Wrong procedure! First lesson, listen to your patients.

I was planning on writing about meeting another gutless cyclist on a local shop ride, on Saturday, while I was taking it easy and still feeling pretty rotten after getting out of the hospital only 36 hours prior.

And, before that, I had intended to write a post about how becoming suddenly and cripplingly ill, and landing in the hospital for a few days does things to my perspective and priorities - and I don't mean that in the cheesey, lifetime special, sort of way. I mean, sincerely, that on Saturday after getting out, I rode my bike like it was both the first and last day I ever would again. And, it was glorious... and rainy.

And, finally, on the list of upcoming posts is one that was triggered by a request from another blogger. She asked a few folks with Crohn's or an ostomy to write about how their age of diagnosis effected their life course and development.
.....

But, instead, I find myself with a burning desire to write something short about the events of the day. At this moment I am feeling frustrated, close to downright angry. In followup to my recent illness I was scheduled for a bunch of appointments with my primary care physician and GI doc, and one minor procedure. However, my GI had to go out of town, and instead I was rescheduled with another physician for both my upcoming appointment and procedure. That's fine. Stuff happens, as inconvenient as that is.

Today, when the scheduler called me with the normal ramble about when to arrive, where to arrive, etc, she also said, "The procedure will take about 3 hours and you will need to have somebody pick you up afterwards".

Whoa! What!?

I said, "I think you must be mistaken. I do not need to be picked up because I will not be under any sedation. And, I think you have me down for the wrong procedure because 3 hours is too long".

Apparently, somehow there was some sort of major miscommunication and I was scheduled for a colonoscopy with general anesthesia! So, the scheduler apparently called the physician doing the procedure to try to figure it out. But, still the same thing! She told me that was the procedure I was scheduled for and was supposed to have.

Now, I'm a well educated and well informed person. I have no memory deficits, and I don't get confused about medical details. If there is one thing I know, it's that a colonoscopy 1.) won't work 2.) isn't appropriate followup!

At this point, I asked for the physician to call me so we could try to figure out how this confusion ocured and fix it.

The physician then had a medical assistant call me instead of calling herself. The medical assistant was in no way equipped to have any sort of conversation about the appropriateness of procedures, and was only able to reiterate that I was scheduled for a colonoscopy. She was very nice. I expressed my frustration that the physician had not called me, and that I thought instead of a one way conversation we needed to have direct two-way communication before I showed up on Thursday.

So, what happens next? The scheduler (who has some medical knowledge. a retired nurse ?) calls me back and reiterates again that all they are showing is a referal for a colonoscopy and that is what I am being seen for, and that I will be under general anesthesia. And, the tone was now changed, as if I was being a difficult patient and was making unreasonable and outragious demands: to not show up for a procedure that isn't correct or beneficial in followup - nevermind everything else.

Is this groundhogday the medical version!? Am I speaking a different language here?

Any patient should be able to voice concerns when they believe they are receiving or in danger of receiving the wrong treatment/surgery/medication/any care!!! It is our job to advocate for ourselves. If we don't, many times, nobody else will.

One of the first lessons I learned as a Paramedic was to listen to my patients (the coherent, lucid ones... and sometimes, especially the ones who aren't). They often have the answer. They know what happened last time, and can often be a great crystal ball for predicting what treatment will work best.

Sadly, I have yet to be taught that lessson at the Yale Medical School, either in the classroom or by example from the physicians practicing here at the teaching hospital.


And, here's an interesting scholarly article about how these sorts of errors in performing the wrong procedure or performing it on the wrong patient happen.


For the sake of my own health, I'll remain a trouble maker of a patient in their eyes. Who in their right mind would go under anesthesia if ANYTHING at all seemed wrong about the plan?

A history of... shhhhhh.....crohn's. And, learning to accept.

Why does it seem like so many of my Crohns and ostomate friends have been getting sick lately? Or having unpleasant setbacks with their disease?

Is it something about the time of year? The stress of school, work, and family as we all get closer to the end of the semester and the holidays?

"I never make it through finals without having at least a little flare up", my friend Jacinta said. I was taken aback. Two or three anticipated flares, often landing her in the hospital, as the price of academia?! Seriously?

This was in 2003, when I was working full time as a Paramedic and living in a tiny Philadelphia appartment. She was my housemate, who also had Crohns. She was one of... no, scratch that. She was THE first person my own age who I met who had Crohn's Disease, or IBD at all for that matter. And, she was a stunningly beautiful, long legged, bubbly, athletic, Ivy-league lady! Maybe in the back of my mind I had always thought people with Crohns were hiding somewhere because they were too socially damaged or otherwise unpleasant to come out. And, who would talk about Crohn's anyway? Wasn't it something to be ashamed or embarrassed about?

It might seem strange that I had never previously met anyone with Crohn's, in all of my years as a child going to doctors appointments and all of my years in and out of hospitals from the age of about 8 until then. But, somehow, it's true. I was never offered the opportunity to talk about my illness, or connect with others who were experiencing the same fears, pain, and often isolation that I was - all on top of the struggle of surviving elementary, middle, and then high school!

My parents treated my illness as a burden, or as some sort of punishment from the universe for something that I should have done better in my childhood. They alternated between avoiding even saying the word "Crohn's", and shaming me for it, and sometimes oversharing details about my illness with friends and relatives in ways that were the exact opposite of supportive. But, for the most part, they defaulted to pretending that it was non-existant, something to be hidden away. During this time, there was no internet, then the internet was new and my family didn't have a computer, and then finally with computer and internet access I didn't even know that I might be able to find community or information online. There wasn't the same easy access to online community and resources that we have today. And, I'm not even all that old!

As the years went on and my disease worsened, with increasing failure of treatments, and hospitalizations tallying in the tens, my parents years of shame and denial left them clearly unprepared for the reality of having a critically ill pre-teen. At one point I was even threatened with something that made absolutely no sense to me at the time; that if I didn't get better/be a better patient/do whatever it was that they thought I should be doing at the time that I would be "pooping in a bag". That sounded pretty gross, and also like a sick and twisted threat. I remained mystified by this for years afterwards.

...

Back to Jacinta, my lovely Crohnie housemate in a slightly overcrowded West Philadelphia apartment.

She wasn't ashamed about her illness, or how it had effected her life. She was happy to talk openly about growing up and being diagnosed with Crohns, giving up salad for good, what past treatments with Humera were like, how a fuzzy blanket and a heating pad got her through chills during flare, and finally... about the time when she got sick in high school. She got really, really sick and ended up not being able to eat for months. She refused to be hospitalized and stay home from school, instead electing feeding by a nasogastric tube, which she inserted HERSELF! When she finally did end up in the hospital, after months of trying to go on with life despite her illness, she was in pretty bad shape and ended up having ileostomy surgery. At that point, she still stayed positive and adjusted to her new life. Around the kitchen table in Philly, she told funny stories about having to educate new resident physicians about her altered GI anatomy, and about botched bag changes.

I was simultaniously in awe of her, floored, and horrified. But, mostly in awe of her and fairly sure that I would never be able to be as accepting of my own IBD as she was, and definately wouldn't be able to adjust to living with an ileostomy if, God forbid (!), I ever had to.


Yet, somehow I have adjusted.

Sometimes I have a hard time staying positive, especially during weeks like this when I've spent more time in a hospial bed than my own. But, I do find that one of the things that helps me the most is connecting with other people who have Crohn's or an ostomy, and sharing my own experience. Maybe my experience will help somebody else adjust to having an ileostomy, but even if it doesn't acheive that specific aim, I hope that it at least helps remove Crohn's disease from somebodies list of things to be ashamed of or silent about.

