Inkwell: Authors and Artists

    

We're please to welcome our next guest into the Inkwell: flash gordon.

Dr. flash gordon attended University of Miami (Florida) for both his
undergraduate and medical school. His Emergency Medicine Residency was at
Henry Ford Hospital (Detroit) and he was certified by the American Board of
Emergency Medicine in 1980. He has served as clinical faculty at University
UCSF School of Medicine, was Director of the Emergency Medicine Residency
Training Program at San Francisco General Hospital (Mission Emergency) and
was Medical Director and Chief of the Medical Staff at the Haight Ashbury
Free Clinic. He has been online since 1980, is married to a biophysicist /
consultant / triathlete, and has practiced in Marin County since 1990.

He has been writing about medicine and motorcycling since the mid-eighties;
first for Citybike, Northern California's Motorcycling Monthly Magazine; for
various national motorcycling publications, and for the last several years
his column Medical Motorcycling has been featured in Motorcycle Consumer
News, a national monthly magazine.

Leading the discussion with flash is Michael Bettinger, a counselor,
educator, writer and biker, originally from Brooklyn and living in San
Francisco for the past thirty two years. He retired four years ago after a
thirty three year career as a psychotherapist and family therapist, working
primarily with gay men and gay male couples. He is the author of Its Your
Hour: A Guide to Queer-Affirmative Psychotherapy. He has ridden motorcycles
for the past forty one years and presently rides a 1992 Harley Davidson FXR.
He is also the "disorganizer" of the annual Queer Biker Invasion of Death
Valley.

Welcome, gentlemen!
  

    
Hi Flash and everyone else,

I’m glad to be here and to be leading the discussion.   I’ve known you
for the past 16 years through is role as the host of the ride, and
other conferences on the Well, in addition to having read your column
in various motorcycle publications over the years.    With this book,
we get a lot of you at one time.   Let me begin by telling you and
others of some of my reactions to the book.

First, my impression is that the book is not just for the
motorcyclist.  It is more of a book on taking care of oneself.  Since
it was originally written as a column in a motorcycle magazine, it is
talking directly to motorcycle riders.   But most of the information in
the book is helpful for anyone.  It is a self help/taking care of
oneself book which happens to be written by a physician, who happens to
be a biker, who happens to be talking to other bikers.   I believe it
is much more about you, flash, as a physician, than as a motorcyclist. 
You draw on your knowledge of the kind of medical issues often faced
by motorcyclists.  But these are medical issued faced by most people at
some time or other, not just bikers.  And many of the subjects are
completely unrelated to the motorcycle experience.   They are just
issues everyone, including motorcyclists deal with.

This book contains a huge amount of information.   Flash
systematically goes over many of the body's systems and explains to the
reader how it works, and what might go wrong and why.  Even though I
consider myself to be medically quite knowledgeable for a non
professional, I learned a lot about my body and how it works from the
book.   

It is a book that begs to be read slowly, to be able to absorb a lot
of what is written. That it is chock filled with information also makes
it a difficult book to read right through.   These original columns
were written to be read one a month, and absorbed for a period of weeks
before the next one comes hits the news stands.  In the book, you get
it all at once.   It is therefore a book to be read slowly, over a
period of weeks.  It is not a page turner that keeps one up all night. 
It might be a good book to read while commuting on a train or a bus
(but not on the bike!).  

I liked how you took the complex medical information and simplified it
in order for the readers to be able to understand how the body works. 
Seeing the simple in the complex is a lot more difficult than it
seems.  It is hard work to explain in simple terms something you
understand as a physician in complex ways.  This is one of the
strengths of the book.

My sense is that you appear to be trying to empower the reader to
understand a lot of what might be happening to him or her, and to be
able to triage what is going on.  The goal of that is that you want the
reader  to be able to make an intelligent decision about whether and
how to self treat, whether to call a doctor for an appointment, or
whether to get emergency treatment.   You are good at making it
emphatic when to get emergency treatment (nice hearing that from
someone Board certified in emergency medicine).  I believe it is
difficult for a lot of guys, especially macho bikers, to ask for help,
particularly emergency help.    We guys are taught to use a lot of self
denial ("I'm ok. I can deal with this").   Macho bike riding men (and
some women) have difficulty in acknowledging something needs immediate
attention.

