Dr John M

cardiac electrophysiologist, cyclist, learner

Ten random thoughts on the 2013 Tour de France

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It’s been tough getting much done the past three weeks. I must admit an affliction. I’m hooked on TDF coverage. High definition TV and DVRs have only made it worse. For the record, my affliction began before Lance–and it remains now, undiminished.

Here are ten random thoughts on #TDF2013:

1. Chris Froome seems like a pretty nice guy. He uses words that make one think he’s both grateful and dedicated. I hear him looking inward at things. I hear grace. That appeals to me. (Gosh does this world need more grace.) On the podium in Paris, Mr Froome said his yellow jersey will stand the test the time. At the risk of sounding hokey, I think it’s possible. (I know; that was sappy.)

2. Another thought on Froome: His riding is amazing. Though gangly and pressured, the results of his pedaling are remarkable. His acceleration on Mont Ventoux made it look like he had a motor in the bike. He rode Contador off his wheel while sitting down on the saddle. And it wasn’t just uphill accelerations; the bony featherweight rider almost won a flat windy time trial. That he could ride so strongly on a windy flat course gives ectomorphs the world over hope.

3. I came away liking American rider Tejay van Garderen. Young TJ rode a terrific TDF last year, and after winning the hilly Tour of California early this year, he was picked as a favorite for this year’s Tour. Expectations, however, can be a curse. It was not to be this year. He cracked in the first mountain stages. He made no excuses, offering only the truth: the watts were not there. But then the young rider made the best of a bad situation. Two weeks later, on the queen stage of the race, he went for broke. He got in the break, dropped his breakmates, overcame a mechanical on a scary descent and then attacked a French rider at the base of Alpe d’Huez. He came within 1k of winning the biggest race of his life. Some say TJ gave up at the end. That’s BS. He gave everything he had and it just wasn’t enough that day. This sort of performance is exactly why sports are so compelling.

4. France is a beautiful country. The images urge you to plan a trip for next year. Coffee and a baguette and a bike in one of those alpine villages…yes that sounds perfect. Do the French know how nice they have it?

5. Imagery can motivate. Something inspired me to ride more than normal. Could watching the Tour actually increase appreciation for the bike and its sensations? Perhaps it can. But one thing is certain: the extra riding had consequences. Fitness said hello to me. If only I could better translate the sensations of fitness to my patients. Five minutes, 350 watts and a tailwind–these are good sensations!

6. Another thing about imagery: Watching the Tour de France is bad for middle-age body image. These guys are fit and lean. In comparison to Tour riders, middle-aged masters athletes look like state fair goers. TDF cyclists wear skin suits that only magnify the summation of genetic gifts, hours of training and careful selection of fuels. The huge rib cages impress me most. Image the oxygen transfer.

7. The hardest thing for me to watch this year was the crash(s) of French rider Christophe Peraud. The former mountain biker first crashed during the warm-up of the third time trial. He fractured his right collarbone. But, as a Frenchman who was riding high in the general classification and with only a couple more stages remaining, he decided to start the TT. Instead of just soft-pedaling and getting though the day, he went full gas. Then, with just 1k to go, and with his family watching, he slid out and landed right on his freshly broken collarbone. Having ridden with a broken bone, that one gave me chills. I understand it though. You don’t think clearly when in pain.

8. I don’t care how often Phil Liggett confuses facts; Tour coverage will simply not be the same without him and Paul Sherwen. They are priceless. I’ve watched sports all my life, and can think of only a couple other voices more associated with their sport. Truly iconic.

9. Professional bike racing is cleaner. You can see it. Riders now ride like humans, not cyborgs. Case in point, the Sky Team (the team of the yellow jersey) was dropped the second day in the mountains. This forced team leader Chris Froome to ride nearly the entire stage alone. That stuff didn’t happen in the past. This year (and to an extent, the past couple years), guys who go deep into their reserves a day or two in a row, give out in the following days. You don’t see one or two teams control the race day in and day out. And the data support cleaner cycling. Measurements like vertical ascent times have reverted to more ‘humanlike’ numbers.

