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Dr. Halverson's Ride for Diabetes
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October 15, 2008
Without further ado, we bring you the exciting conclusion to the Ride4Diabetes.
Dr. Halverson's efforts raised $25, 438.00 and there is still more to come. Stay tuned.
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A dip in the Atlantic
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The thrill of victory
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The glue that held the ride together
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Larry's brother, Greg, welcomes them to the East Coast
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Dannee is pretty sure he's earned it.
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To the victor go the spoils.
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Larry's final note from the road (don't miss his final blog entry below)
We have completed our cross country ride and arrived safely back in Springfield. The last days were harrowing in some respects. Riding in lower New York traffic was at times impossibly dangerous. I compromised riding for about 30 miles in the RV to get through it. I rode the last 40 miles into Stamford Connecticut's Kosziuzko State Park on Thursday October 9th arriving around noon. When I saw the Atlantic and our RV almost simultaneously, I broke into tears. Martee and I celebrated with some wine and fresh cooked Puerto Rican food on the seashore. After pictures, we drove thorugh Manhatten traffic to an RV park in New Jersey. Martee's driving was magnificant. My dear brother Greg brought out champagne and took us to a wonderful restaurant for fabulous steak dinners. He also presented me with emails from family and friends who have supported us on this ride. Martee, Dannee Boy and I then drove home over the next few days with more stories than you might want to hear. We had dinner last night in Springfield with my darling daughters Nicole and Natalie. Thank you for all of your love and support.
Dr. Halverson's final Ride4Diabetes blog entry of hope and determination.
Two years ago I had the opportunity to meet monthly with a number of people who were battling diabetes. We met to create a dialogue about what it means to have diabetes. Participants addressed a large number of issues that were surprising to me as a health care provider. One goal was to explore how well the medical care system was meeting their needs. Although I had been treating people with diabetes for over 30 years, I learned many things that year that have informed me in new ways as I seek to be a better doctor.
Among my revelations, were statements such as "I cried for a week when the doctor called to tell me I had diabetes"; "I have to hide my insulin pump during a job interview to have any hope of being hired"; and "I delivered papers for a year and I saw one of my customers lose his limbs and then his life. When I learned I had diabetes, I knew what would happen to me." Personally I learned that I had no idea of what it is like to have diabetes.
With that caveat, I must say that comparing my ride to diabetes is pompous and far from real. My ride only lasted for 55 days. Then I was suddenly cured. That does not happen with diabetes. Nevertheless, I want to use this column to compare some aspects of my ride to the experience of having diabetes. Some of the comparisons may be useful.
I tried very hard to behave as if I had diabetes to manage during my ride. I exercised everyday, tried to eat healthy foods, maintained a strict daily schedule, and even took daily medications (vitamins and aspirin). I did these things almost everyday, but I was far from perfect. Everyday when I got up, I thought about diabetes. If I did have diabetes, it knew it would be there everyday, not just on days that I chose. So I got up early, ate a healthy breakfast, got on my bike and rode without regard of the day's conditions.
Some experiences on the ride may have been comparable to living with diabetes. Sometimes it was miserable. I was cold, I was lonely, I was frightened, I was tired, I was depressed, and I was feeling hopeless. During these times I imagined some parallels with people who struggle with diabetes. I hypothesized how a person with diabetes might feel when they find out their A1C is worse, or their blood pressure higher, or their LDL cholesterol increasing. I sought warmth, companionship, courage, strength, joy, and hope. It was so great to have support from my wife Martee. Just like I could not have accomplished this ride alone, I can't imagine struggling with diabetes alone.
I also had times of joy. When the weather was nice, when the scenery was beautiful; when the wind was at my back; when the roads were good; when the traffic was light, when I finally saw the RV or was able to contact Martee by cellular phone. I hope that people with diabetes feel joy when their foot exam is normal; when they have no protein in their urine; when the medications are not giving side effects; or when their eye exam is normal.
This all may seem a long stretch from reality, but it helps me to remember I have only a vague idea of what it is like to struggle with diabetes everyday. I suspect there are times of despair and times of joy. I hope that my degree of empathy with people with diabetes has increased. I hope that my efforts at self management might help me work better with my patients. If that happens, this ride will be more than worthwhile.
October 9
Atlantic Ocean here we come!!
H, Martee and Dannee boy are just days, even hours, away from their final destination. H will spend a little time with his brother before his triumphant return to the Show-me-State and does anything say "Show me" more than biking across the entire country? Some brave souls hit the road with Halverson and others chipped in for the cause. Nearly 3,500 mile and more than $25,000 and still more to come!!