You also have a nice writing style.   I like the way you are direct,
playful, self deprecating ("Don't ask me how I know this").  You are
easy to read. 

Those are some of my initial reactions to the book. Glad to be here
and looking forward to seeing how this discussion goes. 
  

    
wow - what great things to read!  how much do i owe you??
  
                      %^)

very insightul comments, michael.  i do try really hard to condense as
much as i can into exactly 1000 words (which is the original length of
each column - some have been altered for the book).

as for empowering folks - well, that's the right thing to do.  it's
like the old saying:

"Give a man a fish, you feed him for a day. Teach a man to fish, and
run the risk of overfishing, contravening EU fishing policy, reducing
the biodiversity of the world's oceans and increasing the economic
decline of our once-great fishing industry."

or something like that.

i see the writing i do in the book as a kind of practice of medicine.
when i practice, i try to keep in mind that the root words for
"doctor" and "teaching" (doctor / doctrine) are the same. i think
doctors (at least, primary care docs like me) have a responsibility to
teach folks what's going on with their bodies and health.
  

    
flash - I find when I write about anything, I get clearer on what I
believe about the subject.  The process of writing changes me and
empowers me.    When I wrote a book about psychotherapy, I got a lot
clearer on what I was about as a psychotherapist.

I was wondering if you had similar experiences writing these columns
and then compiling them into a book.  Did having to write all that out
in clear and simple ways have an impact on you as a physician, or how
you went about practicing medicine?
  

    

(NOTE: Offsite readers with questions or comments may have them added to
this thread by emailing them to <inkwell@well.com> -- please be sure to
type "flash gordon" in the subject line. Thanks!)
  

    
well, having condensed that info helped when i was explaining things
to patients. since i'd already put a lot of thought into finding the
best way to express a concept, it was easy to "plagiarize" myself when
i was talking to patients.

and since i wrote about things that i saw the most as a doc, it came
in handy a lot. so i guess you can say that it did make things easier.

another benefit was that when writing about a subject, i'd do a quick
review of the literature to see if there was something new worth
talking about. this would sometimes lead me to information (sometimes
on another subject) that was new and interesting.

for example, i recently wrote a column about hernias and hernia
repair. one of the questions was comparing repairs done the "old" way
(with an incision, and often using mesh) to using a laparoscope. 

one of the advantages of using a laparoscope is that the cut in the
skin is a lot smaller, which causes much less pain and promotes a
faster recovery. laparoscopes are now used for everything from gall
bladder removal (one of the original uses) to hernias.

i found that now they're starting to use laparoscopes to remove
gallbladders *through the stomach* - without any skin incision at all!
the scope goes down the patient's throat, into the stomach, and
through the stomach wall into the abdominal cavity. once in there, the
gallbladder is removed, just as if the surgeon had enterered through
the wall of the abdomen. 

this was news to me.  
  

    
That kind of operation sounds so sci-fi.  I'm happy that my personal
experience leaves me knowing nothing about those kinds of surgery.  But
I do like the idea of a quicker recovery time that those kinds of
surgery seem to result in.

I find the same thing is true in that when I've written about
something, it helps me to succinctly explain to someone else what that
is about.  I think some of that idea behind a physicians training, "see
one, do one, teach one", involves getting clear enough on something to
be able to simply explain it to another person.