10. My favorite days were when breakaways were given a chance. As a non-sprinter, I appreciate the breakaway. When you get in the break you start thinking…“I’ve got a chance. I’m up here. This is cool.” And that’s a local crit. Imagine the thoughts that pop through the heads of guys who make the break in the Tour de France. A win would be everything for them. Careers are made in these breakaways. It’s great stuff, regardless of the jersey they wear or the country they come from.

What a show it was. I’m sure I’ll think of a few more thoughts in the days to come. Feel free to add any of your observations in the comments. Now it’s back to dinners at the kitchen table…and health care policy.

JMM

Tour de France cyclist comes back from Atrial Fibrillation

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I thought this was interesting:

Six-placed Tour finisher Haimar Zubeldia, who rides for the US-based RadioShack/Nissan/Trek team, disclosed that he sat out for three months earlier this season for “persistent atrial fibrillation.”

As reported by Cyclingnews.com, Mr Zubeldia said this in his statement:

“I had four weeks of complete rest and treatment.”

Fortunately, “everything went well,” and he thanked his doctor, family, friends and team, and now “I can enjoy cycling like never before.”

He said that his team “was aware of my situation at all times,” but the same can’t be said of the public. “Some of you asked me then why I did not race during that time and I answered that I had a hamstring injury … I could not say anything else and I hope you understand.”

It’s not known what kind of procedure he had, if any.

This story has many important messages:

To endurance athletes... Listen carefully: Mr. Zubeldia stayed out of major competition for three months. In other words, he rested, so that his body and heart could heal. Secondly, and perhaps even more striking, is how well his body reacted to prolonged rest. The man misses almost half of his pre-Tour preparation, yet he finishes in the top-ten of the biggest race in the world. He obviously did not lose much fitness. The idea that the human body performs better with adequate recovery–both on the macro (season) and micro (weekly) levels–cannot be stressed enough. Be kind to your body; give it adequate rest.

To AF patients: Remember, AF is not a death sentence. The disease requires attention and sometimes treatment, but it often ends up well. You may not be able to ride like a Tour cyclist, but you will likely ride or run or swim or dance again.

To doctors: Though AF specialists have a long way to go before we can use the word ‘cure’, patients who get to us can enjoy the benefits of many new treatment options. Gone should be the days where AF treatment is worse than the disease.

JMM

Picture credit: From cyclingnews.com

Three Words: Tour de France

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I try to avoid posting personal stuff here. My life is not that interesting. A very funny and gregarious friend helped teach me this lesson very early in my blogging career. JT once mistakenly referred to my blog as: “My-Life-Is-So-Boring-I-Have-to-Read-About-Yours.com.” Though that made me laugh, especially with the expletives added, the concept sticks in my mind today.

But today is different. Today is the start of the Tour De France.

The short but ever-exciting prologue has already begun in Liege Belgium. Triathletes and enduro-addicts won’t be impressed with a 4-mile effort, but trust me…this kind of effort hurts. Try it sometime: set your watch for 8 minutes and go as hard as you can. My guess is that you will look down first at 45 seconds and think, OMG, how will I do another 7 minutes.

In our house, the DVR memory has been cleared and the to-do list set. Tour coverage affects life. We struggle to get other things done during these three weeks. These are not excuses, just facts.

Our favorite North American rider in the Tour is Chris Horner (@hornerakg). I met Mr Horner at a cross race here in Louisville a number of years ago. He was just as friendly and warm in person as he is during interviews. That Mr Horner is humble and nice is one reason to like him, but another is his riding style. He’s been a hard worker, coming up from the grass-roots of cycling. He’s old school, eats cheeseburgers and he’s 40! He is a team guy who many times over has sacrificed personal goals for the team. That’s something. We will be listening to Chris’ interviews over at Bicycling.com.

We have other favorites as well:

On the list of other interesting cyclists to follow, Jens Voigt (@jensie) stands far above the rest. He’s a powerful German rider known to yell at his own legs. “Shut up legs,” is what he tells them. You knew legs were capable of speaking, right? Bicycling.com scored a double when they signed up both Jens and Horner for interviews. It’s possible their interviews are as interesting as the race itself. Seriously folks, go Google Jens Voight on YouTube.