And, just as important as connecting with other Crohnies and ostomates, is being comfortable enough with non-Crohnie friends to allow them into my life. Keeping it a secret means no hospital visits! And, as far as I'm concerned, friends and friendly faces make a hospital stay that much less boring, anxiety-making, and unpleasant. So, friends, if you are reading this, thanks so much for all of the support and cheer this week!

first hospital trip in a while

I just got home from the hospital after a four day stay. You guessed it, abdominal pain. But, in a whole new and unfamiliar way. On Monday night I started having sudden onset of searing pain just above and to the side of my ileostomy site. I watched it for a few hours as it got worse and worse. Finally, when chills set in four hours later, I decided it was time to go to the student health center (required before ER in order to appease the health plan gods). They heard my medical history and said, "We need to send you to the ER. We have to assume there is something seriously wrong."

So, I went to the ER at the huge Yale hospital and stayed there till 6am when they finally admitted me. It wasn't an altogether unpleasant ER stay, despite some nervousness about running into fellow PA or med students. One of the residents reviewed radiology problems with me for a good two hours, which was pretty cool. It was nice to be treated as a future colleague, and not just a patient. It's even different than being a Paramedic and getting sick. Suddenly, all the physicians and PA's want to teach me about everything that comes up in treatment - which is sometimes exhausting and sometimes a relief from thinking about how much pain I'm in!

If there is one thing that can really turn a hospital stay around, it is amazing friends. I have truly been bowled over by the kindness of my friends, housemates, and classmates this past week. I don't even know where to start, but I know I couldn't be a luckier guy.

A real post about thoughts on leaving the hospital, fragility, and outlook on life will be coming soon.

For now, I'm tired, and enjoying cutting my bracelets off! Then I'm going to bed. My own bed!

Winter begins with snowfall and December 1st

You know it's officially winter riding when there is snow on the ground, regardless of the actual calendar season.

Today marked the first riding day that I wished for neoprene shoe covers vs my fall windproof ones. And, handwarmers inside my gloves. Alas, I had neither on. So, I had to conjure the mental fire on my handlebars that one of the New Haven cycling legends swears by to keep him warm.

During the winter I tend to introvert, which becomes something pretty close to isolation at times. I start enjoying the grey skies, and the silence of the road, and my own company. This year in particular, the reprieve from racing and lack of challenge from others is welcome. I pushed hard into both road and track racing for a long March-September 2012 season.

I saw a few lone-wolf cyclists in local team colors, peddling in the oposite direction, chilling in their small ring, and looking like they were enjoying the grey day as much as I was. A nod of acknowledgment, and comraderie from a distance. But, no summer giddiness and doubling back mid-road to see what route I'm on and if you can join in for a few more miles.

Here are a few pictures of the grey Connecticut landscape. Yes, that is a hint of snow hiding in the photo behind my bike. And a local racer caught going the other direction.

Most climbing so far!

Today I completed a 67 mile ride that was among the hardest things I've ever done on two wheels. "Only 67 miles?! what's so hard about that!?", you are probably thinking.

The part about a total elevation gain of 6,900 feet (the elevation shown below is debatably accurate, although much higher). That is a ton of climbing. Six summits, to be precise, plus a handful of smaller climbs to keep things interesting.

And, I will say that I am actually thoroughly enjoying the fact that I got completely and totally beaten up by the elevation on this ride. While I know that I am not slow (I am sometimes frustrated by being the fastest person on a ride), I felt like a brand new rider again. It was like I was learning the true meaning of climbing, and seeing a mountain for the first time - both at once. Aaaannnnd... then I experienced what felt like total body failure at the end of summit 5 (with still about 1000 feet of climbing left to go on the ride back to New Haven.). Everything hurt, and every time the road pitched upwards even slightly my legs felt like bricks. The last long climb seemed to go on forever. A gap would start forming between me and the [notably all elite or pro level racers] group, and then I watched the formation of what felt like an abyss. At some point, one of the strongest riders doubled back for me and rode behind me, periodically launching me forward by a hand on the small of my back. By this point I was beyond cracked and beyond caring about the patheticness of such help. I was only thankful. Since getting back, I've been thinking about the incredible strength it would take to ride up a mountain AND periodically push a 123# weight. Pretty wild. At the time, I was in too much pain to think about anything but the top.

It's nice to be totally, completely and absolutely humbled. And, that I am.

No excuses about Crohn's or having an ileostomy, or nutritional deficits related to the prior. All of that is my back story, and certainly effects my stamina. But, the real determinants of strength and speed are time spent on the bike, sweat, pain, and the will to inflict more suffering on yourself. The only way to get stronger is to put in the effort. So, I'll consider this ride an investment.

Check it out:

Hey look! That's me in a track race!

Things have been busy here at Yale for the past month and a half, but I'm finally feeling settled in and am enjoying my program. I'm also really seriously enjoying the New Haven cycling scene. It is amazing - truly.

You know how you've read articles featuring things like local group rides that are FAST!, with townline sprints, and the local Tuesday Night Cup informal race? I always thought these were fiction or strictly metaphor. They exist here in New Haven and it is awesome. I'm totally enjoying getting my broken butt kicked up hills on a daily basis.

The Yale cycling team is also pretty rad. I finished out the track season last weekend at the Northeast Velodrome in NH, taking 5th in the 4k pursuit (fully lapping my Harvard opponent!), 4th in the points race, and 4th in the scratch race (got nipped by less than an inch at the line in the pack sprint for 3rd. Two guys were way off the front).

Track seems to be my thing, and I'm embracing it wholeheartedly! However, that doesn't mean I don't still need to do the majority of my training on the open roads.

Speaking of track. I found this video on youtube. This is my first track race on this coast, at the Kissena Velodrome in Queens, NYC. Apparently the guy who won the race (and took this helmet cam footage) was on my wheel for essentially the whole race until the end. Hmm...

The race starts at 2:00. The beginning is just announcements and warnings, "This is a huge field! Ride safely! You will be disqualified for passing on the left!"

Track Racing!

Very quick photo post and recap of the Trexlertown collegiate track race:

Note the change of cycling kit from Pitt to Yale!


I wasn't expecting to be in great form today given that I have had the flu for the past three days. However, I woke up this morning feeling less awful. So, that was a good start.

Speaking of starts, here's a neat photo series that one of the race organizers got of me getting set up for a 2km individual pursuit race:

Bracing for the gun! And, we're off! First pedal stroke is the hardest. I need to practice throwing my weight forward more forcefully.

Picking up speed, out of the saddle. But, not too fast, since I have to pace it for 6 laps.

In the scratch race (a simple-concept mass start type race where the first person over the line at the end wins), I managed to get away with one other guy in a break off the front with 6 laps to go. Sadly, I got caught by the pack and trounced with one to go, taking 6th place - just outside of points. It's always easier after the fact to think that I could have done better, forced myself to push through more hurt. But, it's something to build on! Hurt more and don't get caught!

An experienced track racer said of it, "You can't win unless you are willing to risk losing".

All in all, it was a fun day. I learned things, saw some cool dudes I know from the collegiate road season, and am looking forward to more collegiate track racing next weekend in New Hampshire.

Mapletown Road Race

At this point, I've figured out how to do well at a criterium race (short flat circuit race, fast and technical cornering), but still find myself in a world of hurt and dispair when it comes to road races. It's so easy to start beating myself up mentally when I'm in agony on a climb and feel myself struggling to hang on. It's easy to forget that half of the other guys are probably in the same boat, and just pushing through. And, all pain in temporary.

Cycling takes mental fortitude, in addition to physical strength. And, different types of races take different types of mental preparation and strength. Road races take an ability to push through pain for much longer than criterium races, which have become my "comfort zone" of racing. In many ways I think that having a chronic illness has better prepared me to handle the pain of competitive cycling; those of us with IBD know what pain really means. But, in other ways, perhaps this history makes it more difficult to volunteer for a world of hurt, no matter how relatively short a few hours may be. It is both a glorious and terrible feeling to choose to let the pedals stop spinning and make the pain stop before the summit - a choice that we are never given when facing illness or surgery, and one that is soon followed by regret in a race. And, because of Crohns and my relative gutlessness, pushing onwards means that much more to me. I can face whatever agony this race brings, and I will finish it! And, within a few minutes of finishing, none of the suffering will seem so bad. In fact, I'll remember it as a good time.

Few things worth doing come easy. And, there is only one way to get better at road racing: do more of it!