Now I understand this book came about as a compilation and expansion
of columns published once a month in a motorcycle magazine.   In the
original form, they were read almost exclusively by bikers.   I am
aware that this world is filled with guys who have a tough, "I can take
care of myself attitude".  I was wondering what kind of feedback have
you gotten from those guys.   And, are you getting feedback on the book
from non bikers?  Is it any different from the feedback bikers give
you?
  

    
i get feedback thru letters to the editor of motorcycle consumer news,
which is where the column's now being published. most all of them are
positive. 

now and then i'll write something that seems to generate more
feedback: for example, the column on "farts" (it's in the book) got
multiple letters, almost 100% in favor. 

another column on benign positional vertigo (dizzyness w/ head motion,
that's usually simple to fix in a few minutes in the office) got lots
of feedback, too. many people either had it themselves or had a friend
or relative w/ the problem. 

not all docs know that fixing BPV is usually a quick, simple office
procedure that just involves tilting and rolling somebody around in a
certain precise way. since it's something i've had myself, i
researched it and found out how to do it. 

in fact, i think that having had a fair number of medical conditions
myself that i write about makes it easier to empathize and explain
things. that's why it might be better to find an aging, semi-decrepit
physician - he's already experienced a lot of stuff that he's taking
care of first hand.
  

    

<flash> After seeing this topic I was reminded of meeting you IRL on the
Harvey Gamage schooner in the Carribbean too many years ago. I started
thinking about vacations since I really need one about now. Then I my mind
wandered into the realm of how some vacations can have long term affects
since I still remember that one pretty well. In turn that led me to wonder
how your vacation experiences have affected you and perhaps have been
reflected in your writing, if at all?

For the curious, the schooner looks like this:
http://sterlingcollege.edu/HTML%20e-mail/august%20e-news/images/seamester.jpg
  

    
(jmcarlin) - nice schooner.

I can attest that vacations change me in a lot of ways.   It was on a
flight home from a vacation in China four years ago when I realized I
really didn't want to go back to work and on the plane I decided to
retire from being a family therapist, and spend the rest of my life
riding my motorcycle, playing the conga drums, doing my spiritual
studies, and getting laid.  I have my priorities in my senior years.

But what your post reminded me of is all the vacations I have taken on
my motorcycle.   From the first time I did a cross country ride on
motorcycle in 1968, I've been hooked on long distance riding.  Each
summer I take a ride that usually winds up being about 3,000 miles.  
Last year it was to Yellowstone.  

It was on many of those rides that I got to experience many, many of
the medically related issues to which flash refers in his book.  That
includes pavement dermatitis (fortunately, not for many years now),
hypothermia, redneck, cramps, numb hands, stuff caught in the eye, butt
farts, brain farts and monkey butt just to name a few.   

One of the things I have gotten away from in recent years is carrying
a first aid kit in my saddle bags.  It was always there and not needed.
 I started to leave it out in recent years.  I'm going to take flash's
advice and put it back in.

There seems to be a lot of good advice in the book.  Now all I've got
to do is follow at least some of it.  I tend to take good care of
myself, but the book pointed out to me a number of ways I can take
better care of myself.  Having a simple first aid kit along is one of
them.

A lot of time in my role as a family therapist, I would recommend a
book to people, hoping that they come away remembering just a few
things from what they read.   flash, if someone were to only get a
couple of things from your book, and not remember most of the details,
what would you they might get out of the book and take away with them?
  

    
>vacations

i don't know if i learn much from vacations.  nowadays, since i'm
working as hard as i can to build my medical practice, i don't really
take any. usually, over the holidaze my wife and i will drive to L.A.,
stay near the beach in santa monica, and spend a few days at museums.

as far as what i'd like to have folks take away from the book - move
it or lose it. if you've gained more than ten or fifteen pounds since
you were in your early twenties (and if it's fat, which is typical)
you need to burn 300 calories every day to switch your body out of fat
saving mode into fat burning mode. 

300 calories is about 1 hour of regular walking, or a half hour of
more vigorous exercise, like swimming/biking/running. it takes about a
week per decade of age to have your body make the "switch" from "cave
mode" (as i call it) back into "hunting/gathering" mode, where you're
using fat as fuel, not storing it.

unfortunately, one of the things your body does while in
fat-conservation or "cave" mode is to make exercise less fun. my wife,
for example, does triathlons all the time - she's ALWAYS in
"fat-burning" mode. and she loves exercise. 

but don't get me wrong - at heart, i love exercise, too.

i could watch it for hours . . .