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Bicycle trip in still life
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Changing a tire after 2 thousand miles!
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Eating on the road
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Cox Monett's Dr. Allison Heider and
colleauge and friend, Larry Bauer, join H on the road.
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Halverson's TV close up
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Lake Erie College of Osteopathic Medicine students
present $525 check to Ride4Diabetes
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All smiles after all those miles.
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New York, sweet, New York
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Halverson's thoughts from the road
What a day! A beautiful, but difficult hilly ride through the Poconos from Honesdale, PA to Milford, PA. Then a nice downhill route with wind at my back to Goshen NY. Then I got caught on an interstate and had to fend for my life! Finally I came to a lane closure situation with concrete wall barricades that I could not stomach. So I hopped a few guardrails, dodged 6 lanes of traffic, hopped the median, jumped a ditch, climbed a fence, crossed a field (alfalfa!), found a closed bridge and got to a ridable road. Some interesting miles and much time without progressing to the coast. Anyway, tonight we are in Chester, NY and will finish the ride tomorrow near Stamford CN. I will shave off some unridable roads, but have more than made up for them with unproductive riding miles. My brother Greg will go out to dinner with us near the RV park in Jersey City NJ. He has friends who have followed the ride and made contribu tions! I can't wait to see my brother and then head back to Missouri. Martee and Dannee are also homesick, but holding up better than could be expected. We love Missouri!! Larry
October 2
Ohio, Pennsylvania, New York and coming soon...The Atlanic. OH MY!
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Dannee boy gets a case of the road goofies
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Blue flower blooms
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Bicycle in repose
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Pump it up.
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As our hero nears the Atlantic Dr. H is being joined by more friends and supporters. Both H and Martee are able to wax poetic about what they've seen along the way. Stay tuned for a triumphant conclusion to this herculean effort.
Larry's thoughts from the road
Time for another "mass mailing". Internet access has been difficult. If you get 2 (or more!) copies, please forgive me. We are in a public library in Vermillion OH. Stayed at an RV park here last night after I had arrived at the city bike trail start in Cleveland. We could not find a good RV park in Cleveland and the traffic was horrible, so it just feels better out here. Tonight, Allison Heider arrives in Cleveland. We will pick her up at her hotel and drive to our "take off point" where I stopped yesterday. Martee and I are going to go out tonight (or late afternoon) for some Lake Erie perch. We are riding into Erie, PA on October 2 to meet with some of Hershey Bell's med students at LECOM. They are supporting our ride and I am anxious to meet them! Then we ride to Scanton, PA where Allison will catch a plane home. Finally it is off to New York (or near New York City) where I hope to spend an evening with brother Greg. I now hope to be home a few days early. It will be nice to return home. The ride has been great, but I must admit that I am homesick. Thanks to all of my family, friends and supporters. Diabetes may not be getting in the news with the 700B $ bailout, but it is also a ticking time bomb that we must address. Primary care is critical. I hope we can make waves now and in the future. Larry
Martee ponders life on the road
Today is one of those marvelous days where the whole world seems to be in dichotomies. I am viewing the Maumee River in Ohio with its vast span filled with birds and silent pebble streams feeding into the shimmer of silver from the ripe fall sun. Dannee is questing different dog urines. Larry is singing as he peddles and ponders the purpose of life.
I crave the lightly sugar and cinnamon dusted cake donut, fresh from the small town baker's watchfully eyed fryer. Dannee gnaws contently on the crispy critter's dead carcass found along the railroad track. Larry, ever mindful to live as he is encouraging others, is thriving on a seasonal locally grown apple, cheese, and some bread.
And of course there is personal hygiene. Now sometimes this seems trivial but in the world of those of us who live like gypsies in our truck, it is a true barometer of how things are going. I now have tufts of canary yellow hair pinned back from my eyes with a jeweled bobbie pin to improve my driving vision. Long ago I gave up the idea covering the mirror in the back as it reminds me that once in a while, when I can find a brush, it is wise to seem more civilized. This is especially true if I have to ask a stranger for directions and do not want them to walk away with the thought that I might belong in one of those homes for special people. Dannee, he just finds piles of any type of animal droppings, and rolls vigorously until not even a deer would smell his presence. Larry has taken to looking like Forrest Gump in his walking/running across the United States phase. Larry's beard has become full and soft, his face etched with wind like the Bad Lands in South Dakota. He still smells good as he showers each day.
