San Francisco

I've just returned from a 10-day trip half-way around the world to Puerto Rico and San Francisco and back. 

Me racing under the Golden Gate Bridge in San Francisco at the ADA 5k.
Photo credit: Novo Nordisk

The study center visit to Puerto Rico provided a great opportunity to catch-up with the PEARLS clinical trial team at the University Hospital in Rio Piedras (see blog entry below). Albeit a relatively short visit of just four days, we crammed in many meetings to discuss progress and future plans, including phone meetings with our National Institutes of Health program officers up in Washington D.C.. Whilst the study is very challenging, the importance of undertaking health interventions in this underserved and overburdened community remains clear to us all I think, which keeps the team motivated. 

I left Puerto Rico late Thursday afternoon and flew via Houston to San Francisco, arriving at my hotel about 12 hrs later, in the early hours of the morning local time. The nine hour time difference meant everyone back home in Sweden was up and about, so I had a quick call with my wife to catch-up on life back home, before putting my head down for a few hours. 

For the past few years I've traveled extensively with work, clocking-up a couple hundred thousand miles of air travel. These trips often involve traveling to distant time zones, which can really mess with one's sleeping and eating routines, both of which are important determinants of metabolic health. So far as I can, I try to keep fairly aligned with European time, so I don't fall too far behind with work back home or suffer major jet-lag in either direction. Whilst getting up at 2 or 3am local time on the US east coast (8-9am back home) is doable for a few days, getting up at an equivalent time when I'm on the west coast (midnight local time) is completely impracticable, so a bit of jet-lag is inevitable! The early mornings allow time for a run or swim (usually in the dark!) and as well as conference calls with members of my team back in Sweden. E-mail responses are done by 5am, and an hour later I'll have located a cafe and be tucking into breakfast. By 8am, the first meeting of the day will have begun, with almost a full European working day behind me! The down-side to this topsy-tervy world is that nights are short, as dinner engagements often make getting to bed early impossible, but for a few days this is manageable.

My trip to San Francisco was for the ADA (American Diabetes Association Scientific Sessions), the annual Mecca for diabetologists in the US and beyond. The meeting attracts well over 10,000 clinician/scientists and includes hundreds of presentations on the state-of-the-science in diabetes research. These meetings are important events in my calendar, not only because they facilitate the exchange of new knowledge and ideas through formal presentations, but also (perhaps most importantly) because of the social networking opportunities. So I had many discussions on the sidelines of the congress, with almost every breakfast, lunch and dinner shared with past, present or prospective collaborators. 
   
The ADA, like many meetings for health scientists and health professionals, also includes a 5km run race for delegates and members of the local community. The race at this year’s ADA saw more than 1,000 people cross the finish line, with the fastest guys coming from Novo Nordisk’s team of professional runners, all with type 1 diabetes (see: www.teamnovonordisk.com/elite/).  

The start of the ADA 5km, with the Novo pros center and me far left.
Photo credit: Novo Nordisk

It’s half a lifetime ago that I last toed the line for a 5km race. With such a strong and deep field at this year’s ADA 5k, I knew the race would be fast. My hotel was a few kilometers from the start line, down by Pier 32 on the San Fran bay, right next to the Golden Gate Bridge. So I rented a bike from one of the many roadside bike stations around the city, and headed down to the start. The cold windy morning didn’t seem to have put anyone off, and the music and PA announcements blared out from a distance as I approached the start. After ditching my gear at the bag-drop, checking the course map, and catching-up with a couple of friends, we were corralled into the start area and moments later the gun went and we were off. Wow!! I’d forgotten how fast these things are. The three Novo Nordisk team pros went off like greyhounds out of the trap, with a thousand others in tow. I had no idea how to pace my race, as I haven’t come close to running this fast for at least a decade (perhaps two), so I just tried to hang with the front group as long as I could. I hit the first mile mark (1.6 km) in about five and a half minutes, with a bunch of guys ahead - all felt good. Living in a Sweden, where everything is expressed in metric units, I was trying desperately to recalculate my pace in mins/km, which felt analogous to the cognitive tests climbers do at high altitudes and divers do at the bottom of oceans to check their brains are working properly. Hypoxia was apparently getting the better of me though, and after a few rough guesses, I gave up and focused on running. At two miles the pace held and we hit a switch-back, which allowed a view of the runners coming up behind. The night before I’d had dinner with a great pediatrician friend and collaborator at Harvard, Marie-France Hivert MD, and her Canadian coworker Dr. John McGravy. Both are keen runners, and I knew John would be fast, having run competitively for many years through college and after. As I hit the switch-back I saw John was 10 meters down. Another half mile and we hit a second turn and headed back on ourselves, at which point John was hot on my heels, and with 400 m to go he passed me. My lungs were bursting as I tried to respond, but as we sprinted the last 100 meters to the line, I knew it was over, and I trailed in a second behind John at 18.07, to finish 9^th. What a great way to start the day!

