Biking — But Not Better

After riding last Sunday and feeling much better, I hoped exercise would help my current gout flare up. So, on Tuesday, I got home a little earlier than usual and took the bike out for another quick ride. I felt better after an hour’s pedal, but my foot was still sore. However, two hours later, when I went to take the dogs for a walk, I was walking almost normally.

I felt good going to bed Tuesday night, but when the dogs got me up Wednesday morning, I could barely make it to back door. The gout pain had come back with a vengeance. To get to the class I teach in the afternoon, I have a quarter-mile walk across campus. It felt like an expedition. I couldn’t wait to sit when I got to the classroom.

So, I bit the bullet and called the doctor. He didn’t have any slots open, but he’s part of a physician’s group with offices across the metro area, and one of his colleagues could see me this evening.

The diagnosis and treatment is straightforward. First, the aim is to control the pain. He prescribed the “fire extinguisher” — prednisone. (Luckily, I haven’t had the side effects of Prednisone others have had.) Then, there’s Colcrys. That will lower the uric acid levels in my blood. I’ll be on it for about four months. When I see my regular doc next month for my annual physical, we will be talking about long-term treatments to keep the uric acid level low. That will probably involve a drug like allopurinol or Uloric, but once that’s established, my gout should be under control.

I explained to the doctor about the beneficial effects of cycling on my gout. He was interested, but didn’t give it much credence. He was glad I’m still able to cycle, because it turns out he’s a cyclist, too. I had seen a cycling helmet under a chair in the examination room, and he pulled it out.

“This is what I use to explain to people why they should always wear helmets,” he said, handing it to me.

It had been in a big crash at some point, and had a large crack on its side.

“The helmet broke, but my head didn’t,” he said.

We chatted a bit more about cycling, and I got the impression that he travels at about the same average speed I do. But I had to get moving and pick up my prescriptions. My foot still hurts as I write this, but I’m hoping I’m finally on my way to controlling it. And maybe I’ll run into the doctor on the road sometime, too.

Cycling With Gout

I am proud to note that once again, I am suffering from the “Disease of Kings.” Yep, I have another gout flare up.

I have had them before, but this time, it’s different. This is my third attack in about four weeks. The first one lasted only 24 hours. The second one was with me a full week. This one got me on Friday, and we’ll see how long it lasts.

Gout is the crystallization of uric acid around a joint — often the big toe. That’s what I’ve been dealing with. It swells the joint, inflames it, hurts when it’s touched, and makes walking difficult. It’s accompanied by quite a lot of pain.

Walking the dogs around the block this evening was agony. I’m not looking forward to going in to work Monday — I’ll have to connive to stay parked at my desk, rather than walk around the building. Thank goodness I don’t have to move between buildings on Mondays.

A shot of my two feet shows right away which one is afflicted. The left foot is swollen around the joint, and the swelling has moved up the instep a bit, too. (I stood on the sides of my feet a little to show off the problem better.)

gout

But there’s one activity that isn’t adversely affected by gout: cycling. I did a short ride with my wife Saturday morning, and was looking forward to getting out again Sunday. I was even able to cut the grass, wearing fairly stiff-soled hiking shoes. But inactivity makes the pain worse, and when I got up Sunday morning, I could hardly move. I made an excuse to skip the club ride, but pledged that when I had medicated myself and had a decent breakfast, I would ride.

I decided to stay relatively close to home, in case things didn’t work out as I’d hoped. I needn’t have worried. The rigid soles of cycling shoes are great for gout sufferers, because they inhibit the toe joint from hinging. I did a couple of quick laps around the Veloway, attacked a hill going back into the neighborhood, and racked up a nice 26-mile ride before calling it quits.

After showering and getting dressed, I found that I could walk more easily than I could earlier. The increased circulation of blood from the cycling must have had a salubrious effect. It was only after several hours parked in front of the TV watching football that I reverted to the agony of Saturday night. I limped around the block with the pooches, and downed some Ibuprofen for the third time when I got home.

When you get a gout attack, odds are good that you’ll get more. Now, my job is to control the level of uric acid in my blood. Cherries are supposed to help. There are some foods I should minimize. One of the worst things for uric acid turns out to be beer. Cutting beer — even temporarily — will be my biggest adjustment (I really enjoy drinking craft beers!).

