My Skin Ordeal

This is another post on my chronic health issue, psoriatic arthritis.

Over two years ago, after joint inflammation had mysteriously taken over my body, a new nuisance emerged: itching.

Large areas of my torso itched, and I didn’t know why. Was it a side effect of the drugs I was taking? My skin reacting to soap? Landry detergent? A new cat allergy? I couldn’t figure it out.

Eventually I stopped trying, coming to believe that it was part of my then newly-diagnosed condition–psoriatic arthritis.

Over the following months I developed a rash that came to encompass nearly half my skin: around my neck, under one of my arms, on one of my wrists/hands, across a large section of my abdomen and back, my crotch/buttocks, and a majority of my legs. It had a reddish hue and was mostly smooth, but in some areas there were bumps, too.

Some days I didn’t think about my skin, other days it was annoying.  At times I would awake at night scratching.  Sometimes I picked at my skin so much it started bleeding.

My rheumatologist, who said he dabbled in psoriatic arthritis skin treatment, opined that it looked like psoriasis, though not conclusively.  First he gave me nystatin to treat it.  Three months later he switched the prescription to fluocinonide. These cremes temporarily relieved some of the itch, but they didn’t reduce the underlying rash.

My ailment reached its peak this fall when my left thumbnail slowly died. Most of it came off a couple weeks ago.

Finally, I had enough, and reluctantly scheduled my first-ever appointment with a dermatologist (I hate seeing doctors). On the appointed day I went to be examined by a practitioner named Rash–no joke.

Ms. Rash looked me over for a couple minutes, then summoned an M.D. for a “what do you make of this?” second opinion. After taking a few skin “scrapping” samples to the back for enhanced examination, they tentatively concluded that my skin spots are not psoriasis but rather ringworm. Which is not caused by worms, but by a fungus. I’m covered with fungi, presumably.

If true, this is good news because a fungal infection is much more treatable. The dermatologist gave me a three-week course of terbinafine. After a few days I’ve seen a color change in some of the spots, consistent with this diagnosis. The skin has developed a white, powdery texture–as if I has been radiated, or maybe a fungus is dying.

I hope this ailment continues to clear up.  It would be nice to have normal skin again.

Lesson Learned: Sometimes it’s best not to make uninformed conclusions about a problem.  You may need an expert to evaluate it.

2015 Cherohala Skyway Fall Foliage Ride Report

Last week I drove to Tellico Plains, TN, to bicycle to the top of the Cherohala Skyway and enjoy the fall colors.

It was as nice an afternoon as I could expect in mid-October.  The temperature was 72F when I embarked at 2:00 p.m.

There was some traffic the first five miles along the Tellico River, less so the next six miles to Indian Boundary, and not much beyond that.

It’s easy pedaling along the river.

Thereafter, there’s a tough mile to the first overlook, then it’s rolling (but generally uphill) for the next five miles.

The serious climbing begins 11 miles into the Skyway.

I last did this ride five years ago.  Back then I reached the highlands after the leaves had peaked; this time I arrived before maximum color.  So it goes.

Common status during the long, slow (6-7 m.p.h) slogs: standing on and mashing the pedals, eyes focused slightly ahead of the front wheel, attempting to keep audible grunts/groans to a minimum, with a song repeating incessantly in my head.

The most vivid colors were red dogwoods and and other assorted red trees.

Conquering this road is a vastly different cycling experience than my typical rides.  There are rolling hills around Knoxville, but nothing strenuous like this.  It’s a tough climb–more so than going up the North Carolina side, I think.

Just as notable is the solitude.  No shopping centers, gas stations, or traffic lights.  Not even a visitor center.  Just a strip of pavement through the forest, with an occasional passing vehicle.

The aloneness with nature is a powerful experience.

I ran into issues when I got above 4,000 feet, near the North Carolina border.  By this time (~5:00 p.m.) shadows were extending on the east side of the ridge.  It was also breezy up there.  I got chilly, even while laboring uphill.

Moreover, I inadequately fueled myself.  All I brought was a granola bar and an apple.  That’s not enough to eat; I was hungry and running low on energy.