Another notable in the Mandrola house is Swiss cyborg, Fabian Cancellara (@f_cancellara). Mr. Cancellara enjoys unanimous support in our Hall of Fame of heart-lung-leg machines. Other members of this select club include, Secretariat, Lance, Greg Lemond, Eddie Merckx and Haile Gebrselassie. I’ll never forget the 2010 Tour of Flanders when Fabian, staying seated and pulling into the hill, dropped Tom Boonen on the final climb and rode away for the win.

How watching the Tour is different from Football and Basketball:

When Indiana plays hoops, we root for the Hoosiers. If they lose, it lessons the experience. That’s the same for many of the team sports so loved all over the world. It’s important which team wins. We don’t watch the Tour that way. As bike racers, we enjoy the racing; we pull hard for the break to survive, because as non-protected riders ourselves, that might be us in the local crit. We know those guys in the break are so feeling it. I can even see hope in their faces. They are thinking, “Wow…I’ve got a chance to win a stage in the Tour.”

How about the anguish of the guy who flats and then has to chase back? Ouch, does that ever hurt. And the worker-bee riders tasked with riding on the front. How can they pull like that all day, and then again the next day? Somebody mention them please.

Other good sites for the Tour.

I’ll be checking the blog of former pro cyclist and champion master racer, ;Steve Tilford. I like Steve’s site because he doesn’t pull punches. He writes from the perspective of the real racer that he still is.

Another good twitter and blog to follow is over at ;Cyclocosm.

You already know the big cycling news sites: Velonews and Cyclingnews.

It’s Tour time!

JMM

Cycling Wed: What if Lance Armstrong doped?

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Commentary on the latest nutrition and exercise science will have to wait. I just whacked my head on low-hanging fruit for Cycling Wednesday.

Today’s Washington Post report on Lance Armstrong’s newest (and most serious) doping allegations has set Twitter and Facebook abuzz. Though The United States Anti-Doping Agency (or USADA) cannot bring criminal charges, their sting is far from painless. They have banned Lance’s recent foray into Ironman Triathlon, and hold the ability to strip him of his Tour victories. Reading the article makes this time seem more serious.

Let’s chat about Lance.

I am guilty.

I watch Lance. It’s likely you do too. He does this to you.

As a fan of sport, I watch Lance in the same way that people watch Tiger. Exceptional sporting talent comes around only a few times per generation. He’s just that good at endurance sports. It’s amazing really. And it’s highly watchable. Even the tenth time watching old Lance videos of the Tour gets your heart pumping. Adrenal glands do not factor in doping allegations; they can’t help but squeeze out adrenaline when the Texan pounces.

As a fan of science, Lance’s aerobic prowess astonishes me. The man is a watt-generating machine. Biologically speaking, I would go as far as putting him in the same category as Secretariat—or Swiss cyborg, Fabian Cancellara, who once rode so well the NYTimes implicated his bike had a motor. (A sure sign you are going good.)

These are the obvious lures.

I have another. It’s not entirely safe to write about.

My cardiology personality type appreciates Lance’s testiness. Though I don’t condone or desire to emulate his less than warm and fuzzy demeanor, I find such prickliness highly human. Lance gets mad and pretty mean at times. He publicly shows raw emotion. In our sterilized and highly recorded world, this stuff not only stands out but also remains permanent. Do I admire meanness? No, definitely not. But I do appreciate humanness. What can I say, I grew up in a family that admired baseball heroes. I don’t mind champions with flaws.

Now let’s deal with the herd of elephants stomping around the room.

Let’s talk about doping.

Lance and his inner circle are not accused of puffing on too many asthma inhalers. The USADA has gone all in. They are saying what many cycling people (the doubters) have once thought: that there was a widespread systematic doping program that occurred over a decade.

In addition to more mundane hormonal manipulations (ie…testosterone and human growth hormone), USADA essentially alleges that doctors and team directors set up systems where packets of blood were transported into the team’s hotel and riders were transfused with blood before important stages. They allege a conspiracy—an inner circle of secrecy and silence. That’s big.

