Helter Skelter

“Brilliant news!! Still no recurrence of my supposedly incurable #cancer!! Median time 2 recurrence 4 all pts is 6 months; I’m now out to 8 months! Perhaps neoadjuv/adjuv combi immunotherapy is effective?? Need clinical trial.”

Do we need a clinicial trial or do we need to step back and take a rational and unbiased look at the data? I think the latter. Statistically, the median is the mid-point of all observations. That is, 50% of patients with #cancer will have progression free survival under 6 months, and 50% will have progression free survival over six months. The median is a good measure of central tendency when the distribution is non-normal. Under normal distributions, the median, mode (most frequent measure) and mean (arithmetic average) are all very similar.

I am assuming the individual in question is using “recurrence” to denote progression free survival (PFS) which is the new kid on the block for clinical trials attempting to show progress in slowing (not curing) cancer. PFS is a surrogate measure beloved of pharmaceutical companies because it is much easier and cheaper to show a benefit than it is to show an overall survival (OS) benefit in cancer. Sadly, many new cancer treatments, including much hyped therapies and targeted treatments which show a statistical benefit when PFS is used as the endpoint, show no difference at all when compared to the older/conventional treatment when OS is used as the endpoint.

In the case quoted above, there are a myriad of other explanations besides “ neoadjuv/adjuv combi immunotherapy” for why the individual is in the 50% of #cancer patients who have PFS greater than six months. Arguably, first amongst these is this individuals priviledged position in society as a well-nourished, well-socially supported individual with priority access to health care. It’s not hard to imagine that a well connected individual might get priority treatment before an immigrant living in a one bedroom apartment in western Sydney driving Uber whilst trying to raise three kids.

Sadly, income and social position remain the greatest determinants of health in the modern world. No amount of clinical trials will change that. In fact, given the cost and resources these trials suck up a strong argument could be made that we would achieve better outcomes overall if the money that went into pharmaceutical trials of drugs that have high levels of toxicity and incremental (at best) beneft were funnelled into primary and preventative care. Obesity is a leading cause of cancer and yet despite annual increases in the number of obese, overweight and metabolically deranged Australians comparatively little money and virtually no public or political will goes toward curbing the obesity pandemic (the real pandemic).

In the case above, we have one person whose response thus far is comparable to the response of a large proportion of #cancer patients given standard therapy, is this cause to rush towards a clinical trial of several unproven, toxic, and expensive therapies or a call for compassion towards the afflicted whilst we bravely turn towards the real pandemic? I think the latter.

The Last 50

There is no wind and the sea is greasy grey under low clouds and drizzling rain. There are two swells and left over sea from strong southerlies the last two days. It’s a queasy kind of day and I am queasy all the way to Depot Beach, 20 kilometres north up the Murramarang Coast, while Nick is queasy all the way back. Paddling into Depot Beach we wrap around the outside of Grasshopper Island, no-one can be arsed with trying to get the timing right to go through the reef strewn gap between the mainland and the island with a two metre swell running.

PC: DB

At Depot Beach I finally eat breakfast and feel better almost immediately. We don’t stop long. It is mid summer and yet wet as we are, it is cool and uncomfortable on the beach, and, there is still so far to go. Around Three Isle Point we are sheltered from much of the swell and land on Judges Beach, quiet and empty as Judges Beach almost always is. We are 36 kilometres down and the couple of hundred calories I had earlier feels long gone. My appetite fully recovered I eat two meat patties which Nick eyes warily. Even a homemade ginger biscuit can’t tempt him.

PC: DB

Nick streaks off towards the southern beaches, while Doug and I paddle south to the Tollgate Islands, then further south to Black Rock, where currents swirl around the reef, finally turning towards home and, for the last six kilometres paddling into both current and headwind. I feel stronger, not nearly as tired as usual at the end of one of these long days, the result of less sometimes being more. Training is easy, recovering is hard. The beach is inexplicably busy given the strong northeasterly wind blowing in. Boats onto trolleys and the walk up the hill and home. The last 50 was 49 kilometres.

A River And A Hill

Be wise with who you spend your time with. Select people that want you to succeed and aren’t fearful of your success. Brette Harrington. The Ernomocast.

Said a dozen different ways by a dozen different people and always easier said than done -particularly if you live in a small community - but, a worthy goal nonetheless.