Also, I need to do more climbing more often, as evidenced by my pain on the climbs of this course. This photo is of the first summit, when the pack had already broken up considerably. You can see the USA Cycling official on the motorcycle in the back bringing up the last of the real pack - it is possible to fall behind the scooter, and there are few things more demoralizing. When you hear that engine, you force yourself to pick up the pace!

One major success of this race was hydration! I brought 3 bottles with extra concentrated gatorade plus Elete electrolyte add in - 2 in the bottle cages and one in my back pocket - and needed every bit of it. Three bottles might seem a bit excessive for a two hour road race, but with less intestines come impaired hydration. If the race had been longer I would have desperately needed a feedzone handup!

Goals for next time: More watts, less weight, and less negative self-talk. That's the magic recipe. No matter where I place in the finish, it is about achieving my personal best, beating the medical odds, and proving that I can still be competitive in this sport despite my added challenges.

Bethel Criterium

Earlier this month I was in the Yale area looking for housing, and made time to race a local criterium; the Bethel crit.

One of the highlights of this (unusually for a crit) hilly, short circuit race was getting to meet another competitive cyclist with an ostomy! We went for a short ride after the race, talked about cycling in the area, and about how we'd like to see more encouragement of serious athletics for those with an ostomy.

There are plenty of folks out there (many of whom show up on my links page section) who do rad, active stuff - including hockey, rock climbing, running, etc. Now, if only we could get both the healthcare provider community and the general public to recognize that there are no limitations on what you can do after surgery!

Thanks, Alan, for the photos! Here's one of the starting lineup. Check out those wheels on the Tarmac guys! And, also, the yellow crocs on the race official. Wow.

Bannana rice muffins

This recipe is the perfect overlap between the cycling diet and the gentle, easily digestible diets that many people with IBD or other GI issues stick to.

I found it in The Feedzone, a cycling specific cookbook under the "portables" section. They are not quite muffins, but very tasty, dense little snacks. And, as the section of the cookbook would imply, they are easy to carry with you - in a jersey pocket or in a lunch bag.

All you need is a blender and a muffin tin. I found that this made about 10.

Blend the following together:

1 bannana
2 cups cooked rice
2 eggs
2 tbsp of brown sugar
1 pinch of salt
1 tbsp flour (rice, wheat, whatever)
1/4 to 1/2 c milk/rice milk depending on how big your bannana or eggs are.
cinnomon or vanilla to taste


The batter should be thick, smooth and slightly frothy looking.

Pour it into a greased muffin tin, or use tin liners so ease cleanup.
Bake in a preheated oven at 325 for ~20mns.


As the weather has gotten hotter, I've been enjoying these chilled in the morning. Bonus: The potassium content is also useful for those of us with electrolyte issues.

Biomechanics, and the problem with ab muscles lost

Having just finished a fantasticly productive and learning-filled cycling team practice, I am feeling very ready for bed! It's only 10pm! But, I'm pretty much toast, in the best kind of way.

Today we did a lot of pedal biomechanics work - this is the physically and mentally painful stuff. We have been working on perfecting smooth, even, one-legged pedaling in proper form and at a relatively high cadence... and up small hills! The good news, it's getting better. The bad news, my right side is still about twice as strong and fast as my left.

The next thing we've been focusing on for a few team training sessions now is sprinting, specifically with getting forward and low over the handlebars while leveraging the bike side to side underneith you. This takes a lot of control and core strenght! And, I do confess that I don't have a lot of it. I haven't been very good at doing any active abdominal excercises. In fact, I avoid them because they hurt and send my ab muscles around my ileostomy into little spasms! Distressing...

So, now it has become clear that without doing some core strength work, my sprinting will never be as good as it could be.

For those of you with an ostomy out there, if you are reading, perhaps you have input on the ab workout quandry? Have you had similar muscle spasm issues? How have you overcome your own hurdles around building/rebuilding lost core strength?

Also, in preparation for my departure for Yale in August, I had a final fit of rebellion last week! Whoa! Next month, I intend to dye it cotton-candy blue to match my new Yale cycling kit.

I'm doing fine!

It's been a slow month of recovery and reinjury... the week I spent flat out sick with Crohn's symptoms left me feeling depleted and tired for most of the month. I've been slowly working my way back up to speed, and being aware of my lack of reserves has forced me to cycle smarter.

What happened? I got so sick that I ended up dehydrated and in the ER overnight with a systolic blood pressure of just over 80. Again. Why does this pattern have to keep on repeating? Because with an ileostomy it is almost impossible to stop once it gets started. Of course, I've never been one to follow instructions well. So, I've been off all immune suppressant medications for over a year now because I couldn't handle the frequent upper respiratory infections I was getting. Sticking to a strict diet and excercise plan seems to keep me in good working order most of the time. Except when Crohn's strikes back...

I was perscribed a month long taper of prednisone. But, since I'm just that kind of non-compliant patient, I shortened my taper to a week. And, wouldn't you know, a week later I felt ok. Run down but functional. In fact, two days after getting out of the ER, I did a local C (cat 4/5) race and hung on. It's been steadily better since then.

A couple of weeks ago I did my first B race (cat 3/4) and was startlingly comfortable in the field. Too comfortable to just hang, in fact. Sadly, I had a mechanical near the end of the race and ended up a lap down. But, in that race I did accomplish something BIG! I had a super fast lap where I moved up the side of the entire field and moved into overall, all-time 4th place (57 seconds for 0.5 miles with a slight uphill on the finishing quarter, not tied for that place with anyone) for lap times on the course on strava (A neat application that keeps electronic tabs of times for various segments. Most regular racers in the area use it.)! So, I'm pretty proud of that. I am also in overall 9th place for the final sprint on that course (tied about 10 ways though).

And then I did one of the most beastly, demoralizing road races I've ever seen a map of. Tour of Tucker County is rated one of the hardest road races in the country for good reason. It has a legitimate mountain summit within the first twelve miles, and then continues on with essentially no flat ground until finishing at the top of an >7 mile, 7.6% average grade ( pitching up to >20% in sections) climb. Least to say, it didn't go well. That much climbing at a race pace hurts no matter who you are. But then, right when I needed it the most, from the recesses of my brain, came this song. I am now almost convinced it was actually written for occasions such as the Tucker County road race. It is my new favorite race-pain song. Because, as cheesy as it is, it is so right.





But, even with The Gossip on my side, eventually I fell apart. I dropped my second waterbottle of gatorade midway through the course, a mile after the feedzone - where I might have begged one off of somebody's support person, although I had nobody in the feedzone on that course. In 90 degree weather and full sun, the dropped bottle was the death nel, a ticking time bomb. And then, finally, only 4 miles from the finish line, the cramps hit in full effect. Not just leg cramps, but abdominal muscle and hand cramps so bad that I couldn't even hold onto my handlebars.

Yet, strangely enough, through all of the suffering, I still had a blast! (what is wrong with me!?)
The sheer agony of it was somehow beautiful, elegant even.

My new goal is to get stronger, and get to a place where climbing doesn't hurt so much. Or, at least, where it hurts just as much but my speed is much greater!

Crohn's strikes!

Arrrggg... I haven't been cycling all week because I've been feeling awful.

I suppose I should be more upset about being sick. But,instead I'm annoyed that it is interferring with my cycling plans! I had hoped to do a favorite 70 mile loop (3,000+ feet of climbing) through the countryside out of town today, and a similar route tomorrow. But, no... sadly, my hydration status is miserable. I feel like a wilted plant.

Just carrying the laundry upstairs today felt like a lot.

But, it could be worse.

At first I was really scared that there was something major going on, since this new bout of illness all started so fast. By Tuesday I was a human faucet. It was horrible. I spent Wednesday not wanting to move. By thursday night I couldn't keep up with hydration anymore, and the world started to spin and my lips got that weird tingly feeling that means I'm going to black out. In the ER they pumped me full of saline, zofran, some potassium, and did a CT. Luckily, the CT showed no major issues requiring admission or surgery. And, I felt a lot better after rehydration with IV fluids.