Finally, daylight was becoming an issue.  I had planned to be at the top at 5:00 p.m., but I was 20-30 minutes behind schedule.  I knew if I went all the way to the top I would be pushing it to get back before dark.

So four miles into North Carolina, 3.5 miles shy of the summit, I decided to turn around and head back.  I was bothered (still am) that after an afternoon of driving and climbing, I quit just short of my goal.  On the other hand, the prospect of freezing/cramping/bonking miles from civilization, with no support, was not a good thought.  Better safe than sorry.

Fortunately, none of my doom scenarios played out.  I warmed up once I got back in the sun.  I had enough gas in the tank to overcome the three returning hill climbs.  And no cramping.

I enjoyed one more hour amid ridges, lit by lengthening evening rays.  I got back to my car a few minutes before sunset.

Ride Statistics

Distance: 55.2 Miles

Time:  4:02

I didn’t see any wildlife during the ride, other than birds and squirrels.  But I did spot these cute bears in the Tellico Plains visitor’s center.

The End.

My Drug Addiction

I have psoriatic arthritis, an autoimmune condition which causes inflammation in my joints and skin.

For the past 2.5 years the symptoms have been moderate to severe.  For over 2 years I went through several different drug combinations, none of which consistently kept the swelling under control.  Despite hefty doses of immunosuppressants, I still had reoccurring joint flareups.  On the worst days one or both of my knees were so big that it was difficult to walk.  Some days I had a hard time putting on shoes or tying my tie.

Finally this summer I switched to a drug regimen which has succeeded in keeping my joint inflammation in check (although my skin is still a mess).  I can basically do all the things I used to do, every day, with little to no discomfort.  It’s also helped return my blood chemistry, pressure, and pulse back to normal.

The daily regimen consists of the following:

The good news is that these drugs have given me my joints back.  The bad news is that they do more than that.  The first three are capable of causing many serious side effects.  Infections, vision problems, diabetes, depression, cancer–to name just a few.

I would love to stop taking these drugs.  For most of my life I rarely took any pharmaceuticals, including aspirin.  But when your alternative to being a druggie is to be functionally disabled, it’s an easy decision.  You got to do what you got to do.

Hopefully research on the disease will someday soon present me with better options.  But for now I’m popping pills.

2015 Blue Ridge Breakaway

On 15 August 2015 I rode in the Blue Ridge Breakaway (BRB), which started at Lake Junaluska, NC.  It’s the first time I’ve done this event, which follows this route:

and has this elevation profile:

I arose super early and departed at 5:00 a.m. for Haywood County.  I should have left a bit earlier, because although parking and check-in went smoothly upon my arrival, I didn’t make it onto the road until a few minutes after the official 7:30 a.m. start.

I had previously ridden about half of the BRB route, but most of the first half was new to me.

The first seven miles–along highways 19 and 276–are mostly flat.  A gentle prelude to get warmed up on.

It was an overcast morning with patches of fog scenically shrouding the hills.  The weather forecast (in Knoxville) called for a lovely August day, partly sunny skies, highs in the upper 80s, with a slight chance of afternoon showers.  It didn’t turn out that way.

Saturday morning traffic was light.

After seven miles the route departs the highway onto rural roads.

The roads wind around and over hills.

This is the roller coaster part of the ride.  The terrain and curves keep you on your toes.  No snoozing here.

I haven’t ridden in virgin territory much in the last couple years, so it was fun discovering something new around every corner.

I stopped at the first rest area.  All of them, actually.

Fines Creek rest stop

The BRB had eight stops.  That’s more than I’ve seen on any other organized ride.  So it’s well supported in that regard.  But the food selection varied–some stops were much better stocked than others.  If I ride again, I’ll know where to look for the better food.

One criticism of the event, which didn’t affect me, but I heard other riders talking about: at least two of the stops didn’t have any mechanical support.  They didn’t even have an air pump.  The staff said they could call someone in to help, but that’s unneeded hassle and delay.  A rest stop should have essential tools.

Between miles 29-44 the route has several open, flat stretches of road.  I was fascinated by the topography.  The area is surrounded by mountains, but in the valley there’s more level riding than here in Knoxville.  A few times it appeared I was heading toward a tough climb, but then the road would weave its way through an unseen opening between the hills.