Smarter people than I will weigh in on Lance’s doping allegations.

I’ll make three brief points:

Let’s glance back at cycling history. Look at the old videos that show Lance shredding the world’s best cyclists. He looks like an accomplished racer dropping local touring riders on a club ride. Now, after watching the videos, go read about the men he shredded: Pantani, Ulrich, Zulle, Vino, Hamilton, Landis and Valverde, to name just a few. They were all admitted or convicted dopers. A clean rider can ride dopers off his wheel?

This brings me to my second point: the whole idea of Grand Tours. The notion that men can, or should, race 100 miles per day for three straight weeks reminds me of the lesson not learned from Pheidippides. Overcoming this amount of inflammation tempts the honest to cheat. I’ve been in races where competitors look at each other when someone does something unbelievable. You may not say it, but the look in the eyes of other riders suggests they are thinking the same. Is it real? Then comes temptation. If he is doing it, should I? Or…must I?

Finally, if you have watched the Tour and other major cycling races in recent years, you see different things. Riders and teams don’t sit on the front day in and day out. Riders look less like machines. They get tired and have bad days. You might even get the impression the racing would be better if the stages were shorter and dare I say–less epic. A B-student mind wonders whether racing over reasonable distances with adequate rest might help control the urges of human nature.

Don’t misunderstand; I’m not suggesting Lance is guilty of doping. He deserves a fair trial and should be presumed innocent. I’m not even saying that if he did dope, I would think less of him. Nor am I saying the hardness of Grand Tours should act as an excuse for doping.

All I am doing is trying to state the obvious.

Humans will be humans.

JMM

P.S. I have linked two of the many representative videos below. They both offer commentary from Phil and Paul in which they think out loud about the possible explanations of such dominance. My favorite mechanism: the one where Cancer helped Lance lose the weight needed to be a great climber.

Observe the cadence and fluidity of Lance’s pedaling on the steep climbs. Compare his pedal stroke to the World’s best climbers–who were reduced to pedaling squares when he rode away.

Lance on Sestriere in 1999–The action starts at about 20 minutes.

Lance on Hautacm in 2000.

CW: 2011Tour notes…

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This Wednesday, I am going to break away from medical topics.

I will drop the biological vernacular, distancing myself from terms like sarcomeres, ion channels and inflammatory markers.

Rather, I will pedal my thoughts on a bike racers’ biggest distraction each July: The Tour de France.

Okay, that’s enough cycling-related action verbs. Sorry. But this is just a blog, not anything too serious. It is just me, DrJohnM.

Here goes…

The Mandrola family DVRs (is that a verb?) the live Tour broadcast each morning. We then enjoy family dinner together in front of the TV. Since we can’t take 21 days off in a row, we watch the “live” broadcast six hours after the riders finish in France.

Keeping the day’s results of the Tour a secret highlights one of the dangers of our modern-day connectedness. Just the briefest peek of Facebook or Twitter risks spoiling the final plot. Scanning the twitter feed, it is hard to force your eyes to look away from the headline proclaiming the stage winner. And it’s not just social media, you must look away from TVs in hospital rooms—as they may be tuned to ESPN or CNN. You may even interrupt others in mid-conversation when Tour talk comes up…”Stop, I have not yet watched today’s stage.”

Well, what do I think about this year’s Tour thus far?

Overall, I think it has been fantastic. As a fan of sport and competition, I love the intensity of each day’s race. As a bike racer, I appreciate the tension and anxiety of racing in the race that matters the most. This nervousness factor is under-appreciated by most regular sports fans. Most mainstream sports commentators like to talk about the Tour’s length, or speed, or the altitude of its climbs. But the mental tenacity required to race this hard–elbow-to-elbow–for 21 days is something that bike racers find immensely compelling. Talk about pre-race butterflies!

Some specific observations:

Muscular sprinters are attacking in the mountains, and winning. The guy is named Thor, the God of Thunder.  And no, I am not making that up.