However, I've still been dragging myself around and don't trust myself to ride a bike. I think I might fall over.

Sigh...

So, I've got a bottle of prednisone in hand and am debating starting the month long taper that was recommended. I am concerned about taking it due to the many issues with bone density, sun exposure, and the fact that it turns me into a cranky nightmare. I've taken prednisone enough times to know that I do not get along with that drug.

But, since symptoms haven't stopped yet, I'll probably try a short taper (10 days) instead of the month. Hopefully that will be just enough to help the acute issues resolve. And, then, hopefully I can go back to being off all Crohn's specific medications. Diet and excercise have been working well enough for the past year and a half since I stopped taking Humira and methotrexate. Or, maybe that's just luck.

Series points prime taken! Race lost...

Another spectacularly not-sunny day of bicycle racing here in Pittsburgh!

Windy, drizzly, dark, cold. This is actually my favorite race weather, except for the headwinds.

I raced well in the Cat 4 field, driving the pace and taking the first prime (the race within the race) for the first half. Then, I went for the second prime and my ankle started twinging... and I sat up, and let the field pass me with only 5 laps to go.

So, I placed terribly (11th? 13th?) in the finish. But, I did win some series points anyway! And, there were enough flashing cameras that I know I'll have some great photos of me off the front of the pack! People joke about the facebook photos being the only reason to go off the front... but, there is something wonderfully narcisistic and gratifying about having photo evidence. Sometimes when I get home from a race, it's hard to believe that I actually accomplished what I did, racing against guys who are generally taller (longer legs = better levers) and in perfect health.

Now, for some serious rest and then the Steel City Showdown tomorrow!

Top ten finish, and the Steel City Showdown

The semester is over! Thank goodness!

And, my ankle is behaving itself... somewhat, for now!

I've been able to push a slightly more difficult gear effectively again, which means I've been able to start doing more intense training workouts and catch back up to where I would have been.

I will definately say that one of the places where I seriously feel the nutritional deficiencies from Crohn's disease and not having a large intestine is in recovery from racing and high intensity interval work. I notice that I have a seriously impaired recovery time compared to other racers and teammates. I need more cooldown time, more sleep (naps are great! naps in the parking lot or on the lawn at races are the best ever.), and more in the way of nutrients than other guys my age. This means that I bring my gummy vitamins with me to races, so I have no days of missed nutrients. And, I do allow mysellf to go find a quiet place and take a nap. Self care is sometimes hard to prioritize over cheering on teammates in following races, but I've learned what I cannot budge on. Luckily, I have a few teammates who know the issues and have been great allies. My coach is also very aware that I have specialized needs.

But anyway, yes, I've gotten a self care routine down (most of the time) and my ankle is now behaving (some of the time)!

And... on Tuesday I took 8th in a criterium race (short, very fast circuit race with sharp corners)! I'm back in the game! For a minute it looked like I was going to take 3rd, but I got beat out in the final sprint. That's ok though, I'm still not overdoing it with high torque gears. I'll take an 8th if it means preserving my ankle for the rest of the season. It's still a top ten place.

I'm looking forward to a full race weekend, tomorrow and Sunday. Sunday in particular should be exciting! It's the steel city showdown, and I'll be racing in it and trying for another top ten finish. Here's hoping for some sunshine this weekend!

photo post

Racing after the crash... Where did my sunglasses go?

Closeup through a corner...

Catching back on after a sketchy corner... RPI in tow, guys way off the back nowhere in sight.

Warning up on the course, fishbowl lense angles are fun. And, check out that new kit!

Carbs and cadence

Race Recap:
The beginning of the non-collegiate season is here!

This week was the second of the local criterium series. And, oh boy is it a lot less aggressive of a race.

Collegiate cyclists are out for blood and want upgrade points. Local people tend to be more interested in just hanging in the race. This is great news for me, as I'm still struggling to rehab my ankle. I raced this past weekend and this Tuesday in a laughably easy gearing, spinning at over 100rpm for the entirety of the race (except for the many times in the local race where I didn't need to fast pedal or pedal at all).

If there is one great thing that this ankle injury has done for me it is jacking up my cadence! My coach said that this is a great thing, as it will set me up for sprinting when my ankle can tolerate high torque again. Horray for that. Also, I'm planning on competing in the collegiate track cycling season to show off my new ability to hit 140rpm.

Speaking of which, this past weekend I was mistaken for a past national track champion. More than once. My response was at first to laugh, and then reply, "I'm not that fast". It was strange. But, apparently we look semi-alike in that we are both short and have a muscular build (read: not a climber).

All in all, it was uneventful and not terrible. I was last in none of the races, and apparently was towing people that I didn't even know were on my wheel during the last collegiate criterium race. And, I didn't get caught up in any crashes (1/4 of my field crashed in the road race). Also, we took 6th out of 16 in the team time trial.


Interesting interview on metabolism and carbs:


Today while working on a biostatistics class final project, I've been listening to this incredibly smart and relavent interview. I can honestly say that I've never trusted any of the low carb diet hype before, but now I can see how it would be applicable for some types of athletes (marathoners, triathletes... not road cyclists). I not a low carb person. I love carbs. But, I am also fascinated with metabolism and sports performance.

Not having a lot of guts left has forced me to tease out some of the same issues that this guy touches on regarding dumping salt and the resulting potassium abnormalities. Additionally, I think this discussion is very relavant because there are so few complex carbohydrates that I can tolerate while on the bike. This means that I am limited to fast-burning Gu shots, instead of the sandwiches and bananas that other cyclists carry in jersey pockets during long road races. An ultra slow burning carbohydrate sounds awesome! However, cycling requires short bursts of energy in addition to long endurance efforts and brings me back to the Gu.

power up, weight down

My goal for the future is this simple:

Power up. Weight down.

This means two things: 1. more training, more suffering.
2. Cutting out everything unnecessary from my diet.

I am shooting for an functional threshold power of 240 watts. Currently I'm just above 220.

And, I'm aiming for a >= 1 pound weight loss per week, with the hopes of approaching 120 lbs (54.5 kg) by the end of April. Currently I'm hovering between 125 and 126 lbs.


More power, less weight = faster.

Goals! Ready, set, go!

crash!

Ouch.

This collegiate season has not been terribly kind to me so far, unless you think of it as some sort of serious tough love!

What it has been is a learning experience.

So far I've overcome an ankle injury, started collegiate competition in a higher category than the normal pathway (category C as opposed to D), sorted out some major electrolyte issues, and survived a few close calls with crashes/nasty pack dynamics.

This weekend I crashed out on the final switchback of a moderately long descent at the Lux et Velocitas circuit race. I was able to pedal through all of the previous switchbacks, and was trying to close a small gap in the pack. When I approached the final switchback (which was a tighter near 180, off-cant turn than the previous few) the marshal started yelling "inside! too fast!". Once in that kind of turn it is too late to brake. I apexed it, had my line, thought I was going to make it through... and then I felt my rear wheel lose traction just as I was coming out of the apex. Then I was down and sliding through the turn and across the road.

At some point I tried to get my bike off of me, only to have it come back to me and catch my right leg through the left side of my frame triangle. The bike and I ended up tangled in a bush, on the guard rail off the side of the road. The next thing I knew I was being disentangled from my bike and stood up by about 6 people. And, my problem right ankle didn't want to bear weight.

For what it was, I have amazingly few injuries. Just some road rash and a newly achey right ankle.

I rode the criterium the next day, finishing with a group but second to last. I started at the front of the pack (second wheel) for the first half of the race, until stomping on my pedals to stick with a surge and feeling my ankle twinge in a bad way. After that, I reduced my gearing so as not to increase any injuries by over torquing my ankle. But, I'd be damned if I was going to DNF (did not finish) two races in one weekend, so I continued on - hoping for a mercy pull from the race by the officials (it counts as finishing if you are pulled by officials). I was practically - no, litterally- begging to be pulled every time I came around the lap line: pointing to my ankle, making various mercy and please kill me now signs, and finally shaking my ankle at them. This got a lot of laughs from the crowd, and gained me a cheering section because it was clear what was going on - that I was refusing to DNF the race despite serious pain- but did not get me pulled. The race officials even said "Travis, we are not going to pull you!".

