-wise: I really want to go to a few bigger races this year. Originally the plan was Jingle cross and then try really hard to do well at the master's 30-34 race at nationals. Jingle is a logical choice because it's only 5ish hours from my house, the race supports a good cause (always important to justify our self-centered-ness with pseudo-concern for others), and it's a mid-west thing. But last week I got the urge to travel out to Boulder for the Boulder Cup and the Colorado Cross cup this coming weekend. The family situation will allow for that too happen, but right now an examination of our bank account may prevent that from happening. Which is a shame, because it looks like it is going to snow in Boulder on Friday! I guess it's always good to think about goals in these situations, the reality is that money is the biggest limiting factor in being able to travel for a bike race and the 1500mile round trip to Boulder probably isn't compatible with the cost-benefit equation. 

post-script: I was talking to a friend about favorite CX racers and have established this list:
1. Adam Craig
2. Jeremy Powers
3. Tim Johnson
4. Dan Timmerman
5. Stybar
6. Tie between Tristan Schouten and Brian Matter
7. Zac McDonald
8. Barry Wicks
9. Sven Nys
10. Francis Mourey

Performance enhancing drugs

"So, I have a question for all my cycling coach, exercise physiologist, fitness expert friends out there. If one took performance-enhancing drugs and improved their VO2 Max and LT, but then stop taking drugs is it safe to say they may still reap some benefits of the enhanced physiological adaptation brought on by the drugs, even years later?"- Brandon Dwight, of Boulder Cycle Sport.


I've thought quite a bit about this question, and although I'm not credentialed in any of the ways he specifically addresses, I do understand medicine, physiology, pharmacology, and have a descent background in exercise phys. So this is all, from my humble opinion:
The bottom line is that performance enhancing drugs can't all be grouped into the same category. That is to say that Epo and blood transfusions are completely different than Clenbuterol, diuretics, anabolics, and things like growth hormone. 

The physical demands of a baseball player are so incredibly different than those of a stage-racer cyclist, which in-turn are pretty different than even mountain biking and especially track cycling. In baseball, cheaters want to get bigger, stronger, and faster. So their enhancing pharmacology with things like growth hormone, estrogen antagonists, and testosterone enhancers all reflect that. And those particular drug regimens definitely alter gene expression in such a way as to produce long-term, performance enhancing benefits. I would imagine that track cyclists, if interested in the benefits of pharmacology, would utilize similar cocktails. 

I'll never forget reading about some cat 2 cyclist from Houston who got busted taking a very advanced (medically speaking) estrogen antagonist and testosterone enhancing approach. He was on a bunch of breast cancer drugs (which as a cancer survivor, bike racer, and physician-scientist in training, really pissed me off). I'd predict that his ability to recover from training was enhanced and that he had a noticeable increase in short-duration power outputs on the bike. He probably won more sprints. But in terms of time trialing or a stage racing, there's a certain point where there would be diminishing returns and frankly null or even detrimental benefits with that particular pharmacologic approach. That's simply because the demands of endurance sports are so incredibly different than power sports. And size especially, but also to some extent the myofibril adaptations associated with high-power, is/are detrimental to type-I (endurance, skinniness) oxidative fibers. It's literally like comparing the white meat associated with a chicken with the red meat of a buffalo. They're metabolically incredibly different and everything from training to fuel-source are almost diametrically opposed. And this difference is mainly associated with the underlined, bolded term and has everything to do with oxidative phosphorylation, mitochondrial efficiency, and the physiology associated with getting hydrogen ions away from, and oxygen into working muscles. 