Various cycling forums are loaded with posts from gout-suffering cyclists, so I know I’m by no means alone. I’ve taken heed of some of their tips, and will be checking with my physician at my annual physical in a few weeks to see what else he might recommend — there are some effective pharmaceuticals for the treatment of gout.

In the meantime, I’ll stick to a more-or-less regular cycling schedule. Maybe that will speed up my recovery.

Slow Recovery

It’s been a disappointing week. I thought I had been making a good comeback from my fall two weeks ago. Last Sunday, I did an easy 32-mile ride with no bad consequences. But Monday, I developed some pains in my side.

I had been having these feelings pretty much since the fall, but they were minor. I mostly concentrated on that huge bruise I blogged about last week, and then a hip pointer made itself known. Football players (American football) and hockey players get these, from banging the point of their pelvis bones against something hard. Most of the time, it’s not there, but when I bend my left leg a certain way, the pain is enough to make me jump.

Then on Tuesday, I decided to do my after work ride. It’s a 19-20 mile jaunt through my neighborhood. This time, as soon as I got on the bike, I could feel that pain in my side again. It feels as though something under my ribs is bruised, and if I bend at the waist a certain way, it’s quite painful.

On the bike Tuesday, that ache was with me throughout the ride. Instead of 19 miles, I cut it short and did only 12.

“You should see the doc,” said my wife, when I told her what had happened.

Luckily, my doctor keeps evening hours on Wednesday, and booked me an appointment that evening. He’s always been supportive of my biking, because of the changes it’s made in such indicators as blood pressure and cholesterol levels. Of course, this is a negative effect.

He had me do some stretches, which didn’t hurt. He poked and prodded my sides, and found the quarter-sized spot on my left ribcage that triggered the pain. It’s where the rib meets cartilage, and he told me the cartilage is the damaged part.

“In my professional opinion,” he said, adopting a pedantic tone, “you’re banged up.”

There is nothing to be done. “Even if you had a broken rib, we wouldn’t do anything,” he said. “We’ve stopped wrapping ribs. It turns out that can cause pneumonia.”

He did recommend heat. And anti-inflammatories, which I’d already been taking. But it looks like it will be several weeks before the aches and pains go away.

I dug out the heating pad, and it does work. Saturday, I got on the bike and repeated the ride I had started Tuesday. This time, I did the whole 19 miles. My torso felt fine.

I rode again today. The only time it feels sore is when I stand to pedal up a hill, so I rode a mostly flat course. But I can ride without pain.

I’m looking forward to riding again Tuesday after work. My time in the saddle is really down this year. I’ve got some catching up to do.

 

Biking Through a Bruise

My fingers next to the bruise give an idea of its size.

My fingers next to the bruise give an idea of its size.

I’m still feeling the effects of that fall I had a week ago. I’ve got the biggest bruise on my hip that I’ve ever had, and it was quite painful to start with. However, one nice aspect of our sport is that it seems to help in recovery from these kinds of injuries.

The crash was odd in that I wasn’t moving all that fast. In fact, I was just slowing to make a turn when the rear wheel slid out from under me. But the full force of the impact fell on my left hip. I must have hit the pavement a lot harder than it first seemed, because two days after the crash, I had trouble rising from a chair. It felt like the whole left torso was bruised as well, although I could find no marks.

How did I treat the big bruise? It turns out that I did everything wrong. The recommended treatment for a bruise is to stretch and ice the affected area after the workout. In my case, I felt so good after riding this week that I did nothing except shower. For pain, acetaminophen is the recommended treatment — not ibuprofen. I gobbled ibuprofen two or three times a day.

Sitting for awhile, while watching TV, exacerbated the pain. Moving eased it. Except for Sunday, the day after the crash, I have been on the bike every day — sometimes pushing myself to climb a small hill a little bit faster, or do some intervals. Without fail, I felt better once I got home.

In one regard, I was lucky. I wasn’t bruised anywhere that came into contact with the bike. So when I ride, I feel like a normal person. It’s only after I’ve been stationary for an hour or more that pain becomes a problem.

Bruises heal themselves in seven to 10 days. My bruise is still impressive, in terms of the area it covers, but I can tell the coloring is already starting to fade. I expect to be back to normal in another couple of days. But in the meantime, I think I’ve healed a little faster by exercising those muscles under the bruise than I would have if I’d done nothing.