Thinking about the ribbons of joy my family, friends, and those in need have given me over the years, brings me humility. For Dannee, the three retractable leashes that were quickly abolished with impulsive bite-throughs, has freed his roaming spirit. Larry ponders the doctor patient bonds that make change in health outcomes possible for those with diabetes. We all three are blessed by relationships that makes life verdant with meaning.
For me, it is a simple world requiring only that I see it through the robust hues in the autumn of my life.
September 25
Iowa, Illinois, Indiana and (almost) Ohio
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H contemplates
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Iowa windmills
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Adventure in the Land of Lincoln
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7th state
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Dr. H and Martee's brother, Duff, in South Dakota
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Duff and Martee's Mom, Billee, soup up the RV
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In their amazing trek across the United State H, Martee and Danee Boy are inching ever closer to the East Coast. It was just weeks ago that Dr. H dipped his tire in the waters of the Pacific. His amazing determination, Martee's spot on support and your generosity have helped make this venture a huge success. Now, he is headed toward the drink of the Atlantic!! Check below for an update and in a new and exciting twist we are able to offer Radio Free Ride4Diabetes! Dr. Halverson was interviewed about his efforts Avera McKennan Hospital & University Health System in Sioux Falls, South Dakota. Check out the latest notes from the road, Dr. Halverson's take on the weighty issue of diabetes and that radio interview here!!
Notes from the Road
Time for an update as we wind our way through Illinois. Stopped in Wenona, IL yesterday after only 50 miles. Thunderstorms, rain and especially lightening sent me scurrying into a farmer's open tool barn for awhile. As soon as I decided to call it a day, the rain stopped. I rode over the swollen Illinois River all by myself at Henry, IL since the bridge was closed to cars due to flooding. Taking an intentional day off today at a spot with email and cell phone access. Will try to catch up some correspondence, fix some RV and bike problems, and have a little outing into the "real world" with Martee. Planning to make Cleveland, OH by September 30 to meet up with Allison Heider who will ride with us from Cleveland to Scranton, PA. Steve Boedgwick and Larry Bauer have also expressed interest in riding with us somewhere along the line. Around October 2 at Erie PA we will meet (and ride?) with the med students of Hershey Bell from LECOM. A man at an RV park in Kewanee IL walked up and gave me $10 for the endowment. Martee had talked to him about our "signs" before I got there. It made me wonder how to keep fund raising going at home since we have exceeded our original goal. Things are going very well. We are mostly having fun.
Love to my friends, family and co-workers, Larry
Dr. H's diabetes thoughts from the road: Weight loss, don't wait to get going!!
Today is a good day for me to write about weight loss. During a very hard pedaling day against the wind all day, I contemplated what I could say about weight loss. Let me start by saying that almost nothing is more difficult.
It is ironic that we have capacity to gain weight so easily. We were made to store weight. When food is abundant and energy expenditures are low, we can really "pack it on". Well most of us can. Some of us cannot gain weight no matter how hard we try. But we are the distinct minority. Our genes would not have survived the episodes of famine. So, most people today gain weight too easily. Weight gain is the number one reason for the growing epidemic of type 2 diabetes.
You may be wondering why I saved weight loss for my third commentary since it is clearly most important. I saved weight loss because it is the very hard to lose weight. And it is not the best measure of our success. If we exercise more and eat better, we will be healthier even if we do not lose weight. Weight loss is ideal and important, but it cannot be the sole measure of our success.
Weight loss is all about food and energy expenditure of course. In simple terms, it takes 3600 calories to make one pound. If we take in 3600 calories more than we expend, we gain one pound. But some of our genetic wrinkles add more complexity to this simplistic formula. When our genetic code suspects a famine (like a diet), it kicks numerous preservation genes into action. We become much better at conserving energy. Exercise becomes exceedingly difficult when our self-preservation nature tells us to "hibernate". We also release energy from our stores reluctantly, because Mother Nature tells us to save that fat until we are desperate. If we do lose weight, our nature kicks in additional preservation codes and major weight gain following minor weight loss is common. So our nature makes it easy to gain and hard to lose.
The best weight loss advice is prevention. It is much easier to not gain than it is to lose. For most of us, prevention seems too late, but it is not. I think the best place to start with any weight loss plan is first try not to gain any more. I don't care how much we are over our ideal weight, we must first learn to not gain any more before we try to lose weight. This simple necessity is usually omitted from weight loss plans. If we don't first learn how to not gain, then we will usually add additional weight when are diet grows old. I often compliment people who have not gained when they are trying to lose weight. They are often disappointed, but I feel they are passing step one.
