Wear the Right Uniform for the Job

A couple of weeks ago, while I was driving to the office supply store over lunch, I saw a cyclist riding toward me on the busy four-lane road. I’m very enthusiastic about active transportation, including cycling, so like many drivers, I tend to slow down and use caution around cyclists just in case they are skittish in traffic. As I approached this cyclist, though, I could see that he was wearing a helmet and a moisture-wicking shirt. His bike was kitted out with pannier bags and a headlight. His “uniform” indicated that he was no amateur bike commuter. He had clearly done this before. I waved as I passed, and I watched in the rear-view mirror as he switched lanes, signaled, and make an expert left turn behind me.

The encounter got me thinking about the value of a uniform, and that got me reflecting on the pandemic. I’m not the snappiest dresser even on my best days, but all the time at home in front of a computer screen has allowed for some pretty cavalier choices in clothing, especially from the waist down. Eighteen months in, I’ve found generally positive effects to wearing a work “uniform” of my own, mostly consisting of reasonable pants and a collared shirt. First, putting on the uniform signals to me that the day has begun, like James Joyce’s white coat signaled the beginning of his writing day (I promise this is the last time I’ll compare myself to Joyce in this blog post). The donning of a uniform is one of my strategies, along with Cal Newport’s “shut down” ritual, that helps me separate my workday from my leisure day.

Second, a uniform gives the appearance, even through Zoom or Microsoft Teams, that I mean business, much like donning a white coat does in patient-care settings. White coats, originally adopted by doctors to indicate that they were adherents to science, have been linked to improved patient perception in certain situations, in spite of the fact that infrequently laundered white coats are also potentially dangerous sources of infection in hospitals. One of my extended family members has a corporate job in which professional appearance is still very valued, and her strict dress code for her team, even for people in virtual meetings, has drawn praise from coworkers and clients. That’s not to say this can’t be taken to an extreme. In the 1990s, when the national dress code had been relaxing for decades, a friend of mine worked as a computer programmer for Ross Perot. Even though he spent his day isolated in a cubicle and rarely spoke to another employee in person, he was expected to wear a black, blue, brown, or grey suit, starched shirt, tie, and shined shoes to work every day. Needless to say, he found another job. And NBA all-timer Bill Russell famously retired early from basketball after deciding (and I’m paraphrasing) that he was tired of being a grown man wearing shorts playing a children’s game.

Finally, some evidence indicates that a proper uniform may actually improve performance. One of my high school cross country teammates often did his long weekend “base mileage” runs in jeans, and it completely freaked me out. On top of the obvious chafing issues, I could not handle the thought of just rolling out of a tractor cab on Saturday evening and loping off down a dirt road. I needed the ceremony of changing out of work clothes into shorts to help me transition. While sports apparel companies loudly tout the benefits of “moisture wicking,” breathability, compression, and aerodynamics, studies show that simply wearing an appropriate uniform, or even a good luck charm, for a sporting activity may improve performance, presumably because of psychological effects like focus and confidence.

So, even if you’re a borderline slob like me, here’s my advice as a licensed medical professional, for whatever it’s worth: wear the clothes and equipment that match your tasks for the day. If you’re going to the Oscars, wear a ball gown or tuxedo. If you’re exercising, wear whatever clothes are appropriate for the sport. And if you’re employed in knowledge work like I am, wear what you would wear to the office, even if your day will be spent at your own dining room table. You’ll feel better and perform better.

As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.

Wanting to Improve Is Not the Same Thing as Improving

Around 2013, I was diagnosed with pre-diabetes. Doctors fear dying of the diseases they know best: gastroenterologists of colon cancer, infectious disease specialists of sepsis, you get the idea. So, for the sake of my blood sugars, after a decade-plus of abstention due to medical school, young kids, and a growing medical practice, I decided to get back into racing bicycles. I dusted off my old cyclocross bike, aired up the tires, bought some Chamois Butt’r, and congratulated myself for my reentry into competition. But note what I did not do, which is put in the miles that it takes to be a competent, competitive rider. In my first race back, a fifty-mile gravel race around Sun City, Kansas, I barely finished. If not for the help of a fellow rider who felt sorry for me, I may not even have crossed the finish line. To say the least, I had not earned my smug self-congratulatory attitude going into the race. On the drive home, the Stuart Smalley voice in my head told me I wasn’t a bad person. He told me I was human. All I had done was give myself credit for wanting to improve when I should have waited to give myself credit for actually taking the steps to improve.

I was reminded of my past foibles recently when I came across a report in the British Medical Journal pithily titled Wanting to improve is not always the same as knowing how to improve. The authors described a quality improvement project in an English hospital that aimed to reduce the length of stay of patients after knee replacement surgery. Early in the project, the investigators decided that the method of anesthesia–light sedation, heavy sedation, local anesthesia, etc.–was the primary obstacle to getting patients out of the hospital quickly. Then they went through five (five!) different anesthesia protocols over the course of seven (seven!) years. In all that time, they didn’t budge patients’ length of stay. They didn’t show an effect on any other indicator of quality, like time until the patient first walked, the patient’s reported pain, or overall pain medication use, either.

But I’m willing to bet that in that seven years, the folks involved in the study were proud of their work on improving the project, in spite of what we can see now, with the benefit of time and perspective. After all, we give ourselves credit in a number of ways that we refuse to extend to others when we have some distance from the problem, even outside of quality improvement. I may have no problem recognizing how reckless another driver is when he blasts through a fading yellow light. But when I tap the accelerator to do the same thing, since I’m generally intending to be a safe driver, it never occurs to me that my actions, too, have put other people in danger. Princeton University psychologist Emily Pronin calls this the “introspection illusion.” Our distorted self-image, blinded by the stage lights of our own personal sitcom, sees our desire to be good and ignores the fact that our objective goodness might fall short.

This intersects with the “Dunning Kruger effect,” the demonstration that the more incompetent people are, the less aware they are of their incompetence (like a slightly chubby cyclist entering his first race in years, blind to his abject lack of fitness or preparation). The more we miss the mark on a given task, the more our estimation of our success departs from reality. Physicians are especially prone to Dunning Kruger.

So the next time you set out to improve a process in your work, avoid the mistakes made by our English friends. First, measure the outcome you’re interested in and don’t rely on an intuitive understanding of the issue. This may require pressuring your administrative consultants to help you get meaningful data. Then put some distance between yourself and the problem through “meta-cognition.” Instead of saying, “Let’s increase the number of employees getting their diabetes screenings,” say to yourself, “Here is a company [i.e., the company you work for] in which xx% of employees received diabetes screening in the last three years.” Instead of jumping to a presumed problem to solve, think of the environment that led to the outcome you’ve measured. As Don Berwick famously said, paraphrasing others, “every outcome is the product of a system perfectly designed to achieve that outcome.” At KBGH we do this through a process called Ishikawa Analysis, first applied in post-World War II Yokohama shipyards:

https://vanguardcommunications.net/fishbone-problem-solving/

Here, the company has divided inputs into Procedures, Technology, Patients, and People. But those are relatively arbitrary. You may find you have more or fewer input classes and that they’re more process or environmentally-oriented than the example.

Next, use that loose framework to talk to employees and the health care team about what is holding them back, what we call a “stakeholder analysis.” You may have gone into the problem assuming that employees are swamping their doctors with complaints of back pain or depression, based on claims data. But you may find instead that scheduling issues aren’t allowing patients to arrive at the lab fasting before work. This process is what led the folks in the study above to a breakthrough. In talking to staff, investigators realized that, in concentrating so closely on anesthesia, they had overlooked (for seven years!) other potential contributing factors, like patient expectations, limited staff, time constraints, and cultural factors like lack of staff ‘buy in’ to the project.

Eventually, I went on to finish and do well in many, many bike races. More importantly, I lost enough weight and stayed active enough to return my blood sugars to a normal range, where they thankfully remain. And I did it not by wishing my way to better performance, but by eliminating problem foods I knew I was over-eating, increasing my fiber intake to a pre-specified goal, scheduling time to ride, working on specific skills, and measuring specific outputs. But getting modestly faster on a bicycle is trivial compared to the challenge of improving the lives of our covered employees.

As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.

Phil is upset by his inevitable death by car. You should be, too.

I saw Jim Gaffigan in concert last week. He made a series of jokes about how motorcyclists have chosen their preferred cause of death (he also made fun of spandex shorts on cyclists, which I’ll admit was fair).

But his talk about bikers’ inevitable deaths wasn’t half as tragicomic as Phil Gaimon’s soliloquy above. I ride a lot less than Phil, and even I’ve been hit hard enough to come off my bike three times. I’ve had more encounters close enough to feel the heat of the engine than I can count.