Biker’s Elbow

For the last few weeks, I’ve been dealing with some minor pain. It started on the LBJ 100 ride, I think. The day after the hilly metric century, I experienced some soreness in my left elbow when I went out for an easy recovery ride. It’s not a big deal, but it is a noticeable twinge.

I thought it might have something to do with the way I held my arms during the long ride. Maybe I was pushing the elbows too far out for help on the hills. I noticed that if I kept my elbows in, the soreness went away.

I hadn’t realized it before, but I have Biker’s Elbow. No, although I capitalized it, that’s not its real name. It’s called “lateral epicondylitis.” You might know it better as “tennis elbow.” The American Association for Hand Surgery (Yes, it’s a real organization) says despite the name, most people who have tennis elbow have never played tennis. And if you want to get into the medical minutia, lateral epicondylitis is considered a form of tendonitis — but it isn’t really, because it doesn’t involve inflammation. It’s considered more a mechanical problem related to degeneration of the tendon that passes over a bony protrusion on the elbow.

What causes it? Repetitive motion. Any activities that repeatedly stress the same forearm muscles can cause symptoms, according to the orthopedic-oriented website, Orthogate. So besides swinging a tennis racquet, such things as running a chain saw, or using a paint roller can have similar results.

Now, cyclists don’t repeat motions much. Their hands are mostly on the brake hoods or in the drops. But it turns out that gripping can cause the same kinds of pain. Again, according to Orthogate, “When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon. The forces that pull on these tendons can build when you grip things.”

Treatment is simple in simple cases like mine: rest. (Duh.) Aspirin or ibuprofen should help. If it’s more serious, you’d better be talking to a doctor, because then treatment will involve everything from stretching exercises to physical therapy to, in extreme cases, surgery. Most disturbing was this advice from the Hand Surgery website: “It is recommended that activities that aggravate the symptoms are limited.” What, no biking? No way!

Since the LBJ ride, I’ve felt that twinge in my elbow on every ride. But on every ride there’s less of it. On today’s after-work quick 15 miles, I felt it once, moved my arm a little bit, and didn’t feel it any more. Knock wood, but I think the situation is under control. But you can be sure that I’ll be very aware of how tightly I grip the handlebars from here on out.

Riding Away A Saddle Sore

Last week, while I was not riding because of my head cold, I developed a bad saddle sore. How could that happen? Well, I assume I contracted it during that metric century I did on my birthday. After all, it was my longest ride of the year by far, and there was probably some rubbing going on down there. But I wasn’t bothered during the ride. Or after the ride. It was only as the following week wore on that I realized I had a problem. Even walking was painful.

I took a look, and sure enough, there it was — only bigger than saddle sores I’ve had in the past. Typically, they’re about the size of a pimple. But this one was el zitto supremo! I waited for it to diminish, and even got two extra days for that to happen when my Friday and Saturday rides got rained out.

On Sunday though, my wife wanted to ride. I was leery about going with the saddle sore, but I threw caution to the winds and joined her for a nice 16-miler. The ride was comfortable for me. I felt no rubbing, no soreness. Nothing like I’ve gone through in the past when I’ve ridden with saddle sores.

Back home, I found the sore had almost disappeared. Just that one ride took care of it.

I’m baffled as to why. I’m guessing that it must have popped during the ride, but I would think that that would make it even worse because rubbing would aggravate it. So I’m not entirely sure what went on, but I’m glad it did. Today’s 25-miler went off without a hitch.

I think I’ll still be careful about riding with saddle sores in the future, but at least I know now that riding with those little buggers won’t necessarily knock me off the bike for several days.

You’re Going to Fall – Here’s How

Note: The series of guest posts on The Most Important Thing I’ve Learned About Cycling will reappear later this week. I must resume contributing to my own blog!

You might have noticed in the Twitter box on the right of this blog last week that I had a minor crash on my bike. I missed a shift on a hill, dropped my chain, was unable to clip out, and I went over.

Just a bruise on my hip and a sore hand, but that was enough to trigger this reprimand:

“Hands on the bars at all times,” commented Mike Weiland, who should know, because he’s had his share of hard falls.

But that’s the problem. When you find yourself going down, what’s the most natural reaction? To put out a hand to brace yourself when you hit the ground.