Oxygen delivery. That's the name of the game in endurance sports. Anabolic's and cortisol synthetics don't really affect it. Genetics are huge, and effect pulmonary/chest anatomy and physiology in such a way that it's probably the biggest difference between a pro-tour rider and the rest of us. But the genetics of erythropoiesis probably don't factor in much...which is to say that most people's bone marrow is on pretty similar playing fields. Unless of course, you alter the kinetics of hematopoeisis. And like most things in physiology, you can increase hematopoesis or decrease it, and these events can occur naturally (you get a bacterial infection, your bone marrow makes more white blood cells) or pharmacologically/iatrogenically (cancer patient get's radiation treatment which damages bone marrow stem cells, so they become deficient in various blood cells). Just to tie the point back to performance, it is the red blood cells which serve to help buffer hydrogen ions (which isn't always talked about but is a HUGE factor) and deliver oxygen from the lungs (genetically determined) to the working tissues.  Measurements of red blood cells often confuse medical students and physicians, so it isn't worth the effort to go through the meanings of Hct, Hgb, MCH, MCV, reticulocyte count, RPI, etc. But the key to discussing the answer to the question at the beginning of this post is that red blood cells hang out in the blood for around 4 months. So changing the kinetics of RBC production, like with EPO, or simple increasing circulating RBC mass, like with autotransfusions, have short-lived effects. 

So in short, anabolics can have potentially long term performance enhancing effects. Drugs and transfusions to affect oxygen delivery almost certainly don't. But, since doping leads to enhanced performance, which can lead to winning races...then (to quote Adam Myerson) 'It can make the ability to return to that higher level easier than it would have if it was done cleanly, and incrementally. But more importantly, the access to better teams, better races, better support, and better money, all lead to an ability to do better preparation, and reach a higher level still. So, not exactly the question you asked, but an example of how it can indirectly continue to benefit the level of fitness reached after doping.'

To me, the use of EPO in endurance sports is a medical travesty and if you want too seriously talk about long term effects of EPO use, I think you're getting into the realm of oncology and cancer biology. Synthetic EPO saves lives; mostly for cancer patients and renal failure patients. And like any drug that is ingested or injected, there are effects beyond those associated with the therapeutic benefit. I was taught in medical school that there is no such thing as drug 'side-effects'. Biology doesn't work that way, there are only effects. For EPO, it's a mitogenic agent, or something that induces/promotes the cell cycle. Anything that does that, has the potential to facilitate conditions that lead to cancer. So in a sense, a cancer patient or former cancer patient that takes EPO is putting themselves at risk for more cancer. And in another, more abstract sense, spitting in the face of the patients for whom EPO was originally intended. 

Personally, I've received enough radiation over the years that my bone marrow has taken a hit. When you measure my white blood cells and red blood cells, you can see that deficiency. Also, I ride and race bikes with active, living tumors in my vertebrae and in my lungs (although those in my lungs are only 5-10mm). I'm clearly not a world class athlete and could never be one, but my point in saying that is that these things effect oxygen delivery in my body, but I'm clearly still capable of having a descent power output at LT and VO2. My own conclusion based on understanding my own physiology, is that training can trump anatomy, but only to a certain point. 

Medicine and the election

It's been a little while since I've posted anything besides bike racing stuff.

I hesitated to post links to the following on facebook, so will therefore post them here and then link to facebook!

Lot's is at stake in this election coming up in November. In terms of healthcare, you should read the following links and think about them no matter where you are on the ideological/political spectrum:
The conservative case fo Obama care

Also, both presidential candidates wrote pieces for the most important journal in medicine.
Replacing Obamacare with real reform- Romney
Securing the future of American Healthcare- Obama

I'm not sure if there's anything more important in my life (besides my family) than being a physician. I have not yet completed my training, but will in the next couple of years. For me there is no higher calling, nothing more meaningful, interesting, exciting, or engaging than the art and science of medicine. I won't go on a rant about what I believe as far as national health care, but suffice to say that having had cancer as a 20-something made it undeniably clear that our healthcare system has been broken. This article by Atul Gawande, a Harvard Suregon essentially summarizes my opinion.

As an aside, in terms of those two articles from each candidate in the New England Journal, I speak essentially 3 languages: English, spanish, and medical. And honestly, even though I read it with an open mind, I have no idea what Mitt Romney is saying in some sections of his piece.