Yesterday, up a river, up a hill. A glassy calm day that also featured intermittent showers and cloud low over the hills. I like these sorts of days, it reminds me of Canada, and the tree covered hills of Australia look bigger and more mysterious with fog covered tops. I dragged my kayak up a steep bank out of the muddy river bed and hiked to the top of Sugar Loaf Hill. There used to be filtered views but they are all grown in now with wattle regrowth after the 2019/2020 fires. Luckily, there is still enough of a foot pad to avoid bush-bashing.

Why Are We So Slow: The Current Edition

First table is wind speed (from Moruya airport), the last two columns (on the right) for the nautical minded are knots: average wind speed and gusts. Ticking up as the morning progressed (as forecast) but, easy enough to paddle into. The next image is the data from the Batemans Bay wave buoy. The scale is cut off the side but the high point on the graph is five metres with an average wave height of 2.5 metres, bigger waves are up to 4 metres. Not shown is the period, around 12 seconds. No drama if you keep your head up and stay away from bommies and reefs, although landing at certain locations could be a challenge.

The next graph is speed. Whoa, what’s going on there? At around 6 kilometres, our speed decreases. That’s pretty normal as we pass North Head where conditions are almost always a bit bouncy, the swell and sea pick up and there are currents. Around 8 kilometres, however, we are just getting progressively slower and slower. Remember, the wind is only around 10 knots. The last image with all the pretty colours are the ocean currents with a fire hose aimed at the south coast and speeds reaching up to 3 knots! As we were nearing Flat Rock Point, I was doing calculations in my head based on our current average speed and the resulting numbers were not appealing. Our speed was half our usual average!

We often get the East Australian Current along the coast in summer but I think this is the strongest I have encountered. It was reminiscent of paddling the Capricornia Coast in Queensland. Randomly, as we paddled north, we would paddle over patches of boiling water and standing waves as the current ran over undersea features. Turning around near Flat Rock Point, our speed, paddling with the same effort, bumped up to almost 10 kilometres an hour immediately!

I had not eaten so we stopped at Judges Beach for breakfast and a thermos of tea before some sprint training back to our home bay. A light tail wind at this point but enough to enable us to catch some runners. So, half the distance planned, which, as an obsessive finisher of check-lists and goals was a bit tough to reconcile, but not tough enough that I wanted to spend five hours covering only 20 kilometres.

Where The Current Runs

“Forecast looks interesting for Sunday. Any interest in a paddle?” And with that, Quick Nick was out from under the roof, predictably on a day with the northeasterly wind forecast to hit 30 knots. Foreshadowing a difficult day ahead, it was exactly what I needed to fully relax into my deload week and instead of squeezing in one more strength session for the week, I strolled around the rock platforms near home, did some stretching and finally let myself enjoy a day without serious training.

Ironically, conditions on Sunday were the easiest Doug and I have had on a training paddle for a long time. The swell had fallen right off to a mere one metre easterly, and it was mostly calm with little sea or wind all the way to Wasp Island. I called a halt at Mill Beach after two hours so I could eat breakfast. From Wasp Island, we paddled into a light northeasterly until we were a couple of kilometres off-shore. Still, there was very little wind, but, it turns out we were far enough off-shore to benefit from the East Australian Current (EAC) running south.

We started south with a good line should the wind arise as forecast, and made quick time to North Head. I had covered my watch with my shirt sleeve so I did not have to see the kilometres click by demoralisingly slowly but, it turns out, we paddled the 10 kilometres from a couple of kilometres beyond Wasp Island to North Head in an hour. At Yellow Rocks, we finally got the forecast wind and the run back to the beach was one of my best ever – recovery works - but only if preceded by training!  Five kilometres in half an hour and catching lots of runners. I had pulled my sleeve back so I could see my speed as I paddled to provide extra motivation to paddle hard. I wasn’t even shattered when we hit the beach!

D is For.....

Dynamic, damp, deload, disappointed, dusky and delighted. Disciplined athletes deload frequently. The conventional advice – which is actually pretty good unlike traditional nutritional advice – is to reduce load by about 50% every fourth week. I used to do this when I was trail running a lot. The schedule goes roughly like this: increase load (time) by about 10% on weeks 2 and 3, reduce by 50% on week 4, week 5 is week 3 plus 10%, week 4 and 5 increase by 5 to 7%, reduce by 50% on week 4, and etc., etc. You can do this virtually forever, time, injuries and energy permitting, because the recovery week allows the body to absorb the training and “build back better.”

