Tuesday, October 22, 2013

Taking wheat off the table...

Don't remember exactly when or how wheat appeared on the radar. Consciously speaking, it was probably some time earlier this year, after stomach issues on long rides. Also, gym workouts did not seem to make me any stronger. Time to stop ingesting things, see what works.

Honestly my patience with dietary trends and fads goes into the minus territory. That's what gluten-free among athletes seemed to be. But a perk of being an athlete is we get to experiment. The body becomes a real laboratory, one we can control.

(That's also how many people realize what's true for one body is not necessarily true for another. You can see a ton of variation among individual cyclists, for example. It starts to erode the meaningfulness of large, randomized clinical trials. Whose conclusions are the cornerstone right now of medical research.)

Long story short, avoiding wheat and other things with gluten seems to help my gut feel better. A weird little rash and some other skin issues have gone away. Am sleeping better. No idea how long this has been going on.

As it turns out (believe it or not) they've recently found a connection between TBI and gluten sensitivity. Mostly among women. After a brain injury the immune system can develop a reaction to an enzyme that we need to digest gluten. The name of the enzyme is transglutiminase 6 (TGM6). Some TBI survivors go on to develop full-blown celiac disease (CD).

Even without a measurable disease or condition, this doctor believes that wheat (and other grains) can affect cognitive function.

You can have low-level inflammation going on and not realize it. And while still eating some wheat, my reaction was less severe. Now that it's totally gone from my diet, the reaction is obvious.

On the one hand, good to know. On the other, life without bread, pasta, pastries? Is that even possible?

Thursday, October 17, 2013

The travel pillow protocol

Not gonna go into the front-office part of the Valley Medical visit. How the person at reception wanted me to "confirm" Danny's date of birth. Defended their right to send co-pay bills to him. How a 10:30 appointment with Dr. S. became a 12:15 appointment, without a word about the delay. The patients, we worked it out for ourselves what was going on.

At this point it's just low-hanging fruit.

When I finally did see Dr. S. for 5 minutes, he said that the MRI of my spine looks pretty good. No surgery for me.

They did find root cause, too. There's some damage to the disc between the fourth and fifth cervical vertebrae (C4 and C5). It's visible on the MRI. If it gets worse they can do a discectomy but right now, no need.

In Sausalito at the end of the 400K that spot was tingling and burning in a scary way. That was why.

According to Dr. S. whatever got injured probably healed after 5 years. Wearing a travel pillow at night for 10 months was not a bad idea. It likely broke the cycle of pain and inflammation. The body eventually absorbs the little broken bits floating around. It wants to heal.

He still protected himself and the insurance companies by saying there's no way to tell whether the damage was caused by trauma or by normal aging. Of course, there's no history in my family of cervical disk degeneration. And I didn't have symptoms until after the accident. And it's a common whiplash thing. But hey yes, it's possible. The birthers and the people who believe the earth was created 6000 years ago have demonstrated that.

I can keep riding my bike; just don't stick out my chin. I can go back to a regular pillow. If there's more pain, come back. For now, free of the machine!

Dr. S. rocks, in my book. He is a surgeon, the kind of intervention our system is designed for. He works on mechanical problems with visual evidence. His approach is very calm and methodical and low-ego. Maybe he's just one of the good ones.

We need to spread the word about the travel pillow protocol for whiplash injuries… It cost a whopping 9.99 at Marshall's. Will post again in a couple of months to check in.

Wednesday, October 16, 2013

We are hardware and software

Some days, it feels like the Internet was invented so there's a place to rant about the American medical system. Perhaps unfairly. Those nice doctors are just trying their best, right?

Maybe. In a we-bought-into-the-system-so-you-must-be-sacrificed kind of a way. They're trying their best to fit patients into an inhumane system that cannot help. So they can get paid.

At least someone is getting paid.

If this feels like the sound of one individual ranting you should know that others share this point of view, many others. There's an organized, grassroots effort called Health 2.0 to try to reinvent the ways our health is cared for.  It's so mainstream they're on LinkedIn, where the group for Health 2.0 conversations has 32,240 members.

And while it will probably fail, it has triggered a whole lot of discussion and analysis by smart critical people like Vinod Khosla. Pandora's box has been opened. Medicine is being exposed for what it is, a tradition not a science. The white coats and judgmental attitudes and pompous faith in their own opinions, all that smacks of religion. You know a system and its practitioners are fairly entrenched when they refer to those of us with negative feedback as "heretics".

