Sunday, November 25, 2018

N + 1

I bet you're already thinking HJ bought a new bike. Most have now heard of the catchy question "What is the correct number of bikes to own?" The answer is "N + 1, where N = current number of bikes you own." Well, this N + 1 is not that.

Over the last couple years, a number of friends and acquaintances have lobbied to get me into back country skiing (BC), or ski mountaineering (SkiMo), or alpine touring (AT).  These are all variants of where you power yourself up mountains and then ski back down. In the northeast, it struck me as wrought with risk and delivered pour return on investment in time and gear to acquire a new outdoor skill. Last winter I demo'd some alpine touring gear at Loon Mountain in NH. The boots were essentially re-labeled downhill boots and were the most tortuous things I've ever put on my feet. It was a miserable experience. I shelved the idea of getting into this discipline for the time being.

Well, now I live in a state where back-country is a really big deal. There have already been SkiMo races, and it is only November! I did more research. One of the boots I tried on but it was not in the demo fleet last year was a Dynafit TLT 7. It fit like a glove and had tons of effortless pivot. It is an $800 boot though, and I didn't want to commit that kind of money into gear for a new activity that could fizzle out or an activity that might quickly move into a more specialized area. Dynafit also has a non-carbon version of the boot that was available on sale right now, the Speedfit model. That got me thinking. Then Dynafit has a new TUV certified binding. I value my knees, and some of the minimalist "tech" bindings out there have questionable safety records. They don't release in all the same ways that a regular downhill ski binding releases. Toes tend to be locked in until heel comes out. The Dynafit ST Rotation made some improvements in this area. Still not the same as a downhill binding, but at least Dynafit has taken an extra safety step. I liked the idea of getting boot and binding from same company to avoid compatibility issues, which is quite common in this arena.

So what about skis? This is what I struggled with mightily. Some were pushing me into super lightweight SkiMo gear. The problem is, you can't really take it into powder. The skis are too narrow. I will eventually want to untether myself from groomed runs.  On the other end, a true BC ski is super wide to float on bottomless powder. I don't see myself hitting 35 degree avalanche prone terrain right away either. These wide skis are heavier and not optimal for groomed runs.

Just like in the mountain bike world, they talk about "quiver of one" bikes. If you have to pick one bike that did every thing pretty well but was not a pure cross country, pure downhill, endure specific, etc etc bike, which would you pick? The BC ski world also touts skis that can be quiver of one. They are not too wide or skinny, not to light or heavy, not too stiff for flexy.  That is where I needed to be right now. I will ski mostly groomers to start. I would hope to hit powder days on controlled terrain. Chest deep powder in the back country or boiler plate crud at the ski area? Don't need a ski good for those because I won't ski those conditions for now.

I went with mid width Black Diamond Helio 95's. Reviews were decent, they are pretty light, and the 17/18 model year skis are deeply discounted right now. I took a leap of faith this setup would work for me and got it on order.

Black Diamond Helio 95 (173cm long) skis, Black Diamond GlideLite Mix skins, Dynafit ST Rotation 10 bindings, Dynafit Speedfit boots.
I've gotten out twice this holiday weekend at Wolf Creek ski area. They have one of the least restrictive uphill policies in Colorado. Basically, you may only uses the slopes when lifts are in operation. No pass required. Stay out of the way and visible. This is awesome. They are about 90 minutes away. Lift served elevation difference is about 1400ft, just enough to get good value out of transitions between climbing and descending.

The gear performed flawlessly. After more than 6hrs and nearly 10,000ft of climbing, zero blisters on the feet. A few pressure points, but that is it. Skinning up to nearly 12,000ft is no picnic. Even though I'm getting pretty well acclimated to living at elevation, you still can't go as fast up as you can at sea level. At least that feeling like you're going to pass out stuff is well behind me now. It will take some time to regain DH skills. I used to be able to bomb 2000 vertical feet at Cannon Mountain and beat the tram car I rode up in back down. I am so far from being able to do that now.

