I was looking to suffer. For some reason, this cycling season I was motivated to get better at climbing. Hills are simple: there they are, now go up to the top on your bicycle. You either make it or you don’t. The outcome is binary. But the variables constituting each hill are infinite: length, grade, weather, road surface, as well as the cyclist’s fitness, all blend into the individual character of the particular climb.

We were on a family vacation in southwest Virginia. I had not scheduled any activities for the kids on the morning of the 4th of July. At 5:45 am I got out of bed at the hotel, gathered my gear, and drove to Emory & Henry College near Meadowview, VA. From a previous internet search I had set my sights on Hayter’s Gap, a nearby route over a ridge of the low mountains north of I-81. The weather was clearing after an early am shower and the temperature lingered about 68. After hydration and caffeination I set off.

Because of the holiday there was almost no traffic. I was passed by less than five cars on the out leg. I saw more birds than people. Even the dogs were still asleep-not a single bark. It was serenely quiet, just the sound of the pedals, the wind in my ears, my breathing. The route initially descended into the Holston River valley and when I crossed the bridge over the water I knew the warmup was over. The houses gradually disappeared, the woods closed in over the roadway, and the curves began. The higher I climbed, the slower I went, until the last cog on the cassette was reached. Every 20 to 50 yards the road curved away, around the corner and up. Always up. I prayed that each next curve would be “the one”-the one that disappeared over the top instead of revealing yet another stretch of up. I alternated sitting and standing out of the saddle. I chanted on successive revolutions of the right pedal, then the left, using the Jesus prayer, then the names of my children, then counting, and finally nothing, nothing except the turning.

I was tempted. Places where I could pull off the road beckoned. I came close to quitting. But my training to date was just enough to keep me aerobic at the turtle-like pace I was keeping up the climb. There was a small cabin on my left. I started to see more blue sky through the trees, and I knew I was close. But how close? I gave up hoping on the next curve, and began to just accept the effort for what it was. It had its own way, one that anticipation could not alter. And then, there was a sign-literally, a road sign marking the county line at the apex,
and the sunlight glistened on the downhill slope of the descent on the far side. I pulled over to the side of the road and my quivering legs gave thanks.

The descent was quite a thrill as well, since there were so many switchbacks and hairpins. I kept my hands on the brakes and by no means was it a TDF performance but I got to practice following a line through the curve, keeping my head up and sighting my way out of the turns. I took a leisurely pace back to my car and savored my small but discrete achievement in the ages-old story of man vs. nature-aided by carbon fiber, low gears, and good weather.

Tags: climbing

At the beginning of the cycling season, my riding buddy Rob and I decided on a goal: we would finish the Jack N’ Back charity bike ride in October. Well, we did. After doing several other rides together this season, we both decided this one was the biggest, the best organized, and the most satisfying to complete. For the sake of brevity, I will make a list:

• Lots and lots of volunteers, probably hundreds, at rest stops, manning the wrenches, serving food, helping at registration, standing at turns, protecting us at intersections, clapping, encouraging, directing, and thanking us repeatedly for riding in this event.
• Excellent organization, from the luggage train segregated by bib number, twist ties supplied for the bike numbers, early packet pickup to reduce ride day congestion, perfect road markings, police stationed at all major intersections stopping traffic even 30 miles into the ride, etc.
• Enthusiasm of the volunteers and rest stop helpers.
• Great lunch stop: plenty of room, large cafeteria, enough bathrooms.
• Large number of riders on a long course-one was never alone on the road not in sight of another ride, a psychological comfort
• I have never seen so many sag wagons-seems like they passed me every 5-10 miles
• The Gatorade and water never ran out (has happened at other rides)

A few personal observations:

1. I am glad I installed my new cassette with a larger big cog: though the hills were moderate, the longest one was at the end of the first day, a half mile before the finish
2. I’m also glad I spent three or four hours tuning up the derailleurs on my bike before the ride:although I made several mistakes in the process, once I had it zeroed in, the shifting was flawless during the ride: no skips, rattles, or clunks, no lost chains even when I mistakenly tried to down shift off the small chainring, for example.
3. Riding into the wind for 50+ miles is a real test of determination, mostly psychological I think, and the discomforting knowledge that the same power output into the pedals results in forward velocity at least 2-3 mph less.
4. Riders come in all shapes, sizes and outfits. One elderly rider had computer speakers mounted under his saddle broadcasting classical symphonic music. One recumbent rider went the whole 75 miles using only his arms and a top-mounted crank arrangement. Two guys rode unicycles! (Somebody said those guys are so good on one wheel, please don’t give them two...) Obese women rode mountain bikes at ten mph. Skinny guys dressed in identical kits hammered past in large TDF-like mini-pelotons. Women in bright green stockings, women on completely pink bikes, women with fuschia flapping skirts and high-viz jerseys, all provided a little extra color.

