Finally, a wheel that does more than roll down the road! The new Mavik R-Sys has broken all the rules. The new wheel not only succeeds in rolling like your typical wheel, but has the capability of literally "launching" you down the road, creating an intense boost when you least expect it. Adding this wheel set to your quiver of high tech components will certainly make you the talk of your weekly group ride. You will soon be giving performances that no one will soon forget.
The technology underlying the R-Sys is a closely guarded secret at Mavik. But when contacted by this reporter and pressed about the ability of their wheel to "explode" out of corners and "dissolve" while hugging the tightest corners while flying down a mountain road, hubris took over and they felt they had to share more of the technology surrounding this wheel.
Mavik says the R-Sys is developed as a compression/tension carbon fiber spoke rather than the traditional tension spoke system. When designing the R-Sys, Mavik said they were looking for something more than a wheel that just spins predictably. To do this, they ultimately had to rely upon design based upon the physics of string theory and particle physics, which allows Mavik to incorporate random generated variables into wheel performance. Explaining how the new wheel is designed, Mavik spokesman Rip Meoff states "Over the next few years, string theory and particle physics are really going to become more standard in wheel and overall bike design. Both string theory and particle physics include random components that give the new R-Sys everything that a traditional wheel includes, plus that little extra "je ne sais quoi" that boosts performance. Clearly, when you base your wheel design on the same math used to explain black holes and predict time travel, you have a wheel that has tremendous potential. While we still don't understand all of the math underlying the new design, the benefit is clear: the possibility to travel through time should the wheel hit the "sweet spot" of speed, vibration, rider weight, and proximity to a 1500 foot dropoff"
Knowing that Mavik was on to something radically different, they knew they also had to make a "quantum leap" in the quality control systems for the new wheel. Mr. Meoff continues, "Mavik used to base quality control on traditional methods, such as six sigma, and other time tested quality control mechanisms. We began to question how applicable these methods would be to a wheel that is based upon mathematical models that few people understand and in many ways are not yet fully developed or supported in the scientific community. The problem with using our old quality control process was that we were often left without any real world failures to study. Thus we never really knew what could fail or how bad things could get. We believe this is what the cyclist is really concerned about -- what is the incremental risk to get that incremental performance edge? Not some six sigma, whatchamacallit evaluation that ensures failure is remote.
As a result, we decided to move solely to mathematically derived product testing. Mavik solely relies on equations to prove our products will work, albeit in a random manner. This saves Mavik considerable time to market and placed the product out on the road much sooner than if we would have used our traditional quality control approach. We believe this is what our customers want: Performance, but with the potential for the random ability of time travel. We think we've built that into the R-Sys wheel system"
Along with this new approach to quality control, Mavik has instituted a replacement policy for the R-Sys wheelset. In the event the wheel does randomly fail, customers can return the wheel to Mavik and they will replace the wheel within six months. "In the interim", Mr. Meoff explains, "you most likely will be recovering from a few bumps and bruises anyway, so an immediate replacement policy really didn't seem to make sense to us."
http://www.velonews.com/photo/93059
http://www.velonews.com/photo/93056
http://www.velonews.com/photo/93063
Sunday, September 13, 2009
Sunday, July 5, 2009
Cancer Hurts
Unfortunately, ever since the surgeries to remove my lymph nodes, and since the cancer has spread to my lower, middle, and now upper spine and neck, I've started having various pains throughout my body. My left arm became numb and now swells from the removal of all the lymph nodes and two of my fingers (pinky and ring) don't work like they used to. And I have constant, dull pain, especially when it is hot or I move around or sleep on the arm. My back and neck are in constant pain, unless I am taking my meds.
More recently, especially over the last four to six months, the pain increased to the point, where I couldn't work any more. It was impossible to sit at a desk and work on a computer or sit through hours of meetings without having pretty severe pain. Up until then, at times, I was able to manage the pain to a certain extent with only pain meds. But the problem is that the amount of meds I have to take to manage the pain became a bit much and even then I still have quite a bit of pain. I've tried stretching, meditation, and some of the holistic approaches, but really the only thing that works in the heavy duty pain medications, which I can handle mentally to a certain extent, but they do make me sleepy, lethargic, and not as sharp as I used to be at work. The pain also makes me very irritable, which is something I am not used to. My nature has always been more layed back, but when you are dealing with 24/7 pain and not getting your eight hours a night sleep, you get pissy. I really feel sorry for Jen because she has to deal with it, but she has done a great job of not letting me get away with being a pain in the ass because of the effect of the meds and pain
More frustrating is that I haven’t been able to work out or ride my bike since I had the operations. I have slowly started some exercise again, but I have to be careful to pick the right exercise and timing so I don’t exacerbate the problem. I am a tremendous grouch when I am not working out, it has been such a part of who I am that not working out has had a profound effect on my attitude.
