A long way to the top

Since the crash in August I've been plagued by knee and hip problems, not to mention the lingering, renewed Crohn's issues over the past year. It's been a (litterally and metaphorically) wobbly path back to cycling, with a lot of ups and downs.

I've worked up to finally doing some real distances again, but am still distrustful of my knee's integrity and shy away from any real torque or out of the saddle riding. My base miles are still low for this winter and my fitness is behind where I need it to be leading into the next racing season. I've got a lot of work to do, but it's looking up. I have a referral to a new physical therapist; one who worked wonders on a cyclist friend who was told they'd never walk again.

And, one more promising sign is that this weekend I did a relatively fast ride from NYC to Bear Mountain in Harriman State Park and back, which includes 6000+ feet of elevation with a 5 mile climb in the middle. It almost destroyed me, but I survived and even said, "Oh, this is it? I thought it was longer" at the top of Bear.

Here's to continued kneehab to come. If it wasn't hard, it wouldn't be fun. Right?

The view from the top of Bear Mountain, NY.

The season of cold-damp-rainy-snowy is upon us!

It's officially here! It's been here for about a month now. It's winter riding season.

Although sometimes it takes extra motivation to step out into the mist, or onto the frozen ground outside the doorstop, all hesitancy is always erased once I'm on my bike and moving.

Winter changes the landscape, making everything new again. Old routes covered in ice, or bare of leaves with new views at the top of climbs.

Into the wintry mist... friends, fun, and fog!

Tip for winter success: Order a case of those instant hand and toe warmers, so there is nothing holding you back from getting on your bike when it's freezing outside. Toe warmers make the difference for me, as cold feet is my big rate limiting factor.  Also, get some good waterproof shoe covers. Then, it's off into the cold-damp-beautiful world with you!

Chill'n out and doing some focused strength exercises

Since the crash in August I've been keeping it pretty low key. Not that I've had much of a choice, between a wicked concussion that kept me off the bike for about 6 weeks, and then realizing just how badly I'd messed up my knee once I was back on the bike. I've also continued to have some lingering Crohn's related ick. So, I'm continuing to ride it out, and try to enjoy the time I can get out on the open road even if it's at an easy pace.

The benefit of the easier pace is that I get to spend time with our newest riders on the Yale team. And, I must say, I do love helping folks master cycling skills like pacelining, cornering, and climbing hills! Getting to see the huge gains in confidence and the satisfaction of mastering a new skill is so satisfying.

40 degrees and sunny in New Haven! 

Plus, it's fall. And autumn riding means we are back to base miles anyway, so my easy pace is right on target.

I've also been taking the time to work on some other stuff while I've been in the saddle less.

The problem areas:

- Core strength: I have terrible core strength, which is likely because I have trouble with ab spasms on my ostomy side if I do much direct core work like sit ups.

- Medial leg strength: It's easy in cycling to work only the front and back muscles, as we have no side to side movement.

- Gluteus Medius strength: Yep, that's the muscles on the side of my butt. A lot of cyclists have  this issue. Have you ever seen a competitive cyclist on a bike and noticed that the side of his butt looked almost indented? That's the gluteus medius underdeveloped. And, according to my physical therapist friend (it was a strange night of casual consults and laughing about it), mine are sincerely lacking.  She said that my "massively hypertrophied hamstrings" had been doing all the work instead.


The remedy: 

- planks! Oh man, I am terrible at these. But, I'm making myself do at least 5 sets of holding it for 30 seconds with keeping good form before bed every night.

- Spider-mans: 2 sets of ten. From a plank-like position with your arms straight, bring one knee out to the side and touch it to your elbow. Then bring it back together with your other leg. Now do the same on the other side. This should make you side ab and back muscles burn.

- cross training: and by this, I mean cyclocross training. Yes. Running, leaping onto a built up road bike with knobby tires, and then jumping over barriers and roots. It's good for building stability in all of those other little muscles that don't get used in just moving forward. Still not sure what cyclocross is? Check it out: http://www.behindthebarriers.tv/

- Actually cross training: Really, not bicycling. Walking vigourously while focusing on form - ie, not compensating for my lack of gluteus medius muscles by using just legs. It's suprisingly difficult to focus on using butt muscles while walking. Try it.