At mile 44, the route starts climbing on 215 through the forest, eventually passing by a lake.

Lake Logan

Me, posing with the view upstream from Lake Logan

I was lucky rider #6, out of what I heard was 100 century riders, and 300-400 total riders.

After the mile 50 rest stop, there’s a continuous ten-mile ascent.  Most of it is ~5% or less, but there are some steeper pitches.  I generally climbed in the 7-9 m.p.h range.

The first part is under forest canopy.

After the waterfall, the view opens up more.

At last I reached the Blue Ridge Parkway (BRP).

The views along this part of the BRP are spectacular.  Unfortunately, the promised sunshine never showed up during the ride.  At one stop I optimistically applied sunscreen, but it was all for naught.

Traffic was light on the BRP, even though it was the weekend.

At the mile 70 rest stop I got bad news.  According to radio chatter, there was rain ahead.  Not just a shower, but a “downpour.” A stop volunteer helpfully offered a poncho, which I stuffed in my jersey pocket.

Last photo before the rain

At mile 75 it started raining and continued to do so–in varying intensity–for the remainder of the ride.  Not a downpour, but enough to get wet.  And once you, your bike, and the road are wet, you’re wet.

The next five downhill miles weren’t fun.  It was sloppy, difficult to see (wet sunglasses), the poncho/parachute made a racket, and my wet brake pads didn’t grip.  I had to apply the brakes well ahead of the curves to negotiate the road.  If something had forced me to make an abrupt stop, I would have been in trouble.

I was relieved to reach the (temporary) bottom and slow down with the day’s final climb: eight miles up to Waterrock Knob.  And it was a slow, steady 7.5-8.0 m.p.h., most of the way.

Physically, this climb, and the day in general, went well.  I didn’t set any speed records, but I was in good enough shape to comfortably complete the event without any bouts of cramping.  My knees were good–no problems with arthritic inflammation.  The latter part of the ride I had some minor discomfort in my right hip, but it was tolerable.

View from the mile 89 rest stop.  Heavy rain in the distance.

Being concerned about my braking issues, I asked a rest stop attendant about any steep descents the remainder of the route.  He told me there wasn’t anything steeper than what I’d already seen on the BRP.

Turns out, he either he didn’t understand my question, or he forgot about this part:

When you turn off the BRP there’s a steep decent on Highway 19 back into Maggie Valley.  To make matters worse, the road is high traffic, has only two lanes at the top (it broadens to four in Maggie Valley), and a 50 m.p.h. speed limit.

Self-preservation being my top goal, I didn’t go anywhere close to 50 m.p.h.  I kept it under 25 m.p.h. regardless of how many vehicles were backed up behind me. [There was another cyclist just ahead of me, so I didn’t feel so bad about slowing traffic.]

Frankly, this three mile descent, and the last seven miles through Maggie Valley/Lake Junaluska, were my least favorite part of the ride.  It would have been O.K. if it was dry, but the sloppy conditions, combined with the traffic, left a sour aftertaste on what had otherwise been a tranquil outing.

At any rate, I was happy to make it to the finish line without getting run over by a monster pickup truck.  Officially I completed the 105.7 mile course (9,600 feet of elevation gain) in 9:10:08. According to my computer, 7:21:42 of that was riding time–the rest was stoppage time.

I was hungry and enjoyed the post-ride meal, which included two black bean burgers, nachos, coleslaw, and sundry snacks.

After I finished the rained stopped, the sun peaked out, and it turned out to be a nice evening.  Great timing.

Lake Junaluska

We decided to drive home the scenic route: a short stretch of the BRP, then through the Great Smoky Mountains National Park (GSMNP) to Townsend/Maryville/Knoxville.

There was a surprise awaiting just inside GSMNP.  I saw a bunch of cars lined up on both sides of 441, and then this:

Oconaluftee Visitor Center

Three elk!  It’s the first time I’ve ever seen them in the Eastern United States.  One was in the field and two were wallowing in a small ditch.

We reached Newfound Gap shortly before dusk, allowing one last look at the mountains:

Sunset over the Southern Appalachians

Although tiring, I enjoyed this full day.  Two thumbs up for the Blue Ridge Breakaway.  The scenery is terrific and the support is good.  I hope to do it again next year.