The next step in my experience is to set reasonable goals over reasonable time frames. Many want to lose weight quickly for a major personal event, but too often we try to lose too much too fast and start a roller coaster of lose a few pounds and gain more afterward. I suggest we lose no more than 10 percent of our current weight and lose it no faster than over one year. That, of course, is after we have taught ourselves how to not gain weight. This is too slow in our quick results oriented culture, but I am aiming for ultimate success. We have to lose it at least as slowly as we gained it.
Of course both diet and exercise must be employed for us to achieve success. However, this easy equation also needs a dose of reality. If we jog for one mile we will burn approximately 100 calories. If we don't reduce our food consumption we have to jog for 36 miles to lose one pound. For most of us most of the time, we cannot find time to jog 36 miles for every pound we hope to lose. Therefore, calorie consumption reduction is primo.
A final point is the role of self esteem. I don't think I've ever seen a person lose weight over the long haul if they detest themselves. We must first learn to love ourselves even if there is currently more to our bodies than we desire. When we love and respect ourselves sufficiently, we can begin by learning not to gain, then losing a little over a long period of time, and get ourselves healthier even if we don't shrink. We deserve health. We are good people. I hope some of us will begin to try not gaining any weight over the next month. I look forward to hearing about your progress when I return.
September 18, 2008
H, Martee and Danee have sailed through the Dakotas (easy for us to say) and are pushing their way across Iowa. One look at a map will have you gasping at their amazing efforts so far. Let's send them our love, prayers and energy!!
Story City, Iowa
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"Life is either a daring adventure or nothing"
~Helen Keller
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Ride4Diabetes, making a name for itself.
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Can you spot the dog in this picture ?
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Free to RV
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Breathtaking
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Add one more great face to South Dakota
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Notes from the Road
Larry is doing Great. We are in Story City. I am getting the gypsy-moving the RV every day and setting up a new site down to an art.
I can not believe we have been out here for 30 days. Dannee figures this is the way life is- just one big dog house on wheels with a different venue each night. I rode my bike last night, walk everyday, and try to eat- alright except for the donuts and cheetos- with some restraints. Driving the RV has become second nature. I do find there is not much left of a day after getting supplies, finding a site, cleaning, and all. Just like a mini home on wheels. I am so missing friends and connections. All will mend when the adventure changes back to Springfield.
As Larry and I become veterans at this RV/gypsy life style, we have found the real important items to be considered. Larry-above all else- wants a shower. For me, a bit of space and a nice spot for Dannee to lay are essential. Simple joys are the most cherished. We are in Story City, Iowa tonight. The cornfield comes right up to our RV so we are truly embracing the countryside. All is well in our lives. Dannee went into the swamp after frogs, washing clothes in the RV laundry, Larry went 92 miles today.
take care- it is a good world. Martee
Dr. H's thoughts from the road on the need for support while battling diabetes
Tonight I will write about personal support and mental health. My predetermined order for this was next after bad habits. But I have been thinking about this subject all week, so I will arbitrarily change the order.
Personal support from someone(s) or some group(s), must be essential for people with diabetes. Since ideal diabetes management and outcomes requires an entire change of lifestyle, I cannot imagine doing this alone. Diabetes means a person must change the way they eat, sleep, exercise, work, address habits, seek medical guidance, and deal with cultural pressures. I suggest that reducing complications from diabetes is more likely when a motivated person with diabetes works in concert with a activated support system (individual or group)to deal with this necessary lifestyle upheaval.
But what does working in concert mean? It means that all parties are communicating, following the "Platinum Principle", mutually uplifting and, as a result, performing wonderful music together. I have been thinking about this so much this week, because my total support partner (Martee) and I have been learning that this beautiful music does not just happen. I could not complete this ride without her, so I have had to re-learn some of these basic principles. Being supported and being a support person requires that both parties change. It requires nurturing, education, love and effort.
First both supporter and supportee need to communicate. Communication does not just mean saying something or writing something to each other. True communication means a message was delivered, received, understood remembered and acted upon. Saying "I told you and you did not listen" only means that communication did not happen. Being good with communication requires years of genuine effort and practice.
I emphasize the importance of the so-called Platinum Principle. The Platinum principle is a variation of the Golden Rule. It is great to "do unto others as we would have them do unto us". However, this is often short of ideal. Since we all have different personalities, different needs, and different desires it is often better to "do unto others as they would have us do unto them". For example, when I am ill, I prefer to be left alone. When my wife Martee is ill, she would like me to check on her frequently. If we follow the Golden Rule, we irritate each other. If we communicate and follow the Platinum Principle, we are more likely to meet each other's needs. Again communication is essential, since we intuitively follow the Golden Rule. Changing to Platinum requires effort.