- Thigh master like it's 1992: Just kidding. But, same idea, squeezing a soccer ball between my knees while doing a slightly more upright wall sit. This targets the muscle groups on the inside of the thighs without activating the larger quad group.

Awestomy Wrap Review

About a month and a half ago I got a new wrap from Awestomy, a new company that makes ostomy undergarments, and I have been meaning to write a review since then.

Beyond a review, I also wanted to talk a bit about what the deal is with wraps. I'm usually pretty amazed that so far none of my GI docs have ever seen a patient wearing one before, and no ostomy nurses I've encountered have had any idea such a thing existed! No wonder there are so many folks out there stressing out about what to do with their pouch as they go about life! No, you don't have to have it flopping about, or hanging outside of your clothing, as I've seen many a question on facebook groups and message boards. Tucking it in to a wrap helps keep you discrete and helps smooth out any contents. I'm honestly not sure how I'd function if I didn't have wraps to keep the pouch secure, and I can gaurantee that my wear time would be less due to the weight of the bag pulling on the adhesive. This is one of those product types (like Skin-Tac) that was a game changer for me, when I found the ostomysecrets.com website years ago.

These ostomy specific wraps are different than a simple tube top, which you could wear around your waist just as easily, in that they have two inside pockets on the right and left side. This keeps your bag from resting against your skin, where the edges can be irritating and in warmer weather the plastic makes for a sweaty time. The pockets are on both sides so as to work for folks with an ostomy in either (or both!) location.


Personally, I'm a minimalist. I don't like having to fiddle with zippers, or velcro or other elaborate contraptions to empty, and I hate wearing any more clothing than I need to (no wonder I love cycling!). I also don't like the constricting effect of standard, old fashioned, elastic ostomy straps. I like wraps for their simplicity and freedom of movement, as well as low profile under a t-shirt or dress shirt. In the past I've had wraps from ostomysecrets.com, and those are still the majority of my collection.

Pros: 
1. The wraps from Awestomy.com are different in that the top is a bit higher and they have a silicon band around the top seam so it will not scoot itself down during activity such as running, biking, etc. For activity this is super nice, since repositioning a wrap mid-run is always a bit awkward.

2. The silicon band and higher waist ensure that the top crest of the pouch doesn't peak out over the top of the wrap, which was ever so slightly the case with the ostomysecrets.com wraps. This is a nice features if I know I'll be changing in public (not that I care either way or have ever been shy!), running around topless, swimming, etc.

3. They come in more colors than white and black! I'm a fan of the grey and argyle.

4. The material is soft enough to be comfortable all day long, and the seams don't rub.

5. Customer service is awesome. I custom ordered a 27 inch waist size, and they were happy to oblige, despite that not being one of the standard sizes available. And, the size seems to be pretty spot on (note, I did order it a hair big due to my anticipated issue with the band, in case you were looking at the photo and thinking "that doesn't look tight at all"). Nice work, guys.

Cons: 
1.  I will confess that the silicon band does make it slightly harder to access the pouch and empty it - a very minor inconvenience, and I suppose I'm just fussy or lazy.

2. The band does make you aware that you are wearing something around your waist, not uncomfortable but aware, much in the same way that a loose elastic band on your wrist feels present but not uncomfortable. Again, maybe I'm just inordinately fussy, especially for somebody who spends a lot of time wearing spandex.

3. Finally, why no neon colors, guys?! Don't you know pink is the new blue for men in 2013?! Yet, these are all minor complaints, very minor complaints.


The verdict: Awestomy is awesome. The pros of having a wrap with a higher top and a silicon band to keep it in place outweigh the cons, and you can't have one without the other for this feature. Hot pink, or maybe some electric green (?), would make my day. Zebra print would also be sufficiently loud. But, I'll settle for ordering another grey one for now! Thanks for making such great products, Awestomy! I'm not sure what I'd do without such creative folks out there looking out for their fellow ostomates!

Setting the record straight

Even at Yale School of Medicine, sometimes we have supposed expert lecturers say things that aren't correct. Or, alternately, present important material inapropriately.