Whenever I sit in an exam room listening to yet another useless, denigrating interpretation with no data behind it, I find something else to focus on. Often that means visualizing the mental flow chart that the practitioner is operating from. Reverse-engineering it, if you will. And thinking silently You, you could be replaced by software. And software would do a better job.

Take a look.

Tuesday, October 15, 2013

Summoned by the machine

Over 2 weeks ago the MRI of my spine finally happened. Yay! If they find something at least there will be a story. And it would be great to fire the neck pillow.

What I should have hoped for was a call back. Y'know, with next steps, results, little stuff like that. Nothing.

Yesterday I called Valley Medical to see what was going on. The MRI department because it's the number I have and they seem to pick up the phone.

The guy acted like no big deal. He recommended I call my doctor but when I informed him that doctors at Valley Medical don't seem to have phone numbers that didn't faze him at all. He offered to send the MRI results to my home. Very helpful!

Literally by accident, watching an applet do its thing on the Stanford Hospital site, I saw the neurosurgeon's face and name go by. He teaches at Stanford, too. There was a phone number! Called, got voicemail.

Today the land line rang. An automated voice on the other end said it was Valley Medical. I'm expected Thursday at 10:30am in the Neurosurgery Clinic.

Well, they seem to have found me.

People ask why I'm going to Valley Medical at all. They're the county hospital; they don't turn anyone away. Well you might be wondering too…

Valley Medical is the only facility in California with traumatic brain injury unit and an end-to-end Rehabilitation Medicine process. Where they follow you the whole way through. At least in theory.

To me it looks like patients are required to devote countless hours to playing their game and when the ball gets dropped, it's never anyone's problem.

Except mine.

Saturday, October 12, 2013

Now on Kindle!

Discovered this cool feature and had to use it. Kindle users can subscribe to a blog and new posts arrive wirelessly, automatically. Read at leisure!

Bonking left and right


After a 1200K the Big Sur Ride is a convenient, social way to get back on the horse! If you ride to the start in Carmel Valley it's three days, ~280 miles total. The second day is the hard one, with 110 miles and ~8K feet of climbing. A hot tub waits at the motel in King City…

Of course, to get to the hot tub you have to climb Nacimiento-Fergusson Road. The first 2 miles are steep. Then it's a regular hill until mile 5.5, where the road tilts up again slightly. That lasts for about a mile, after which it's another three-quarters of a mile to the summit.

Whether this is your first or eleventy-first time up Nacimiento it's always a test.

Today after the first 2 miles my legs are completely, inexplicably out of gas. There is nothing in the tank. Bonnie, who started with me from the bottom, climbs up out of sight. I struggle. Try taking electrolytes. Then an Espresso Love GU for sugar and caffeine. Sweat too much. Push like hell. Get totally dropped.

What's going on?

Hard to tell, but this isn't the first time. In the last few weeks it's happened on both Tunitas and Highway 9 as well. Since I (mostly) gave up gluten. Pretty scary stuff.

Looking back, a couple of possibilities. What I'm learning is wheat has a profound ability to raise your blood sugar and keep it high for a long time. Long enough to climb Nacimiento! After giving it up it's rare now that I actually feel hunger. My thinking also seems clearer.

While avoiding wheat is not as hard as I thought, it might be taking a while for the metabolism to get the message. Steadier, lower blood sugar seems to require an adjustment period. Without ever signaling hunger, my body is bonking big time on the big climbs.

Or maybe I just carelessly ate some gluten and threw everything for a loop.

Either way, no photos after this point, no stories. The GU helps somewhat but finishing the ride takes all my focus. There's the fear of needing a lift in Chuck's white, air-conditioned truck. By taking it easy on Jolon Road, no truck is required.

Just a hot tub, which is indeed hot, and heavenly.

Friday, October 11, 2013

Eventually home




Last month Pico Iyer wrote a piece for the New York Times on suffering.

I read his words on a warm fall day in California, where an entire culture based on seeking pleasure and avoiding suffering has evolved. No one talks about suffering here. It's a no-no, a downer.

While the rest of the world is asking, does a lack of suffering also drain life of its meaning? Can any meaning exist, in the absence of suffering and loss?

At this moment I'm sure of exactly one thing: China Grade is the steeper, shorter way through Big Basin State Park. Narrow, forested, devoid of other humans. Quiet. In the greater Bay Area there are a few places to be organic and still.

