and Meetings with old friends.
Tuesday, June 28, 2011
Sunday, June 26, 2011
Saturday, June 25, 2011
Friday, June 24, 2011
Thursday, June 23, 2011
According to Susie their names are: "Trevor, Adam, Algernon, Bobby Smith, Alex, Stephane, G-rod, TT All Day"
Rich adds "The autograph hounds were in Greenville, IL. All were amazed at what Randy is attempting to do. They wanted to follow him down the street, but we told them it would be too dangerous."
Wednesday, June 22, 2011
The occurrence of Shermer’s Neck is one of the ultra-endurance cyclist’s most feared problems. The onset can be very quick. The only commonly reported prodromal symptoms (warning symptoms) are tightness and discomfort in the upper trapezius, and erector muscles of the cervical spine. This leads, after a variable period of time, to rapidly progressive loss of the ability to extend the neck, and to neck and upper back pain.
There were a number of periods with higher winds, and also some very long descents where Randy spent many hours in the aero position prior to this. Our experience indicates that riding in the aero position may hasten the onset of Schermer’s Neck. Randy began to have prodromal symptoms by about 600-650 miles into RAAM. He complained only once or twice of upper back and neck pain before abruptly realizing that he could not extend his neck to see, nor could he properly position his head when he attempted to climb in the standing position shortly before coming into Durango, CO. We deployed an adjustable Laerdal Cervical Collar as immediate first aid. For the reader who experiences Schermer’s and attempts to use a cervical collar, you should know that this solution is very confining and uncomfortable. Also, the collar completely prevents neck rotation as they are designed to protect a broken cervical spine. Thus, with the collar on, Randy could no longer rotate his head at all to see to the side or behind him. He was, however, able to ride on while we addressed the issue.
When Rehab to Racing signed on to provide sports medical and physical therapy support for Team Mouri, Mary and I began to study the range of reported medical and physical problems. First, there is almost no scientific literature on this group of athletes. There are a few antidotal reports; mostly case reports and letters to the editor. The ultra-cycling blogosphere is replete with what from a scientific point of view are wildly variant statements of the origin, treatment, and prevention of Schermer’s Neck. These are often stated with certainty and conviction. We could find no single instance of a statistically valid survey or scientific study of the causation or treatment of Schermer’s Neck.
There are a number of theories of the causation of Schermer’s. These range from “Spinal mis-alignment”, to sternocleidomastoid muscle spasm, to weakness of neck muscles in general, to sequelae of prior neck injuries. Treatment recommendations are even vaguer. There are only two reports in the literature of physical examinations by medical experts of Shermer’s victims immediately after onset. One common thread seems to be the once Schermer’s occurs on an ultra ride, then the rider is stuck with the problem until they can rest (off the bike) for at least 24-48 hours. Randy has a past history of Schermer’s, which occurred after about 600 miles during the Paris Brest Paris Brevet ride.
We examined Randy with acute onset Schermer’s. First, there was no evident active sternocleidomastoid muscle spasm at all. Both were tender to deep palpation. Maximal discomfort on examination occurred in the upper trapezius, and the cervical erector spinae muscles. There were several trigger points in this area. Motor exam revealed that Randy had near complete inability to extend his neck against gravity. Attempting to do so caused posterior muscle pain in the previously mentioned muscle groups. Thus the current R2R theory of Schermers causation is that these muscle groups have simply been exercised to failure. Failure onset is accelerated by fatigue induced muscle spasm. This theory is strongly supported at present by Randy’s response to subsequent treatment.
At present we are 1800 miles into RAAM 2011. Randy is not using a collar at all. Randy can extend, and rotate his neck with only minimal discomfort. He has had no analgesics at all except 2 ibuprofen 200 mg tabs when the problem first started what seems like days ago. He rides about 20-30% of the time in the modified aero position with our McGivered chin support. We changed out his stem, raising the handle bars approx. 5 cm.
Additional therapy based on preventing/treating muscle spasm, while using the chin rest to give intermittent rest to the neck extensor muscles, has resulted in progressive resolution of Randy’s Schermer’s symptoms while at the same time he has had three back to back 300+ mile days through all of
Chemically, we have markedly increased Randy’s [Mg] and [K] intake. Also, we immediately started the muscle relaxant methocarbamol 750 mg TID. Potassium intake has also been increased by feeding potassium rich foods. Immediately at onset, our expert Massage Therapist, Connie Griffith massaged his beck extensor muscles and upper trapezius. She has helped all follow vehicle staff learn to massage the neck extensors at every single stop. Randy’s neck continued to improve at this point.
UPDATE from Crew: ""Randy is now resting. A pattern has emerged the past 3 days. Randy rides 150 miles, gets so tired he is falling asleep on the bike so he goes down for a nap. After the nap he is on the bike for up to 200 more miles. We have 20 more miles to the shuttle across the Mississippi (route detours have required this change), then 10 miles to the Time Station. The average speed will jump because of the 20 minute car ride."
UPDATE 2 from Crew: "What a mess! Heavy urban traffic. Incomplete and complicated detours. Road construction. No miscues but lots of delays and the Itallian spies were funny Randy did ride his bike over the Mississippi River after all. He made the time cut off. Regrouping to see what is next. Now ridden 2030 miles!"
Tuesday, June 21, 2011
And this is what Randy and the Follow Van look like moving down the road. I'm not sure where this shot was taken, so I'm guessing Colorado.