Today in one of our Human Sexuality classes on sexuality and disability/illness, our professor stated that people with an ostomy smell bad, which can be a barrier to sex, and this can potentially be addressed with cologne. He also stated that people with an ileostomy can wear a stoma cap to reduce the size of the bag.

Sigh.

Wait, no, not "sigh...". This type of perpetuation of negative stereotypes (smelly, undesirable) is infuriating!

A cap?
First off, the misunderstanding of who wears a stoma cap is just silly and only communicates the lack of familiarity with ostomy issues more than anything else.

Anyone with a good understanding of the logistics of an ileostomy versus a colostomy would know that in an ileostomy a stoma cap generally really won't work well because of the nature of the output, which is more continuous than a colostomy which may be managed through means like irrigation. For many people with an ileostomy, a stoma cap would probably cause more problems than it was worth by puffing up like a small balloon if used for more than a very short period of time. For intimacy and activities like swimming, many people prefer to change to a mini-bag which is larger than stoma cap but smaller than a full size bag.

Like roses...
Now onto the issue of smell. In the break between hours of the class I approached the professor about why this sort of statement only reenforced a negative stereotype which might be passed along and negatively impact patients. I also offered up that what he didn't know was that most of my classmates know that I have an ileostomy. His response was that he was not wrong, and that I am a one of a kind exception to the rule, and that this was my personal sensitivity and that I was "blowing it out of proportion" it into an issue with him that wasn't real. He then repeated multiple times that from his own experience as a doctor he has seen only people who smell bad and have had resulting problems with relationships.

Let's address the facts here and clear this whole thing up.

These days, nearly all ostomy supplies are manufactured so as to be impermeable to smells when adhered correctly. When one of the guys farts in the car after a burrito stop, it's convenient to be able to deny any responsibility because it truly couldn't have been me. You can't smell mine because they are in a contained bag! So there! ha!

Leakages are still possible, but with some help from an ostomy nurse on finding the right combination of adhesives, can be very rare to the point of not being a major concern. Even with training intensively 6-7 days a week, and racing, and ahem... having an active sex life... I only need to change my appliance 2 times a week, and haven't had a leak in about 3 years (knock on wood!!!).

If I smell bad it's not because of my ostomy. It's because I sweat a lot and sometimes am a gross dude who doesn't shower after riding my bike. Sorry, world.

Of course, there will be lots of people in the world who smell bad. Some of them have bags, most don't. Some other people just have poor hygeine. And, some people with an ostomy have issues with appliances due to skin folds, adhesive allergies, or diminished eyesight or dexterity.

As ostomates, friends and healthcare providers who may encounter people with an ostomy, it is important to differentiate between what is a fear and what is an inevitable reality.

A person with an ostomy might FEAR odors, especially if they are new to having one or have recently had a leak which has made them trust their appliance less.

A person with an ostomy does NOT smell bad and have leakages prohibitive of having sex as a part of their UNAVOIDABLE FUTURE  You can solve these problems in most cases, with an appropriate referal and education to a GOOD ostomy nurse or other community experts.

The issue with intimacy, for somebody with no unaddressed appliance issues, is FEAR, not a bad smell itself. Putting on cologne might help with feelings of being self concious, but won't be the cure to a leaky appliance. And, if your appliance isn't leaky, and you've taken a shower recently, you probably don't smell.

Perpetuating negative stereotypes doesn't help anyone. It does people with an ostomy and their providers, who might help solve the problem if they knew it wasn't to be expected(!), a disservice.

Spandex bike shorts! Wear them with an ostomy? Yes!!!

Twice this week, bicycle shorts choices with an ostomy has come up.

1. Can you actually wear tight clothes, even skin tight spandex with an ostomy? 
Yes, absolutely! The thing I've learned is that people really aren't paying that much attention to you. They are too hung up on their own appearance to notice a small ring on your abdomen. Most people area a little bit lumpy. And, I'm sure you've noticed some people wearing very tight clothing on the street who don't have chiseled bodies. It doesn't matter if you're thin, thick, or somewhere in between. It's just a little ring, or maybe a small bulge under your clothes or skin tight clothes. And, really, that's all it is.  Can you notice it in the last of the photos below? Probably, if you look really closely. You can definately see it in the correct lighting if I am standing upright, off the bike, and am wearing a skinsuit for time trials. Personally, I'm fine with telling people what it is if they ask, and most of the time people's responses are positive ones. Especially in the setting of competition, I think people have respect for those who have overcome challenges to get there. But, even without a competitive setting, I've stopped caring.
Try it. Wear bike shorts. Nobody is looking. And, if they are, it's your good looking bike or tight clothing, and not your ostomy.