There are a bunch of comments following each piece. My own view is summarized by the following:
"We Need to Go Deeper Than Glossy Rhetoric

We will never have a smart, cost-effective healthcare system in this country until we address the way we pay for health care. Our third party payer system - private as well as government-funded - supports the health industrial complex, not health care. It provides all the wrong incentives for specialist care, overmedicalization and procedures, and shapes the way a doctor practices at least as much as medical science does. To think that an unregulated free market system will put less emphasis on profit and put patients' interests first is to be stuck in a 1950's mentality: as long as clean cut white men in suits are in charge, we are all in good hands.
The Affordable Care Act, as well as its earlier version, Romneycare, moves us towards providing incentives for quality outcomes and cost-effectiveness rather than for productivity. We the people, in the form of a democratic government, need to continue to work towards this critical goal, keeping special interests at arms length. Private business has very different goals, ones that are often directly at odds with patient's best interests."

-RANDY KOZEL, MD | Physician | Disclosure: None

JAMESTOWN RI

Gateway Cross

Getting a top-10 at this race, and therefore a UCI point, was a major goal of mine. I was pretty psyched with the result, but honestly feel like I just made a ton of stupid mistakes so have mixed feelings about the race as a whole. 

The funny thing now is that I don't really know what I'll do with that UCI point! It was really just a goal too see if I could get one! Traveling on my own to USGP's doesn't really sound like much fun. And I guess I can understand why people that want to compete at the national level really benefit from a team with whom too travel. 

But, Last night was fun for sure...racing fast dudes I don't know is awesome. Man, it was muddy! Really weird too race in such thick slop and not have it be cold. 

The first 2 laps (of 8) were typical big-race craziness. Not so much because there were lots of participants, in fact it was a pretty small race, but because things are really aggressive when there are pro's and want-to-be pro's.

On the first lap, I botched 2 run-up's and then on lap 2, I crashed in a boggy, peanut-butter mud poorly lit corner. I think I was riding 7th at that point. Despite mistakes, I was never worse than 13th. WIth 6 to go, I found myself in a group with the guys who all ended up 10th-15th.  With 5 to go, I was 5th wheel in my group coming through the start finish. Everyone looked like they were going hard on the concrete, so I wanted to test my legs and put in a little dig which ended up with me passing those guys. So I basically kept going with it, which broke up the group and made it me and 2 others. The pace with those 3 guys wasn't too hard, so it seemed like we wouldn't catch who ever was in 9th, so our race was for the last UCI points spot.

With 2 to go, I attacked on the boggy straight near the pits and got a gap. But towards the end of that lap, I lost grip on my hood and crashed and was passed by Brandon Cross a fellow mountain biker from Salt Lake City, who I would end up chasing really hard on the bell lap. I caught him with about a quarter of the lap left and passed on a tricky little kicker. I then blocked and pegged it coming through the turns before the start/finish straight. It was then a sprint finish for the last UCI point. I've only sprinted for a win a handful of times; so was mostly just winging it!

Now it's back to work and research. In terms of bikes, I can't really decide what to do with myself during October. My mountain bike was sold in order replace Maggie's bike, or otherwise I think I'd start riding more singletrack and try my legs at the Berryman Epic.

The thought of traveling to Ft Collins on my own or with Maggie/Cassidy in tow, seems like a quixotic quest and just not in the cards in terms of money/time. So, I'll probably do some local bubba races and try to get faster in time for Jingle cross, where I can put my UCI point too use!

Hermann CX

Sometimes I can't believe my wife tolerates me.

Saturday was her 30th birthday and somehow in the grand negotiation that is marriage, I had the green light to go race my bike in the evening of her birthday, while she went to a party at one of our friends houses here in Columbia.