“You brace, you break a hand or a collarbone,” said Mike. Or an arm, or dislocate your shoulder…

Even experienced riders brace for falls. It’s a natural reaction.

Okay, so I’m going to resist the temptation to brace next time (yeah, right). What can I do instead?

It depends on the type of fall. If you find yourself going over the handlebars, you can plan to roll on your shoulder. I did this in the first bad fall I had on my road bike, and although I was sore, I wasn’t hurt badly.

The guy in this crash looks like he might be able to drop his right shoulder, and roll on it.

Ted Rogers, who runs the blog, Biking in L.A., urges cyclists to do two things: stay clipped in, and hold the handlebars tightly. He tucks his elbows into his body. “At the same time,” he says, “I tuck my head down between my shoulders, and round my shoulders to shape my upper body into a ball. My momentum will continue to move my body forward, rolling me over the handlebars, still attached to my bike, which helps me maintain my curved position.” With luck, you’ll be able to roll on your shoulder rather than fall on your face. If he finds himself going down sideways, instead of over the bars, he does pretty much the same thing. When I went down last week, I stayed clipped in (not intentionally). That may have prevented me from being hurt worse than I was.

The roll might work for low-speed crashes, says Mike Weiland, but at higher speeds, all you can do is just skid. “Of course the one a few months ago at 24 mph I ended up hurting my hand/wrist not from bracing, but more or less punching the ground as my hand was still in the drops when the bars made contact with the pavement,” he told me.

It appears the best place to land in a crash is on your side. Hitting your chest or back on the ground could mean worse injuries. “As you hit the ground,” said one commenter on a biking forum, “try to stay as loose as possible. If you’re tense or stiff, it’s easier to get hurt.”

In practice, none of this might be possible. One cyclist posted to a forum that he’d been in two bad road crashes. “In neither case, do I remember having any time to react,” he said. “I was aware that I was in trouble, and then on the ground bleeding.”

What’s the old saying? “There are two kinds of cyclists: Those who have crashed, and those who are going to.”

Keep the rubber side down.

During the coming week, Bike Noob will feature two more posts in the series, What’s the Most Important Thing You’ve Learned About Cycling? If you’d like to submit your thing, check here.

Hot Spots

One of the discouraging aspects of last weekend’s metric century was a recurrence of the hot spot in my foot that bothered me in last fall’s Imperial century. It creeps up on me. At first, I don’t notice it. Then suddenly, the ball of my foot is burning. It hurts to pedal.

My usual remedy for hot spot is to stop, take off my shoe, massage my foot, maybe even take off my sock and let the air cool it. I was lucky Saturday. After I gave it that treatment, I didn’t get a hot spot for the rest of the ride.

Other times, like last fall’s century, I haven’t been so blessed. It plagued me for the rest of the ride, and was one of the reasons I rode slower than I had in that ride in the past.

I’m not alone.

A cursory check of biking online forums (fora?) reveals other cyclists who report much the same symptoms. So now that spring is here and warm weather rides will soon be common, maybe it’s time to talk about hot spots and how to handle them.

The most common advice is to loosen your shoes, move your cleat back — either a little or a lot, depending upon who is giving the advice, and get carbon fiber soles with a wide platform cleat.

In my case, I wear Specialized shoes with carbon soles. My cleats are back as far as they’ll go, and have been for a couple of years. I do keep my shoes fairly loose, because I know from experience that my feet swell up on long rides in warm weather.

But according to cycling coach Fred Matheny, hot spots are a neural problem. The burning sensation is caused by pressure on nerves in the feet, says Matheny. That pressure can eventually cause a neuroma, or swelling of the nerve between two metatarsal bones, as seen in the illustration at right. The coach suggests getting metatarsal buttons. These things are little foam domes that can be attached to insoles just behind the ball of the foot. They cause the metatarsal bones to spread, which keeps the nerves running between them from being pinched by pressure or swelling. You can buy metatarsal buttons in the foot care section of drug stores. Insoles with the buttons already built in are also available.

I’ll have to give them a try. I’m also going to dig around in my dresser drawers and try to find some running shoe insoles that I think I still have.