Last week (last week of May), I finally saw a pain specialist at UCLA with Jen. I think this was a smart move because we were able to get a professionals perspective on the level of pain meds I've been taking (I'm currently at the low end of the scale, which makes me feel better), the doctor also came up with some alternative products that we might want to start using if the existing cease to work. The doctor even recommended picking up exercise again. Since then, I've made a point of walking the dogs, or going to a couple spin classes with Jen, and just getting out and about as much as possible. It hasn't necessarily helped with the pain, but it has helped with making me more tired so I can fall asleep at night.
Some Good News?: Recently I noticed that my neck has a bit more flexibility without pain. I am hoping that the new chemo drug, Sutent, is having some effect on the mobility in my neck. We won't know for sure until we have our next round of scans and confirm that there is tumor change. I'm certainly hoping that is the case. As of today, I am on my fourth pill out of a twenty eight pill cycle. So, in three or so more weeks, we should have an idea of how well the new pills are working.
More recently, especially over the last four to six months, the pain increased to the point, where I couldn't work any more. It was impossible to sit at a desk and work on a computer or sit through hours of meetings without having pretty severe pain. Up until then, at times, I was able to manage the pain to a certain extent with only pain meds. But the problem is that the amount of meds I have to take to manage the pain became a bit much and even then I still have quite a bit of pain. I've tried stretching, meditation, and some of the holistic approaches, but really the only thing that works in the heavy duty pain medications, which I can handle mentally to a certain extent, but they do make me sleepy, lethargic, and not as sharp as I used to be at work. The pain also makes me very irritable, which is something I am not used to. My nature has always been more layed back, but when you are dealing with 24/7 pain and not getting your eight hours a night sleep, you get pissy. I really feel sorry for Jen because she has to deal with it, but she has done a great job of not letting me get away with being a pain in the ass because of the effect of the meds and pain
More frustrating is that I haven’t been able to work out or ride my bike since I had the operations. I have slowly started some exercise again, but I have to be careful to pick the right exercise and timing so I don’t exacerbate the problem. I am a tremendous grouch when I am not working out, it has been such a part of who I am that not working out has had a profound effect on my attitude.
Last week (last week of May), I finally saw a pain specialist at UCLA with Jen. I think this was a smart move because we were able to get a professionals perspective on the level of pain meds I've been taking (I'm currently at the low end of the scale, which makes me feel better), the doctor also came up with some alternative products that we might want to start using if the existing cease to work. The doctor even recommended picking up exercise again. Since then, I've made a point of walking the dogs, or going to a couple spin classes with Jen, and just getting out and about as much as possible. It hasn't necessarily helped with the pain, but it has helped with making me more tired so I can fall asleep at night.
Some Good News?: Recently I noticed that my neck has a bit more flexibility without pain. I am hoping that the new chemo drug, Sutent, is having some effect on the mobility in my neck. We won't know for sure until we have our next round of scans and confirm that there is tumor change. I'm certainly hoping that is the case. As of today, I am on my fourth pill out of a twenty eight pill cycle. So, in three or so more weeks, we should have an idea of how well the new pills are working.
Saturday, July 4, 2009
Neuroendocrine Tumors: How many people get them?
Overall, Neuroendocrine Tumors (NET) are seen in a variety of organs. My tumor, just happens to originate in the Thymus, which is very rare, even for a NET. Less than 1% of NET are found in the Thymus. The overall occurrence of NET's in the population is 2-4 per 1000 people. If you work this math out, about 20 to 40 people in the United States will get a NET originating in the Thymus each year, a very select group.The problem with this is that there are not enough patients with this type of disease that any major medical centers or doctors can get experience with the tumor, so there really isn't a standard of care like you have with Breast, Lung, Colon and other cancers that have a much larger patient population.