In summary, it was a great way to end a season of cycling in which I got fitter, learned more about my bike, achieved a goal, and had a lot of fun in the process. Please take a look at some of the photos in the gallery, too.

Just wanted to announce some new photographs I selected for the Photo Gallery section of the site. Most of these are self-explanatory but if there are questions feel free to let loose in the comments. Enjoy!

As the days grow shorter (autumnal equinox today), the time available for riding on the bike diminishes. Unless, of course, one is willing to ride in the dark. Yesterday, after not being able to ride for several days due to travel, work schedules, and laziness, I was determined to get in a good circuit. Although I rushed to finish work early enough, I still couldn’t get started until about 5:45 pm. I had a particular route in mind which was really tough (subject of another post?) but midway though the ride the dark descended quickly. That’s when I busted out the night gear:

• 2 watt Blaze headlight
• blinking red taillight
• reflective left arm band
• reflective mesh vest
• shoes with reflective heel tab

Plus, by that time in the ride I was on roads with very wide shoulders. I felt as if
was actually more visible than I am during the daytime. I returned to my starting point without mishap. As I finished the last couple of miles, I was on Lower Station Camp Creek Road


View Larger Map
which runs along a wide brook. White men have been using this route for over 200 years in this community. There were few lights, the nearly full moon was peeking behind the clouds, and the only sounds were from the evening bugs and the nearly silent drivetrain of my bicycle. I felt as if I was skimming along the surface of the earth, a silent observer of the nighttime gifts, exerted but only with pleasure, a grateful recipient of the moment’s graces.

Vacation is a mixed blessing. On the one hand, you’re away from the work routine. On the other, there are extra stressors: traveling to and from the destination, deciding about activities, spending money, odd food, irregular sleep patterns, and site-specific hazards. In the latter case, at the beach for example, one could include sunburn, biting flies, bedbugs, sand scrapes, and too much alcohol. Oh, and if you take children the list expands exponentially. For example, if the children are not off from school, you might try to take the assignments for the week with you to the beach along with all of their textbooks, workbooks, pencils, erasers, paper, protractors, and assorted supplies. Then try to get kids at the beach to actually do homework-Ha! Or you could just give up and resolve to finish at home, with the following result:



So my advice is: don’t take any vacations until there are no children along. . . but then that would only be about half as much fun, right? Right?

Tags: vacation

Knowing when to stop

There’s a delicate balance in medicine when performing a procedure on the human body. Each patient is different; human biology is not stereotyped despite vast homogeneity of physiological principles. In attempting to reach a therapeutic objective one has to gauge how hard to try, when to push, when to let up, when to quit.

Coronary intervention is no different. Here’s a general guide to the technique. Study this description for a while and then come back.

OK, you studied, now you’re ready? Recently I had a patient with recurrent angina despite the best in medication therapy. We decided to perform a diagnostic coronary angiogram to examine his native coronary arteries as well as his bypass grafts ( he had undergone previous bypass surgery many years previous). Turns out there was a severe blockage in the native coronary artery supplying the bottom part of his heart. At the outset, it looked straightforward: about a 90-95% narrowing but in an accessible region of the artery with a reasonable diameter to the vessel. So I began. The first clue was that it was difficult to find a guiding catheter that stayed put. Although the guide wire went down easily, every time I tried to advance a balloon, the guide catheter disengaged from the artery back out into the aorta. I then tried multiple different combinations of guide catheter, wire, double wires, shorter balloons, smaller balloons mixed with small aliquots of cursing, praying, and hoping. It looked doable, and I didn’t want to give up. Fortunately the patient was stable and not symptomatic during the procedure. At one point, I actually managed to make the artery worse with the initial severely limited flow now being no flow at all-that is not a good thing. The staff in the room were getting restless, and I was wondering where the risk/benefit ratio now was. Every new combination of hardware meant more time, more fluoroscopy, more radiation, more contrast potentially toxic to the kidneys, and more frustration. Every re-engagement of the guide catheter increased the risk of dissection. Every new wire brought the hazard of perforation. But the patient had not been helped yet.

Finally, with a certain combination of catheter, two wires, smaller balloon, and perseverance, I managed to get the balloon across the lesion and inflated. Stenting followed with a good result. The patient was quiet and without complaints. Everyone in the room was relieved to be done.

Similar scenarios occur in any medical procedure. Sometimes you can’t get it done. Sometimes the result isn’t perfect. Sometimes you violate the principle of “primum non nocere” because taking no risk means getting no useful improvement. “The enemy of good is ‘better’”, a wag once uttered. But the enemy of bad is sometimes gritty effort with measured calculation-where’s the philosopher for that one?

Tags: angioplasty