Another bike ride

I did the easy route again today. Perhaps I should call it Easy Route #1 in case I later have an Easy Route #2. This time it was cooler and there was wind.

If anything, I think I could say that I felt less pain today than I did the last time. I did not stop at all, challenging myself, and what I most noticed is that my endurance can use a little work and that my seat hurt. A couple of times I stood up on the bike just to relieve my crotch. The elements of that pain:

* I am not adjusted to riding yet.
* I am way overweight.
* My seat hardened while it sat for a couple of years (I could use a new one).

So clearly there are things I can do about it and I intend to.

I was occasionally thinking other thoughts while riding, somewhat not-bike thoughts. I think this comes from greater ease with riding. Right now I am still too fearful. I fear falling off the bike, mainly, because my balance is not great and I am not well coordinated. Yet I have fallen off three times that I can remember in my riding time, and the worst of that was that it hurt and it was embarrassing. Well, big deal. I expect to feel less fear and more exhilaration as my strength builds (and my weight declines). I still remember how great it feels to accomplish what for me is a difficult ride, including those wonderful interludes when I am really on my game.

Bike again

I took my bike out on the easy ride again, Orcutt-Tank Farm-Broad-Orcutt. This time I got off the bike three times - the first at the corner of my street and Orcutt, just to be safe turning the corner, the second when I slid into a gear that wasn't a gear and it froze up on me, the third when I walked it across Industrial Way to avoid traffic while getting back to Broad. I didn't stop for a drink or to buy anything.

My knee felt less pain this time than the last. I suspect the weather contributed, even though I have yet to find a real correlation, personally, between weather and how my knee feels. Yet it was hot and there was little wind, and those two factors might have meant less pressure on the knee joint. It was a nice feeling in any case. I even made the effort to use a little more muscle power. Just a wee bit. It's still a wimp's ride but I'm not proud and I don't care. It's working for me.

I think by this time I can say with near certainty that there has indeed been a change in my knee. It's as if the bottom level, the bad pain, the problem discomfort, has either gone altogether or shows itself very rarely now. This has been consistently so for at least two months. I suspect the glucosamine has done some work repairing the joint.

Getting back on the bike

I took my bike out again today. The last time I went out I felt nervous and edgy for about half the distance, and more comfortable toward the end. I felt I was getting my bike legs back. Today was an effort to do more of the same.

Some things I learned when I rode regularly:

• Don't grip the handlebars. Hold lightly. When I first rode as an adult I had a death grip on them and eventually developed symptoms of carpel tunnel syndrome. After I lightened up the symptoms went away.


• Think ahead. My riding mentor from those days past told me that when I rode a bike I would really be practicing "advance planning", and he was right. You have to be ready to change gears at the right time.


• Don't be afraid of breathing noisily. When I first rode with T, the mentor, I tried to muffle my loud breathing so I wouldn't sound like I was trying too hard. One of those mensch things, I guess. When I let myself breathe naturally, which meant all-out and noisily, I found I had more energy and was more capable.

I have never been a great rider, but I managed to become a competent one. Even at my best I wasn't able to hold still at a stoplight without putting a foot on the ground. I am not particularly graceful or balanced. It's a tribute to the flexibility of the bike design that I can ride at all.

When I power down on the pedals it hurts my knees. Not a good situation for the future of my riding, but I'm counting on the pain to lessen. It is not excruciating. In the meantime I just downshift a lot. And get off the bike when I feel the need. I'm not proud. I've been here before and I will be again.

Today's ride was a simple loop. Orcutt - Tank Farm - Broad - Orcutt. There are a few gentle rises and a couple nice downhills and even a few flats. San Luis Obispo has very few flat areas. It's a wimpy ride, I admit, and yet it gave me such pleasure to sit outside the coffee shop on Broad and Orcutt and realize I had gotten there under my own power. That sense of freedom is what I love so dearly about bicycling. Motorcyclists have absolutely nothing on me.

Glucosamine

The story from Wikipedia, admittedly not a perfect source but probably adequate for my purposes:

Oral glucosamine is commonly used for the treatment of osteoarthritis. Since glucosamine is a precursor for glycosaminoglycans, and glycosaminoglycans are a major component of joint cartilage, supplemental glucosamine may help to rebuild cartilage and treat arthritis. Its use as a therapy for osteoarthritis appears safe, but there is conflicting evidence as to its effectiveness.


Use
A typical dosage of glucosamine salt is 1,500 mg per day. Glucosamine contains an amino group that is positively charged at physiological pH. The anion included in the salt may vary. Commonly sold forms of glucosamine are glucosamine sulphate and glucosamine hydrochloride. The amount of glucosamine present in 1500 mg of glucosamine salt will depend on which anion is present and whether additional salts are included in the manufacturer's calculation. Glucosamine is often sold in combination with other supplements such as chondroitin sulfate and methylsulfonylmethane.

Glucosamine is a popular alternative medicine used by consumers for the treatment of osteoarthritis. Glucosamine is also extensively used in veterinary medicine as an unregulated but widely accepted supplement.


Safety
Clinical studies have consistently reported that glucosamine appears safe. Since glucosamine is usually derived from shellfish, those allergic to shellfish or who have kosher concerns may wish to avoid it. However, since glucosamine is derived from the shells of these animals while the allergen is within the flesh of the animals, it is probably safe even for those with shellfish allergy. Alternative sources using fungal fermentation of corn are available. Another concern has been that the extra glucosamine could contribute to diabetes by interfering with the normal regulation of the hexosamine biosynthesis pathway, but several investigations have found no evidence that this occurs. The U.S. National Institutes of Health is currently conducting a study of supplemental glucosamine in obese patients, since this population may be particularly sensitive to any effects of glucosamine on insulin resistance.