A lot of time, energy, planning, and of course, money goes into amateur bike racing. Sometimes it's quite staggering to think about. This year, the bike racing associated bargain with myself, family, and work is that I'd race much less going into cross season and then try not too race every single weekend from now until January. As such, Hermann and Gateway cross were the clear targets for early season racing. Both are reasonably near home and are national-caliber events. I feel pretty confident in saying that if people drove from out of town, they would not be disappointed with the course, volunteers, and promoter of Hermann CX. I only wish more people from Missouri could fit the race into their schedules.

In the build-up to September's CX racing, I opted to not race at all during August. Mostly too stoke my competitive fire, i.e. to get really hungry for the entire experience. But also just too have more time on the weekends. I took a 2 week break, almost completely off the bike in late July and early August, then did 2 weeks of endurance riding in the 13-15hrs/week range. Those are big weeks for me, as I normally average 6-10, sometimes 11 or 12hrs/week. After that, it was 4 weeks of specific CX-style training almost always first thing in the morning as per work and family obligations.

Anyway, we're in the process of moving right now so things have been pretty hectic in general, so the escape to the pain cave of cyclocross racing really served as a much needed mental re-ordering. I still don't know what it is about cross that I find so incredibly fun and engrossing, but I really do love every minute of it.

The weekend started with a trip to a bed & breakfast in Rocheport for me and Maggie. I figured it'd be a nice way to celebrate her birthday and get in a mellow evening in this very hectic time. I had picked up some kind of GI-nastiness on Thursday which persisted all day Friday, so at about 5pm friday, I thought I might need to pull the plug on the plan to race saturday. But come Saturday, I was feeling much better and proceeded to gorge myself full of food just about all day.

I really had no idea what to expect from my body that evening. I knew that Josh, the Ethos boys, Devin, and Jay could all cause some serious pain, so my race plan was too keep the pace pretty high early and then see what happened. I was particularly watchful of Josh, as I knew he's fast from a bunch of road racing and always the smoothest guy out there, so a course like Hermann is right up his alley. On a side note, if you're an intermediate or beginner cyclocross racer, do yourself a favor and become a student of the riders who ride the smoothest (Josh). Study every turn they make, where they go hard, how they recover, and just generally how they manage their energy in a CX race. For me, it's made the learning curve over the last 4 years much easier. Hard too believe that just 4 years ago, I was showing up to my first bike race in 10 years in a t-shirt, on my Surly cross check, with my wife, and 2- week-old baby in tow for Bubba #1 2008.

Anyway, the race started, Jay took off like a mad man, and the next thing I knew I was riding with Devin with a little gap on people...which is a situation I found myself in quite a bit last year, but this year we're on different teams! Josh was close behind, dangling at about the same distance for the remaining 10 of 12 laps. I'm not sure why an hour on a course where you do 12 laps seems so much longer than an hour where you do 7 laps, but man was that a mental battle.

Devin and I rode hard, occasionally putting in little digs but also not full-on attacking each other. He crashed 2 separate times and each time, I rode the same pace we had been riding, which was probably a 6 or 7 out of 10. I'm guessing that too catch back on, we was 8 or 9 out of 10 effort. So when it came to the last lap, I dug deep and buried myself on every section I could hoping that he had burned some matches earlier. I made it to the stairs without him passing, which basically meant I had a few turns, a technical sandy run, then a short swooping grass section to the finish. I don't mean to sound at all like it was nonchalant or no-big-deal, as the reality of coming across the line first on Saturday night was pure elation. A whole lot of heart, soul, blood, sweat, and tears poured into training and riding over the past few years. I always hate it when people make hard things sound like they were easy. So, I just want to say that I don't take getting to ride my bike in a race like this for granted. There are times when I feel like the little tiny metastases in my lungs are keeping me from riding hard. And trying to be a decent Dad/husband, going to med school, and actually staying healthy while being completely addicted to entering a world on the bicycle where I can push myself as hard as I possibly can, somehow, at least for the time being, seems to find equilibrium and strangely, bring peace.

I can summarize day 2 by saying, it hurt. And running the entire length of the stairs at Faurot field was excellent training.