But, all in all, it was still a fun weekend despite the crash and the miserable criterium finish.

I am sore today. But looking forward to the beginning of the local crit series starting tomorrow evening!

Youngest person ever on potassium supplimentation

Ah, yes, the electrolyte issue again!

After I got back from the race weekend in NJ, complete with ER trip, I had repeat bloodwork done at my primary care physician's office. And, wouldn't you know, my potassium levels are borderline low.

I took this weekend off from racing and have been training closer to home while I do a trial of K-dur (a prescription potassium suppliment usually given to older people with heart issues who are on diuretics!). This is interesting because taking a daily potassium suppliment could be very dangerous, if I were to alter (lower) my training/racing plan. Potassium has a very narrow normal range, and then it can cause lethal heart problems including sudden death.

I am currently starting on a fairly low-moderate dose, once a day, and will be completing another set of bloodwork before going to race out of town next weekend. Figuring out my dosage with my physician was an interesting conversation, involving laying out exactly how many hours per week I am training/racing at a high enough intensity to drive down my potassium levels.

Yes, exercise does naturally drive potassium down. Your cells need it to function properly in an aerobic state. And, chronic diarhea also lowers your potassium. Having a high output ostomy and high intensity training/racing for 8-12 hours per week is enough to really knock out some potassium.

How has it been going so far? Well, it took a few days for my body to readjust after getting screwed up last weekend. But, at the end of 5 consecutive training days, I'd say it's going pretty well. I did some team time trial practice with another teammate who didn't race this weekend, and got well into that satisfying place of feeling the hurt!

A photo of me lined up with the most interesting time trial team ever. Notice where I line up to the shoulders of the two guys on either side of me? Oh, Crohn's, why did you have to stunt my growth so terribly? There is almost a full foot height difference there.

Just hanging on...

The quick recap of the three races at Rutgers this past weekend:

Team Time Trial: 14th out of 15 teams with less than a two minute gap between the first and last teams.

Circuit Race: I narrowly escaped one crash, and being pulled down by my jersey pocket! Then, got stuck behind a second crash. On the way back out of the second crash, I latched onto three University of Pennsylvania guys and pacelined with them for about 3 miles. Then, at the top of the hill near the lap line, they were gone! (on looking at the board later, I see that they gave up and DNF'ed) So, I soloed off the back for 12 miles, in the wind alongside the river. It was more of a mental excercise than a physical one. I wanted to throw in the towel, but was determined to finish the race and not get pulled. So, I cranked it on the flats, spun fast up the two climbs and drove myself as hard as I could on the downhills. With one lap to go, one of the marshals wasn't paying attention and misdirected me on the course. So, I had to go back and do that segment again. In that chicane, I slowed down enough to actually have about a minute of conversation with my coach. But, it was what I needed to keep it going for another time around while I was feeling frustrated and like my shoulders couldn't hold my weight anymore. Note, because of the tired shoulders from staying in a severe aero position for so long, on the flats I ended up doing some very interesting invisible-aerobars-elbow-and-upper-arm-steering maneuvers. And, finally, it was over. I finished. I didn't get pulled, but I did get dead f*cking last (DFL). Still, from the time on the course and distance, I would have had to have averaged about 19mph by myself for 12 rolling miles. Not too shabby. Now I need to learn to avoid crashes and position myself better in the pack. Oh, and, being stronger and lighter would also help. More on my new diet plans later...

Sadly, after the race, the hard part of my day wasn't over yet! At first it started out as just a nagging headache. And, I didn't help it much by standing around in the sun cheering for team mates. Then, bam! raging headache and feeling like I'm going to hurl! And, let the vomitting begin! I forcefully vomitted for hours on end, so hard that I pulled an ab muscle above my ostomy site and could hardly breath between heaving. It was horrible. My kind and patient teammate drove me to an ER and sat in the waiting room with me. By that point I was feeling dizzy, with cold tingly hands. And, then I sat in the waiting area some more... until I started having palpitations. But, because I was still vomitting so hard I could hardly speak. Pointing at your chest in an ER waiting room is suprisingly ineffective.

Once I was able to communicate that I was having palpitations, they took me back to the ER immediately and started me on saline IVs, and zofran for the vomitting. When labs came back, my potassium was low, yet again. So, it seems that I haven't solved my electrolyte issue after all! Sigh.

It was 10pm by the time I got out of the ER, leaving a 6+ hour gap from the time of my races to the time when I was able to eat and keep food down. My legs were already cramping and feeling deflated by that point. It was a horrible lesson in what happens if you race and then deprive your body of the nutrients it needs to refeul and recover afterwards.


Criterium (short flat circuit): Yes, I did race in the criterium on Sunday! Even after a night of vomitting and low potassium, I made it to the starting line! I can't say I did much else. I was pulled an placed midway through the race, after 6 laps according to my coach. Honestly, I was in so much agony that I didn't know what lap it was. I felt like somebody had beaten me all over my body with a crowbar. And, like I was going to vomit again - residual naussea, anyone? I was both sad to be pulled and relieved to stop. Everyone said I looked like hell. But, then, I've been doing a lot of that at races this year.

For some reason I am strong on training rides but consistantly underperform on race days. Yet, I'm having the time of my life and learning a ton! Even if I take DFL again next week, it will still be a fun time! But, I'm hoping for better.

A fast, hilly 60

Today I went against my training plan... and rode 60 miles on what was supposed to be an off day.

I couldn't help it! It was so sunny out! It was the last day of spring break! And yes, I confess that this was a premeditated crime against the training plan.

And, it was soooo sooo good. Even after 3,000+ feet of climbing, my legs aren't toast and my ankle is feeling fine.

Here's looking forward to TTT (team time trial) practice this week, in preparation for races in Philly next weekend!

----

On a deeper note, I keep on thinking that I should tell at least some of my teammates what is up - that I have an ileostomy. Clearly, some if not all of them have noticed that I wear an extra piece of clothing and am funny about what I eat. I feel like it would be helpful if everyone was on the same page. But, I'm not quite sure how to go about filling them in without making a little public service announcement at a team meeting. Telling everyone individually seems overly energy intensive. So far, our coach is the only one who knows what's up.

breakfast, then a training ride

Breakfast.

Hydrate.

Wait.

Ride!


If you do any reading or talking about bicycling, you've probably heard people say over and over again how important a good pre-ride meal and hydration routine is. Yet, with IBD or an ileostomy, it is all too easy to cut one's self short.

Eating leads to an active gut, and that's the last thing anyone with IBD or an ostomy wants on a bicycle. I like to not have to think about my guts when I'm trying to get my daily miles in, or set a new personal best up that climb that haunts my dreams/nightmares.

I used to be afraid of eating much before going out to ride. And, that meant that (especially if I was starting early, 7 am anyone?) I'd be running on just a piece of toast and peanut butter plus some gatorade as I headed out the door. And yes, I've done centuries more than a few times on this routine. But, midride I start feeling like I just can't keep up, and later that afternoon I end up feeling like somebody beat me with a baseball bat - regardless of how much post-ride feuling I did. Worst is the next day, if I'm riding again, when I felt like my legs just didn't want to work no matter how hard I willed them to.

But, I've reformed my ways.

These days I know that if I'm heading into 3 consecutive days of interval training, and preparing for the next race weekend, I have to always be thinking about the future - not just the ride today. I know that if I run myself down to empty on the first day of training, because I didn't eat appropriately, I will blow any chance of being productive on the next two days.

I started eating oatmeal and some juice before rides later this past summer, and carrying a few GU shots with me, and thought I was doing pretty well.

And then came the equation....

To prepare for a race effort (or long, high intensity training), (according to my coach) an athlete should be eating ~2 grams of carbohydrates/kg, 3-4 hours prior!!! Or, ~1.5g/kg 2 hours prior.

Plus enough protien to keep you running efficiently. And, don't forget the water!