In spite of the negativity Phil and I are displaying here, the rate of cycling deaths relative to the number of people cycling is going down:

The dashed line stays steady because the number of cyclists on the road rises year-over-year. (Source: https://www.cdc.gov/MMWR/preview/mmwrhtml/mm6431a1.htm#Fig1)

It’s easy (but lazy) to turn this into a plea for more cyclists to wear helmets. Nope. Don’t get me wrong: I wear a helmet most of the time, and 100% of the time if I’m riding hard. But helmets alone do precious little to save commuting cyclists’ lives:

Source: https://i0.wp.com/usa.streetsblog.org/wp-content/uploads/sites/5/2016/06/Cj-L75WVEAADWl_-1.jpg

In fact, up-armoring cyclists to prevent deaths is an extremely questionable practice. Helmet laws kill cycling rates and bikeshare use. And it would be interpreted as absurd to expect walkers or joggers to wear helmets, even though car crashes and falls by elderly walkers collectively account for far more head and neck injuries than cycling:

Source: http://cdn3.vox-cdn.com/assets/4459545/Screen_Shot_2014-05-15_at_3.04.49_PM.png

What saves lives? Critical mass, laws, and protected bike lanes. Let’s get on it.

Links for Monday, October 15, 2018: Uber quantifies the curb, non-yelling coaches, criminal malpractice, and handlebar shapes

Uber—not a bus company—has proposed a formula for optimization of curb space that makes buses look pretty good:

(quoting directly from the article)

Activity/(Time x Space)

“Activity” is the number of passengers using the curb space by a specific mode, “time” is the duration of their usage, and “space” is the total amount of curb footage dedicated to that use.

Here’s the example that the consultants use in their report, where a 20-foot length of curb is used for four hours as a parking spot by a single car carrying two people:

2 passengers/(4 hours x 20 feet) = .025 passengers/hour-feet, or 0.5 passengers per hour per 20 feet of curb

But if that space is instead used as part of an 80-foot bus stop serving 100 people in that four-hour block, the equation looks like this:

100 passengers/(4 hours x 80 feet) = .3125 passengers/hour-feet, or 6.25 passengers served per hour per 20 feet of curb

Clearly, the bus stop is a better use of public space. And naturally, those Uber cars that don’t take up curb parking look good, too. No surprise there, considering the source.

John Gagliardi is dead, which means that the Nick Saban school of coaching just got a little stronger. That’s a tragedy

My antipathy toward football is cresting (just search for “football” in this site and you’ll see why). But who can argue with a philosophy like this one?

“Gagliardi essentially preached a philosophy of anti-coaching, one that prized self-reliance and self-motivation and abhorred cruelty and authoritarianism. These were not bullshit, repackaged, supposedly out-of-the-box ideas like you find coming out of Silicon Valley. Gagliardi’s philosophy was deeply HUMAN, and deeply trusting. It also happened to be highly effective, so much so that similar techniques are now widely used in parenting books, academic teaching, and other fields.”

One thing the best coaches I’ve had did well—in sports, medicine, music, or other—was to make me feel good about what I was doing. They made me feel good about the process of improvement, no matter my starting point in terms of skill. They essentially told me, “I know you’re a person who tries hard. Let me help you direct that effort in the way that will get the most out of your foundational ability.”

A Texas neurosurgeon was so bad at his job that he got life in prison

When I was a resident, a local doc prescribed so many narcotics to so many patients at such outrageous doses that admitting one of his patients was a near certainty on any overnight call shift. But what did the guy in wasn’t that he was committing malpractice on a daily basis; it was that he improperly supervised his wife as a mid-level provider, leading to money laundering and conspiracy convictions.

We in medicine do a bad job of policing our own. The surgeon who body-checked Dr. Death away from the operating table in Texas deserves major credit.

On a lighter note, What Bars? lets you compare the shape, drop/rise, and weight of a few dozen different handlebars

Links for Monday, October 8, 2018: Ashton Lambie, vibrator myths, really old-timey pumpkin spice, Mac is skinny, and the thyroid diet

Since I’ve been hustling to finish a couple big projects the last month, we’ve fallen behind. Got some catching up to do!

Meet Ashton Lambie, Kansan and new World Record Holder in the 4k Individual Pursuit

I've watched that giant 'stache ride away from me in approximately 1,000 gravel races.

Your favorite party story about how doctors used to manually "stimulate" the genitals of hysterical women with vibrators? That one? It's probably a myth.

And we're all worse off for it. 

Even prehistoric Asians couldn’t resist the #PSL

“Look, it's not that hard. All you need to do is lift weights six days a week, stop drinking alcohol, don't eat anything after 7 p.m., don't eat any carbs or sugar at all, in fact just don't eat anything you like, get the personal trainer from Magic Mike, sleep nine hours a night, run three miles a day, and have a studio pay for the whole thing over a six to seven month span. I don’t know why everyone’s not doing this. It’s a super realistic lifestyle and an appropriate body image to compare oneself to.”

No more cultivation of mass for Mac. I hate, hate, hate the culture that pretends that models and actors/actresses can eat all they want and somehow magically stay thin. Maybe Rob McElhenney gets to say things that actresses can’t.

Is there such a thing as the “thyroid diet?”

Within reason, no. (registration required)

Links for Monday, August 23, 2018: Where your wine corks come from, LeBron on bikes, Huffy's tariff fantasy, American hoarders

LeBron James hearts bikes

LeBron is 1) probably the best basketball player ever to lace up his shoes, 2) obviously a smart guy with a near-photographic (domain-specific) memory, and 3) clearly more into bikes than the average person. But there's clearly some shading around the edges going on in this interview. The guy's a gazillionaire, and he rides around a bike he apparently got years ago for free or for a steep discount. Dude should see inside my garage.

"[Huffy's] bikes are an antidote to cycling itself." 

Ouch.

Americans are becoming hoarders because it feels good

It feels good to buy things, that is. Even for me. But the mental image of what that item is going to look like in a few months, covered in dust, on its way to the Goodwill or the DAV, should keep us all in check. The idea of a storage unit is the most batshit-crazy thing I've ever heard, and Americans have doubled use of them in the last decade? 

This reinforces one of my central beliefs: Obesity and its attendant problems, climate change, and poverty are all different legs of the same elephant:

Pic: https://wildequus.org/2014/05/07/sufi-story-blind-men-elephant/

Hear me out: one person drives to work when he should be walking, busing, riding his bike, and he complains about how he doesn't have any money and he wishes he could lose weight. Person number two takes his unhappiness about the state of his life and tries to bury it by buying a bunch of crap he doesn't need, then complains about his lack of money. Person three wishes someone would do something about climate change as he drives a giant gas-guzzling truck to and from work, impoverishes himself with (government-subsidized) fuel costs, deprives himself of physical activity, and further contributes to the problem. Person four not only drives that truck to and from work, but also takes it through the drive-through at the local fast food chain where she buys (government-subsidized) sugary, fatty, low-fiber food to eat. 

Riding is the answer

I own zero articles of Rapha clothing. But I love one little part of this video: at 48 seconds, the group rides by a couple staring at their phones. The contrast between life lived through a screen (like you're doing right now, probably) and life lived behind bars (the bars of a bicycle, that is) is brilliant.

Oh, and the song, Catamaran by Allah-Las, ain't too shabby, either. Happy Thursday. 

Pedal powered vehicles are some of the best parts of the Air and Space Museum

The post about Skylab's probable clipless pedals was fun to write. But the sweet 70's leisure suit vibe of the Skylab ergometer couldn’t touch the wood-wheeled elegance of this bike, one of five (5!) surviving bikes built in Dayton by the Wright brothers. Tim Moore, the author of Gironimo!, who completed one of history‘s hardest Giro d’Italia courses on a wood-rimmed bike from the teens, would kill for this bad boy:

Its price in 1898 was $42.50. The inflation calculator from the Bureau of Labor Statistics indicates that  this works out to a little over $1000 in 2018 money:

Since the calculator only goes back to 1913,  I assume we can tack on a few bucks, although I think inflation was pretty low at that point in time. And knowing that this bike, the St. Clair, was Wright Cycles' mid-range model below the Van Cleave, it’s at least in the price ballpark of modern day bikes.

Here's the St. Clair with the original Wright Flyer in the background:

That’s the actual bike next to the actual airplane that flew at Kitty Hawk in December 1903. The Wright Flyer is five years newer than the St. Clair. That's what I call A-U-T-H-E-N-T-I-C-I-T-Y. It will not surprise you to know that I was more excited about the bicycle. And not because the Wright Flyer has been re-skinned twice since it flew.

Lucky for me, just around the corner was the Gossamer Condor to merge my interests:  

To explain the significance of this Saran-wrapped beauty, you have to step back a few years. In 1959, the Kremer Prize was established by London’s Aeronautical Society. The rules were simple: a human-powered plane had take off by itself (no catapults allowed) and climb to an altitude of ten feet to clear a marker. Then the plane had to make a 180° left turn, travel to another marker a half-mile away, and make a 180° right turn before clearing the same ten-foot marker prior to landing:

https://hackaday.com/2015/01/27/retrotechtacular-the-gossamer-condor/

This was a beast of a challenge, and not just because it pre-dated the metric system. Even the strongest cyclists (who, I'm guessing, aren't the best pilots in most cases) can only sustain about half a horsepower for any meaningful amount of time on a good day. Which means that any human-powered aircraft has to be really, really light. It also introduces a chicken-and-egg paradox: is it easier to teach a cyclist to fly, or is it easier to train a pilot to generate the necessary wattage to keep the fragile plane aloft? Gossamer Condor builder Paul MacCready tried it both ways. First, his son Tyler flew the Condor because of his small size and his experience flying hang gliders. Then, racing against what they thought was a Japanese team with a balsa-and-paper plane, MacCready hired professional cyclist (and onetime US National Team member and 1989 contestant in the Human-Powered Vehicle Race across America) Greg Miller as pilot. Greg proceeded to set the world record for man-powered flight in the Condor, but he reportedly couldn't negotiate the Kremer course and crashed in a later test flight (see the video below). When Greg had to go to Europe to race, MacCready found Bryan Allen, an avid amateur cyclist and hang-glider (and now scientist at Jet Propulsion Lab), to do the penultimate Kremer test:

The Flight of the Gossamer Condor, of which this clip is an excerpt, won an Academy Award for Documentary Short Subject in 1978.