You might also consider wearing thin cycling-specific socks, and even buying high-end cycling shoes that come in widths. My friend Rick, who doesn’t get hot spots, rubs his feet with Chamois Butt’r before a long ride, and then puts on two pairs of socks — just the opposite of the conventional wisdom.

(Illustration from Synergy Massaging Insoles – www.synergyinsoles.com)

 

I Need To Ride

Guest poster Jeff Hemmel has been away from biking for a bit, and that’s had him frustrated.

At some point, if you ride long enough or just become hopelessly addicted to cycling, getting out for a ride changes from a “want” to a “need.” I know, because I need to ride right now. Badly.

This has been a pretty good year for me cycling-wise. I’ve averaged about 500 miles per month, and even nudged that total up to about 700 during the fall. My fitness is probably close to an all-time high in terms of endurance, and I’m feeling strong. Or at least, I was feeling strong. After months and months of high mileage, December proved to be one cruel month. Yes, I know I’m a wimp, but we set the record for coldest December in recorded history here in my area. That was already making the month a challenge, but then I got a stomach flu that was raging through my family over the Christmas holidays, just as I was trying to make up for lost time. One minute I was out riding marveling at my hearty immune system, the next I was headed for the…well, I’ll spare you those details. Before I knew it, I was looking at the month’s end feeling weak, dehydrated, and with the fewest miles logged in over a year.

With a new year comes new hope. I got out for my first ride in a week with a friend, and knocked off 45 miles without really feeling the effects of my illness. In fact, I felt really good. Unfortunately the very next day I went in for some rather extensive dental surgery, the unexpected result of an injury I had suffered a year earlier. (Good news – I still have all my teeth!) That stomach that was just beginning to recover has now been assaulted by antibiotics and painkillers, and thanks to a mouthful of stitches that will stay for two weeks, my diet has been limited to mostly liquids and mush. To add insult to injury, the doctor told me I’d need to take about a week off any serious aerobic activity, and even then ease back into it. I’m feeling sore, weak, and depressed…and unable to do the one thing I know will make me feel better.

At the conclusion of his book Tour de Lance, author Bill Strickland quotes Lance Armstrong as saying “I think people are better, smarter, more present, and more patient when they’ve done some type of exercise—that goes for an eight-year-old and a sixty-eight-year-old—and I need more, perhaps than most people, to get the results I want.” Strickland goes on to note there’s some scientific evidence to back up Armstrong’s theory, specifically when it comes to cycling. Basically, cycling mixes sustained aerobic exercise with complex brain functions — balance, timing, and spatial awareness. For that reason, it may literally be able to “soothe” the brain. Studies at universities including Vanderbilt, Johns Hopkins, and Georgetown back up this theory. I know I feel much happier after I’ve returned from a good ride. Sometimes, if I feel I’ve ridden particularly well or hung with certain people on a group ride, I’m almost giddy.

Right now, however, I’m going crazy. Somewhere along the line, between accomplishing that first 30-mile ride and riding my first century, between trying to fit in rides around life to fitting life around rides, riding a bicycle has gone from something I want to do to something I need in my life. That’s why today, with my doctor’s blessing, I’m getting out on the road, sore mouth and stitches and bad conditioning and all.

Because, as a lot of you will understand perfectly well, I really have no other choice…

Falling Into Fall

Guest poster Don Blount recalls a year-old incident.

The first day of fall brings back memories of the day I first fell. At least the day I fell badly enough to suffer a significant injury. It was Sept. 22, 2009 and I was halfway through a 46-mile ride. The turnaround point was at an area nature preserve and I had gone to the visitors center to look for a trashcan to throw away a banana peel.

A long driveway and sidewalk leads to and from the visitors’ center, and as I was on my way out, a car was on its way in. The driveway is just wide enough for two oncoming cars to pass each other if they go slowly. As the car approached, I moved to get over and onto the sidewalk to be completely out the driver’s way.

I vaguely remember the feeling of falling. I clearly remember the pain of being slammed to the ground. And then the next thing I remembered was someone, the driver of the car, asking me if I was alright.

It took me a bit to collect myself, check my bike and then ride the remaining 23 miles home – with a fractured left wrist.

The gap shown in the photos is what caught my front tire. The sidewalk is about an inch higher than the road surface and that gap is just wide enough to trap a tire.

I watch out for these little road inconsistencies more closely now and work hard at keeping the rubber side down.