Monday, June 22, 2009
Health Economics 101
Health Economics 101: Avastin is part of a new class of drugs called mono-clonal antibodies. They are protein based drugs that can have decent efficacy with minimal side effects. I know quite a bit about these types of drugs because the company for which I work, Amgen, also sells similar drugs, or what we call "biologics". These are expensive drugs. One treatment of Avastin is $13,000 to $15,000-- ONE TREATMENT. Knowing this, I made sure my insurance would cover the cost of treatment, and I was assured that the drug did not require pre-approval (more about this later). So I started treatment.
Compared to chemo, there were absolutely no side effects from Avastin. I took it in the morning and was back at work in the afternoon and eating pizza by night. No problems period. However, about three days before my third scheduled treatment, I received a $28,000 bill from UCLA. OUCH!!!! It turns out "doesn't require pre-approval" does not mean that they will necessarily pay for something. I had to make the decision to continue with a treatment that would cost me $14,000 every three weeks for an unknown period of time (if the drug was successful, I could be on it indefinitely), or stop treatment. I made the call to stop treatment, no easy thing to do when you know you have tumors growing in your body and this treatment is your best chance at slowing their growth.
My doctor was great with helping me through the situation, but I essentially went without treatment from October 2008 until May 2009, since there wasn't any treatment that the insurance company would reimburse. Given that what I have is very rare, there really isn't a standard of care and my insurance company calls everything the doctor recommends "experimental" and thus they won't pay for it. I decided (or rather was forced) to take a few months of a break to sort out my options and focus on work.
Compared to chemo, there were absolutely no side effects from Avastin. I took it in the morning and was back at work in the afternoon and eating pizza by night. No problems period. However, about three days before my third scheduled treatment, I received a $28,000 bill from UCLA. OUCH!!!! It turns out "doesn't require pre-approval" does not mean that they will necessarily pay for something. I had to make the decision to continue with a treatment that would cost me $14,000 every three weeks for an unknown period of time (if the drug was successful, I could be on it indefinitely), or stop treatment. I made the call to stop treatment, no easy thing to do when you know you have tumors growing in your body and this treatment is your best chance at slowing their growth.
My doctor was great with helping me through the situation, but I essentially went without treatment from October 2008 until May 2009, since there wasn't any treatment that the insurance company would reimburse. Given that what I have is very rare, there really isn't a standard of care and my insurance company calls everything the doctor recommends "experimental" and thus they won't pay for it. I decided (or rather was forced) to take a few months of a break to sort out my options and focus on work.
I'm Cured?
I'm Cured?: Having gone through the surgeries, chemo, and radiation my doctors were very optimistic that I had a high chance of being cured. The most optimistic was convinced I was cured while the more conservative thought I had a mere 15% chance of the cancer coming back. It was during this initial period of remission, that, ironically, I suffered from the most anxiety. It is hard to explain but having gone through aggressive treatment and still being pretty weak, I couldn't help but worry that the cancer would come back and I would back in treatment again. Also, I knew if it came back, it was likely incurable and I would be dealing with it for the rest of my life.
On the bright side, I started riding my bike again within one week of completing chemo and took a new position at work in the Corporate Real Estate Group, which I enjoyed. The biking was great since I had built up a new titanium bike while I was sick so I would have something to look forward to when I was done with treatment. I began to ride 150 up to 250 miles a week, which is quite a bit of mileage for someone just out of chemo treatment. And within six months, I rode from San Francisco to LA in a sponsored bike ride that raised money for arthritis patients. I absolutely felt great and was back to 100%, although I still was carrying quite a bit of anxiety around about the whole ordeal. Also, Jen and the kids were all doing great and we continued to make plans for the future, having believed we dodge a rather large bullet, we even put our house on the market, planning to move to Santa Barbara since that is where we ultimately want to live. We figured we might as well live where we want to live after having gone through what we did (Ultimately, this fell through but that is a different story altogether).
What's that under my arm?: Every three months, I would get a PET/CT scan. This is a scan that can detect any new or recurring cancer. I went in for my quarterly screening just before Christmas in 2007. I got the call from my doctor a few days later, he said there was a bright spot under my arm showing up on the PET scan, but most likely it was from an infection and not cancer related. Of course, this drove me crazy because up until then every scan had been totally clean. They recommended waiting another three months and then do another scan to see whether the bright spot on the scan was still there.
In the month after I got this first result, I noticed that I could feel a hard lump forming in my armpit, so I went into the Oncologist. He also felt the hard lymph node. He still didn't think it was anything, but since it was such a low risk procedure to remove the lymph node, he recommending removing it, since then we would be 100% certain what was going on.