Let's geek out over the similarities and differences in the Wright Flyer and the Gossamer Condor:

Did Skylab have early clipless pedals?

In case my newfound e-bike fandom didn't give it away, I made a quick trip to Washington D.C., last week. We hit the Smithsonian museums hard, and it was worth every minute. But the most entertaining elements for me by far were the pedal powered equipment. Here's the bicycle ergometer from Skylab:

You know this is my personal photo by the fuzziness and poor composition. 

https://www.flickr.com/photos/nasa2explore/11456762794

http://spaceref.com/nasa-hack-space/skylab-shoe-fashion---with-duct-tape.html

I can't embed the video here, but take another look at Pete's mounting of the bike. He clearly works to get his feet situated in some kind of clip or strap before he starts pedaling. I tried to find schematics, but I can't find the contractor for the bike. The orbital workshop itself was built by McDonnell Douglas (right):

And while there were early, proto-clipless pedals around for cycling, this was at least a decade before Look pedals debuted at the Tour de France (see Greg winning Worlds in Look clipless below in 1989; Sean Kelly and Dimitri Konyshev are still rocking clips and straps):

https://www.cxmagazine.com/greg-lemond-echelon-dirt-gran-fondo-hood-river

https://starchild.gsfc.nasa.gov/docs/StarChild/space_level2/conrad_bicycle.html

Look at those handlebars! 

Astronauts Charles C. "Pete" Conrad Jr. (seen space-cycling above), Paul J. Weitz, Joseph Kerwin, (Scientist; I love that Skylab missions included people simply and officially dubbed "Scientists."), Alan L. Bean, Jack R. Lousma, Owen K. Garriott (Scientist), Gerald P. Carr, William R. Pogue, and Edward G. Gibson (Scientist) undoubtedly knocked out some Zwift-style mileage on that baby. 

Legend has it that the bike was rated to 300 watts, but it could really only get to about 270 watts reliably. I have no idea why. But 270 W is no joke.

All the exercise was intended to prevent muscle atrophy. Since astronauts are in microgravity, their muscles don't get the same routine, day-by-day work that yours get just in the process of sitting and standing. The data that came back from Skylab was fascinating: cardiac output was down 30% (mostly from a 50% reduction in stroke volume; heart rates actually went up) upon the astronauts' return to earth. Peripheral vascular resistance was up, presumably to keep the blood pressure up with such a big drop in output (mean arterial pressure didn't change). No matter how long the astronauts stayed on Skylab (approximately 1 month, 2 months, or 3 months), they returned to normal within 30 days of landing. 

I wondered if the same shoes that allowed them to clip into the floor allowed them to clip into the pedals. Skylab had a bungee cord system that was designed to strap the astronauts down. Here it is being used with the "treadmill" (really just a piece of teflon-coated metal) on the third mission (left).

But Pete's not wearing the bungee harness in the photo, so he must be clipped in. I can't find a good source, but the shoes were definitely up to the challenge, even if it took a little duct tape:

https://lsda.jsc.nasa.gov/Mission/miss/40

Even though I'm not much of a runner myself, I'll admit that the bike looks like less fun than Skylab's famous "exercise wheel," or as I prefer to call it, the "Zero Gravity Stripper Pole":

Re-post: You wanna do the Dirty Kanza 200? Here’s how.

If you're one of the lucky ones from last winter's lottery, you're a month out from the 2018 Dirty Kanza as of today. Maybe you're nervous about preparing. Well, since I'm a completely mediocre cyclist (see: painful, sunburnt non-finishing of last weekend's Open Range 200k) and I've still managed to complete two Dirty Kanza 200s, I thought I'd share again my experience with the DK and what I think makes for a successful day. Warning: what follows is advice for people like me who perform in the vast middle of the range of abilities on a bicycle:

Based on my performance, it is obviously not for people who expect to be on the pointy end of the race. If you're one of those, you can find good advice from folks like Ted King, Rebecca Rusch, Allison Tetrick, and Dan Hughes.

1. Prepare your body

If you want to really enjoy the day of the DK and feel confident about finishing, I think more preparation than that is probably needed. One of the hardest things about the ride is just the act of being on a bike for 12 hours or more. Not many of us do that routinely. So my recommended routine is something like 8-10 hours a week in the months leading up to springtime. Too late for that now, I know. But you still have some time to build fitness. Since hills are hard to come by here in central Kansas (not to worry, there's a crapload of climbing in the DK itself; see the profile below), I make sure 3 hours per week are intervals. I don't do anything fancy. I don't have an interval timer. One day a week I go to my favorite road/crit loop, pictured below, and I ride laps for an hour. At three spots on the map, each one of them 1/8 to 1/4 mile long, I sprint. If you don't have a nice tidy loop like this, just pick out landmarks ahead of you 300-400 meters and sprint to them a few times an hour on your usual rides a couple days a week. After each sprint, or just pick out a landmark a few hundred meters ahead of you and sprint to it. Rest a couple minutes and do it again.

That's the loop around Botanica in Wichita. 

The next best thing to do to prepare yourself is to ride a couple hard gravel races ahead of time if you can. Here in Wichita, I like the Rage Against the Chainring series. The races are short, about 50 miles each, but that's okay. The DK200 itself is really just four 50-mile races stacked up in a day.

And--this is really important--make sure you go for at least a couple of very long rides before the big day. Like, at least 3-4 hour rides. This isn't for cardiovascular or leg fitness as much as it is to see if your shoulders, back, and butt can handle long stretches on your bike. If you have trouble on these rides, be sure to get your fit checked out (see #2 below). 

Practice your hydration strategy. Again (dead horse alert), you probably go on rides without thinking much of food or water all the time. This is not one of those times. I'm a legendary sweater (I'm sweating just typing this [not really]), so I know my fluid needs are above the norm. I take that into account in my preparation. After intentionally riding long distances on some warm days, I came up with a strategy is to fill two large bidons with Skratch. I like Skratch because it doesn’t upset my stomach like more sugary drinks do. Preferably one of the bottles is insulated to stay cool. I drink it second. On top of this, I wear a one-liter hydration pack that’s just water. I found I could easily drink all three on a typical 50-60 mile ride.

Food-wise, you need mostly carbs, with a touch of protein thrown in. Don't make this complicated. Even as a physician, I get bored with talk of "nutrients." Use trial and error. My experimenting taught me that, even though I'm disgusted by gels, I needed to eat one gel every hour on long days like the DK. As they say, strawberry goo forever. Between every gel that I manage to choke down, I eat a snack-size Payday. After some experimentation with other bars, I found I liked them because they didn't melt in my jersey pocket. So if you're doing the math at home, that's eating every 30 minutes. It's not scientific. It's just what I've found my stomach can handle. 

2. Pimp your ride

This seems obvious, but between now and the race, make sure your bike works. You'll be amazed how many clickety-clackety derailleurs you hear on the course. This advice extends from the grips or bar tape to the tires to the drivetrain. That little click or loose spoke is annoying on a commute or a two-hour ride, but it’s potentially catastrophic on a 15-hour ride over rocky gravel roads. If your bike needs tuned up, do it a week or two ahead of the race so the cables have a chance to stretch before the big day.

Do you need anything new on your bike? Well, I'd at least consider new tires if yours are more than a year old. You'll wanna replace those old, squeaky brake pads with new ones, since the descents in the DK can be fast and hairy.

Really consider a GPS. I know they're expensive, and my goal here isn't to convince everyone to spend a bunch of money on their bike. But pre-loading the route makes it soooo much easier and nicer to stay on course, especially during the times you find yourself all alone. And occasionally someone gets asked for their GPS data to prove she finished the course and can't provide it. Don't be that person. 

3. Race day

Don't overdress. Kansas can still be a little chilly early in the morning in early June, but don't let it fool you. It'll be hot later in the day. That 80 or 90 degrees later on is what you should dress for, not the 50 or 60 that morning.

Have a plan for support during the race. If past is prologue, you'll have a color-coded spot to seek out in the parking areas of the checkpoints:

But the crowds are huge, so have a plan for your support to flag you down, or have a plan for where to find them within your designated area. I like the idea of having a flag flying to look for.

That's Colby Reynolds, past DK Half-Pint finisher and my badass 2017 Crew Chief. (other crew included wife and kids)

Have some other food handy with your crew. The DK is many things. For that one day, it's a license to eat. I hit the bananas and pickles at the rest stops, along with a bottle of Coke (I drink bug juice exactly one day a year, and it invariably keeps me from sleeping that night). Cut the ends off your Payday bar wrappers. They can be hard to get out of the package.