Being mutually supportive reminds us that both parties need love, grace, positive feedback and rewards for their work. It is very difficult to have diabetes, but being a support person is also difficult. Sometimes what a person wants is not what they need. The partner must give in or fight it. Both choices are difficult. With love and grace there is usually a negotiated position that is best for both parties, but this is extremely hard work. Loving partners do not have the life changing condition, but they often need to adopt the lifestyle of the person they are supporting. They need love and genuine gratitude for their devoted efforts.
I have not yet mentioned mental health. Both persons with diabetes and their mates often suffer with depression, anxiety, substance abuse, or other mental health problems. Often they blame themselves and each other for diabetes management difficulties. With mental health problems adding to the already enormous burdens that people must manage, good results are even more difficult. Mental health problems underscore the difficulty of this work. But again I say it is essential to have support, and learning the roles and principles can build self-esteem, foster love, and give meaning to a full life. We all grow with our loving friends, family, and community.
September 11, 2008
Larry, Martee and Dannee have left Montana and entered the Dakotas, they hope to be to Sioux Falls by this weekend!! Larry survived sleet, rain and hail on the road. They were welcomed to their home state by family and friends.
Notes from the Road
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| Sleet street |
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Neither rain, nor sleet, nor flat tire will stop H |
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| It's all worth it |
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Not so neat sleet |
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| Hope |
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Friends warm the heart |
We are in Wolf Point Montana and it is hailing about the size of marbles as I type. I hope I don't see that on the road tomorrow. I rode 100 miles today from near Saco to Wolf Point. I can't brag too much because I had a nice tail wind. However, I did have one more flat tire (#2 for this trip).
A sharp stone was stuck through my tire. Thats the trouble with having to ride on the gravel on the shoulders. We are doing well. If I can manage 100 again tomorrow, we will be in Williston, ND!! I won't guarantee that until I check the wind in the morning. We did have a nice visit with Edie and her family. They have a gorgeous organic botanical paradise. All accomplished with their own sweat and earthly knowledge. Ate well, visited late and left with pounds of fresh produce. Had a brief one day stay in Chester. We went down to the dam for a Labor Day camp out with Karla and crew. Rained hard on the night we stayed and I held my breath climbing out of the dam the next morning. Rode to Hingham on Monday in a driving cold rain and totally
BONKED!! I was so tired I could not visit much with Ken and Jan. But they treated us like royalty and forgave me for me long early nap.
Rode to Harlem the next day then Saco and here we are. My next timeline is to be in Sioux Falls by September 15. I should make it, but it will not be easy. Must make Stanford Connecticut by October 14 to be home on time. I'm enjoying this, but it is hard on Martee. She has a cold now and is trapped into doing my necessary biddng. She is a total master on care, upkeep and repair of an old RV. She is also totally occupied by the care of Dannee Boy our, one year old golden retriever. He is a mess, but I think she would be totally bored without him. I hope all is well with all of you. Thanks so much for your love and support. Love, Larry
Dr. H's thoughts on Food and Diabetes
This week I comment on food and diabetes. Much has been written on this subject and some of the dogma has been subjected to scientific scrutiny. So what do I, a lone bicycler, have to add? Despite all of the attention given to this subject, we are a poorly nourished culture and the problem is increasing.
There are many reasons for our malnutrition. I will comment on four of these reasons. First we are created or designed to withstand the famine. Second, we are omnivores. We can and do eat anything. Third, our food production and processing capabilities have exceeded imagination. Fourth, our competitive culture is not primarily interested in our better health.
Our bodies are very well designed to withstand the famine. We are genetically programmed to eat for the present and not for the future. We are especially inclined to seek foods of high caloric value. Fats taste good to us because they provide the highest calories per unit of weight compared to the other two nutrient categories (carbohydrates and proteins). We crave sweets because of the instant impact we can feel when sugars go virtually straight into our bloodstreams. We can pack in enormous quantities of food when it is available. And food is increasingly available.
Our species has been granted the blessing to eat almost anything. In times of hardship, this is a great advantage. We caravanned with a wildlife biologist during the first part of this trip. He told us that starving deer cannot be rescued by alfalfa hay. Unless they have been programmed, they will eat alfalfa, but not absorb the nutrients and die of starvation. Michael Pollan, in his excellent book The Omnivore's Dilemma, explored this blessing. Because we can eat anything, a good and healthy diet can come in many disguises based on our geography, culture, and traditions. Now that cultures are merging the question is not what can we eat, but what should we eat.