Most people are shocked to find out that I have an ostomy. And, I've never had somebody see me in spandex and figure it out. Even teammates who are oncology nurses haven't known before I told them (or walked around with my shirt off).

2. What kind of bike shorts are best? 
There are really two types of bike shorts. One's with a waist band, and bib shorts with shoulder straps and no waist band. Personally, I swear by bib shorts because they keep everything tucked in place without any additional support garments/belts/whatnot, and don't have elastic constricting my bag anywhere. Pretty simple reasoning, yes?
At first I was afraid to wear bib shorts because I was afraid it would be too tight around the appliance itself. I started biking again after surgery wearing standard shorts and found it was ok for a short time, but after a longer or harder effort it would start to tug on my bag, or if I had any output while biking it would all collect above the elastic line and become both an unsightly bulge and uncomfortable.

Here's how it works, in photo blog format.

                 

3. How do I buy bike shorts? 
It really comes down to a matter of preference.
The ones below are team issue shorts made by champion systems. Some of my other favorite brands for high quality shorts are Voler, Castelli, and Giordana. I recommend you trying them on at a reputable, bicycle-specific store (not a big multisport, box store like REI, City Sports, or Dick's sporting goods.) Ask the sales people about the sizing. They should feel snug enough to keep everything in place but not so tight that you can't get them on. As a point of reference, I usually wear a 28 or 30 waist jeans around my hips, and have a 25 inch natural waist. I wear a small or extra small in most european brands. In larger cut american brands (Hincape) I wear an XXS.

PS- Sorry for the fuzzy iphone photos and the split mirror!!! It's what I've got to work with!
PPS - Note in the corner, the evidence that I do religiously wear zinc sunblock, as should you! Especially if you've ever been on an immune modifying drug, which can increase your risk of cancer!

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.

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.

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.

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!

Not again! More dehydration...

Uggg...

This past weekend I found myself [again] needing IV rehydration. I got behind and couldn't catch up. Least to say, it threw a wrench into my Sunday.

Now I'm trying to solve the mystery about what it is in specific that puts me behind in such a way that I can't recover. Sometimes, even when I've played by the rules, I still get into trouble.

Starting out dehydrated?
Having a cold or other minor viral infection?
Drinking coffee?

I'm hoping it can solve that mystery before I wind up needing any more time in an ER or urgent care!

Best quote of the weekend from an urgent care nurse (not the brightest crayon) after being told that I had just biked over 50 miles out to the airport and back, and seeing that I had been to the ER for similar dehydration and vomitting a month ago, "Your heart rate is 76, that's normal!" This said while I was laying flat (between vomitting) in a quiet room, and should have been at my resting rate.

"Not for me. That's me compensating. Check out that diastolic blood pressure number again"

My BP was 100/42. Not that the bottom number is sometimes a better reflection of hydration and actual blood volume in a person who is compensating by vasoconstriction and mild elevation in HR.

"What's your normal heart rate?"

"Low-mid 40's"

"oh..."


Hopefully in the future there will be less posting about dehydration and trips for IV rehydration, and more posting about fun stuff. That may require me to get a functional computer!


In other news, I'm planning some bike touring over the next year, with trips ranging from Lake Erie all the way up to Toronto!  I've been doing some weight training with fully loaded panniers on my Volpe and now feel comfortable (as much as one can!) on climbs in the 15% range for over a mile at a time.

[De]Hydration!

Well, this is the topic of the month for me and will be one of a series of posts I'm sure (assuming my computer starts functioning again).