The suffering takes the form of a mile and a quarter of 11%. It keeps on coming too, demanding all your focus and attention. Today it's good.

Hullo, another cyclist! Stopped in the road. On a town bike with panniers. Feeding treats to a dog!

As the canine trots over to check me out, I put down a foot and remove helmet and glasses. To pass muster, look more human, less stormtrooper.


What's he doing out here with touring gear? I have to ask. On a freaking steep, remote climb no less. Well, he and the dog are headed for the coast. Three times a week they make the 18-mile round trip. Their pace is set by the dog. In other words between 2.5 and 3 mph uphill, and as fast as possible on the downhills.

He turns the question back to me… well it's kind of like going to church, I say. Recently got the news that three people, all boys I knew from growing up, have left this world. On the early side, unexpectedly and with suffering. All three gentle souls.

This week I've been swimming in sadness. Trying to prospect for meaning. Get things back in the proper relationship to each other. Feel the loss without becoming a hostage to it. The whole experience is a lot harder and more painful than I imagined.

The other cyclist asks how old they were and if I knew them well. I did. He has no advice to offer. Instead we chat about other things on the last steep part, with the dog trotting alongside.

At Highway 236 they cross over and head west, toward a dirt road leading to the ocean. For me it's the predictable asphalt toward Waterman Gap and Saratoga Gap. A couple of miles from the summit there's a view back into Big Basin, through the smoke and haze.

This perspective doesn't begin to describe the terrain below, what it's like to be down there among the oaks, redwoods, fir and manzanita. Sometimes tracing the spine of a ridge and sometimes moving orthogonally, directly across the contour lines. You can never tell exactly where you are down there. It's about just following the road where it goes.

On Highway 9 and Redwood Gulch the descents go every bit as fast as the Seven can handle, which is very fast indeed. You have to feel alive, going that fast.

Down, down, down into Stevens Canyon, along the creek and eventually home.

Tuesday, October 8, 2013

League of denial

Just saw a great Frontline documentary on brain injury in the NFL. Now coming to a TV near you… Highly recommend.

It's the story of how the NFL has obstructed progress in researching concussions and CTE in players. They bullied and discredited scientists, for one thing. The scientists recognized very early on what they were seeing. An epidemic of neurodegenerative disease.

When the NFL were finally hauled in front of Congress in 2009, a lawmaker compared the league to Big Tobacco, trying to deny the link between smoking and lung cancer. That didn't stop the NFL  though. They just bounced back with the same arguments. Even today they're still saying there's not enough evidence.

All I can say is mamas, don't let your babies grow up to be linebackers...

These posts on Route 66, a journey followed the NFL concussion story:

Friday, October 4, 2013

It's our therapy

Road Closed.

Then another sign, Detour with a circular arrow. Huh? They must mean 'turn around and go back'. There are no intersections here on Skyline. Detour, no can do.

It's a perfect warm fall day. Usually a bike can get through so I roll up to the orange cones where two guys are talking. Ask what the deal is.

The younger one says there's a tree down. He's wearing a white cap that says BATS on it, white lettering against a black bat outline. Bay Area Transportation Services. A contract response crew. Just up the road in the shade something is lying across the grey asphalt, barely visible.

"This gentleman just had an unfortunate accident with his car" Mr. Bat-on-Hat says, waving toward the shoulder. There's a new Ford Mustang, silver, shattered windshield and crumpled hood. Looks like the second guy discovered the tree.

"Still got the adrenaline going" says Mr. Smashed Mustang. The trunk is in the shadows, hidden like a tripwire. "A little higher and I'd have been decapitated. Two hours until the tow truck comes." He lights a cigarette, shaking.

Mr. Bat-on-Hat has strict orders to let no one through. Two places where live wires are down on the road. A crew is working on it. Worth waiting for a few minutes.

The three of us stand there talking for a while, like it's a normal thing. About cycling and safety, about roads around here, and then Mr. Bat-on-Hat's motorcycle. A Suzuki sport bike (we see a photo on his smartphone). When something's bothering him, he just takes off with his buddies. Rides from San Jose all the way up to San Francisco, over to Oakland, back down to San Jose. Makes him happy.

Mr. Smashed Mustang knows these roads because he loves to drive. Especially to clear his head. He says "It's my therapy."

Mr. Bat-on-Hat says "It's MY therapy."

They can't believe someone rides to Boulder Creek and back.

I laugh and say "It's my therapy."