Biopsy 2: The second biopsy was also an out patient treatment. I was in and out in a couple of hours. The doctors couldn't tell much from looking at the lymph node, but said they would have pathology results within a week. A week passed and I went into the doctor’s office. It turns out that the lymph node was in fact cancerous, so I was back in action for more surgery, radiation, etc.
I don't think most people realize the seriousness of a recurrence of cancer. When cancer first shows up, if it is limited to a small area or can be removed by surgery, you have, many times, a very good chance of a cure. Even with chemo, radiation, etc., if you get rid of the cancer from the primary site, it is very good news. However, when cancer comes back, and it comes back to an area that is not close to the original site and it is the same type of cancer (thymic cancer in your bone for example), this is not good and in most cases it means the cancer is most likely incurable. Given that my cancer recurred in my lymph underneath my left armpit, which is pretty far away from the original location, it was indicative of metastasis. Or in other words, the cancer had spread widely throughout my body, not good news.
At this point, we decided to remove ALL of the lymph nodes under my arm. There are anywhere from 25-40 lymph nodes in this area. It varies from person to person. We decided that there was a small chance that the cancer had spread there via my chest wall and therefore we still had a small chance for a cure, if we could remove all of the cancer cells and be lucky enough that the cancer had not spread anywhere else.
Surgery 2: This surgery was done by a different surgeon than my first three procedures. The procedure I had was the same procedure that woman have when they biopsy lymph nodes for breast cancer. Therefore, I had the chief breast cancer surgeon perform the surgery since she was more familiar with identifying and removing lymph nodes in this area. The plan was to keep taking out lymph nodes until she was confident that any remaining were cancer free. In total she removed about 30 lymph nodes and about 12 of them tested positive for cancer cells.
Jen and I were pretty shocked to learn that so many nodes were positive for cancer, this means the cancer definitely has the ability to move throughout my body, which is not a good sign. The doctors at this point still thought it would be worth radiating the whole area under my arm, just to make sure all cells were killed. And if this was the only place the cancer had spread, then I still had a chance of a cure. However, before they would get me setup for radiation, I needed to have additional scans of my whole body to ensure that the cancer had not metastasized anywhere else, otherwise the radiation would be a waste. You may wonder why this is, well, if the cancer had metastasized outside of the area then it meant that the cancer got there via either my blood or lymphatic circulation, rather than through the muscle of my chest. If the cancer had spread via my chest wall, then it would possibly mean that the cancer had not spread throughout the rest of my body. Earlier scans had not indicated any other cancer in my body.
I went for these scans and we were about ready to start radiation treatment when I got the call from the radiologist. He saw a very small "bright spot" on my hip joint. It had been there before in other scans and didn't think it was anything, but wanted to perform a more detailed MRI of my whole spine and hip to make 100% sure I was clear. He said he was 95% sure it wasn't anything but wanted to check. Well, I had the MRI and it turns out that I, in fact, did have signs of cancer throughout my hip socket, upper femur, hip, and lower spine, but it was very small and difficult to make out. The tumors were smaller than bb size. At that point, we canceled the radiation since it would have been a mistake to take on extra radiation if it was possible the cancer had spread. This was in June of 2008.
About a month later, my Oncologist called and said he had reviewed the scans and had the experts at UCLA review them as well. Given my PET/ct scans were negative for cancer, but the MRI was positive there was still a small chance that what they were seeing wasn't cancer, but they were pretty sure that it was. He recommended I start treatment with a new product named Avastin and then have scans in a few months to see if there was any change to the tumor size/location.
On the bright side, I started riding my bike again within one week of completing chemo and took a new position at work in the Corporate Real Estate Group, which I enjoyed. The biking was great since I had built up a new titanium bike while I was sick so I would have something to look forward to when I was done with treatment. I began to ride 150 up to 250 miles a week, which is quite a bit of mileage for someone just out of chemo treatment. And within six months, I rode from San Francisco to LA in a sponsored bike ride that raised money for arthritis patients. I absolutely felt great and was back to 100%, although I still was carrying quite a bit of anxiety around about the whole ordeal. Also, Jen and the kids were all doing great and we continued to make plans for the future, having believed we dodge a rather large bullet, we even put our house on the market, planning to move to Santa Barbara since that is where we ultimately want to live. We figured we might as well live where we want to live after having gone through what we did (Ultimately, this fell through but that is a different story altogether).