Our food production capabilities have eclipsed imagination. Farmers, food processors, delivery systems, and food preparation artists are a tribute to mankind. However, like all systems, food production is designed to achieve an ultimate purpose. That purpose is to provide more food with more appeal to our basic desires. That means we are successfully producing more appealing fats and highly sweetened foods.
Our competitive culture is not fully focused on our good health. In our capitalist society we focus on increasing our consumption of everything. Food is no exception. Increasing our consumption of food is not in the current best interest of our cultural health. Even diet books are competing for sales rather than our good health. Many are promoted without any significant scientific scrutiny.
So how should we digest this problem? I prefer simple approaches. Michael Pollan suggested three rules. Eat food (meaning whole food that is minimally processed), not too much, mostly plants. This makes sense to me. Less processed foods provide fewer calories per weight of food ingested. Not too much needs to be our mantra. A famine is not in the forecast. We are hurting ourselves by self-storing food for the future. Plants provide taste variety to delight the omnivore. They also, for the most part, provide lesser concentrations of fat and more complex sugars that are sweet but not so toxic.
During this trip I try to follow advice that I have often offered my patients. That is "Count to Five". This means, eat a total of five fruits and or vegetables everyday. Half of the shopping cart should be fruits and/or vegetables. Half of a meal plate (only one plate per meal) should be veggies and fruits. Do not eat a snack unless it is with fruit or vegetables. This commentary is written for people with diabetes. However, in our culture, we are all pre-diabetic. Those of us who do not yet have the diabetes diagnosis are fortunate. We all could do well with "counting to five" everyday.
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| RV Makeover with Ride4Diabetes bling |
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A visit with family and friends |
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| The people who keep H going |
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Family and friends |
Notes from the Road
This is the latest of Larry's work. He rode 100 miles today. Amazing. All is well. Thank you for "being there"
It is wonderful out here- just the nicest people all telling stories about people in their families that have diabetes. With the sign on the RV in bright yellow and black (like a bumble bee) people honk and wave. I drive about 60 mph but in Montana, there really is no speed limit so some people wave but not always with good intentions! We are truly learning and enjoying what we see from the mountains to the plains. Sounds like a Greenwood song I heard. Take care, hug those you love. Martee
Notes from the Road
All is well. We have passed Chester, Montana with time for the family.
It rained a bit, 40degrees but the family warmed our hearts with stew, fresh bread and encouragement. The RV and Dannee are doing well.
Dannee does not like two kinds of horses and will bark. The ones that are ridden and the iron horse (train) that move in Montana continually.
We will be in Sleeping Buffalo Hot Springs tonight. This has been such a wonderful, insightful experience. It's all good.
More later.
Our road warriors are now in the middle of Montana. This week Dr. H tells us about day to day life on the road for he and Martee and how valiant pup, Dannee Boy, is taking freedom in his own paws. The Ride4Diabetes team also caught up with some old friends and have made some new ones. Please check back later in the week for the new Ride4Diabetes "look" supplied by a friend met on the road.
Cutbank, Montana
September 3, 2008
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| Home, sweet, roam |
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State-of-the-art open air kitchen |
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| R.V. accessories provided by Dr. Shannon Kelley |
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GO HALVY GO!! |
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| Great heights |
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Dannee laying down on the job! |
We have heard from some that you are wondering how we are doing as a family as we ride across the country and focus on diabetes care. For those interested, I will try to describe some of the daily life events that have occupied us over these first two weeks.
We get up early usually around 5 to 6AM and fix a light breakfast while I prepare to ride. On cold and rainy mornings, this has been rather difficult. Our old RV was quite cold for a few mornings, but better since we have crossed the continental divide (and Martee got the heater fixed). I usually have microwaved coffee, cheese, bread and fruit to begin my day. Preparing to ride is sometimes slow and laborious. It all starts with which clothes to wear initially and where to discard extra clothing if it warms or quits raining. If I try to dress in short sleeves and short pants, sunscreen application is meticulous. Adjusting mirrors, headgear, water bottles, camelback, GPS and carrying handlebar bag takes some time (especially when it is raining). Immediately before takeoff, I add air to both tires.