The closer to the effort you get, the less carbs and calories you should be loading. You also need to give yourself time to hydrate (and pee) prior to hitting the bike, so you don't head out with a sloshy stomach and the desire to hurl on the first hill.

I found that when I did the math, I was still selling myself short. Oatmeal with honey and PB was still only ~50g of carbs.

I weight 58.5 kg (divide lbs by 2.2). This means that I need to be loading 87.75 grams of carbs 2 hours prior to racing or high intesity training.

This is equal to: 1 bagel (the real kind, not the ones that are just circular bread!) with peanut butter and honey, 8 oz of OJ, 8 oz yogurt, 1 bannana.

Or, today's breakfast: a stack of sweet potato pancakes with maple syrup, a large bowl of nonfat yogurt with a sprinkling of cocoa crispies cereal, and a coffee.

For a hilly 3 hour ride, I will be bringing 4 GU shots, each equal to 100 calories.

Eastern Collegiate Cycling Conference season opener

This past weekend was the ECCC ("E tri-C") season opener! The Pitt team caravan got home close to midnight last night, so I'm feeling a bit tired and achey. But, it was a blast!

The team report:
Our team did well overall, with a few guys in upper categories (A & B) making massive breaks off of the front of the peleton. The break in A was a 45 second gap for half of an hour long criterium, with three points Primes (sprint laps with points awarded)picked up. The breaks in B were in both the road and crit, with close to a full minute gap on the pack and overall top ten placements in both rides. In women's our team got 6th place time trial and 7th place womens A/B crit places. MIT cleaned house in the road and crits in men and womens, with a number of pro team members in the race (the men's A road winner is a Garmin development team member).

Sadly, we had one teamate crash in the D category, and one get caught in a major pileup in the C road race. They are both ok, but sore.


My report:
I went into this weekend not fully expecting to finish either the road or criterium, having only ridden a few times since spraining my ankle. And, I did pull myself from both the road and crit because my ankle was hurting in a bad way. It wouldn't be worth throwing away a whole season on the first weekend.

I did start in C category (the categories are A, B, C, D, and Intro) despite this being my first season racing with a team. And, after some initial intimidation and aprehension, it felt like a good place to be!

What I will say is that the collegiate categories are overall more way aggressive than the local categories. The guys are fit, fast, and not afraid of bumping in the pack. There was significant overlap in the time trial results for the A,B and C men's categories, and the C men's road and crit races were FAST! As the announcer said, "C men's: kinda fast, kinda dangerous". As opposed to B mens which is fast, and A men's which is blazingly fast and more stategic as a race.

Saturday: The road race
Prior to pulling myself in the road race, I learned lessons about not getting boxed in on a narrow road, about strategic placement on corners (don't get squeezed out to the curb!) and about when it is appropriate to start yelling at people. My teamates said I should have yelled more when two Penn State races tried to push me over the yellow line on a steady ascent (automatic disqualification for crossing the yellow line). But, it was also the first time i got to do some elbowing back in a road race. Three times! I've never honestly elbowed somebody with the intent of pushing them over before! It was a good learning experience. I still couldnt get out of the middle of the pack and move up until I was at the point where my ankle was twinging and I let myself drift out the back. luckily, I pulled myself just before the entire back of the pack wrecked. It looked like a landmine went off under the pack! Bodies and bikes flying through the air. A few major injuries with loss of conciousness resulted.

Sunday: The criterium
I was feeling more confident, despite starting with a bad right ankle and a mechanical issue with my left cleat (couldn't get muddy crud out of my finicky Speedplay cleat, despite lots of banging and resorting to putting it under a sink.

1 minute prior to staging, as my coach was holding me up on the bike while I was trying and failing to force it to click - which would have forced me to start on the wrong leg- he said "you're going to have to do a Lance on this one... don't push it too far if the stress is too much on your bad ankle".
I was consistantly able to move up towards the front of the pack on the 1/4 mile climb (atypical crit course!), and realized that I'm a much more aggressive descender than most others in C. But, doing most of the work with my right leg because my left was unclipped was too much stress on my ankle. One lap under half way through, I let myself fall off the pack on the climb. If I hadn't had to take myself out of the race, I might have stuck with the front group for the crit and gotten a top 20 finish. It was a confidence booster, but also a good lesson in what I have to work on before the next race!

Two top priorities for things to work on:
1. Finding my most efficient climbing gears for a race pace.
2. And, I desperately need to improve my nutritional status and get more sleep on a regular basis.

I was definately feeling the effects of anemia from recently diagnosed iron deficiency - it feels kind of like drowning and desperately trying to stay afloat on hard efforts. Not a fun feeling. And, the nagging cough I've had since strep throat came around my office a couple of weeks ago. I've always found that I got sick more often and more intensely than my non-autoimmune disease friends. This is yet another example of how much harder it can be to recover from illness when you are starting with any other nutritional deficits, or on immune suppresant medications (which, for the moment, I am not).

I can't wait for the race in a couple of weeks! Hopefully my ankle will behave better and I'll be back with a vengance as the only gutless cyclist in the ECCC, and maybe all of collegiate cycling history!

Back on the bike!

This week I'm back on the bike, after three weeks of resting my ankle.

It's still a little bit cranky, but managable. What I am really feeling is the lack of real exercise for the majority of the month! I did a bit of trainer riding on Sunday and was amazed at how jacked up my heart rate was, how relatively difficult it was to keep my cadence above 110 and steady, and how low my watts were.

This is scary since the collegiate season opener is this coming weekend!!! I'm assuming that I'm going to get completely dropped off of the circuit race, and probably get lapped and pulled on the criterium course. But, I know that going into it and plan to use the race weekend as training and a good warm up for future races.

Regardless of how I do, or if I even finish, I'm psyched for the start of the season! And, I'm glad to go out there with my team and do my best.

More trainer riding tomorrow evening and on Thursday with the team, and then we travel to New Brunswick on Friday. Time trial and circuit races on Saturday, Crit on Sunday.

Here we go!!!

Low iron and vitamin D

Oh rats, I'm nutritionally wacked out again!

And, it's despite my near-excessive dairy consumption, supplementing with chewable Calcium and D softchews (chocolate flavored!), taking a multivitamin with extra iron, and eating a lot of iron heavy greens blended into sauces and shakes.

I just got labs back that say that my vitamin D2 and D3 levels are outragiously low. As is my Iron.

This explains why I've been so draggy and mentally foggy lately. While my B12 levels were fine because I inject it weekly, without Iron and B vitamins together you still become anemic. So, I was missing the other half of the red blood cell generating equation.

Vitamin D is so much more than just a nutrient necessary for healthy bones. It actually functions as a steroid hormone, and is involved in the repair of tissue and differentiation of cells, neuromuscular functioning, and inflammation.

Both of these are extremely important nutrients for anyone, especially if you are involved in strenuous physical activities.

Sadly, it seems that despite my best efforts I am not absorbing them well enough. Tomorrow I am going to call and see if I can be put in for an iron infusion appointment soon, which I have had to resort to in the past.

First video blog! On swimming with an ileostomy

Check it out! My first attempt at making a vlog entry!

Here I talk about why I'm going swimming, the types of concerns that come with considering a new activity (here, swimming in a large university pool), and what I'm wearing to keep my ostomy secure and make myself feel comfortable.

Check it out!

Off the bike for a week, leads to swimming?

Here in Pittsburgh we have snow!

And, I've been off the bike since I injured my ankle last weekend. The official verdict was that it was a "classic but fairly mild" sprain, and a posterior tibial tendon strain. See how that tendon hooks under to support your ankle? And, if it's injured could also seriously mess up the back half of your pedal stroke?

The doc who checked out my ankle was impressed by my calf muscles, declaring them to be "like a lesson in muscular anatomy!", which I found funny because it says more about the sedentary lifestyle of American society than my athletic abilities. There are probably a couple of hundred cyclists in the Pittsburgh area alone who have better legs than I do.