                 %^)
  

    
>I realized I really didn't want to go back to work and on the plane I
decided to retire... and spend the rest of my life riding my
motorcycle, playing the conga drums, doing my spiritual studies, and
getting laid.

Ah, Michael! I realized that when I got out of the Navy. I was 20. Now
I am old and still paying the bill.

It seems posters here are giving a brief introduction. I'm Rob Hill, a
wine merchant and long-time motorcycle rider. I like long trips like
Michael does. I have read flash's articles in City Bike and MCN  and I
read the book - I have notes in the margins. I know him from
discussions in the motorcycle conference on the well. I also met him
and shared jokes and a flask of single malt with him at Song Dog Ranch
(a motorcyclist camp-out) a few years years ago. Flash was somewhat of
a techy camper. He slept on a cot (rare for a motorcyclist) and peed in
some kind of gizmo that turned his urine into a colorless, odorless
gel. I have since begun riding with a cot in my duffel but I still pee
in the bushes.

flash, I notice that the book is mostly directed at the "aging" biker,
which is probably a good thing since the median age of all bikers is
going up. Besides, young riders don't have as many health concerns.

Most of the problems I discover riding seem to be because I'm becoming
an old coot. (I'm 59.) Lately it's my knees and my eyes.

In Blood, Sweat & 2nd Gear there is a chapter about eyes, but it is
mostly how to remove grit - a useful skill. But my problem on long
rides is that my eyes feel like they've been sunburned or something.
What can I do about that?
  

    
Ride side-saddle.
  

    
flash - re: vacations, you appear to be are a very hard worker.  that
is clear from my limited interactions with you.  It seems like you are
in constant motion, doing one thing or the other.  I think you are in a
lot of ways a typical male, in that you get off on getting things
_done_.  Where you found the time to write all those columns and then
turn it into a book is beyond me.   It takes me a long time to write
anything well (thank you all my editors!). I'm a relatively hard
worker, but never on the level I think you are.   After I signed a
contract to write a book, all my friends heard was how I wrecked my
life for the next 18 months.  It seemed writing the book and working
took up almost all the time.   And I've never been a full time worker. 
 Being in private practice as a family therapist, I was able to take
off Fridays for most of my working career.   Fridays were often
dedicated to riding the bike.  I have my priorities.

Glad to see (rob) and (static) here.

I appreciate what you say about being active.  Gaining weight has
never been my issue, but then again, when I finish writing this post I
will head to the gym.   When I was young, I made an agreement with
myself to try to do something for my mind, something for the body and
something for the spirit each day.   So I've always gone to the gym, or
taken a dance class, or something to keep me active (if I miss a day
or two each week, I don't care).  A lot of this just became habit,
including eating the right stuff.  Now that I'm getting older, like
rob, I am feeling the effects of aging, and can relate to a lot of the
stuff in the book.  But despite my having some fairly serious long term
chronic medical issues, I'm in pretty good shape.

I try to give my body the same level of care I give my motorcycle. 
And I always follow the manufacturer's recommendations regarding when
and how to get the bike serviced.  I do the same with my body.
  

    
I use deferred maintenance on *both* my body and on my bike.

Anyway, as I have been reading the book, I have been struck by three
things (one of which was a bus, so I appreciated the chapter on
fractures).

One was the brevity. Short, to the point and as if you were being
charged for each word. I appreciate that very much. I realize that the
brevity is necessary when writing a newspaper column. I was speculating
that the intended audience (male lunkheads like me) would not even
crack over a thicker tome, and, if short, concise chapters were
intentional, even though you could have expanded each chapter when not
faced with the limitations of a magazine. So: ?

Two, I was horrified that the puns and bad jokes that you are so well
known for had made it into print, and if you realize that you will ride
a pink Honda Aero in hell because of the puns, and...

Three, how much more fascinating the chapters are to read than I had
expected. It was as if you had written the book especially for me. 
(A grumpy, middle-aged, portly old biker who avoids looking after my
own health) So: thanks!
  