Powder/packed powder conditions at Wolf Creek on November 25. All natural snow here, 66" claimed so far this season. Lots of intermediate terrain to get started on.
On Sunday I brought my skate skis and AT gear to Wolf Creek. The 4km Nordic track drifted in with the high winds yesterday and they did not regroom it. Didn't matter. Four skin laps to the top did me in. BC skiing will take a chunk out of Nordic skate skiing for sure. Even though I didn't push myself too hard skinning up this weekend, you can surely bury yourself in this activity unlike any other. No part of the body is spared. Not to worry though. I did buy a season pass at Durango Nordic Center. I'm keeping my fingers crossed they'll get snow this season, unlike last season.

Back to N + 1. N + 1 is not a new sport toy added to a quiver. N + 1 is a new outdoor endeavor. What is the correct number of outdoor passion pursuits? N + 1, where N is the current number of pursuits you are engaged in.

Tuesday, November 20, 2018

I didn't see this coming

Before "Fat Doug" became a memory, even before there was a Fat Doug, I've had an interesting relationship with food. I ate a lot, had a reputation for eating a lot, and got picked on for dietary habits. When I was 10 or 12, my best friend's older brother gave me the nickname of Fart Pants. I was an active kid and stayed thin until family and career made a totally sedentary lifestyle an easy trap to fall into.

Back in 1999, a recovered Fat Doug got a routine wellness exams with full blood panel. Everything was good, except for liver function. The marker enzymes were extremely high. I was only 37. This concerned my doctor and freaked me out just a little. He drilled me on alcohol consumption (zero) and Tylenol use (near zero). My liver results were indicative of liver disease. I got retested a few weeks later. Results were still above normal, but much lower than a few weeks earlier.

Like anybody facing a medical malady, you scour the web for hope it is nothing, or fear it is your worst nightmare coming true. I learned highly athletic people can have elevated liver function enzymes. Those same enzymes exist in your muscles too, and if you break down muscle tissue enough, you release these enzymes into the blood. I mentioned this to my doc on a follow-up visit. He looked into it a bit himself. After ruling out other potential causes, he kind of shrugged and said yeah, maybe you're training too hard. He wanted me to go two weeks with ZERO exercise and repeat the labs again. That didn't quite happen, lol.

Over the years, my liver function has been right at or above the normal threshold. I was healthy, fit, never had hepatitis and didn't drink. It was just my "normal" without a solid explanation.

In 2010, I had what I felt was a freak ankle fracture. Simple putting a foot down to catch my balance while riding resulted in double fracture. A complete assortment of hardware was needed to put my ankle back together again. After I was out of the cast and healed, I asked my doctor if a bone density scan would be worthwhile. He agreed. My spine and both hips were abnormally low, especially my spine. This freaked me out a lot, as I was about two full standard deviations below normal. I was many times more likely to break my back in a bike crash than my peers. I greatly curtailed bike racing after this. The stress worrying about life impacting injury just didn't make the thrill of winning races worth it anymore.

But why were my bones in such poor shape? I've been a life-long dairy consumer. I've been very active most of my life too. It was possible I could've been Vitamin D deficient. My doctor started testing for it and it never came in low. But long Michigan winters without supplementing with D could have caused low serum levels when I was younger.  I was pretty much a pure cyclist at this point, and I was aware that elite cyclists have been known to have poor bone density. It is not well understood why. Lack of weight bearing activity was believed to be a factor.

In response to poor bone density, I started running. Running kind of sucked, especially on pavement. Even though I ran only an hour or so a week, I still managed to pull off a sub-18 minute 5km just before turning 50. But even after a few years with greatly increased weight bearing activity and taking all the right supplements, my bone density continued to decline. My hips started to plateau, but my spine continued to drop at nearly 2x the normal aging rate. Projecting the curve out, I was no more than about 3yrs from full blown osteoporosis.

My doctor said maybe it was time to go on a bisphosphonate drug. This class of drug is wicked scary shit. Women who stayed on it too long ended up with horrific femur fractures that wouldn't heal. The drug stops bone turn-over and thus changes the structure of bones. I really wanted nothing to do with that.