I usually hit the road around 7AM if is light enough to see and be seen. Riding is the bulk of my day. There are times of difficulty, times of pure joy and occasional moments of terror. Going up steep grades is difficult. I crossed 4 mountain passes in 3 days in Northern Washington and all were difficult. The Continental Divide in Montana was easier. That is probably due to geography (slower ascent and higher starting points) and physical conditioning (it is reassuring that I can still gain strength with exercise at age 60!) Some roads are difficult. Narrow shoulders, road debris, steep drop-offs over short safety rails, narrow bridges, and misplaced "rumble strips" are some of my most difficult challenges. I find I have to focus particularly well on good roads, since higher speeds seem safe but the occasional pothole on the shoulder can be big trouble.
Equipment problems can be annoying, but I am getting much better at adjusting my shifting mechanism and changing tires. Today I fairly flew down the slope after Marias Pass with a strong tailwind on a good road. That was pure joy and a great reason to recommend riding to everyone. The moments of terror are to be avoided. For me, these fall into four categories. The first is heights. I suffer with acrophobia and some areas are difficult. The second is other vehicles. Some seem to hog the road including my shoulder of the road. Others get joy by honking when they are about to pass. Occasionally I have spaced out and been totally shocked by a thoughtful driver. Dogs are a concern, but I have only had two minor incidents so far. It is when I don't see them coming that I am at risk. The fourth is the previously mentioned road conditions. It seems there are no warning signs for bicyclists when the shoulder is about to narrow or rumble strips attempt to drive me into a treacherous off-road disaster.
When the day's ride is done, I demand an instant shower in the RV or in the RV Park shower where we are staying. I spend some time cleaning, lubing and checking my bike.
Martee and I catch each other up on our day's experiences, fix something to eat, read and retire early.
But, that is only half of this story. Martee's day is very different but also quite eventful. A large part of her day is spent maintaining, repairing, problem solving and hassling with our old RV. We bought an Itasca Winnebago 1993 Class C mobile home especially for the trip. It was old, but low mileage, full featured and small enough to suit our desire. It has been perfect in some respects, but because of the time Martee has spent in repair shops, on the phone, and improvising. So far, she as had to fix the heater, the refrigerator, change a tire, fiddle with the hot water heater, and fix a waste disposal valve. This is in addition to the daily chores of adding fresh water, disposing of old water (especially problematic when one valve-yes that one-is leaking!) buying fuel for the engine, buying LP gas, and looking for the next problem. She also has to try to keep track of me, watch for bad weather, buy needed supplies, and equipment and find a place to stay each night. This is only a small portion of her job.
Day and night she toils mightily trying to care for our now one year old golden retriever named Dannee Boy. Dannee has had great joy and major disappointments during this journey. He has plenty of room to roam at home and is not fond of the dreaded leash! So far, he has chewed through three of them. He has been introduced to the choke chain, he has had diarrhea, he has eaten anything he can reach, he has nearly knocked over an old lady in his path, and has made lots of friends. Even going out to eat can be difficult with the ever present Dannee Boy. But Martee has taken him on long walks, found places to let him run and enjoyed his constant companionship while I am pushing the pedals. Something tells me there are many more stories to come during the next six weeks.
Idaho is in the rearview mirror and Dr. H has entered the great state of Montana he is headed toward his home town
Libby, Montana
August 27, 2008
We are in Libby, MT. Doing well. Over 500 miles so far. Hope to reach my home town of Chester, MT by September 1. No major problems. I plan to do 89 miles tomorrow. Maybe I better write tonight! TO bed soon!! We are on schedule.
Estimate Cleveland area around Oct 1. Larry
Dr. H has a challenge for you as he crosses the miles and more thoughts from the road on the fight against diabetes.
Challenge!!
August 27, 2008
My next commentary is about exercise, or let me call it large muscle activity. Because I am riding a bike for 6 hours per day, I think about this often. Large muscle movement, lots of movement, is part of our human heritage, but this activity is rapidly decreasing. My grandfather's generation averaged spending about 3600 calories more per day than I expend when I am not riding my bike. This is a huge difference in just two generations.
The post WWII years were a time of dramatic development of "labor saving devices". In every aspect of life, we were able to reduce our large muscle effort. From electric dishwashers, to automatic door openers, escalators and elevators, drive in windows, remote controls and even emails we have reduced the need to move our large muscles. In many ways these devices have been a godsend. But this did not come without a price.
A major part of our diabetes epidemic has been this dramatic shift of large muscle activity. Obviously this change has contributed to our obesity epidemic and type 2 diabetes is directly proportional to obesity. I start these commentaries with exercise/muscle activity because it is a little easier to approach than obesity. Even with dramatic exercise efforts many of us fail to lose much weight. But if we exert our large muscles more often, even if we don't lose weight, all diabetes parameters improve.
