Wednesday, 27 June 2012

pain, injury and perspective

recently, I've been reflecting on a few things, it's not as if I don't have a fair amount of time on my hands (or hand). I'm lucky enough to have some great friends in San Diego and they have been wonderful in helping me out in the past week. People have taken me shopping, chopped up vegetables for me (try that with one arm in a sling and the other on a crutch), bought me beer, helped me modify my crutches and, in one case, come over when some coats fell on my bed and i got stuck (yes, really, I have turned into Mr Burns).  One thing these friends always ask me is "how's the pain?"

to me this seems like an odd question: pain has never been an issue, it's not that i enjoy pain, far from it.  I think i have a slightly faulty ability to perceive pain. Maybe it's something to do with nerve damage, or maybe i was born this way but last Thursday I walked home on a broken pelvis, I've climbed the pyrenees with broken ribs (and a backpack, at night) and i once broke my cheekbone and survived  a week on asprin and lollipops before someone thought to x ray me. I don't think i'm hard, or tough because i'm really not. anyone who's seen me trying to get into an ice bath will affirm this. I think what's at stake here is the difference between Pain and injury. 

I can still remember playing prep school rugby, tough little 13 year old that i was i had probably sustained some crippling affliction, i imagine a bigger boy had stood on my toe. My coach was stood over me and my teammates gathered around (on reflection it may have been more severe than a toe standing, or a it may have been a very big boy) my coach took a look at me and said "well Stout, pain or injury?" and for the first time i appreciated the distinction. Pain is a feeling, injury is a state and, as Thom Yorke reminds us "just 'cos you feel it doesn't mean it's true". Feelings are important, I'm not one for giving it the old HTFU and ignoring them  (that's why it says STFU on my jersey) but in the case of physical sensations, they can be ignored. Pain, is something you can deal with. you acknowledge it, you see it and then you put it in the place where it doesn't bother you. I used to get scared in crits, really scared, until i learned to do the same thing with fear, i play my little video of the impending stack, then i put that video in the corner and get on with what i'm doing. I don't know how but somehow i learned to habitually do the same thing with pain. It's not always cool, I've picked up cast iron pans and not realised until i get them to the sink that i am burning my hand. Injury is different, your body tells you if it is injured and it tells you to stop, if you can be dispassionate about the pain and focus on the injury you know when you can and can't do something. i knew last Thursday that there was something more than road rash and bruising, you can block out pain but injury won't go away, nor should it. 

When you find yourself in jured, you find yourself in hospital. I was talking to my friend John Behrens (who got hurt far, far worse than i did, and needs your help) about this today. We both got to spend some time in a trauma ward. I'd estimate that 30% of the people who came into that ward left it with the covers pulled over their faces. It's sad, but it's true. I saw a young girl die less than a yard away from me last year, seeing things like that changes your perspective on pain, injury and life. Yes i'm upset, today was the longest road race at TOAD, it was a yellow highlighter day, a big race and i spent today in the library, this doesn't make me happy. But i find it hard to summon up the suicidal moping that you see amongst some injured athletes because ultimately i walked away, with all my limbs, with my face intact and alive. I know bike racing is fun and i know it's important but it's not tantamount to life and we have to think first and foremost about how lucky we are before we moan about the minor inconveniences. If i'd been born in parts of Africa i would have most likely died one year after diagnosis so every day of the last 6 years has been given to e by accident of birth. And i should be grateful.    

Bike racing wise i am replanning my season, i might end up at green mountain, or even racing cyclocross (without a hangover) but this all depends on the doctor's decision tomorrow. I will be sure to update, good or bad news it could always be worse and moaning will never make it better. 

Sunday, 24 June 2012

Hip, not cool

Just when I thought I'd got ll the bad luck out of my system, I found a reserve of I'll fortune of unprecedented size on which to draw.

I love the Midwestern crit stage races in the summer. Great people, fun courses, long evenings full of quality racing and questionable beer. Big purses and my annual visits to the Alterra coffee shop in Milwaukee. Sadly all this got cut a bit short this year,, where I had a whole month of non atop racing planned I now have a month of non stop resting.

I'd love to go into detail about what happened but I'm not entirely sure. I was getting into the bunch after a flat. Going about 35 and next thing I knew I was on the deck. My crank arm Es threaded, front wheel folded and my elbow hurt. I manged to walk over to the med tent and get some dressings (in team colours no less) and tried to get back into the race. But I'd missed too many laps and, although nothing else hurt I couldn't roll off the table. Perhaps the most entertaining part of the evening came in the form of the spectator who. Upon seeing my skin suit pulled down to reveal a pretty mangled left hip promptly lost consciousness! I have that effect on ladies sometimes.