So, off the bike in a snowstorm. Could be worse. Off the bike in blue skies would be torture. However, you know it's bad when you start to get jelous of the rest of the team's trainer riding. Oh well.

This injury is pushing me to look for alternatives to cycling, that don't heavily involve my ankle. The answer appears to be swimming. I haven't been swimming in years. Actually, not since I had ileostomy surgery in 2009. And, to be honest, I'm not really sure how I feel about it.

Yes, it is true. I do spend a significant amount of time wearing spandex, and have no problem with that. But, no, I'm not ok with wearing a speedo now. And, I'm also not ok with not wearing a shirt to cover up my bag.

So, wear a wicking shirt with a speedo? Nah, that looks weird. A wicking shirt and some board shorts in the pool? Awkward for swimming, but at least the top and bottoms are equally awkward. Plus, not having touched a pool in close to 4 years, I'm sure that my swimming will be awkward anyway! Maybe I'll just stick to some kickboard laps. I'm very content with my shrimpy T-rex arms and lack of upper body mass!

Minor setbacks... and the ECCC calendar!

I don't know how, when or what I did to my ankle. But, it hurts... in the bad way.

There is no major point tenderness, so I'm taking that as a good sign that it is just a strain of some kind. And, you know what they say about sprains and strains! RICE!

Rest
Ice
Compression
Elevation

Since it's not swollen, I'm not sure that compression or elevation would do much good. But, I did ice it today and will be resting it tonight. I tried going out for a ride earlier today and realized after about a mile of pain not going away that it was a bad idea. Walking up the hill on my way back home also didn't feel so great.

Why am I always sabotaged on the nice days?!


In other news, for those that are in the Northeast and into cycling, the Eastern Collegiate Cycling Conference calendar is becoming more and more populated with race details every day! Check it out! And, drop a line if you'll be at one of these races! I'm hoping to do as many as possible, but probably not New Hampshire.

The power is on!

The PowerTap SL+ on a Velocity Deep V rim with DT Swiss Competition spokes is mine!

It was a team mate's "old" wheel from 2009. As he said about the deal, "I'd rather sell it to someone on the team and ensure we ALL get stronger." Word. I love discounts on well loved bike stuff! And, by the end of the season I may have a national champion's old wheel.

No more training without knowing my watts! I'm excited! And, training smarter means bringing my lofty goal of finishing the summer a Cat 3 more within reach.

That's all for now. Just had to say how excited I am.

Hope! Knowing somebody has ridden this path before...

I'm not sure why I had continued to search for other competitive cyclists with an ileostomy. I had resigned myself to not finding anyone else a couple of years agoe. I feel safe saying that my internet search skills are truly excellent, refined by years of undergraduate and graduate education.

When I stumbled upon this page, by a competitive cyclist with an ileo since '98, I was shocked.

Seriously, dumbfounded.

I got that funny feeling of mixed excitement and disbelief that makes my head buzz. Immediately I thought, "I have to email him! Please please please please, write me back!!!!". I hadn't realized exactly how important it would be to me to just know that this pursuit is possible - that I'm not crazy for thinking that with training, I could perform at an elite level in an endurance sport. Of course, it is crazy to think that a person would have all the answers. Or, that his answers to questions about hydration and things like cycling with ostomy belts (which, by the way, he makes) would work for me - everyone is different.

But, HE EXISTS!!! And, that's what matters.

Cycling is a very specialized sport. Dedicating yourself to cycling is not the best way to achieve overall fitness, if that's what you're looking for. And, cycling at a high level (like running or distance swimming), brings its own set of specialized physiological needs, beyond those of having a digestive disorder. So, go ahead and throw all of that popular anti-carb, anti-calorie, salt-restricted nutrition advice out the window! In fact, go ahead and throw the BMI chart out the window with it (I'm "normal" on the BMI chart, but still heavy for my height for a cyclist). And, it will probably no longer be possible to get sound nutritional advice from the general, non-endurance athlete, community or professionals who aren't used to working with endurance athletes.

But, then what do you have left to reference? I've been a "one of a kind" to all of my physicians, nutritionist, and coach. But, at least now I know for sure that I'm not truly the only one. We are just a very tiny minority. There are probably even another two or three competitive cyclists out there in the world who have or had an ileostomy at some point. But, it's making contact that matters. This reinforces the reasons why I created this blog in the first place. I want to be visible, just in case it helps somebody else along the way.

Knowing that he is out there cycling with a team, and has been for over 10 years, brings me real hope and comfort. And, it makes me more determined to succeed - because I know it is possible.

Rainy winter days. Powertap or not?

Rain, freezing rain later on, and lots of wind.

That was today's forecast. When I woke up, I had a brief glimmer of hope of going for a ride outside. But, then when I checked the weather and saw the quickly plummeting temperatures and wind speed I had second thoughts. And, then when I opened the door to let Sharkey outside, and was almost blown back into the kitchen (!) I resigned myself to more trainer time.

The trainer corner: wedged between the couch, a coffee table, and a desk. The fan stays on even in cold weather! Yoga mat to avoid sweat stains on the floor. And, now you know why trainer time gives me cabin fever!.

I sometimes wonder if all of this riding inside on a trainer is going to have unexpected consequences. Are all of these just below threshold intervals going to improve my hill climbing abilities when I actually get out there (and the roads aren't slick with ice/snow/freezing rain)? I hope so.

I'm currently debating whether or not I want to snag a powertap rear wheel off of one of the guys on the Pitt team. It's his older, 2009 wheel. It would be really really helpful to be able to see my watts all the time, not just when I'm at our sponsor shop's training studio. But, then part of me feels silly for investing in that sort of training equipment at this early point in my development as a competative cyclist. Getting a powertap wheel wont make me better or faster, and unfortnately many people newer to racing seem to feel that fancy equipment does make them a better cyclist. And, they get made fun of. And, nobody wants to get made fun of for having excessively fancy equipment beyond their training needs.

So, there lies the problem. Get the powertap wheel for an unbeatable price now, and use it to improve my training? Or hold off for now, because there are many other things I can work on and see improvement without a powertap wheel to read my watts?

Training tired/sick - "all pain is temporary"

Oh, right, tonight is Tuesday? That means 90mns of high intensity intervals including 5 x 2mns of fast pedaling and 3 x 8 minutes just below FTP (my threshold).

And... I'm feeling a little bit under the weather. Not really sick. Just overtired from too little sleep, and maybe some exposure to sick people over the weekend. But, still, I hardly ate anything today. That alone is a sign that I'm not quite myself... I'm usually ravenous, all the time. Seriously, I'm hungry all the time.

Anyway, so I ate a small dinner, drank some electrolyte mix before getting on the bike, and then after a brief facebook-based check-in with coach about the coming week, it was trainer time.

Today I added some planks and extra stretching to the beginning of my workout. Front planks are HARD when you have a hole punched in your abdominal muscles! More about core strength training another time...

Training under the weather is rough. It wasn't impossible, I just started feeling tired - as expected - and ended each interval feeling a lot more tired.

Training mildly tired/sick takes more mental stamina than anything else. Maybe you're starting a little dehydrated from too much coffee or cold medication, and your heart rate is higher than you want it to be in your warmup, or you find that you need more than just the terry cloth on your gloves to wipe your snot today.

And then, you look down at your index card and see another hour of pain!

I start bargaining with myself. "What if I just cut off the last interval?" "What if I do only a 7.5 instead of an 8 on the perceived effort scale" "Do these last 30 seconds really matter?".

And then I kick that part of my brain and shut it off. Partially because I know it is a slippery slope, and partially because I want to be proud of my effort and training slightly under the weather gives me more of a chance to be proud of my sweat.

So, I do the intervals. On time and on target. And, it hurts. And I suffer through those grueling last 30 seconds of each interval. And, I remember that much quoted Lance Armstrong line "All pain is temporary" and take comfort.

And, then, I'm done. I'm on the last 10 minutes of cooldown and my dog is wagging at me because she somehow knows that this means I will now detach myself from my bike, and pet her while I stretch.

Time for a hot shower!

Sleep. And, revamping this blog.