Once I heard a gastroenterologist say that the average person with an ostomy is approximately 2% dehydrated at all times. For a person with a high output ostomy, this could be higher. Also, because people with active Crohn's, Colitis, or other intestinal disease may be malabsorptive to some degree, electrolyte balance can be more difficult to acheive. It may be impossible to follow a standard hydration regimen and expect the same results as your peers without intestinal disease.

For myself, I notice that I require a drastically higher concentration of electrolytes, and more water intake, than other people who are cycling at the same effort. I've been known to concentrate my gatorade to the point of it being gritty because no more salt and sugar will go into solution! Gross! But, the alternative is getting terrible leg cramps early on. I had this happen on approximately mile 20 of the NY Get Your Guts In Gear Ride, and have had terrible calf spasm on hot days in Pittsburgh when I have skimped on gatorade mix since then. Increase salt and potassium, and magically my cramps go away.

But, it's not that simple. Hydration is not something you can make an afterthought without getting into trouble and not being able to get out fast enough. When you notice you're dehydrated, it's often too late. How do you stay ahead of the game?

1. Prehydrate: I carry around my tall bike bottle all day and make sure I'm drinking enough. If I feel foggy, my electrolytes are probably a little out of wack. If my symptoms improve after some gatorade or Emergen-C (has more potassium than sports drinks, little sugar), then I've validated my suspicions. Some guys who race drink Pedialyte the night before a ride. This is great, but you can do it for a lot cheaper by mixing up your own balance of gatorade and Emergen-C.

2. Eat enough carbs: Carbohydrates help you stay hydrated, beleive it or not. I don't eat immediately before riding, but will eat a rice cake with some peanut butter, or some tortilla chips and mild, fine cut salsa, about two hours prior to a training ride. Both of these food items also have a little bit of a salt kick to them as well.  Your body doesn't hydrate well if you are running on too few carbohydrates. It just doesn't work out well. Plus, we all know that carbs equal quick energy, which is important for feeling up for an up pace ride!

3. Hydrate on the ride! Bring more water than  you think you need. Drink every time you stop. Get more gatorade at every chance you can. I have started carrying extra gatorade powder in my jersey pocket, so I can add it to water or mix it into gatorade that I've bought at a convenience store stop on a longer ride.

4. Don't forget to bring your 'lytes! Headlights and taillights are usefull as well, but I'm talking about quick sources of electrolytes, just in case you start getting into trouble. Bouillion cubes are small, portable, don't melt and are a great source of sodium. I went to a local natural food store and got some vegetable broth ones because I couldn't quite get past the fake chicken smell and taste of regular ones. The veggie cubes have just as much sodium in them, and taste intensely like parsley... which does nice things to your breath for a while as an added bonus!  Although they are more expensive than some boillion cubes, I've also become quite fond of the Margarita flavor of Cliff Shotblocks. This flavor in particular has 3x the sodium of others, and shuts down those calf cramps quickly the majority of the time. If I'm starting to feel slow and foggy on a ride, I eat a few and suddenly feel alive again. It's amazing what a difference it makes!

5. Know your stats: Know what effort you can expect to maintain in what conditions, and what sort of feul you need to keep yourself going. When you plan a route, especialy one off of main roads, it only takes a few minutes to google gas stations in the area. Put them on your map in marker.  Using a cyclocomputer helps me keep track of my effort and pace myself. I use a computer with a heart rate monitor built in, and I know what I can expect my heart rate to be at different speeds and percent grades. If my heart rate is higher than I know it should be, and there is no other good reason (too much coffee at work, getting over a cold, etc) then I can assume it is because I am dehydrated enough to jack up my cardiac effort. Keeping track of my heart rate does more than help me pace myself, it also helps me set my rate for hydration and rehydration.

6. Be willing to readjust your plan: Be aware of your hydration status, and how much longer you can go on. If you are really truly getting into trouble, maybe it's time to consider how much longer you MUST keep on going. If I'm cycling in town and am a mere 12 or 15 miles from home, that is a very different situation than finding myself getting dehydrated or with electrolyte abnormalities out accross the West Virginia or Ohio state border. If you are close to home and can plan on getting back to your end point before hydration, go for it if you can do it safely. But, with 50 or 60 miles to go, it may be time to start planning a longer stop of an hour or two. Depending on how far out of wack you are, you may need longer, or a real exit plan. But, that's the worst case scenario. Probably a few bottles of gatorade in the shade of a convenience store and a snack will get me back on the road to home. If others on the ride will absolutely not wait, that's ok. It's better to ride home alone and make it home, then have a major emergency while trying.