Back in the Caribbean

The Kullamannen ultra now seems like a distant memory, albeit only a little over a week ago! My lungs, muscles and brain recovered quickly, with almost everything feeling back to normal within 3 days of the event... almost everything except an inflamed ITB (iliotibial band) that is!! The ITB is the long band that inserts into the hip and at its base into the outside of the knee (to the head of the tibia). About halfway through the Kullamannen it was starting to feel quite sore, but my stubbornly competitive nature convinced me to complete the event, perhaps unwisely!! 

The four runs I’ve done in the past week have all ended with more pain and inflammation in my knee, a clear sign that this is shifting from an acute to a chronic injury – the classic ‘runner’s knee’!! Fortunately, it’s happened at a good time, the point in my preparation where I’d planned to switch from just running to full on IronMan training, and it turns out that my knee feels just fine when I swim and bike, so I’ll put my running shoes on the shelf for a couple of weeks and focus on the other two events!!!!

Looking out from the apartment in Ocean Park, Puerto Rico

My wife Camilla is also 'IronMan training'. Her event is little over 2 weeks away in the south of France, so last week she and I swam and biked together. Cam’s an awesome athlete, so good that she made the Swedish women’s team last year, finishing 9^th at the world championships and top 10 in several other IronMan and half IronMan events in her age-group. Her next race is on a particularly challenging course that includes more than 2,000 m elevation on the bike, climbing up through the foothills of the southern French Alpes. She raced this event 2 years ago, and I myself raced it twice about 20 years ago, so it’s something of a favorite. Despite her achievements, Cam’s pretty new to triathlon. The IronMan in France, exactly 2 years ago, was her first ever triathlon (of any distance!!!), and five months prior to the race she couldn’t swim! But Cam’s an incredibly driven and athletically gifted woman, and so she learned to swim, trained hard on the bike and running for 5 months, and went out and hammered the IronMan, finishing high enough to qualify for the world championships the following year. Truly amazing!!

Late last night I arrived in San Juan, Puerto Rico for a four-day visit to the University Hospital in Rio Piedras, where our clinical trial is based (see post below). It’s my first visit since January and much has happened on the trial since then. The US Government sponsors the trial and took some major decisions in March concerning how we should proceed, which have required considerable reorganization. The team here in Puerto Rico has been doing a stellar job coping with these new challenges, led by my co-Principal Investigator Prof. Kaumudi Joshipura. Today I’ll met with the team to hear how they’re fairing, and to receive updates on progress with data collection and participant interactions.  This is very much a real-world trial, with participants recruited from a population in desperate need of health intervention. The trial is focused on helping these pregnant women manage weight gain during their pregnancies and to teach them about healthy diet and other lifestyle habits, which we’ll help them sustain during the first 12 months of their babies’ lives. Behavior change is always a major challenge, especially in tightknit communities where social pressures to eat lots of unhealthy foods and refrain from being physically active prevail. But as much as these factors make this trail hugely challenging, they also make it extremely important. So the work we’re doing here, will, I hope, have numerous positive knock-on effects, which in some shape or form will help improve the lives of these women and their children.