I managed to crutch home and took some ibuprofen and melatonin. Hints got worse the next day when I woke up and it became pretty clear I was stranded in bed. Two hours and a fair few squeals later I made it to the edge of the bed, stood up, and passed out. I called my hosts and they helped me back into bed and called an ambulance. I won't bore you with the details but the people in the hospital were exemplary. Time passed in a morphine and fentanyl Induced haze. Cat scans and x rays confirmed two pelvic fractures and a chipped radial head. Once I'd demonstrated an ability to stand and retain consciousness and to consume some kind of bacon and cheese based pastry (bacon cures all known ills, aside from those affecting Jewish or Muslim people, who I honestly think would get along much better if they would just sit down over a porcine breakfast) they unleashed me on the parking lot in a wheelchair and, once I'd thoroughly pissed of all the drivers by doing a few hot laps, they decided to get rid of me.

No night in hospital, that's a bonus. Not least as I have two ambulance rides (Er and transfer) and a multitude of scans to pay for.

Jeff and Marcia were exemplary hosts and their kids were the most charming nurses imaginable. They set up a bed, donated their wii and covered my boring crutches in dinosaur stickers.

I'm flying back to San Diego now, being at a race and not riding was getting to me. I feel awful about letting my teammates down and all the people who came out to watch. But I'm trying to relax, keep my sugars down and recover in time to refocus for August and the rest of the season. Maybe some of that dairyland milk will help heal my broken bones!

Wednesday, 20 June 2012


I was invited to a party last week, one where lots of my friends would be but also where I'd get to meet lots of people who don't ride. We then proceeded to joke about, asking if such people really existed. I think I've seen them, they're the ones who get in between me and Ben and jerry when I'm shopping, right?

One of the things I love about living where I do is the traffic. The first 25 minutes of any ride I'm constantly passing cars and being passed, I used to hate it. I'm a bumpkin at heart and if I pass five cars on some of my rides at home I'll ask the fifth one where everyone's going. I used to do rides in the alt camp where I would see nobody except the goats for hours, and I loved it. But now I'm learning to love the traffic as well.

Passing cars, motorbikes, busses and lorries gives me a little, 3 second window into the lives of others (which, by the way, is a much better film than the one that shares a name with this blog post). I can hear their music, see them check their nail varnish, do up their ties, watch them suppress or embrace the urge to dance, hear their children cry and their passengers laugh. I like to construct little back stories, imagine what it would be like to be them for a day. I like to guess where they're going, what they're doing and who they're talking to on their Britney spears' headsets. It gives me an appreciation of my good luck; I see people forced into nylon suits and high heels and it makes me happy that I still don't have to wear long trousers or socks at work. It makes me happy to be outside and traveling under my own power and it makes me grateful that I never have to eat my meals from a white paper bag with a logo that your grandmother had never seen, and you can't travel 10 miles without seeing.

I look at the old men on motorcycles and wonder if they get the same sense of freedom as I do on my bike. The young men in sports cars don't look like they get the same feeling of speed as they sit there revving their machines at 10 mph and give me the evil eye when I cut in front of their manicured bumpers to avoid one of San Diego's bottomless potholes or the remains of someone's bottomless big gulp.

I even met one of these people, I was having pizza after the velodrome, he said he passed me every day on his blue triumph on my green bike in by zebra kit. He said he wanted to honk because I looked like I was enjoying riding, but he didn't because he didn't know me. Now he does and now he can, and I'll have one less life to construct on the basis of 3 seconds of evidence.

Riding your bike is fun, wherever and however you do it. It's good for your legs and your soul and even if it's only a commute it's the best part of your workday. So ride more, drive less and lean to love traffic.

Friday, 15 June 2012

Diabetes in the DR and just about everywhere else

I'm on my way back from the dr. From one of the most inspiring events I have taken part in since I started dabbling in this world of diabetes advocacy. I want to tell you about the incredible people i met, about their hospitality and mutual respect, about how they gave of their time and of themselves when it would have been easy to give of their money and buy off their guilt. I want to also share with you the great food, Incredible experiences and exciting rides; and I intend to do all of this but I want to start with what seems important for me to say now, because this ain't the sort of stuff that can wait, it's about saving lives.

I think it's easy for us To forget the extent of the diabetes community and to indulge in a very limited perspective with regards to advocacy which allows us to ignore the real issues which become apparent with a global perspective. Whilst its wonderful, meaningful and life changing to empower diabetic people by giving them the ability to exercise and to change their life and improve their health I think this cannot come at the expense of a global perspective On diabetes community.

In the dr I met some of the happiest people I have ever come across. Some of them were better of than others both in physical and economic terms. But it pains me to see these people suffering from their diabetes, this need not be the case.

The people at Aprendiendo a Vivir are doing fantastic work in the dr, 25% of the people there have diabetes and many of them don't even know. Those that do know have to make the difficult choice between buying expensive basal / bolus insulin or using previous generation insulins such as nph and r.