Take care of your butt. I know, I know: you ride a lot. But you don't ride 200 wet, dusty, sweaty miles in a day very often. I've used Chamois Butt'r and Deez Nutz, and I honestly can't tell them apart. They both work. I use a lot more Chamois Butt'r because they sponsor the DK along with some other local races here, and I want to reward them for their support. Use the stuff liberally. Apply a little at each checkpoint if you're unsure. This last year I forgot to re-apply at the third checkpoint, and by the time I hit Emporia, my perineum was a white-hot glowing ember.

As far as that goes, make sure you wear your best shorts for the DK. 

Ride with a goal in mind. If you have a heart rate monitor, set a goal HR and try to stick to it. Ditto power if you have a power meter. Speed is an unreliable indicator of effort in gravel races. Even former pros run lower speeds than you'd expect.

17.9 mph ain't no joke, but it's not what World Tour guys are used to riding, either. 

It can be very seductive to fall in with a group going ten percent faster than you're comfortable early on in the race. But you're gonna be out there for 12 hours or more. Going faster than is comfortable early on is a recipe for suffering later.

Don't try to win the race on the descents. Every year I've done the DK I've seen people have horrendous, ass-over-teakettle crashes on rocky jeep road descents. Jim warns everyone about it every year, and it still happens. And even if you don't crash, the risk of getting a flat tire going 45 mph down a rocky path is high. Be careful. 

This was the result of stupidity on firm, level ground, not a descent. But there were no witnesses, thank heavens.

5. The finish line

Sign your name on the DK Poster. This is mandatory:

Enjoy sitting on something--anything--that isn't a bike seat. 

Here's a checklist of what you may need for the DK:

1. Four to eight large water bottles (preferably half uninsulated, half insulated)

2. Hydration pack: If you're a light sweater, you may be able to get by without this, but it's risky in my opinion.

3. A dozen snack-size Payday candy bars. I eat one of these an hour (alternating with gels).

4. A dozen gels (pick your favorite flavored goo and eat one an hour). Alternate, minimally tested choice: Ted's Untapped Maple syrup.

5. Skratch. I use it in my water bottles and keep my hydration pack filled with water.

6. Three gallons of water (for refilling said hydration pack and bidons)

7. six-pack of Coca-Cola. Long races are the only time I allow myself bug juice. Old-fashioned Coke, with its caffeine buzz and high sugar content, is hard to beat at checkpoints.

8. Pickles and bananas. The data on pickles for cramp prevention is light and inconsistent, but the salt tastes great on a hot day. The bananas are bland and smooth enough to still taste good at the end of the day.

9. Sunscreen. Don't even try to go without it. Reapply at checkpoints, too. 

10. Butt lube. I like Chamois Butt'r. Have enough on hand to re-apply at every checkpoint.

11. Three extra inner tubes. This goes whether you're running tubeless or with tubes (I've done it both ways, and I can't say one is dramatically better than the other).

12. Patch kit.

13. Chain breaker. I hear stories of broken derailleurs every year, and if you can't shorten your chain your day is done. Get one that has an attached multi-tool or carry a multi-tool separately.

14. Extra chain link. Make sure you get one that matches the size of your chain, i.e., 10-, 11-, or 12-speeds.

15. Multi-tool. See above. 

16. Extra brake cable if you have cable-pull brakes. This isn't to carry with you, but it's nice to have at a pit stop if things go wrong. 

17. Extra shift cable. See above. 

18. Chain lube. When you lube your butt, lube your chain. I like wax-based lubes because they're less finicky about wet or dry conditions. 

19. Glasses cleaner and rags.

20. Extra water to clean your bike at checkpoints in case of heavy mud. 

21. Mini-pump (or a frame pump if you're old school).

22. Three CO2 cartridges (one for every spare tube).

23. Tire levers.

24. Headlight, fully charged (so bring your charger).

25. Taillight, fully charged (so bring your charger). 

26. Gloves.

27. Lawn chair.

28. Three moist towels folded inside plastic zip-loc bags. They'll be nice and warm when you take them out to wipe off your face between stages. 

29. GPS, fully charged (so bring your charger). I know this sounds like a techie ad for unnecessary doo-dads. And yes, the race organizers do a good job with cue sheets. But having the course loaded onto your GPS is so much nicer. And later, you'll have the GPS data to use to brag to friends. And you'll be able to turn off your phone. Phone reception is non-existent for much of the course, anyway, and your phone will drain its battery trying to find a signal.

And do bring your helmet, jersey, shorts, socks and shoes. That goes without saying. 

I won't be in the DK200 this year. I'm planning on doing the 25 mile ride with my son. Look for me at the finish line. See you there!

Replacing a worn-out bike tire makes you feel thrifty and badass

I love the way road tires wear down to a flat shape right before the rubber wears through to the casing. That flat spot tells you you've put in some time on the bike. You've covered ground that would really show up on the map. You've gone from point A to point B. Or more likely, from point A to point A many times.

The last few hundred miles before the wear finally breaks through are super-suspenseful. Kind of like waiting for a kidney stone to pass, but without the pain. And then one morning you're innocently getting the bike of the rack for a morning ride, and your fingers run over the rough of a torn blister in the tire:

If you're in the U.K., I guess I mean "tyre."

And then you get to replace the tire with a nice, round, new one:

Old meets new.

Then a quick pump up to 95 lbs, and you've gone from flat-top to round-top:

I'm more of the 80 kg variety.

Ahhhh. That's better. 

Continentals are great. They look euro-sophisticated, with the dark gumwalls that haven't changed since forever and the "Hand-Made in Germany" that you wish was true but you know probably isn't. They set onto the bead with a satisfying "pop." And the gator hardshells are almost flat-proof. It took a stray decking screw to puncture the last one that flatted out on me.

Not that kind of goat. Side note: Awwww!

I hear grumbling from people like the Velominati that they "don't corner well," and blah blah blah. Listen: south-central Kansas is goat head country.

This kind of goat. Side note: Ouch!

I'm not going out there with some lightweight, flimsy-ass tire or (gasp) tubulars just so I can walk my bike home. 

And you feel like you've really extracted your money's worth when you throw the old tire away, or recycle it, or turn it into a monkey habitat.

Or is that a lemur? Could be a lemur. 

I don't think you get this kind of satisfaction with many other sports. You can't really wait for running shoes to wear out like this without putting yourself at risk of injury. Ditto tires on motorcycles or gas-powered wheelchairs. (though to be fair, if I lived somewhere with hills or technical roads, I wouldn't run my tires as long as I do)

How to break up with your phone, Double Arrow Metabolism edition: Days Six and Seven

Saturday's (Come back to [real] life) assignment: Get back in touch with what makes me happy in my offscreen life. I'm asked to complete an exercise:

• I've always loved to...ride my bike
• I've always wanted to...publish something non-academic
• When I was a kid, I was fascinated by...reptiles
• If I had more time, I would like to...write more
• Some activities that I know put me into flow are...none. Ever. Don't get me started.
• People I would like to spend more time with include...friends from college

I'm supposed to make a list of specific fun, off-phone things to do in the next few days. Here goes:

1. Visit the Monet to Matisse exhibit at the Wichita Art Museum
2. Volunteer for Bike Walk Wichita
3. Meal plan for the week
4. Ride my bike every day
5. Visit the herpetarium at the Sedgwick County Zoo

Sunday's (Get physical) assignment: Make some time to get back in touch with your body by doing something physical and enjoyable. I plan to commute by bike to my volunteer activity with Bike Walk Wichita today. Two birds, one stone.

The second assignment is to buy an alarm clock so as to more effectively banish my smartphone from my bedroom. I've been thinking about doing this for a while. My trusty, rusty old clock radio from college has been commandeered by my daughter, so now when I wake up in the night I can't tell what time it is without looking at my phone. My beloved George Nelson clock is hard enough to read during the day:

I'm not super-pumped about the style of the normally reliable Wirecutter's top pick, so I'll add "shop in-person for a clock radio" to my list of non-phone activities for the weekend. 

How to break up with your phone, Double Arrow Metabolism edition, Day Two

Today (Tuesday) is my chance to "Assess my Current Relationship" with my device. I've been instructed to answer the following questions:

1. What do you love about your phone?

I like podcasts. A lot. I don't subscribe to many of them, but the ones I like, I really like. An hour of Zwift time with a podcast in my earbuds is a very, very good way to start the day. Not as good as riding outside, earbud-free, but still.

I also like my calendar. I remember my pre-smartphone days, barely, when I lugged around a thick planner full of crossed out appointments and smudged eraser marks. I graduated to a Palm Pilot in my third year of medical school, and it transformed me. I put surgical schedules and hospital rounds in the calendar and missed or was late to a tiny fraction of them. I am much more reliable as a result of Google Calendar. It may have come at the expense of some part of my brain that would normally be keeping track of my schedule, since my first instinct at the thought of any new obligation or appointment is to put it on my calendar. But on net, the effect seems very positive.

I love doing RubiconMD consults, and my phone helps me get them done. Mostly, it makes me get to a computer to do them, since I don't love the RubiconMD app, but it alerts me reliably. RubiconMD makes me feel like a real doctor, even on the days when I'm doing things that aren't particularly doctorly, at least in the classic sense. I'm not sure I'd have that opportunity sans smartphone.