Monday, June 20, 2011
Sunday, June 19, 2011
Saturday, June 18, 2011
From the Crew:
"Well we made the cutoff with time to spare. Randy has been a little tired of late. Coming into
Cutoff is the 81 hr time limit to reach
Al is the Team MD
Day 2 1250 RAAM Time (Day 3 will start at 1537 today) Mile 535.8 Time Station 8
Shift #1 (Rich, Al and Mary) are leaving Flagstaff with Randy, headed for Tuba City, AZ
53 miles away. Beautiful puffy clouds, sunny and 77 degrees, with a tail wind. This is a perfect change from yesterday at this time when the thermometer reading 112 degrees and not a cloud in sight! We were crossing the desert from Parker, AZ to Prescott, AZ and that was not the max temp. That was to be 114 degrees!
LONG POST - Update on Randy condition from a medical perspective from the Team MD.
We survived the desert of day 2 with temps up to 114⁰. Randy required continuous cooling w/ice to make it across. We used “insulated” Water bottles, 1 with iced water to wet himself with. The second bottle was for Randy’s drink. The relevant temperature management strategy was to change bottles every 15 mins with one ice cold, just half full. Another component was a plastic bag lined ice sock around his neck, tucked under his jersey, and changed every 30.
Going into that day from a medical perspective, Randy still did not have sufficient internal sodium and magnesium stores to allow good endurance in that oven going to Congress, CA. We even dissolved 1 Lava Salt tab in each of multiple doses of ice cold chicken broth which he drank like it was cold beer during the ride the day before, and with all of the different methods of administration, he received 9000 mg of various sodium salts, and 6.5 gms of magnesium sulfate in less than 24 hours. The use of white sun shield arm covers, kept continuously wet along with his head sweat and upper jersey in the <15% relative humidity allowed sufficient evaporative heat loss due to rapid evaporation to allow him to ride throughout the day. Whew, I don’t know whether he or the vehicle air conditioners were working harder. A few doses of SPF 70 sun screen got the whole Team through with no serious sunburn.
As we rode thru the night of day 1, and thru day two, Randy’s fluid status improved, and the impressive net weight losses (up to ½ lb per hour riding) we observed during the first 24 hrs begin to abate. His ability to tolerate street food improved. All readers should note that when a rider is going hard in 110⁰F+ temps, they do not tolerate ANYTHING solid, chocolate, or really sweet tasting, and are generally limited to about 200-250 kcal per hour intake. Without this nutrition and enough high salt fluids, they will eventually just fall off their bike. This finding is consistent with experience in much shorter events such as a hot IM race or International Long Distance Triathlon Championship event.
My opinion about the physiology is that under such extreme stress such as the Desert, the stomach requires VERY simple things to allow continued function. Isosmolar fluid intake only, simple sugars, nil fat, no protein, just amino acids.
The issue of the next several days: THE ARSE. Almost all distance riders experience at least some perineal discomfort on longer, and especially multiday rides. RAAM lore is replete with tales of unimaginable misery due to perineal breakdown, and resultant almost unbearable discomfort. Randy had previously experienced prolonged perineal folliculitis in the anterior perineal region on more than one occasion. This responded very nicely to the appropriate antibiotic ointment in March. Prior to this he had tried several therapies, had recurrence with each return to increased saddle time, and was at least very frustrated. His posterior region pre-race was pristine, but by about 14 hrs or so in the saddle, the areas over his sit (ischial) bones on both sides were red and getting sore. We increased lube and began increasing the frequency of changes to fresh cycling shorts, and applying hi Vit E cream to the area in addition to his chamois cream. By 40 hrs in the saddle, we clearly were not winning the battle, but skin breakdown was not imminent. As his weight with each stop was stabilizing, indicating at least temporary continued resolution of our previous fluid and electrolyte battle, a worsening situation in the basement could soon become Randy’s major limiting medical problem. Not that the usual severe sleep deprivation for all concerned is not really a problem, just the normal environment in the game of ultra-endurance multiday cycling.
After my 16 hr shift, I tried to get my sleep break started while remaining completely confused as to why the location and nature of Randy’s perineal misery was so completely different than his previous problem……At about 0200 RAAM Race Time, I bolted straight up awake with an “Ah Hah” Moment, only to crack my head on the overhead of our RV. The reason was that Randy lowered the saddle nose weeks ago due to the painful pressure on his anterior perineum due to the chronic infection there…AND it was still down!!!! Damn, I must be getting old! The increased pressure posteriorly simply must be the underlying cause of why the location of the trouble had moved so far in less than 6 weeks. One part of the solution must be to level the saddle…Done at TS 13, saddle back to level, and that should reduce pressure on the sore areas. The saddle sore saga continues, more to follow.
Randy has now covered 875 miles passing through the Time Stations at Motezuma Creek, UT, Cortez, CO, and Durango, CO. Randy changed bikes (to climbing bike?) after Cortez on his way to Durango. According to the Crew, Durango was "accomplished with a lot of pain and effort."
Friday, June 17, 2011
TS # TS NAME Miles In TS Day/Time
Thursday, June 16, 2011
Wednesday, June 15, 2011
Yesterday Earl and Randy pre-rode the 24 mile parade section of the race. That's the section that gets the racers out of town before the race proper starts. "An easy spin on a pretty day. Earl was practically giddy. Randy was confident."
Randy will enter the desert early in the ride. At Borrego Springs the high was 105 yesterday, and expected to go higher today.