The real issue isn't with insulin though; it's with education. Insulin is meaningless if I doesn't come with knowledge of how to use it. It's like driving in the dark with no headlights, the speed of your car is not the salient issue. Nobody can charge 50 dollars for 250 units of knowledge and thus it doesn't get funded and it doesn't happen. This is where aav comes in, they take young type one diabetics and educate them about their condition, about how to live with diabetes and not suffer from it.

Diabetes advocacy in the us doesn't talk about this, it certainly doesn't talk about the parts of Africa where post diagnosis life expectancy is less than 12 months. It doesn't say that untreated chronic disease is the genocide of the 21st century.

What diabetes advocacy does talk about is going on safari in Tanzania, while people there continue to go blind from a perfectly treatable condition. Diabetes advocacy talks about wearing blue on Fridays and lighting up buildings, we should be sure to inform the people who have one set of clothes and no electricity how much this increases "awareness". It's a pity they won't be around to see the results.

It's merely and accident of birth that i happened to be born in a country were I receive insulin for free and have had the luck to receive the education tools which let me keep my blood sugars in the healthy range which helps me avoid complications in the long term. I'm not really sure I did anything to deserve my diabetes, I'm not sure anyone did. I am really sure that nobody did anything to deserve where they were born, and they don't deserve to suffer for it. Artificial Insulin was invented as not patented 90 years ago, its a positive externality public good and people still don't have access to it, that's not right either.

The question is what to do about it, it's not an easy question to answer but I've some ideas. Firstly we can stop donating to organizations Which promote the nebulous concept of "awareness": I would love to know how a blue t shirt helps people who don't have access to affordable supplies. You can channel your help where it will really make a difference.

Support organizations who are working for education and building sustainable futures for diabetes. Not organizations supported by drug companies, there simply is not a profit incentive for them to move away from the status quo and these are for profit entities, if they bankroll an organization it isn't because they are all about saving lives. They might sincerely believe they are they might be trying to but they aren't. This requires system level change which doesn't occur under the impetus of those who do so well from the system that exists today.

We can't just parachute in supplies either. Turning up like some kind of blue wristband wearing Cecil Rhodes in Africa with a suitcase of strips isn't sustainable. It looks good and it helps some people for a short whole but all were really doing is propping up a system which is failing the people were claiming to help. We need to create and distribute low cost generic insulins, without strips and supplies to test. Basal bolus is meaningless, studies show better control with previous generation products which don't make profits for drug companies anyway but which are still being aggressively defended as intellectual property and thus being prevented from spin what they are supposed to do: saving and improving lives in order to ensure they can do what they now exist to do: generate profit.

We can also perceive a sense of community which we don't right now. Diabetes is a very individual condition. It needs us to be selfish sometimes but we need to be global as well. I have said this before but I share more with a type 1 in Somalia than my next door neighbor in San Diego, we need to exercise empathy and ask ourselves what we can do, and there are things we can do, because there but for the grace of god go all of us.

We can combine all of these things by giving of our time, and money to sustainable organizations like Ayuda. Not for profit drug companies like pharma futures and organizations which educate people like aav.

- Posted using BlogPress from my iPhone typed with my thumbs, and some very sore legs.

Wednesday, 6 June 2012

island update

apparently the old i phone didn't post this while i was IN the dr, so here is a retroactive insight into what i was up to, more to come! 

I've found myself with ten minutes to spare and a wifi connection so here is te most rapid of updates.
Here in the dr I am helping to promote an event called @ganemosle a 10k and 5k run and walk for diabetes. More than that were doing a media blitz, to promote the event and it's message. What matters here is to tell people that there is no stigma and that with diabetes you can achieve whatever you want, but that a lack of knowledge is as fatal as a lack of medication. I'm here to share some of the things I've learned, through years of trying, and failing, on my own.

Our days are pretty full and this is no holiday on the beach. Up at six for breakfast tv and radio, to bed in the small hours after dinner and some of the local hospitality. Everyone here is really pulling together, these guys run companies and countries and yet were all in a very sweaty room pinning bin numbers to timing chips.

I had two hours for a ride yesterday. Fun and fear have never been so effectively combined. Potholes which you would need a mining license for back home. Multiple minibus Madison sessions and a national contest which appears to challenge individuals to fit as many pineapples as possible on a single moped.

Against my better Instincts I seem to have been renters for the race. I've only got flip flops here and haven't run outside of a cross race for three years and even then it's kind of a muddy waddle. Oh well it's for a good cause, right? I also have a ride to do on Saturday night, more my scene.

I wish I had time to share more with you and in time I will. For now stay tuned to the twitter and whenever I get wifi, I'll be documenting our efforts to make a real change to real lives. If just one child sees what we are doing and changes their outlook, if we can make one horizon broader or one dream closer to reality then it will all be worthwhile. And If I have to run
10k to do that, then So be it.

- Posted using BlogPress from my iPhone

Typed with my thumbs

"If you tolerate this then your children will be next"