Like many recreational athletes, I have the discipline to complete the build but lack the courage to live through the deload week. People like me are not ultra-disciplined, we are actually neurotically worried that if we take a week off training our hard won fitness will completely disappear. We take time under tension to its anxiety ridden extreme.

PC: DB

This never works. Never. It might be week 10, week 15 or even week 37, but at some point, fatigue sets in – if injury has not side-lined you first – and regardless of how willing the mind is, the body cries out for rest. Perhaps it’s fitting that I entered the first week of 2024 feeling deeply fatigued with a tweaky tricep, shoulder, neck and IT band. Deload weeks, if you can let yourself relax into them, are actually quite enjoyable, although I think, true to form, I did a bit too much to consider the week a true deload.

PC: DB

On Friday, we paddled south to Burrewarra Point, a round trip of about 22 kilometres so maybe not the best deload, but after four days of no paddling, I started to feel that twitchy anxiety that I must surely have lost ten kilograms of muscle and be unable to hold the paddle for an hour, much less actually move the paddle through the water in an efficient manner. In a nod to deload week, I did however, paddle easy.

It was dynamic, in a lumpy kind of way. Lots of big waves, swell, clapotis and general confusion. East of Mosquito Bay where there are lots of bommies and reefs and shallow water, there were breaking waves from all over the place. It drizzled with rain (D for damp), and, as we neared the end of the paddle, we passed by a shark tagging boat with a Dusky whaler shark alongside being tagged and released. We pass the shark drum lines all the time but this is the first time we have encountered the team catching, tagging, measuring and releasing a shark. This one was 2.5 metres long, way off our guess of 1.5 metres!

When you skip  deload week, PC: DB

It’s Park Run day today but I won’t be there. Somehow, I’ve gone from forcing myself to attend the Park Run every week to ensure I get my intensity training done to enjoying the process. There’s a lesson in there, fake it until you make it, might just work. But my IT band is just beginning to recover and five kilometres at zone 4/5 is not recovery in any dictionary. I’m a bit (D for) disappointed, but perhaps I should instead (D for) delight in the freedom of the deload week.

Into The New Year

Will you have a New Years resolution this year? Did you have one (or more) last year, and, if so, how did that go? It will surprise no-one that I’m not a New Year’s resolution kind of person; although, like so many other people, I feel the temptation to start afresh on a date that, despite January 1 only having significance because we live in a society wide communal delusion wherein we’ve all agreed that somehow the 1^st of January is radically different to the 31^st of December, is really no different to any other.

It took me years to realise that the power of dates is almost the exact opposite to what we think. How often have we decided that we’ll start our new program of self improvement on a Sunday or a Monday (people seem to differ on which day they consider the first day of the week), or the first of the month (regardless of whether that falls on a Sunday or a Monday)? Too often in all likelihood. I know I did that for years before I woke up and realised the true power of dates is that if you want to change something you should start now, literally right now; which might be the third of the month, or the fifteenth, or even the last day of the month or even 2:00 pm on the 21^st of the month. The power is in the starting without delay because the longer you procrastinate the more grooved in becomes the habit you want to change. And, it’s all about habits. You are kidding yourself if you think you can go through life making rational and well reasoned decisions about every single choice in life (“thinking slow”). Success lies in developing a series of habits that are congruent with your goal.

Maybe you are a climber, maybe you’re not. Doesn’t matter. If you have any type of goal for 2024, read this essay by my favorite climbing coach, Steve Bechtel. I particularly like his strategy for dealing with fear – doesn’t matter whether it is fear of falling on a rock climb or fear of getting trashed in the surf in a kayak. Two things: one, I wish I’d written this essay because it is brilliant; and two, I wish I had read this essay 20 years ago. Eventually, I worked out that progressively practising success is a winning strategy but had that epiphany come 20 years ago, I would have progressed so much faster.

Here is one more essay for the new year which is about the power of labels. I dislike labels as they pigeon hole people into boxes which are hard to escape. But, this essay is not just about labels and boxes, it’s about metabolic health which is the biggest driver of modern disease today and is ubiquitous in Australia. A month could be all it takes to convince you that “no sugar, no grains, no industrial seed oils” makes a huge difference in, to quote Robb Wolfe “how you look, feel and perform.” Of course, we live in a free world, and if the latter is of no interest to you, you are free to continue with the former. In 2024, you get to choose your own box.