In a sense, muscle activity is a panacea. Large muscle activity helps blood sugar decrease, blood pressure go down and HDL cholesterol (good cholesterol) increase. It also makes people more likely to quit smoking. It is definitely helpful for depression which seizes the minds of many people with diabetes and contributes to their health declines. In all of these and more, movement is just what the doctor ordered. Exercise is not easy but more muscle movement is more reasonable in the beginning. It is a good place to start.
Of course, not everyone has the good fortune to ride their bicycles across the country, but even small doses of activity help. We can start with parking further from the grocery store and carrying our own bags. Many have succeeded in hiding the remote controls. Better yet, turn off the TV altogether for one night each week. Invent your own strategies and then share them with others. This can do more good than expensive medications and research on weight reduction pills. We have the power. I hope you will pedal with me this week.
Dr. H has conquered Washington and is headed across Idaho!!
August 26, 2008
Take a look at these pictures from his first week on the road along with his wife, Martee Robinson, and their trusty pal, Danee Boy. Martee and H say they are having a blast!! Stay tuned for another blog update from Dr. H in the next few days.
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| Team Ride4Diabetes, H, Martee, Dannee Boy and Spirit, the RV |
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Dannee Boy is ready to go |
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| Back tire dip in the Pacific |
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Washington Pass-the climb of a lifetime |
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| Hard Day's Night |
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The Zen of Bicycle Maintenance in North Cascade State Park |
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| Duct tape donated by Family Medicine Residency to the rescue |
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Beauty and the bicycle |
Priest River, Idaho
August 25, 2008
The ride is beautiful. Larry has completed over ten percent of the goal!!~Martee
(Please stay tuned for pictures and more updates. Dr. H has run in to some spotty internet reception on those mountain passes)
Waconda, Washington
August 22, 2008
Great news!! We are finally back in internet/cell phone contact. I am sitting in an internet cafe in Waconda, Washington (on highway 20) near (but not over) the pass. We are averaging about 60 miles per day. Have gone over 4 passes in 3 days. Last big one is Sherman tomorrow. They are heck going up, but fun and frightening going down. I am having fun, but thinking constantly about diabetes and the endowment. Thanks for great work at home!! Larry
Dr. H's thoughts on diabetes from the road
August 22, 2008
Diabetes is killing us. One third of people in hospitals currently have diabetes. One fourth of people in nursing homes currently have diabetes. National prognosticators predict that one third of our current eight years old children will have diabetes by the time the reach age forty. People who get diabetes before age forty suffer more serious complications. Over 1200 people who have visited our clinic in the last two years have diabetes.
I've begun a 3400 mile bicycle ride to publicize and develop funding for our Cox Family Medicine Diabetes Endowment. I start this "blog" by emphasizing my passion for this mission. Thirty years in Family Medicine has revealed many things to me. At this time, my most startling revelation is that diabetes is wreaking havoc with my patients. As I reach the "golden years" of my life, life is not so "golden" for many of my patients who have diabetes. I know we could have done better for those now with cardiac bypasses, those with heart failure, those on dialysis, those who died too early, those with amputations, and those who are blind. But we (I) didn't get the job done.
Five years ago, our program began carefully tracking and analyzing the care we are accomplishing with our patients with diabetes. Our electronic medical record afforded us the ability to scrutinize our data on ALL patients. The data was disappointing. Many patients had not received basic preventive services (eg. eye exams, foot exams and flu shots). Most patients were not a goal for intermediate indicators (A1C, LDL cholesterol, and BP levels) that correlate with the devastating complications of diabetes.
It struck us that it was not what we don't know that was contributing to our disappointing performance. These were basic services that were not being delivered. We began focusing on our processes of care, teamwork with clinical staff, and careful analysis of our regular data reports. We have made major progress and published our work in Family Medicine.1 But our progress has slowed, and we want to do better for our patients. My belief is that seeing more patients and seeing them faster is not going to help us do better. Of course, that is the way we get paid. I think it is time to change our efforts to promote self-care, teamwork, motivational strategies and data analysis.
Thus we began an effort to obtain external funding to continue our efforts. But fund development has been slow so this bike ride is my effort to stimulate our community and nation about this problem. While riding I will contemplate and write a series of approximately weekly commentaries about this disease, chronic conditions, and primary healthcare. After this introduction, I will address exercise, food, weight loss, bad habits, personal support and mental health, medical care, and my ride as a metaphor for diabetes. I hope you will read along. I also hope you will contribute to our effort to change our approach to help our patients.
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