In the United States, glucosamine is not approved by the Food and Drug Administration for medical use in humans. Since glucosamine is classified as a dietary supplement, safety and formulation are solely the responsibility of the manufacturer; evidence of safety and efficacy is not required as long as it is not advertised as a treatment for a medical condition.

In Europe, glucosamine is approved as a medical drug and is sold in the form of glucosamine sulphate.

Clinical studies
There have been multiple clinical trials of glucosamine as a medical therapy for osteoarthritis, but results have been conflicting. The evidence both for and against glucosamine's efficacy has led to debate among physicians about whether to recommend glucosamine treatment to their patients.

Multiple clinical trials in the 1980s and 1990s, all sponsored by the European patent-holder, Rottapharm, demonstrated a benefit for glucosamine. However, these studies were of poor quality due to shortcomings in their methods, including small size, short duration, poor analysis of drop-outs, and unclear procedures for blinding. Rottapharm then sponsored two large (at least 100 patients per group), three-year-long, placebo-controlled clinical trials of the Rottapharm brand of glucosamine sulfate. These studies both demonstrated a clear benefit for glucosamine treatment. There was not only an improvement in symptoms but also an improvement in joint space narrowing on radiographs. This suggested that glucosamine, unlike pain relievers such as NSAIDs, can actually help prevent the destruction of cartilage that is the hallmark of osteoarthritis. On the other hand, several subsequent studies, independent of Rottapharm, but smaller and shorter, did not detect any benefit of glucosamine.

This situation led the National Institutes of Health to fund a large, multicenter clinical trial studying reported pain in osteoarthritis of the knee, comparing groups treated with chondroitin sulfate, glucosamine, and the combination, as well as both placebo and celecoxib. The results of this 6-month trial found that patients taking glucosamine HCl, chondroitin sulfate, or a combination of the two had no statistically significant improvement in their symptoms compared to patients taking a placebo. The group of patients who took celecoxib did have a statistically significant improvement in their symptoms. These results suggest that glucosamine and chondroitin did not effectively relieve pain in the overall group of osteoarthritis patients. However, exploratory analysis of a subgroup of patients suggested that the supplements may be effective in patients with pain classified as moderate to severe (see testing hypotheses suggested by the data).

In an accompanying editorial, Dr. Marc Hochberg also noted that "It is disappointing that the GAIT investigators did not use glucosamine sulfate ... since the results would then have provided important information that might have explained in part the heterogeneity in the studies reviewed by Towheed and colleagues[PMID 15846645]" But this concern is not shared by pharmacologists at the PDR who state, "The counter anion of the glucosamine salt (i.e. chloride or sulfate) is unlikely to play any role in the action or pharmacokinetics of glucosamine". Thus the question of glucosamine's efficacy will not be resolved without further updates or trials.

A subsequent meta-analysis of randomized controlled trials, including the NIH trial by Clegg, concluded that hydrochloride is not effective and that there was too much heterogeneity among trials of glucosamine sulfate to draw a conclusion.

From this it appears that the jury is still out.

34 Weeks

I finally went back to my calendar and counted up. This is my 34th week on the program. That's approximately eight months.

I have read that it takes six months or so for glucosamine to have an effect on joints. That is, for it to start rebuilding the joint, to some extent. Is this true? My memory is that there have been actual studies that show joint regeneration but is my memory wrong?

If it is true than what I have noticed in the last several weeks can probably be attributed to rebuilding. That would account for the lessening of pain overall, my ability to take on stairs without so much pain.

I'm going to hunt down the facts now.

Biking

Yesterday I took my newly-tuned bicycle out for a test ride. It had been so long - years - since I rode it that I felt a bit uneasy just riding. I worried that I would not get my foot out of the stirrup in time when I stopped the bike (I have had stirrups for many years). I worried that I would not be able to control it in traffic.

Of course I found I am way out of shape. More, my left knee hurt. But not so much that it stopped me. Ever optimistic, I am counting on that pain to lessen over time.

I rode down the railroad path into downtown. I stowed the bike in a rack while I went into Barnes & Noble and bought a book and an iced coffee. Then I rode back by way of Osos and Broad Streets. By that time I was starting to get some of my street smarts back.

My knee makes it just about impossible to stand up and power anywhere. In other words, I really need to keep my seat on the seat to avoid more pain. But if I lose weight I figure I'll be able to use my strength more effectively.

It's a bitch always struggling with weight. But then, I don't struggle enough, really.

Bike!

Yesterday I went to the gym and did thirty minutes on a stationary bike. My knee acted up, made it painful, but not so bad that I had to slow my pace. I gradually went from level 4 to level 8, doing the random hill program, and when I got off the bike I did not limp.

I consider it a positive outcome.

So today I got my bike carrier out to put on my car. I was unable to attach it correctly, so I had the sense to take it to a bike shop and let them do it. Then I went home, put the bike on the rack, and went right back to the bike shop. The bike is getting a tuneup! Plus a new rear tire and a few other sundry parts. At last!

What I love about bike shops, the real types that is, is that the workers there never seem to suggest that one might get a new bike. If you bring a bike in for repair then they will repair it and not even stop to glance at a newer better bike that you might want. I think they know, because they are cyclists too, that 1) bikes essentially can last forever and 2) we form deep attachments and 3) when we're ready for a new one we'll tell them.

I say this about "real" bike shops because I've been in some where the owner and workers don't even ride bikes and they certainly don't repair them. My advice: do not buy a bike there. This shop where I went brags that everyone who works there rides. For whatever reason this makes them nice people, too.