    
Seems like we are having a bunch of older, slightly decrepit male
bikers here who are poring over the book to understand a lot of what is
wrong with their bodies getting together here.  None of this aging
stuff actually bothers me, having had a bunch of friends die young. 
I'm still here, I'm still riding, I'm happy to discuss with my doc all
the age related issues that are coming up.  My bike is also reaching
late middle age being 16 years old now with 84,000 miles on it.  We've
grown older together.   Both of us are showing signs of wear and tear. 
 

The book really is about what goes wrong and why in a normal aging
process.
  

    
right. getting old's not bad, considering the alternative.

joe, i'm delighted to hear you like the book. one of the reason's it's
concise is that i make it a point of always writing exactly 1000 words
in each column. and the reason the book chapters are short is that the
publisher simply took the columns, did a little rearranging, and
voila! a book!!

i spent about 20 or 30 hours going over the book, updating stuff, and
helping things flow together, but the editors at whitehorse press did
a great job. 

i try to make the info painless, and easy to absorb.

anyhow, if there are any health areas that folks want to hear about in
the future, i'm open to suggestions. i've got to write a column this
weekend, and i have not a clue what it'll be about.
  

    

I'd like to know more about the relationship between biking and farting 
that merits a mention in the book.
  

    
I'd also like to hear more, if there is anything extra you can say
about being sleepy behind the handlebars.  I've often thought that this
is more likely to do me in than driving recklessly, which I almost
never do.   After a good breakfast or lunch, long before I should be
tired from fatigue, I tend to get sleepy from the eating.  I can't stop
eating.  And I need to be alert.  I don't drink coffee, and the only
caffeine I get from my diet is in diet cola drinks, which is not a
whole lot.  So I've taken to having a couple of 100 mg. caffeine pills
in my shirt pocket, just in case.  

I've pulled over at rest stops at 11 AM and have laid down on the
grass and gotten 15 minutes of shut eye.  That helps a lot.   But other
times that option is not easily available.   That's when I pop the
caffeine pill, which I find helps quite a bit, not only with keeping me
alert, but I am able to concentrate on riding more.  I don't think I
have ever exceeded 200 mg. of caffeine in a day from pills while
riding.   But I've also drank more than a few Mountain Dew and Red Bull
drinks for the same reason.

One of the reasons I am concerned with is that I lost a riding buddy
last year.  The reasons are not clear but he might have fallen asleep
while riding.  He was headed from San Francisco to Los Angeles, along
I5, and got a late start.  As he was nearing Los Angeles he just rode
off the road.   He also was diabetic and that could have been part of
the problem, but he was fastidious about checking his blood, even at
lunch stops when we were riding.  So it is a mystery but signs point to
falling asleep.

Any additional thoughts about this?
  

    
Yes. This is relevant to everyone on the road, not only bikers.
  

    
<flash> rides long distances (and hopefully he will ride out to the
Very Boring Rally in Duluth where he is giving a talk!) and I am also
interested in his "staying awake" methods.
  

    
calling dr. flash,

I'm dealing with the issue of sleep deprivation this morning !!!   I
was up late last night partying with friends, and here I am up at my
usual early time.  I seem to get up the same time regardless of when I
go to sleep.  I'll try to take a nap later, but I sure wish there were
a magic cure (other than stimulants) for lack of sleep.  I know there
is no magic cure but still look forward to hearing how we as bikers are
suppose to be able to party all night and ride our bikes all day. 
That is what we are suppose to be able to do, isn't it???
  

    
hello all, i'm coasting in and it looks like so far i'm the only model
46xx rider among us.  like the pseud says, i'm a nurse.  my favorite
way to commute to work is by motorcycle-  when i lived in san
francisco, my commute to work in burlingame was 16 miles down 280.  i
stayed part-time with that job when i moved here to the napa valley
last year, and now it's a 72 mile ride to get there, and i still do it
by motorcycle.  my coworkers say to me 'how can you do that long trip
on a *motorcycle* ?' and i say 'how can i not ?!?'  my ride to work is
such a scenic cruise: napa, sonoma, marin, across the golden gate
bridge and through san francisco, and then along by crystal springs and
down to the bay. as far as the road goes, there's a little bit of
everything from twisty country roads to the high speed run of the waldo
grade and coming through neighborhoods transiting the city of san
francisco.