Finally, I love the idea of having the world's knowledge in a rectangular piece of glass in my pocket. When I watch period movies set pre-smartphone, I want to take an iPhone back in time to the poor detectives and academics.

2. What don't you love about your phone?

I despise notifications. They are the most intrusive thing I've ever encountered, save for 2 am blood glucose calls from the hospital. But back in my days of 2 am glucose calls, I was at least getting paid for the work. Notifications don't pay squat. They're the absolute worst. I've disabled almost all of them. 

I hate that people don't have silly arguments anymore. In college, we settled more than one argument in the dorm by using a neighbor's almanac(!). Phones have destroyed the free-wheeling, ridiculous tavern-style arguments people used to have. Everything is too available now. People don't think about their answer to the problem as much as they think about what somebody else's answer to a problem might be. I think half the amateur economists on the web just go to Tyler Cowen's website and see what he has to say about a problem, then pretend they made up the answer.

I wish people still made plans. Once upon a time, if someone didn't show up for a movie or a dinner date, we went looking for him or her, since we suspected something bad had happened. Now, with texting, people are so squirrelly that I only half-expect anyone to show up for an appointment we've made. Plans mean less than they used to. I can't imagine trying to date in the smartphone era, even without Tindr and its cousins.  

3. What changes do you notice in yourself--positive or negative--when you spend a lot of time on your phone? (Depending on how old you are, you can also ask yourself if you've noticed any changes since you got a smartphone to begin with)

I don't notice any of the physical manifestations that some people talk about. My phone doesn't make my neck hurt. I suspect I read enough already that my phone doesn't change my position much. I'm doomed to have a stooped neck someday. I don't text enough to get the thumb pain I've heard described. I have noticed my eyesight getting worse the last couple of years. Some of it is surely due to nighttime insomnia reading of my phone. (some other fraction is probably due to my advancing [but still young! still young!] age)

But if I let myself get too attached to my phone, I feel like I'm over-caffeinated. I can't focus. I can't feel. I try to drown every little negative thought with another click through my favorite websites or my email. It doesn't work. I stop observing my surroundings. I feel like I miss things that I should be noticing. 

But to be honest, I'm more annoyed with other people's phone use. When I see a family at a restaurant and three-fourths of them are on their phones, I want to slap the phones out of their hands, Dikembe Mutombo-style. Maybe it's because I know I sometimes look as bad as they do. FWIW, I've never actually committed assault on a phone user. But I've definitely fantasized:

In the process of finding that gif of Dikembe, I stumbled across this one. I don't know what he's disgusted with, but I hope it's his phone:

4. Imagine yourself a month from now, at the end of your breakup. What would you like your new relationship with your phone to look like?

I'd like to leave my phone in the car during most of my trips into a place where I expect to either watch or listen to something I've paid for, or into places where I expect to interact with others. I want to no longer feel phantom buzzes. I want to be freed from pre-movie warnings to silence my phone. I want to have the same relationship with my phone that I have with the pliers in my toolbox: I know they're there, but I use them only when I have a task that I need them for.

5. What would you like to have done or accomplished with your extra time?

I like to write. I like public speaking. I'd like to do more of both. I'd like to set an example for my kids that screens aren't the only pastime worthy of our attention. I'd like to ride my bike more. 

6. What would you like someone to say if you asked them to describe how you'd changed?

"The last time we talked, you made me feel like the most important person in the room."

7. Write your future self a brief note or email describing what success would look like, and/or congratulating yourself for achieving it.

Dear Dr. Moore (I didn't do nine years of medical training to call myself "Mr."),

Congratulations on becoming human again. While our cyborg future may be inevitable, with cardiac implants and insulin pumps and brain dust and the like, we shouldn't have to sacrifice our attention or our humanity in order to achieve great gains in health from technology. I hope you're enjoying your extra hour a day. I hope you're using it to do something that makes you a better person and maybe makes the world a 0.00000000001% better place. I hope you can have a conversation without peeking at your phone. I hope you don't feel phantom buzzes in your pocket anymore. I hope your kids don't think that "acting like a grownup" means being glued to a phone non-stop. 

Sincerely,

Justin

You wanna do the Dirty Kanza 200? Here’s how.

You may have heard that the new lottery for the Dirty Kanza opens Friday and continues from December 1st - December 16th, 2017. This replaces the old system that was in a sense a lottery of its own, run through the steaming-hot servers at bikereg.com. That's not me picking on bikereg.com. They have a great service. What I mean is that the volume of people applying to race through their site in past years overwhelmed the site, and I think a certain amount of luck went into whose ones and zeros penetrated the server to get a spot in the race.

Anyhoo, I thought today might be a good time to share some of my experience with the DK and what I think makes for a successful day. Warning: what follows is advice for people like me who perform in the vast middle of the range of abilities on a bicycle:

Based on my performance, it is obviously not for people who expect to be on the pointy end of the race. If you're one of those, you can find good advice from folks like Ted King, Rebecca Rusch, Allison Tetrick, and Dan Hughes.

And I'll likely update this post as I remember more. So if you see something embarrassing here the first time you read this, hopefully it's gone by the time you come back. 

1. Prepare your body

You're going to know whether or not you're in the race by early January. Don't wait until then to start preparing. I think it's possible to get in good enough shape in five months to complete the ride; don't get me wrong. But if you want to really enjoy the day of the DK and feel confident about finishing, I think more preparation than that is probably needed. One of the hardest things about the ride is just the act of being on a bike for 12 hours or more. Not many of us do that routinely. So my routine is something like 8-10 hours a week in the months leading up to springtime. Since hills are hard to come by here in Kansas, I make sure 3 hours per week are intervals. I don't do anything fancy. I don't have an interval timer. One day a week I go to my favorite road/crit loop, pictured below, and I ride laps for an hour. At three spots on the map, each one of them 1/8 to 1/4 mile long, I sprint. If you don't have a nice tidy loop like this, just pick out landmarks ahead of you 300-400 meters and sprint to them a few times an hour on your usual rides a couple days a week. After each sprint, or just pick out a landmark a few hundred meters ahead of you and sprint to it. Rest a couple minutes and do it again.

That's the loop around Botanica in Wichita. 

The next best thing to do to prepare yourself is to ride a couple hard gravel races ahead of time if you can. Here in Wichita, I like the Rage Against the Chainring series. The races are short, about 50 miles each, but that's okay. The DK200 itself is really just four 50-mile races stacked up in a day.

And--this is really important--make sure you go for at least a couple of very long rides before the big day. Like at least 3-4 hour rides. This isn't for cardiovascular or leg fitness as much as it is to see if your shoulders, back, and butt can handle long stretches on your bike. If you have trouble on these rides, be sure to get your fit checked out (see #2 below). 

Practice your hydration strategy. Again (dead horse alert), you probably go on rides without thinking much of food or water all the time. This is not one of those times. I'm a legendary sweater (I'm sweating just typing this), so I know my fluid needs are above the norm. I take that into account in my preparation. After intentionally riding long distances on some warm days, I came up with a strategy is to fill two large bidons with Skratch. I like Skratch because it doesn’t upset my stomach like more sugary drinks do. Preferably one of the bottles is insulated to stay cool. I drink it second. On top of this, I wear a one-liter hydration pack that’s just water. I found I could easily drink all three on a typical 50-60 mile ride.

Food-wise, you need mostly carbs, with a touch of protein thrown in. Don't make this complicated. Even as a physician, I get bored with talk of "nutrients." Use trial and error. My experimenting taught me that, even though I'm disgusted by gels, I needed to eat one gel every hour on long days like the DK. As they say, strawberry goo forever. Between every gel that I manage to choke down, I eat a snack-size Payday. After some experimentation with other bars, I found I liked them because they didn't melt in my jersey pocket. So if you're doing the math at home, that's eating every 30 minutes. It's not scientific. It's just what I've found my stomach can handle. 

2. Pimp your ride

This seems obvious, but in the weeks leading up to the race, make sure your bike works. You'll be amazed how many clickety-clackety derailleurs you hear on the course. This advice extends from the grips or bar tape to the tires to the drivetrain. That little click or loose spoke is annoying on a commute or a two-hour ride, but it’s potentially catastrophic on a 15-hour ride over rocky gravel roads. If your bike needs tuned up, do it a week or two ahead of the race so the cables have a chance to stretch before the big day.

Do you need anything new on your bike? Well, I'd at least consider new tires if yours are more than a year old. You'll wanna replace those old, squeaky brake pads with new ones, since the descents in the DK can be fast and hairy.

Really consider a GPS. I know they're expensive, and my goal here isn't to convince everyone to spend a bunch of money on their bike. But pre-loading the route makes it soooo much easier and nicer to stay on course, especially during the times you find yourself all alone. And occasionally someone gets asked for their GPS data to prove she finished the course and can't provide it. Don't be that person. 

3. Race day

Don't overdress. Kansas can still be a little chilly early in the morning in early June, but don't let it fool you. It'll be hot later in the day. That 80 or 90 degrees later on is what you should dress for, not the 50 or 60 that morning.