The End.

2015 Cherohala Challenge

On 20 June 2015 I completed my 9th Cherohala Challenge.  It’s become a tradition–my annual cycling Super Bowl, if you will.

The biggest issue going into this year’s edition was the weather.  When I checked the forecast at 4:something a.m., I saw that it called for  a 60% chance of rain, with a thunderstorm watch.  I’m no fan of cycling in the rain under the best of circumstances, and I certainly didn’t want to get caught in a thunderstorm in the mountains.  But as I embarked for Tellico Plains in the pre-dawn darkness, there was no way of knowing how the day would unfold.  I could luck out and stay mostly dry, or it could turn into a miserable wet day.

Event registration at sunrise

Registration check-in went smoothly.  The only issue was that we had to park in a field that’s farther away than the previous field.  This year there were nearly 400 riders, the most in over five years.  Due to the added walking time, I got rolling about five minutes after the mass start, when most of the century riders departed.

Two miles into the ride, looking back at the plains


At some point during the Challenge I inevitably ask myself, “Why am I doing this?”  Usually the question pops up 70-80 miles into the ride, while toiling up the mountainside.  But on this day it came much earlier, when it started raining 30 minutes into the ride.  Not a good omen.  It wasn’t a hard rain, but enough of one for me to question my sanity and contemplate how miserable conditions would have to get for me to turn back.

Fortunately, it only rained for a few miles, rendering my doomsday scenario moot . . . for the time being.

I stopped at the first rest stop for water and the porta-pottie, then continued.  The next several miles went without incident.

Vonore, TN

Along TN 72

At this point my camera went kaput, and I couldn’t take pictures for the rest of the day.  You can see pictures from the last 70 miles in my 2014 report.  The scenery this year was mostly the same, only much cloudier and wetter.

I encountered another short rain shower on the Chilhowee Lake section of the route.  One positive aspect about the conditions was that there wasn’t much wind in the morning, which can be taxing along the water.

After that it was on through the famed Tail of the Dragon, with its 311 curves in 11 miles.  Professional photographers stationed along the road captured some action pictures.

Traffic wasn’t too bad on the Dragon.  The dampness kept some people away.  A majority of the motorcycle traffic was of the Harley touring variety.  Most of them were courteous enough.  I didn’t get buzzed by many crotch rockets.

I stopped for lunch at the second rest stop, at the North Carolina border.  It had been 5+ hours since breakfast, and I was hungry.  So I ate a lot.  In addition to the usual assortment of junk/high-energy food, they had hot French toast.  I enjoyed the meal.

Thereafter I braked down the steep descent past Cheoah dam and then made the gradual climb through the Cheoah River gorge.  There’s little traffic on this road, and its remote setting–nestled along the river between ridges–lends itself to deep contemplation on life.  Or at least it does for me.

At the third rest stop I took stock of my physical condition in anticipation of the 12-mile mountain climb ahead.  I felt as good as could be expected, I just didn’t know what lay ahead on the Cherohala Skyway.  The sky was teasing us with a few breaks in the clouds.  So I applied sun screen, just in case.  But I knew that a thunderstorm could fire up at any point with little warning.

Onward through the woods bordering Lake Santeethlah on Joyce Kilmer Road.  Not only is this road secluded (just a handful of buildings and some camping spots) but it’s also rough.  Not a particularly enjoyable part of the ride, frankly.

But the scene quickly changes once you skirt the west end of the lake and turn onto Santeetlah Road.  You round a bend and suddenly it’s up, up, up the mountain on the unshaded roadway.

I climb relatively fast for my level of cycling.  Not that I climb fast, but compared to similar riders, it’s faster than my flat or downhill riding.  In short, most of the passing I do is going uphill.  Then the passees often catch back up either when I stop or on a downhill section.

Because of this I pass some riders 2-4 times.  One rider joked, “There goes 310 [my jersey number] again!” as I lumbered by.