General classification favorites are actually racing downhill, and on non-mountain stages. This is a novel concept in recent Tour history. In the past decade or more, the formula for wining the Tour has meant going hard in the mountains or in time trials. In this year’s race, however, the favorites are dueling for seconds on “regular” stages. This, I find really cool. (For the record, I love racing down hills, probably for the same reason that I like writing: because there’s a lot of room to improve.)

The yellow-jersey holder at the moment is a short Frenchman who resembles a happy-faced cartoon character. Most everyone loves Thomas Voeckler because he tries so darn hard, wears his emotion on his sleeves, looks grateful for his gifts, and is realistic about his chances. In other words, he looks highly comfortable in his own skin. Given that he has held the yellow jersey for more than a week, and holds more than a minute lead, some might say Mr Voeckler is overly pessimistic in giving himself “zero” chance of winning. We shall see soon. No matter what happens, the Mandrola family likes Mr. Voeckler a lot.

It is neat that American teams and bikes are figuring prominently in the race. Garmin and Columbia Sportswear sponsor teams that have won stages. Many of the dominant teams and riders are on American-made bikes like Trek, Cannondale and Specialized. Like me. My first bike was a Trek, my second a Specialized and now I ride a Cannondale.

The most obvious difference that cyclists see (and are talking about on rides) in this year’s Tour is the lack of stick. 2011 Tour racers look more human, more real, more like us. A rider might launch off the front of the race, but invariably they cannot hold the effort and are pulled back. Thus far, we have yet to see a rider do anything “unbelievable.” Is this a sign that our sport is “cleaner?” Most bike racers would answer a resounding, “yes.”

I am looking forward to the next few days when the Tour climbs over the most famous Alpine passes.

And until Saturday, I will be treading lightly on the social networks. Shh. Please don’t tweet anything about the day’s Tour stage until 2300 EST.

JMM

CW: Forgiveness and heart-health…at the Tour de France?

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Few sporting events cause more inflammation than the Tour de France. It’s long, fast, tiring, and stressful. These facts are not news, and neither are crashes.

By now, many of you have seen or heard that crashes have marred the first week of this year’s Tour. Even before the first day in the mountains, potential winners have been forced to abandon from injuries sustained in these accidents. This includes my personal favorite, Chris Horner (@hornerakg).

Of course, Tour de France crashes are not unusual, but rarely are they as vivid as the one involving cyclists Juan Antonio Flecha (Spain), Johnny Hoogerland (Belgium) and an inattentive motorist from French TV.

As you can see, when a car collides with a cyclist, the cyclist loses. Mr Flecha was thrown onto the pavement, while young Mr Hoogerland was catapulted into a barb-wire fence.

I refrained from posting the pictures of Mr Hoogerland immediately after the crash because, along with the horrific lacerations on his legs was his completely exposed gluteus muscles—an image that might not past muster in my Southeastern state. The anatomically inclined can click the Google images.

I am not posting this video to point out the plight of cyclists struck by cars. I will not rant about how distracted drivers threaten cyclists. Nor am I writing about the coolness of how both riders got back on their bikes (Mr Hoogerland changed his shorts first) and finished the stage, though this was plenty cool.

What struck me was the heart-healthiness of Mr Hoogerland’s response after being both robbed of a chance at glory, and badly injured by the blatant inconsideration of another human. Remember readers; this is a twenty-something young man who, when struck, was rotating pulls in a Tour de France breakaway that was destined to make it to the finish.

He should have been inflamed. Angry. Incensed, even.  No one would have faulted him for lashing out at the race organizers or the driver of the car.

But instead he offered this…

“We can still be happy that we’re alive. It’s horrible. I can blame everyone but I don’t think anyone does this sort of thing on purpose. I think the people in the car will have a very big guilty feeling and they will surely apologize to me and Flecha,”

And…

“Nobody can be blamed for this. It’s a horrible accident and I was in it. But I said to Flecha, We’re still alive and Wouter Weylandt died in a crash.”  (Ed note: Mr Weylandt, a Belgian cyclist, was killed in a crash two months previous in the the Tour of Italy.)