Have a plan for support during the race. If past is prologue, you'll have a color-coded spot to seek out in the parking areas of the checkpoints:

But the crowds are huge, so have a plan for your support to flag you down, or have a plan for where to find them within your designated area. I like the idea of having a flag flying to look for.

That's Colby Reynolds, past DK Half-Pint finisher and my badass 2017 Crew Chief. (other crew included wife and kids)

Have some other food handy with your crew. The DK is many things. For that one day, it's a license to eat. I hit the bananas and pickles at the rest stops, along with a bottle of Coke (I drink bug juice exactly one day a year, and it invariably keeps me from sleeping that night). Cut the ends off your Payday bar wrappers. They can be hard to get out of the package.

Take care of your butt. I know, I know: you ride a lot. But you don't ride 200 wet, dusty, sweaty miles in a day very often. I've used Chamois Butt'r and Deez Nutz, and I honestly can't tell them apart. They both work. I use a lot more Chamois Butt'r because they sponsor the DK along with some other local races here, and I want to reward them for their support. Use the stuff liberally. Apply a little at each checkpoint if you're unsure. This last year I forgot to re-apply at the third checkpoint, and by the time I hit Emporia, my perineum was a white-hot glowing ember.

As far as that goes, make sure you wear your best shorts for the DK. 

Ride with a goal in mind. If you have a heart rate monitor, set a goal HR and try to stick to it. Ditto power if you have a power meter. Speed is an unreliable indicator of effort in gravel races. Even former pros run lower speeds than you'd expect.

17.9 mph ain't no joke, but it's not what World Tour guys are used to riding, either. 

It can be very seductive to fall in with a group going ten percent faster than you're comfortable early on in the race. But you're gonna be out there for 12 hours or more. Going faster than is comfortable early on is a recipe for suffering later.

Don't try to win the race on the descents. Every year I've done the DK I've seen people have horrendous, ass-over-teakettle crashes on rocky jeep road descents. Jim warns everyone about it every year, and it still happens. And even if you don't crash, the risk of getting a flat tire going 45 mph down a rocky path is high. Be careful. 

This was the result of stupidity on firm, level ground, not a descent. But there were no witnesses I

5. The finish line

Sign your name on the DK Poster. This is mandatory:

Enjoy sitting on something--anything--that isn't a bike seat. 

Feel prepared to enter the lottery? Here's a checklist of what you may need for the DK:

1. Four to eight large water bottles (preferably half uninsulated, half insulated)

2. Hydration pack: If you're a light sweater, you may be able to get by without this, but it's risky in my opinion.

3. A dozen snack-size Payday candy bars. I eat one of these an hour (alternating with gels).

4. A dozen gels (pick your favorite flavored goo and eat one an hour). Alternate, minimally tested choice: Ted's Untapped Maple syrup.

5. Skratch. I use it in my water bottles and keep my hydration pack filled with water.

6. Three gallons of water (for refilling said hydration pack and bidons)

7. six-pack of Coca-Cola. Long races are the only time I allow myself bug juice. Old-fashioned Coke, with its caffeine buzz and high sugar content, is hard to beat at checkpoints.

8. Pickles and bananas. The data on pickles for cramp prevention is light and inconsistent, but the salt tastes great on a hot day. The bananas are bland and smooth enough to still taste good at the end of the day.

9. Sunscreen. Don't even try to go without it.

10. Butt lube. I like Chamois Butt'r. Have enough on hand to re-apply at every checkpoint.

11. Three extra inner tubes. This goes whether you're running tubeless or with tubes (I've done it both ways, and I can't say one is dramatically better than the other).

12. Patch kit.

13. Chain breaker. I hear stories of broken derailleurs every year, and if you can't shorten your chain your day is done. Get one that has an attached multi-tool or carry a multi-tool separately.

14. Extra chain link. Make sure you get one that matches the size of your chain, i.e., 10-, 11-, or 12-speeds.

15. Multi-tool. See above. 

16. Extra brake cable if you have cable-pull brakes. This isn't to carry with you, but it's nice to have at a pit stop if things go wrong. 

17. Extra shift cable. See above. 

18. Chain lube. When you lube your butt, lube your chain. I like wax-based lubes because they're less finicky about wet or dry conditions. 

19. Glasses cleaner and rags.

20. Extra water to clean your bike at checkpoints in case of heavy mud. 

21. Mini-pump (or a frame pump if you're old school).

22. Three CO2 cartridges (one for every spare tube).

23. Tire levers.

24. Headlight, fully charged (so bring your charger).

25. Taillight, fully charged (so bring your charger). 

26. Gloves.

27. Lawn chair.

28. Three moist towels folded inside plastic zip-loc bags. They'll be nice and warm when you take them out to wipe off your face between stages. 

29. GPS. I know this sounds like a techie ad for unnecessary doo-dads. And yes, the race organizers do a good job with cue sheets. But having the course loaded onto your GPS is so much nicer. And later, you'll have the GPS data to use to brag to friends. And you'll be able to turn off your phone. Phone reception is non-existent for much of the course, anyway. 

And do bring your helmet, jersey, shorts, socks and shoes. That goes without saying. 

I won't be in the DK200 this year. I'm planning on doing the 25 mile ride with the fam. Look for me on the tandem. See you there!

Links for August 30, 2017: self-propelled cyclists, what makes life worth living, and Google's depression test

In the Vuelta a Espana, riders frequently have to ride back over giant hills to get to their team buses from the finish line.  

What makes life worth living? 

These astounding things, which you will soon encounter and see for yourself, are so easy to lose sight of, and there are almost as many ways of doing that as there are people. That is why I am writing this book for you. I want to show you the world, as it is, all around us, all the time. Only by doing so will I myself be able to glimpse it. 

Google made a depression test  

More accurately, Google linked the Patient Health Questionnaire 9 (PHQ9) to search queries related to depression, the same way a calculator might pop up when you search "tsp to tbsp." 

How to make your BB30 bottom bracket stop creaking

Two things here: first, I'm trying out some YouTube content of my own. Second, I think the ability to fix your own stuff is a way to take control over your life and feel better about yourself.

Oh, and if you've never noticed, bikes are a pretty big deal for me. 

If you've ever experienced the annoying creak of a BB30 bottom bracket, consider yourself lucky. If you have, and if you've wondered about a quick, easy way to make it better, watch the video above.

Diabetes testing is for the [puppies and hoglets and billies]?

The Ad Council (with pro bono help by the ad agency Ogilvy) has released an admittedly adorable set of ads to encourage people to get tested for prediabetes. I agree with them in principle: testing for prediabetes is cost-effective in the long-term as long as it's paired with a lifestyle program that reduces the risk of advancing to full-blown diabetes:

 (mandatory conflict of interest disclosure here: I'm a consultant on a CDC 1422 grant that aims in part to increase screening, detection, and referral of pre-diabetic patients into the Diabetes Prevention Program)

Baby hedgehogs are called hoglets.

But unfortunately, the "testing" offered in these ads is probably far too sensitive. That is, it picks up too many possible pre-diabetes cases and over-diagnoses people.

The evidence for my contrarian stance is here:

Investigators publishing in JAMA Internal Medicine found that, according to a test very similar to the one in the commercials, almost 60% of patients over age 40 would qualify as "at risk" for pre-diabetes, and 81% (!) of those over age 60 would qualify. These numbers are clearly too high; the total population of pre-diabetic persons in the United States is about 86 million:

That's less than 30% of the population. Yet the puppies-and-hoglets-and-goats test says that almost twice that number is at risk. The United States Preventive Services Task Force, on the other hand, says that testing should be done based on only two factors: age (between 40 and 75) and Body Mass Index (25.0 or above). This is a more reasonable strategy based on risk of heart disease, but it unfortunately misses almost half of cases. Investigators publishing in PLoS Medicine found that, by looking at 1.6 years of electronic health record data from 2008-2010, only 45% of patients ultimately diagnosed with diabetes or prediabetes would have been screened under the USPSTF criteria. 78% of the missed cases would have been missed because they were under age 40, and 29% would have been missed because they were too thin, with a BMI under 25.0.

So what's the answer? The answer is to keep yourself from ever transitioning from "person" to "patient" in the first place. If you think you're at risk, based on the puppies-and-hoglets-and-goats test, a hunch, a past blood test, or a soothsayer, make a change. Jump into a new life and reduce your risk. It'll be cost-effective in its own right: Ride your bike to work. Pledge to eat only food that comes from the produce section without packaging for a month. Go to bed earlier at night. Give up bug juice for good. Make a change. And then, only after you've adopted the life you want and deserve, think about whether or not you want to get tested on your own terms.

RIP Warner Blackburn: sadness at the Dirty Kanza

I finished the Dirty Kanza 200 yesterday, and I plan to write about the experience in detail. But for now, I want to mention Warner Blackburn, a man who died during the 50-mile race. He was given CPR on the course by a friend of mine and taken to the hospital, where he died of an apparent heart attack.

I suppose the most cyclist-y thing to say is that "Warner died doing what he loved" or some such crap. But I don't know that. I don't know that Warner even liked cycling. He left almost no trace on the internet. Maybe he was doing the DK 50 on a bet, or maybe he was trying to support a family member. My wife makes fun of me because I automatically assume that people in cycling and other outdoorsy pursuits are nice, even though I'm not the warmest cuddliest type around. So I'll say this: whether Warner liked cycling, or whether he was trying to support someone else, or whether he was trying to support a cool event for the local community, he went out on a high note. 