A conundrum I encounter at rest stops: the toughest stretches are the ones immediately after I take a break.  My leg muscles tighten up when I stop, rather than rejuvenate.  It takes several minutes of pedaling to loosen them up again.  It makes me wonder if stopping is worth it.  But I have to stop, either for water/food, or to give my sit muscles/contact points a break.

It’s a problem.

Riding the Cherohala Skyway

It takes a couple hours to ascend the Skyway climbing at 6-8 m.p.h.  And during that time the weather can change, sometimes dramatically.  I almost made it to the top dry.  But with two miles to go it started sprinkling, then raining (the third time of the day).  Not a downpour, but enough rain that it got sloppy and difficult to see when I accelerated to 15 m.p.h. on the flatter stretch near the top.

The rain tapered off as I recharged at the peak rest stop.  But the wind picked up and visibility declined as a cloud enveloped the mountaintop.  By the time I started rolling downhill it was down to ~100 feet.  The first couple miles I was riding the brakes much more than normal because you couldn’t see around the corners.  Thankfully, things cleared up quickly once I got out of the cloud, because that segment was slow and nerve wracking.

The atmosphere got brighter and warmer (by about 20 degrees) as I wound down through the range into Tennessee and finally back to Tellico Plains.  My bicycle computer blanked out shortly before I finished, so I don’t know exactly what my riding time was for the 113-mile course. I finished at 4:40 p.m.

For the first time (that I’ve done it) participants got medals.

Everyone (who finishes) is a winner

Sadly, no podium girls awarded me the medal.  Just a middle-aged bald guy standing at the finish line.

All in all, it was another enjoyable cycling experience.  I would have preferred a warm, sunny day, but the rain showers were tolerable.  The event support and rest stops were good, as usual.  Given my health challenge the last two years (psoriatic arthritis), I’m thankful I can still tackle this demanding course.

I look forward to doing it again in 2016.

Virtual Therapist

This NPR story alerted to the newest kind of psychological therapist being built by the the University of Southern California Institute for Creative Technologies (ICT), in conjunction with the Pentagon.  I say built because “Ellie,” the experimental therapist, is not a person, but rather a computer.  In this instance “she” is being used to interview veterans and screen them for signs of depression and post-traumatic stress disorder.

Ellie works by asking the research subject questions and recording/analyzing his or her responses, as shown in this demonstration video:

Ellie focuses not on what the interviewee says, but on his or her non-verbal cues,  using an interactive technology called multisense:

Multisense automatically tracks and analyzes in real-time facial expressions, body posture, acoustic features, linguistic patterns and higher-level behavior descriptors (e.g. attention, fidgeting). From these signals and behaviors, indicators of psychological distress are inferred to inform directly the healthcare provider or the virtual human.

Studies have shown that Ellie interprets some of these expressions quite well.  Reportedly she asses the genuineness of a smile, for example, as well as a human psychologist.

This is a nifty technological achievement, certainly.  But what’s just as interesting to me as the computer capability is people’s willingness to interact with the computer.  Many people not only carry on the somewhat awkward conversation with the machine, but they actually share more than they would with a human counterpart:

“People opened up more to the virtual human than to a real person. They said they felt less judged by the virtual human,” [ICT psychologist Gale] Lucas said, even though they knew that their answers would be recorded and viewed later by workers in a lab.

“It’s about what’s happening in the moment — having a safe place to talk,” she added.

Why are interviewees more open when talking to a computer?  An article in Computers in Human Behavior elaborates:

participants who believed they were interacting with a computer reported lower fear of self-disclosure, lower impression management, displayed their sadness more intensely, and were rated by observers as more willing to disclose. These results suggest that automated VHs [virtual humans] can help overcome a significant barrier to obtaining truthful patient information.

Lower “impression management”?  That is the “goal-directed conscious or subconscious process in which people attempt to influence the perceptions of other people . . . they do so by regulating and controlling information in social interaction.”  In other words, interviewees are less concerned about being judged by the machine, and express themselves in a less inhibited manner.

Computers can also facilitate communication by being better listeners.  They can be programmed not to interrupt the speaker.  And they avoid distracting body language–e.g., looking around, checking the phone, and yawning.  Today it’s challenging finding a human who gives such undivided attention.

At any rate, given continuous technological advancements, we’re sure to chat with more virtual humans in the future.