What's that under my arm?: Every three months, I would get a PET/CT scan. This is a scan that can detect any new or recurring cancer. I went in for my quarterly screening just before Christmas in 2007. I got the call from my doctor a few days later, he said there was a bright spot under my arm showing up on the PET scan, but most likely it was from an infection and not cancer related. Of course, this drove me crazy because up until then every scan had been totally clean. They recommended waiting another three months and then do another scan to see whether the bright spot on the scan was still there.
In the month after I got this first result, I noticed that I could feel a hard lump forming in my armpit, so I went into the Oncologist. He also felt the hard lymph node. He still didn't think it was anything, but since it was such a low risk procedure to remove the lymph node, he recommending removing it, since then we would be 100% certain what was going on.
Biopsy 2: The second biopsy was also an out patient treatment. I was in and out in a couple of hours. The doctors couldn't tell much from looking at the lymph node, but said they would have pathology results within a week. A week passed and I went into the doctor’s office. It turns out that the lymph node was in fact cancerous, so I was back in action for more surgery, radiation, etc.
I don't think most people realize the seriousness of a recurrence of cancer. When cancer first shows up, if it is limited to a small area or can be removed by surgery, you have, many times, a very good chance of a cure. Even with chemo, radiation, etc., if you get rid of the cancer from the primary site, it is very good news. However, when cancer comes back, and it comes back to an area that is not close to the original site and it is the same type of cancer (thymic cancer in your bone for example), this is not good and in most cases it means the cancer is most likely incurable. Given that my cancer recurred in my lymph underneath my left armpit, which is pretty far away from the original location, it was indicative of metastasis. Or in other words, the cancer had spread widely throughout my body, not good news.
At this point, we decided to remove ALL of the lymph nodes under my arm. There are anywhere from 25-40 lymph nodes in this area. It varies from person to person. We decided that there was a small chance that the cancer had spread there via my chest wall and therefore we still had a small chance for a cure, if we could remove all of the cancer cells and be lucky enough that the cancer had not spread anywhere else.
Surgery 2: This surgery was done by a different surgeon than my first three procedures. The procedure I had was the same procedure that woman have when they biopsy lymph nodes for breast cancer. Therefore, I had the chief breast cancer surgeon perform the surgery since she was more familiar with identifying and removing lymph nodes in this area. The plan was to keep taking out lymph nodes until she was confident that any remaining were cancer free. In total she removed about 30 lymph nodes and about 12 of them tested positive for cancer cells.
Jen and I were pretty shocked to learn that so many nodes were positive for cancer, this means the cancer definitely has the ability to move throughout my body, which is not a good sign. The doctors at this point still thought it would be worth radiating the whole area under my arm, just to make sure all cells were killed. And if this was the only place the cancer had spread, then I still had a chance of a cure. However, before they would get me setup for radiation, I needed to have additional scans of my whole body to ensure that the cancer had not metastasized anywhere else, otherwise the radiation would be a waste. You may wonder why this is, well, if the cancer had metastasized outside of the area then it meant that the cancer got there via either my blood or lymphatic circulation, rather than through the muscle of my chest. If the cancer had spread via my chest wall, then it would possibly mean that the cancer had not spread throughout the rest of my body. Earlier scans had not indicated any other cancer in my body.
I went for these scans and we were about ready to start radiation treatment when I got the call from the radiologist. He saw a very small "bright spot" on my hip joint. It had been there before in other scans and didn't think it was anything, but wanted to perform a more detailed MRI of my whole spine and hip to make 100% sure I was clear. He said he was 95% sure it wasn't anything but wanted to check. Well, I had the MRI and it turns out that I, in fact, did have signs of cancer throughout my hip socket, upper femur, hip, and lower spine, but it was very small and difficult to make out. The tumors were smaller than bb size. At that point, we canceled the radiation since it would have been a mistake to take on extra radiation if it was possible the cancer had spread. This was in June of 2008.
About a month later, my Oncologist called and said he had reviewed the scans and had the experts at UCLA review them as well. Given my PET/ct scans were negative for cancer, but the MRI was positive there was still a small chance that what they were seeing wasn't cancer, but they were pretty sure that it was. He recommended I start treatment with a new product named Avastin and then have scans in a few months to see if there was any change to the tumor size/location.
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