FWIW, for anyone thinking of starting exercising after a long period of physical inactivity, please take the Physical Activity Readiness Questionnaire first. It's a little too sensitive, meaning it may flag a few people who aren't that high risk, but if you have a "yes" anywhere on the form, it's worth talking to your doctor about before you go out and hit it too hard.

The 2016 Dirty Kanza 200: a look back

It's coming. The 2017 edition of the Dirty Kanza 200 is tomorrow, Saturday, June 3. I'm under-prepared. But I feel that way about every race I enter, as my notes from last year prove. Step into the time machine and travel back a year with me: 

I knew going into the 2016 Dirty Kanza 200 (my first attempt at the full distance) that I’d under-prepared. I’d done a few long-ish rides in the spring: several rides over 60 miles, a couple over 100 miles, including the local Wicked Wind 100. I’d even spent a few days at altitude, climbing hard in Santa Fe and Albuquerque, but the last day of it was complicated by a sticky bout of gastroenteritis. My vomiting wasn't from the exertion, but it might as well have been,  because climbing anything, at altitude or otherwise, has always been hard for me. I’d failed by a couple miles to summit Haleakala in February 2016. And I’d hardly started, let alone finished, Elrod’s Cirque in Winfield, thanks to an early mechanical on my coaster brake bike (I'd raced the Krazy Koasters division because of a chance of rain and a desire not to have my rear mech ripped off). So I’d given up hope on any real accomplishment at the DK other than finishing. There would be no real competition with my faster 40-something peers. I likely couldn’t sustain a pace to “beat the sun.” Finishing with a modest amount of suffering was my goal.

I felt like I needed to do some planning to make up for my lack of preparation. In the week leading up to the event, I tried to get on my bike for an easy-ish ride daily to keep my legs turned over without costing myself any rest. I strategized my food: I would eat protein at checkpoints and mostly carbs on the road. The protein would come in the form of Snickers bars and “PBJ Sushi” prepared by my daughter.

I would tear into a stockpile of stroopwafels on the road. Hydration would come in the form of water in a hydration pack and Skratch, a drink that has served me well in the past, in bottles. And even though the literature on it is sparse, I'm a fan of eating pickles at checkpoints, so I'd stocked up on those.

I intended to pack light on the road. Previous finishers had convinced me to treat the race like four 50-mile races strung back-to-back, and this seemed to make the likelihood of needing bulky provisions fairly low. So there would be no tangle bag, feed bag, or extra bottle mounts. Just my trusty, rusty steel Ritchey Swiss Cross, me, and the hydration pack. My wife, the Chief of Sunscreen Police, would tend to keeping me unburnt with ample sunscreen at each checkpoint.

I’m not a 100% glove-wearer, but for the sake of decreased hand fatigue I would wear them for the DK. I would, as a lifelong heavy sweater, wear a Halo sweat cap under my helmet to keep the sweat out of my eyes. The cap would earn me extra points from the Sunscreen Police for keeping my forehead and scalp covered.

Effort-wise, I planned to keep my heart rate around 130 beats per minute, a pace that my home experimentation showed my should 1) be sustainable for a very long time, and 2) get me to a ~14 mph average, depending on the roughness and grades of the roads.

I checked in and went to the riders' meeting, ate a huge Mexican dinner downtown, then retired to the hotel room to make sure all my gear was in order. After being awakened by a 3 am rumble of thunder and the sound of heavy rain, I slept fitfully the rest of the night and woke up early. I ate the complimentary breakfast at the hotel, then skedaddled downtown and lined up to start near the 15-hour sign. I was later getting to the starting line than I’d intended, and I’d walked my bike the three blocks from our parking spot to the start. So as the countdown began, I looked down and saw that my chain was off the front chainring. I unstraddled the bike to put the chain on and, thank God, noticed that my front cantilever brake’s (I’m old school like that) straddle cable hadn’t been re-attached after taking my bike off the rack.

Look closely at the chain and wonder to yourself how this bonehead expects to be able to move the bike down the road. 

So as the leaders rolled out, I took a deep breath and re-attached the cable. I rolled out five seconds behind schedule and, relieved to find myself moving on a functioning bike, I forgot to his “start” on my Garmin until I was a half-mile or so down the road. It started without trouble, though, and the route popped right up.

South we rolled out of town, on a mixture of old-timey brick streets (“Kansas cobbles,” as they say) and pavement. The previous night’s thunderstorm had wetted the street. I was unsure how far outside town the storm had reached. As soon as the group hit the first right turn onto dirt roads south of town, order descended into chaos. Riders were charging through mud and standing water, and within two miles of town, they were already paying the price with broken derailleurs and clogged cogsets. Dozens of riders were in the ditches, working furiously on their bikes. Many of their days had ended 12 hours early.

I rode gingerly through the mud, watching my derailleur closely to try to keep from breaking it off (I've sacrificed more than one rear derailleur to the mud in my day). I had to stop pedaling at one point as a rock positioned itself perfectly between the chain and the pulleys and flipped the mechanism up behind the dropout. I was millimeters from suffering my own early abandon. But with a little caution and a lot of luck, I made it to the point outside town where the mud transitioned into gravel, and I was off. 

Lucky socks, only partially caked in mud at this point.

The first checkpoint at Madison High School was challenging in that you had to follow a little spur road to get there, and since the riders were still fairly bunched at this point, it was hard to find my support crew. But after a quick phone call, I found her by the road. 

I used a water bottle to try to rinse the mud out of my chain and cassette. Then, after a quick refill of water bottles and pockets, a couple pickles, a Coke, and a Snickers, I was on my way.

That's not cake batter on my face. It's sunscreen, applied by the Chief. 

My apologies to the guy on the Open U.P. bike that passed me at about mile 85. As soon as we turned north into the headwind, I wheel-sucked him for several miles, then passed him as soon as the route turned east and out of the headwind. He didn’t seem flattered by my (sincere) compliment of his bike, and I don’t blame him.

Not the guy on the Open U.P. But a nice guy, as I remember. 

We kept a nice tailwind from the north as we rolled toward Eureka. Some of the last few miles into town were even downhill, which felt great. By Eureka, the crowd had thinned, and I found my wife-slash-support crew easily this time. My chain was in dire need of lube by this point, so after the usual refills and a quick application of lube to the drivetrain I was on my way. Very uneventful stop.

Miles 100 through 120-ish were OK. I was riding either with the same tailwind we’d had all morning, or I was riding with a brisk but tolerable left-to-right crosswind. But the heat was starting to rise; blue mirages started to appear on the roads ahead. I actually saw a vulture circling. The heat and dry wind started to take their toll on my hydration somewhere around mile 120. That was about when I peed for the last time all day. Somewhere around mile 140 I took my last drink of Skratch (from a water bottle) or water (from my hydration pack). Then I entered a dark place. A dark, cotton-mouthed place. A wrestling match with a bicycle in a field of heated talcum powder. My tires rolled over a flattened, dry snake carcass. I was temporarily relieved by a four-wheeler driving dude hanging out water bottles at about mile 143. He limited me to one bottle, which was reasonable, and I poured it into my own bottle, thanked him profusely (I may have offered him a kidney. Things get fuzzy here), and took advantage of a descent eastward.

I descended a couple hundred vertical feet and drank half my bottle in one long pull. Then a river crossing came with advice from some volunteers who suggested that I ride through the foot or so of water instead of walking. I did as they said, and the cold water splashing up against my feet and legs felt incredible. It felt so good that I briefly considered stopping and sitting in it, but I didn’t like the idea of a wet-diaper chamois for the next two hours, so I pedaled on. Foolishly, maybe, I ate a melted Snickers bar and drank the rest of my charity water in the next mile or so.

It was about here that the cramps suddenly worsened. I had felt a familiar twinge in my right calf a couple of times, but it hadn’t progressed into a full-on cramp. I can’t explain the timing, since I’d just had some water, but once my dehydration intersected at just the right place with my muscle fatigue, and once I had spent some time going into the wind, a cramp seized my right inner thigh, then the left. I’ve done enough distance cycling to know this feeling. Stopping does not help. Stopping may make the cramping worse. There is something therapeutic about the forced circular motion of your feet. I embraced the therapy and kept turning the pedals.

Somewhere in through here I passed a guy in a green Salsa kit. Having forgotten the exact location of Checkpoint Three, I asked him where to look for it, mileage-wise. He good-naturedly told me mile 161 (we were at about mile 150 at this point), and I thanked him and moved on. My cramps spread into both calves. I became sufficiently desperate for water that when I saw one of the hundreds of inadvertently jettisoned water bottles on the route, I stopped, reversed course for 100 feet, and picked it up. Finding only ~10 ml of sticky, red, backwash-laced liquid inside, I sighed, dropped the bottle, and turned back north into the wind. By the way, a big shout-out to King cages here. The ability of everyday aluminum or composite cages to hold on to bottles in such bumpy conditions is overestimated, because in races such as this you see hundreds of bottles on the road or trail in the first ten miles, let alone the remaining 195. The most dramatic places are at the bottoms of hills, where full bottles have been bounced from cages. So Kudos to King cages.