Cycling is getting more and more hectic which is also nice because more and more people are watching but, for sure, some people will say that it may be like this because… well, I can’t explain it – but I think most people feel very, very bad about this sort of thing.”

Mr Hoogerland did something very inspiring.

He forgave.

He moved on.

He saw the positive.

All this, my friends, is a glorious example of a very heart-healthy way to manage an inflammatory situation.

We cannot eliminate stress from our lives. To even try would be futile; smart people would call such effort, maladaptive. What we can do however, like this young professional bike racer did, was manage stress in a constructive and “good-hearted” manner.

These kinds of stories are why I am a fan of sports, and people, and of course, bike racing.

JMM

Cycling Wed: My favorite TDF story so far…

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In America, and in the doctor’s lounge, news about the Tour de France parallels news about Lance.

But ask bike racers what they think is the most compelling story of this year’s Tour, and Lance is far down the list.

That’s OK for me, it doesn’t diminish the most colossal bike race ever.

Want a bike racer’s favorite story of this year’s Tour?  Look no farther than the German rider Jens Voight. He is not a household name in America, but if Americans studied his story, he surely would be.

In the bike racing fraternity, Jens is famous for his raw power, not just pure wattage output, but more the power of his inner spirit.  He is selfless (a rare commodity in bike racers), a consummate teammate, and he exemplifies the ethos of taking pride in one’s work.  Further adding to his coolness is that no doping investigation has ever implicated him.

Check the pedals

During yesterday’s stage, Jens’ crash on the first mountain descent provides the byline for my favorite story of the Tour. Despite injured ribs and disseminated road rash, he mounts a junior-sized bike with old-fashioned pedals and rides miles until the team car can get him a new bike.

He refuses the broom wagon. “Oh, no, I do not need you.”

Here is the video of the interview after the stage.  Classic Jens.

Teamwork in anything, be it medicine, marriage, or sport, requires the sacrificing of personal goals for the greater good.  For me, a previous runner, swimmer and triathlete, the camaraderie of cycling is its most compelling feature.

JMM

Could this be the most interesting Tour yet…

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He is a liar.  A really profound one at that.  He took donated money for his legal defense, which was a lie.  Then he wrote a book filled with lies. How do we know this for sure?

Because now he says he lied, and this time it’s the truth.

As reported in an opportunistically timed WSJ report, Floyd Landis, disgraced winner of the 2006 Tour de France, having admitted to both doping and lying, is now accusing most of his former cycling colleagues of systematic cheating.  Blood transfusions and testosterone patches (not for lowT) were the performance-enhancing agents du jour. As said in the WSJ…

Doping is a scourge in professional athletics, and pro cycling has seen numerous scandals and suspensions over the past decade. The picture painted by Mr. Landis in the interviews, and in a series of emails he wrote to cycling sponsors in May, provides the most detailed view yet of what may be one of the biggest and most intricately coordinated cheating conspiracies in sports history. It involves blood transfusions taken in a bus on a remote alpine road, riders wearing testosterone patches to bed, and an operative posing as an autograph-seeking fan to deliver a bag of blood to a rider after a race.”

Is a liar now telling the truth?  Is a liar capable of ever telling the truth?

Tonight, I watched a few Tour highlight shows in which Lance rode away from his rivals as if they were overweight golfers–but in reality they were the second through fifth best cyclists in the world.  Even more interesting is that said rivals have subsequently all been either busted for doping, admitted to doping, or mysteriously left the sport.

Regular people–outside the bike racing cult–who know I ride, often ask me, is Lance clean?  

I don’t know for sure.  But a truism from the inside world of bike racing is that competitive cyclists do not believe the unbelievable.

It is a drug in a way.  The amazing sensation of when the pedals turn effortlessly, for forever, it seems.  Competitors squirm with discomfort as you pedal harder. And as if this sensation was not a high enough high, remember that the heavy load of an athlete’s self-worth is hung on a single peg.  Validation of a winning performance surely strengthens the peg, albeit only transiently, as impermanence is truth.

What is the truth?

It is hard to know with absolute certainty, but this dramatic his-word against-our-word story only adds to the intrigue of the next three weeks.

JMM