7. Rehydrate! Agressively rehydrate sooner than later. Drink more than you think you need to, eat some salty snacks (especially if you are craving them. That means your body is telling you that you need it!), and cool down. V8 is suprisingly effective in replacing electrolytes and micronutrients. Get some good carbs in after a ride too, it will help you recover for next time. With so much attention to protien in popular media, it's easy to forget the carbs after a workout.


Even with all of that planning and thought about hydration, I am still trying to figure it out. I like to ride hard, and this past weekend rode myself right into the ER (well, figuratively, not litterally...) by getting seriously dehydrated and running a low potassium because I was not replacing it as well as sodium.  I've also started seeing a sports nutritionist for some guidance on making these subtle tweeks to my daily diet and hydration during cycling.  More on that to come!

Oh, and, want to see who joined me on a ride yesterday evening?

Check out these guys!

Just a short 50 mile ride... and thoughts on replacing lytes.

Ok, ok... so I confess, I'm really terrible at sticking to the limits I set on myself for an easy day. I was planning on just doing 20-30 relatively flat miles today, given that yesterday I did a grueling hill hammer-fest... and got hit by cars.

But... it was sunny out... and one mile led to another, and soon I was 50 something miles in and seriously bonking because I had only brought a pocket full of gummy bears and a mini banana. Baaaaddddd idea. And, really really stupid... Sometimes when it comes to biking, I can be like an addict fiending for the next mile, or like a glutenous small child binging on candy. And, both of those analogies end with somebody (me) getting hurt or sick.

One thing I have learned about endurance activity while gutless, is that I have to stay ahead of dehydration, electrolyte imbalances, and hypoglycemia. And, I have to be vigilant about it. Even if I think I'm fine, I still need to drink water/electrolyte mix and eat a gummy bear every 10 minutes after the first hour to stay on track. This means that there *is* a set end time; when I run out of carbs and lytes.
After that, it all goes downhill in very fast and out of control way. So far, I've been fortunate enough to have not had any real injuries from pushing too far, but I have reached the point of seizing from electrolyte derangement. Not a good time, trust me on this one!

Just from having an ileostomy, a person can lose 1-2 littres of water a day! Without excercise! Now, think about how much water you need to drink to replace that PLUS what you are losing from sweat. And, add back in the electrolytes that your body doesn't absorb from all of those two litters of water that you aren't absorbing because you don't have the guts to make it happen.  In addition to an extra disolvable electrolyte drink mix tablet, I also take salt and electrolyte tablets with me whenever I'm going out on a long ride, or kayaking, or hiking. That way, even if I run out of sports drink, I am able to quickly replace electrolytes even if I can only find water on my route. I have found that my mental clarity and general physical function improves dramatically after taking the salt +lytes tablet, which reaffirms that that truly was the problem.
What is a salt tablet? You can get them perscribed, which is how I originally got turned onto them, or you can find similar items at sports stores (they are called things like, "endurolytes" and salt is their number one ingrediant, with potassium somewhere near second). It was actually my gastroenterologist who suggested I start using them, not a sports medicine doc. He remarked that I appeared to be in great shape and asked how the biking was going, to which I answered that I was becoming frustrated with what at that time I was describing as an intensified , accelerated sort of bonking. He gave me an Rx for something called Thermotabs, which are normally given to people with autonomic (central nervous system) dysfunction, not athletes with malabsorption issues! But, they worked! They probably even saved my life a couple of times when I was way out in the middle of nowhere; giving me just enough ability to recover to make it back to a place where I was able to more fully rehydrate and replenish glycogen stores.

But, the bottom line is that I need to learn to have better self control. Even if it is sunny and the miles roll by easily, there is a time to stop. Having a medical issue is certainly not on my mind much of the time, especially when I'm riding, but there are some things that I have to take a lot more seriously than I used to.

Back to drinking my electrolyte solution,
t.