Anyway: I was tired and thirsty and crampy. I wanted a drink of water. I rode by a restored foursquare house with outbuildings, a well-maintained flower garden, and some cattle pens. I turned into the driveway, laid down the Ritchey, and knocked on the door. No answer. I walked toward the outbuildings and called out. No response. About then, the guy with the Salsa kit followed me into the yard. I told him I didn’t think anyone was home. We agreed that the homeowners surely wouldn’t mind us using an outside hydrant. But we tried two, with no luck. The water was shut off to both. I cursed, rode toward a stock tank to make sure I wasn’t missing a hydrant, and failing to find one, rode on.

The dehydration and cramping, combined with forced physical exertion, had the effect of inducing an attitude of introspection and retrospection. Introspection regarding the choices I have made. Have I spent my days meaningfully? Have I wasted them? Have I taken my days for granted, or as a gift? This is not the thought of a dying or starving person. This wasn't a Jack London short story or the Revenant; my cell phone was in my empty hydration pack, after all, on airplane mode. Even though the cell coverage in rural Kansas is spotty, I could surely have thrown down a pin and had help within an hour or so. Retrospection for past bicycle-related follies, like the time I was stuck above 11,000 feet outside Angel Fire, New Mexico, out of water, with a wrecked bike, and forced to drink from a stock tank out of desperation, my reward of moisture having outweighed my risk of diarrhea from a mountain stream pathogen. I wasn't there yet.

A couple miles up the road I came across another farmhouse, and after following the same procedure as with house, number one, with largely the same results, I found a hydrant that yielded a trickle. I filled a bottle, dropped it, and spilled ~90 percent of the water, filled it again, dropped it again and spilled ~50%, and gave up. Mi amigo en Salsa was waiting for me to finish. I rolled back onto the road, back into the dust, back into the routine of pedaling and breathing, cramping and pedaling. The solitude of the Dirty Kanza is surprising. Nine hundred riders start, and for the first 50 miles you feel like you’re part of a swarm of ants. Then the group gets spread out, and by the time you hit the third checkpoint, there are times you can’t see another rider. It’s just you and the grass and the rocks and the sun and the wind.

A word on the people of Emporia, Madison, Eureka, and the surrounding areas of Greenwood, Chase, and Lyon counties: they have embraced this event. When I started spending a reasonable amount of time on the roads on bikes in the early 1990s, cycling, even mountain biking, carried a bit of a trashy, conceited euro patina that seemed to turn outsiders off. And this was right after LeMond won the Tour de France for the third time. I can’t imagine what the atmosphere in small towns was like before “LeMan” made cycling more familiar to a mainstream audience. Maybe it’s the gravel scene itself or maybe it’s a move toward everyone, rural, urban, athlete, or otherwise, being more accepting of cyclists in general, but I encountered nothing but smiles, waves, and courtesy in my fifteen-plus hours and 200-plus miles of the DK. On two separate occasions, a diesel truck--long the natural enemy of the cyclist--passed me with an outstretched arm ringing a cowbell.

With the encouragement of the locals I rolled on into Eureka, caked in salt, feeling completely fatigued. I used the lawn chair my wife had brought for the first time all day. I aired up the tires on my trusty Ritchey and sat both of us in the shade. I plugged in the external battery to my Garmin just in time to avoid it going completely dead, and I sat. Then I sat some more. I didn't keep time, but looking at the splits on my race, I suspect I was there for at least 30 minutes. I eventually resigned myself to needing to get back on the bike. I checked my hydration pack and my two bottles. I felt through the left pocket of my jersey to confirm it was full of goo and stroopwafels, and I rolled out. Slowly. 

Cockiness gone. Replaced by salt oozing from my skin, iguana-style.

I tried to concentrate on things other than the discomfort: the constant crunch of gravel, interrupted only occasionally by the soft whoosh of knobby tires on rain-softened clay or the splash of a water crossing. The chatter of grass in the first two hours had given way to the soft sway of adolescent corn stalks in the 13th and 14th hours. I concentrated on keeping my breathing low and steady.

It was a while until I was able to get on top of my cramps, but I eventually did. At about mile 170 my Garmin, with the external battery plugged in, gave me the “turn off in 15 seconds” warning. I X-ed it out, but then It did the same thing twice more until, at mile 199-ish, I missed the warning and let it shut off. I panicked al little because, 1) I didn’t want to lose the data (few classes of athletes, I suspect, are as paranoid as cyclists in regards to losing proof of their effort), and 2) I didn’t know the route from memory. I didn’t want to try to navigate home by cue sheet in the dark. The red flashing taillight I’d been following had dropped me or become otherwise invisible. I was too proud to wait for a follower to catch me. Fortunately, when I hit the power button, the Garmin lit back to life just as it had gone to sleep. I unplugged the external battery and tucked the cord away. I double-checked my headlight and taillight and put my head down.

About the time I entered Emporia city limits, a couple guys caught me, then we caught a couple more, all of which led to a nice little rotating group for a mile or two. I was able to tuck in and go fast for a while, all while getting some rest, what with the draft and the intermittent pavement. Sweet Lord, the pavement. There’s not much, but the few miles of pavement mix in give you needed relief. The feel of pavement after 200 miles of gravel, mud, grass, and water is soooo good. Think of pushing a shopping cart across rough parking-lot tarmac, then hitting the smooth linoleum of the grocery store. It was like that. Only better because, see, in the Dirty Kanza 200, you’ve earned that smooth feeling.

But then, with some complacency setting in on my part, we missed a right turn by about 100 feet. I swore at myself, turned the bike around, and made the turn. I was getting impatient at this point, so when we finally made the turn and regrouped, I abandoned the (admittedly thrilling) nocturnal paceline and went to the front. After a minute or so I realized that the paceline was intact, but was no longer rotating. I was driving. In a fit of hypoglycemic, hypoxic grandiosity, I actually thought to myself, “I’m going to drive this train home.” Those who have spent any time with me on the road know the absurdity of this thought. But on I pedaled until I saw a stop sign and approaching car lights from the south.

“Car left!” I called out in the usual cyclist parlance, and I braked for the sign. My compatriots in the paceline, maybe feeling a bit hypoglycemic/hypoxic themselves, didn’t even pause.

“I think we’re good,” I heard one of them say, and they cheerfully blasted through the stop sign as the approaching car slowed. I waved, sensed that the car was going to wait for us, and got back on the pedals.

The final couple miles of pavement up the final climb through Emporia State then downward toward the chute with cowbells in my ears made me feel like Superman.

That guy looks so happy to be off his bike. 

I took 20 minutes for photo ops and a beer. When I got back to the hotel, I showered and fell almost immediately into bed. Then I immediately got back up to walk off a cramp in my foot. Then I laid back down and felt the beginnings of a chill. My mind settled into sleep, but I didn’t feel the familiar, reassuring drift toward family or childhood memories. I felt the sudden, intermittent jerks of fever dreams, of heat and thirst and middle-school rejection. The jerks woke me, and I had to get out of bed from time to time to stretch a cramp or to go to the bathroom. The trips to the bathroom were welcome. I hadn’t urinated for 12 hours before, so even though urination burned a little and my bladder never felt empty, and even though I would discover the next morning that my urine was a burnt orange color, it felt reassuring to know my kidneys were back in business. After each urination I would fall back to sleep and feel the suffocating heat on my face. Adjustment of the hotel’s A/C did not help. I briefly feared that I'd picked up a bug, or contracted old-timey "dust pneumonia." (after this kind of effort, your mind may not work exactly right. But by the next morning, though, all was well. 

Why ride a bike for 15 hours? Doesn’t the law of diminishing returns start to apply? Well, no. The 14th hour on a bike is only slightly like the first hour. And to experience the change from giddy excitement to cautious anticipation to pained determination, to experience the camaraderie first with enthusiastic pace-leaders, then hopeful bike-pushers, then finally determined, steel-faced stragglers, you need to have those middle hours from two to 14. You need to feel that first tug of a cramp in your right calf progress to an annoying knot, then you need to wax nostalgic for the cramp once it’s gone.

About 48 hours after the ride, my butt was back to normal. No more numbness. The soreness in my legs reminded me of the four hours of cramps I’d had; cramps bad enough to notice, but not bad enough to limit me, really. My hands, counterintuitively, were weak enough that it was hard to write longhand. My pinkies were numb. My neck, shoulders, and back were surprisingly unaffected, considering my lower back gave me some trouble during the ride. 

Meeting these aches and pains was inevitable once I’d made the decision to do the Dirty Kanza 200. But they were a small price to pay for the rest of the experience: the view of waving, chattering grass, long vistas, natural water crossings and bridges. The comaraderie. The encouragement of the locals, with their ringing cowbells in the dark and the Emporia State students cheering us on as we rolled through campus.

People who don’t ride bikes, like people who’ve never been in love, think that the middle and the end must be the same, too. But if you last long enough, if you push through those initial bumps and slips, you find out that the middle and the end are what you were really looking for. And you know what? After the soreness was gone, I actually missed it. But I know where to find it again: tomorrow, June 3, 2017 in Emporia, Kansas.