About a year ago, I wanted to get an second opinion on what's going on. I went to an orthopedic center, the same outfit that put my ankle together in 2010. They treat problems arising from osteoporosis, so they know a thing or two about it, but not necessarily secondary causes of osteoporosis. The physician assistant that saw me ordered up a whole bunch of labs that my primary care doctor never did. Things like thyroid, testosterone and a 24 hour urine calcium excretion test, among other things.

The hormones were ok. What stood out was how low my calcium excretion was. The PA surmised I was not excreting calcium because I was not absorbing calcium. He also noted my elevated liver function enzymes and asked if I had ever been tested for celiac disease. Huh? "No, I seem to tolerate gluten just fine," I said. He said it doesn't matter, he treats patients with extremely poor bone health that never knew they had celiac disease. One of the many symptoms of celiac disease is poor bone density because the small intestine fails to absorb vitamin D and calcium. People with celiac disease who consume gluten (bread, pasta, etc), also often have elevated liver function enzymes. In fact, says testing for celiac is called for when there is no other explanation for elevated liver enzymes. The orthopedists doesn't treat secondary causes of poor bone health, so he sent me back to my primary care doctor.

Armed with this new info, I went back to my PCP. He basically scoffed at the whole idea, said of the orthopedist, "he's guessing." My doc wouldn't test me for celiac. He said if I really wanted to get treated, I should go see an endocrinologist. These are the guys that treat diabetes, among other things.

Well, this whole process got shelved when we bought a house in Durango and then this summer decided to put our NH house on the market. Once settled in Durango, I picked up where this left off in NH. I sought out a new family doctor. Super cool dude. Turns out everybody that lives in this town is an active outdoor person. Anyway, I mentioned some of the earlier lab results, the calcium excretion, liver function, poor bone density, and even having the DQ2.5 gene that is pretty much a prerequisite to having celiac disease (30% of whites have this gene, so pretty common). New doc said of course we'll check for celiac. I mainly wanted to rule this out so then I could decide if it was time to go on the bone meds.

The blood test came back literally off the chart positive! I didn't see that coming. A positive blood result is just the first step. Definitive diagnosis is determined with intestinal biopsy. Sounds scary, but it is just upper endoscopy where they take a few small samples of tissue while looking at things. You are sedated no more than 15 minutes. I had this done earlier this month. The gastroenterologist said yep, it all looks like celiac. I got the biopsy report back last week. It supports full-blown celiac disease. This explains so much now.

Interestingly, the nurse that prep'd me for the endoscopy told me her husband was not diagnosed with celiac disease until after multiple freak bone fractures.  Like me, he did not have the usual GI symptoms that are prevalent when celiacs consume gluten.

So now some big changes. Eating my favorite Italian and Mexican dishes must come to screeching halt. Cathy and I do like to dine out on weekends. Road trips are going to get tricky too. No more grabbing a burrito or burger after the ride, hike or ski. At home changes will be more subtle because most of the things we buy are whole foods with no ingredient labels on them. But bread and pasta were staples. Cathy has dabbled with gluten free recipes, breads and pastas over the years. THEY ALL SUCK! I refuse to eat something that is a crappy substitute when there are other foods that fit the bill nicely. Thinking whole grain rice instead of pasta. Corn tortillas instead of bread.

The nurse practitioner at the gastro center said it can take up to two years for intestinal damage to heal after going on strict gluten free diet. There will be more labs at 3 and 6 months to see if the blood antigens come down, an early indication that diet is working. After that, there will be another endoscopy scheduled. Liver function will be monitored too. The good news is there was no pre-cancer, which celiacs are at much greater risk for. The biggest hope here is that as I heal, my bone density will start to reverse its death plunge and actually improve naturally. Will be at least 2-3yrs before I know this.

I think the take-away from this story is you must be your own health advocate. Research things yourself. Get second opinions. If you don't think you are being properly treated, try a different doctor. Everything has a cause. It is best to address the root cause of problems than just take a pill that addresses the symptoms. The human body is incredibly complex and there is more we don't understand about it than we do understand. It may take some work to get to the root of problems.

It will be interesting to see if I feel any different after I've been gluten free for a while. Most celiacs report feeling much healthier - ailments go away, more energy, sharper mind - after cutting gluten. But many celiacs are pretty sick too. Time will tell. Stay tuned...