Working on revamping this blog... it might be ugly for a while. Trainer time tonight! And, then sleep. I've been feeling unusually sleep deprived and super cranky for the past week. It is true that I haven't been getting enough sleep (~6hrs/night), but that's not unusual for me. Maybe I've been coming down with something... there seems to be a lingering cough going around Pittsburgh. Or, maybe it's the increase in intensity of bicycling. Perhaps I should try to address this issue. My goal is to get to bed before 10pm tonight. We will see how that goes.

The best "Shit ____ say" video so far

Bicycle dreams

Also, I am super excited that this movie is coming to Pittsburgh!

Danny Chew, the masochist who invented the Pittsburgh Dirty Dozen Race and two time winner of the race across america, is giving a talk afterwards.

Enjoy the trailer! And, if you live somewhere it's being shown, go see it in theaters!

FTP testing. Lousy numbers, but a place to start!

So, today about 10 people from the Pitt cycling team (self included) did FTP testing at an indoor studio with cyclops spin bikes with power wheels!

I haven't ridden with a power-meter before so it was really interesting to see how even slight changes can have a huge impact on how many watts you are putting out.  Besides cadence and resistance, slight changes in form made my watts jump or fall. I can see how useful riding with a power meter would be for refining my budgetting of energy, setting goals, and working on making my pedaling more efficient.

I do confess to having been nervous about seeing my first numbers... and failing in front of the other guys in the group.

The results were unimpressive, but not terrible terrible terrible either. My max watts were somewhere in the mid 240's. And, I was able to sustain ~200 watts for an 8 minute interval riding just below threshold, at a fairly reasonable 8/10 on a scale of perceived effort.

This puts my current max watts (the unofficial numbers) at around 4.06 watts/kilogram. And, 200 watts puts my effort during the SSI (sustained effort at ) 85-95 cadence) at 3.39 watts/kilogram.  This puts me in "not terrible, but not great" territory.

We are retesting in 2 weeks, and I'm hoping for better numbers. I'm going to ask our coach about changing around my training block schedule so that I'm not testing on the third of a series of 3 consecutive training days. And, I will make sure I am better rested and adequately hydrated before next time - both things that were lacking today.

Great data on bicycle commuting trends in the USA

Check this out!

Awesome work on bicycle commuting trends, and some very sad statistics about bicyclist deaths in the USA.

Why do people hate on spandex?!

I was just on the local bicycle commuter message board and, suprise suprise, yet again the conversation has turned towards the problem with those hammerheads wearing spandex. Does wearing jeans on your bike grant  you moral highground? Or some other sort of merit award?

Maybe it does. I sure as heck couldn't bike for any real distance wearing jeans - at least not a pair that fit properly!

1. Totally unrelated to having an ostomy, it is just downright unpleasant! When I bike, even just up the huge hill to work, I sweat. Sweaty jeans are gross. They stick to you, make your crotch feel damp for the next couple of hours, etc. Also, I have big quads and find jeans that fit my waist to have legs that are too tight if I'm doing more than standing or sitting around. Yes, I can bike slowly on flat ground in jeans, or even some fancier clothing. And, I do it on occasion. No, it is not my idea of a good time, and usually I'm going to encounter a hill or want to get to my destination faster than a sweatless pace.

2. I do have an ileostomy! This means that I have an appliance stuck to my abdomen just above the waistline of a pair of modern (fairly low waisted) jeans. When I bend forward on a bike wearing jeans or other pants with a hard waistband it starts to get into the dangerous territory of messing up my ostomy appliance. It's also uncomfortable to wear a waistband that compresses my abdomen in that sort of way. Disrupting my ostomy appliance is generally not a risk I'm willing to take. So I don't do it. Even on my commutes, I wear bike shorts. I am comfortable and get to work on time.

Maybe those people who think that biking wearing spandex reflects poorly on a person's charactor should realize that for some people bicycling clothing is not about fashion. There may actually be a physical reason for wearing bike shorts even when just commuting.

Don't shame me! I make a point of not shaming less serious cyclists for their lower yearly milages or higher resting heart rate. Just imagine how silly that would be! And, how much of a jerk would I be?! A big one. So, let's all respect each other and stop the judgement.

Spandex wearing and proud of it,
t.

Tuesday trainer time on a rainy winter night

It's Tuesday night, which means high intensity trainer time on my new training schedule!

I've got my index card of intervals taped to my bars, The Girl Who Kicked The Hornets Nest cued on Netflix, and a couple of waterbottles filled and at the ready.

Although I'm not excited about the cold, rainy weather here in Pittsburgh, I am glad to be back from my trip to California.  And, I'm glad to back on my CAAD 10 and I'm glad to have finally put to bed any idea about me mountain biking... even for fun. I don't like when trees pop up at me out of the mist!

Still, there is something special about wading ankledeep into the surf at sunset in the middle of January... and not being cold!

The electrolyte mystery

Did you know that the active ingredient (glycyrrhizinic acid) in liquorice (the real stuff, not twizzlers) can cause hypokalemia?

I didn't until recently! Apparently, licorice and anything made with anise contain a potent and long lasting aldosterone inhibitor (it's more complicated, but I'll keep it simple). Aldosterone is a corticosteroid hormone that acts on the distal tubules and collecting ducts of your nephrons. In other words, it is a hormone that out adrenal gland makes that helps us to regulate electrolytes. So, if your body senses that you need to hold onto your potassium and sodium, your kidneys usually don't let you excrete more than you should be. At the most basic level, aldosterone stops you from peeing out all of your electrolytes.

There are warnings about licorice use for people on dialysis because of the risk of hypokalemia. A simple internet search provides that much. However, nobody ever said a thing about licorice until a month ago when my new primary care provider asked whether I ate it. And, I do love licorice.

 I continue to be suprised at how something so seemingly important as electrolyte balance and nutrition were never addressed by any of the hospital staff, my GI doc, or my previous primary care physician. It has only been at my own request that I have had any type of attention to nutritional deficiencies, and my health plan has never covered a nutritional consult. One might think that these types of information would be necessary for a person without the majority of their intestines!

Here's a project that I would love to have the time to take on: A campaign for the adoption of nutritional counseling as a standard of care for those with an ileostomy, or even IBD without an ileostomy. This type of intervention has been the standard of care for diabetics and heart disease patients upon diagnosis for years. It is time that people with digestive disorders receive the same attention.

I should mention that I do see a nutritionist, specifically a sports dietician who is herself a pro iron-man (woman?) competitor. She's awesome and while there haven't been many competative cyclists with exactly my circumstances, was excited about the challenge of getting me back on track. However, those consultations have been all out of pocket expenses, and the only person who has ever asked me to get a nutritional consult is my coach.   I recognize that I am fortunate to have a smart coach who could refer me correctly, the motivation and education to be able to stick to a plan, and the financial priveledge to afford nutritional advice.

Licorice... a contributor to my problems with hypokalemia!

Cold feet

It's true, I'm a big baby when it comes to cycling outdoors in cold weather. If it weren't for the problem of cold feet, it wouldn't be so bad. I have an awesome pair of Endura neoprene booties, yet my toes still get cold. So cold that I don't want to put a foot down at lights, for fear of falling over due to numb/painful feet.

Sigh, if only the warmth that I generate from work on the bike would travel to my toes...

It's snowy here this week and I'm inside on the trainer. And, I'm looking forward to going to Southern California next week! Biking outdoors in 70 degree weather! No cold toes!

Happy New Year!

Happy New Year everyone!

It's been a busy fall semester, and I admit to having cut out a lot of the peripheral things in my life. But, not bicycling! I've been riding with the university cycling club for the past few months, and putting in my time on the trainer and track. Things are looking up.

This year will be my first year competing at a collegiate level, in the C division (cat 3/4). In preparation for the cycling season, I'm getting into a more serious training schedule and finally sorting out a nutritional program to help me meet the demands of training. It looks like for the next few months until the season starts in March I will be doing two back to back endurance days, and two midweek high intensity days. I'm excited about competing and looking forward to seeing where a more structured plan will take me!

More to come...