the other thing my medical professional coworkers always ask me is
'aren't you scared?'  i answer that indeed, every time i get on the
bike, just about everything i do before, during and after i ride is in
acknowledgment of the inherent risks.  i wear leathers.  i wear
earplugs.  i have a good helmet.  i check the chain, and the tires, and
my brakes, and the weather.  that's all before i even kick start the
cafe racer.

flash, i've also been reading the city bike columns for a long time
and i'm very happy to see another collection of them off the presses as
a book.  the 1000 word per topic format is great-  each chapter has
such a specific focus and covers that topic so well, it's an engaging
read, and, as everyone here has said, for anyone with blood and sweat,
not just motorcyclists.

mcpsycle -  i was thinking about your query about having a good
breakfast or a good lunch and then feeling drowsy on the bike.  just a
thought-  what about stopping more often, to stretch, take your helmet
off, and having a bite-  the small frequent meals way to go, rather
than three big meals.  you'd be giving your body a more consistent fuel
supply and you might notice the difference in how your body responds. 
 this does assume you haven't been partying all night though!  my
answer to 'how we as bikers are supposed to be able to party all night
and ride our bikes all day' is ...  find someone who wasn't up all
night and ride bitch! 
  

    
Hi nurse Flanagan,  Welcome to the discussion.  With both you and
flash being in the medical field, I guess we can expect answers from
two different medical perspectives to some of our questions.

Regarding your suggestion to eat fewer and smaller meals to avoid
fatigue.  Yes, that does do it.  Only trouble is it is hard to find
anything decent to eat on the road.   Fast food restaurants have become
better with serving salads.  But the choices for a good meal are often
few on the road.

And regarding commuting on the bike.  That is one of life’s pleasures.
  When I commuted form San Francisco to Oakland, I often came back to
the city around sunset with the sun setting behind the Golden Gate
Bridge.  Not bad.  I once told flash after he bought the Tuono that
anyone who has a daily commute that takes him over the Golden Gate
Bridge and up and down the Waldo grade in Marin on a Tuono is leading a
blessed life.  People save their entire lives to come to the Bay Area
and see the GG bridge once, and he gets to commute over it twice a day,
every day.

I found the way to deal with my sleep deprivation is the oldest method
in the book.  I took a nap today.  I’m not a party guy so staying up
late for me is unusual.    But sometimes  guy just has to have some
fun.  
  

    
Hi Flanagan. Nice post. I've always commuted to work on the bike, too.
I crossed the Bay Bridge to work four days a week for a couple years.
Sometimes the motorcycle ride is the only thing that excites me about
going to work. And the ride home makes a great way to unwind so you
don't bring work shit home to the family.

Michael, I have never had the problem of feeling sleepy while riding.
Tired and stupid, yes, but never dozy and nodding off like when I'm
driving a car.

It's funny but other physical symptoms often fade while riding my
motorcycle. I suffer from bad headaches and they often go away while I
ride.

Where's the doctor? flash must be off seeing people who pay him for
it. 
  

    
>Where's the doctor? flash must be off seeing people who pay him for
it.

I'm an optimist.  Until I hear otherwise, I am hoping the reason the
good doctor has not checked in is that he is busy riding that Tuono all
over Northern California and has had a massive brain fart about
checking in here.  Perhaps he needs to reread his book and call us in
the morning.

For those outside the Bay Area, it is another perfect riding weekend
in Northern California.  The weather is a bit cool for early May, but
still great riding weather.

I'm up in Guerneville this weekend.  That's a resort area about 70
miles north of San Francisco.  Massive number of both bikers and
bicyclists ride through this town each weekend, and this weekend has
been no exception.   Lots of groups of Harley riders along with other
groups of sport bike riders.   And then there are the BMW riders.  
They are easy to spot at a distance.  They are all wearing Aerostitch
riding suits.  Each of the groups I just mentioned has their own
particular dress code for a Sunday ride.