California Coast: SF to SB (~400 miles in 4 days)

Just prior to starting podiatry school in 2010, myself, Kimber and a buddy, Jeremy Koons, rode down the entire Oregon coast. We did the roughly 400 miles over an enjoyable period of 10 days. We were able to stop and see the sights and relax in the afternoons on the beaches. It was a pleasant trip. I had always hoped that eventually I would be able to do more sections of the west coast but I never really got an opportunity until just recently when the doctor I was working with was going to be out of town for a few days, giving me some time off. Having just matched at a residency program in Seattle Washington (yay!!) I was due for some adventure. Jeremy and I discussed various plans including riding from Oregon to San Francisco, San Francisco to Santa Barbara and I even presented the idea of doing a climb in a the Eastern Sierra's following by a multi-day ride in Owens Valley. Due to weather forecasts and logistical reasons we settled on the SF to SB option a few days before departure.  Having only 4 days for the ride meant we were planning to ride roughly 100 miles on day 1, 100 miles on day 2, 120 miles on day 3 and about 100 miles on day 4. Quite ambitious since I had only ever ridden over a 100 miles in a day a few times and Jeremy never had before.

Day #1: San Francisco to Santa Cruz, 93.3 miles, 7.5hrs peddling time, 5,300ft elevation gain. 

We caught the BART to the Embarcadero St. station and met up with one of Jeremy's buddies who joined us for a quick tour of SF. Jeremy wanted an iconic start and talked us into peddling up an insanely steep hill allowing us to ride down the famous Lombard Street which has 8 hair pin turns within a one block section. We headed over to the south side of the Golden Gate Bridge and then down through Golden Gate Park on onto Highway 1. It was a beautiful day. We took stops at Half Moon Bay and San Gregorio State Beach and made it to the Santa Cruz New Brighton Beach Campground around 6pm. Hike and Bike campsites are basically awesome; $5 per person, right next to the showers and no need for reservations. Slept like a rock. While there we met a guy who was riding from Montreal Canada to San Diego and then over across to Louisiana. He said he started in freezing temperatures. What an adventure.

BART Elevator

Lombard Street

Day #2: Santa Cruz to Big Sur State Park, 85.5 miles, 6.5hrs peddling time, 4,700ft elevation gain. 

We were on the road by 8:15am. My ischial tuberosity was screaming but would intermittently go numb after being on the bike for about an hour. The route took us inland and we ended up stopping at an awesome fruit stand and loaded up on some avocados, oranges and apples. Tastey!  We stopped in Monterey near the Aquarium for lunch and basked in the sun. The second half of the day we traveled around Monterey on the famous 17 Mile Drive which follows some beautiful coast line and through the prestigious Pebble Beach Golf Course ($500 per 18 holes!) We came up through Carmel and then over the hills and into Big Sur. We were spent when we arrived at the Pheiffer Big Sur Campground and set up camp in the redwoods. 

17 Mile Drive, Monterey CA

Big Sur, CA

Day #3: Big Sur SP to Pismo Beach, 125.3 miles, 10.2 hrs peddling time, 9,200ft elevation gain. 

Up at 5:30am and on the bikes with lights flashing at 6:30am (we had to wait a few minutes for it to get light enough to see the road). We started the morning off with one of the bigger climbs of the trip and then up and down along the shear cliffs along the crashing ocean below as the sun came up. It was amazing. Jeremy's knee had been painful the second half of yesterday and was much worse this morning. He was digging deep to keep going. We took things real slow and were constantly considering bail out options. I took the majority of his gear and loaded it on my bike. The plan was to do 120 miles which seemed impossible at lunch when we had only traveled about 40 miles in 5hrs. We talked it over and decided to just keep peddling and see how it went. After lunch we got out of the mountain section and onto some flatter road which was better on Jeremy's knee and allowed us to make up some time. We ended up bending Jeremy's back rim, popping a spoke and having to do some crude roadside spoke work with some pliers to stop the rim from rubbing on the brakes. We rolled into the Pismo Beach area at sunset exhausted and then spent the next hour riding back and forth through town trying to find a hike/bike campsite. We eventually found on, got a hot shower in and hit the sack. Dead. I haven't slept that hard since salmon fishing in Alaska.

My view for many many hours. 

Enjoying my daily ration of Nutella and Peanut Butter

Roadside trueing session anyone? 

At mile 100, 25.3 to go, just outside of San Luis Obispo CA

Finally found a hiker/biker camp spot.

Day #4: Pismo Beach to El Capitan Beach (20 miles short of Santa Barbara), 80miles, 6hrs peddling time, 4,000ft elevation gain. 

We were on the road by 6:45am in good spirits. We spent the morning peddling through rough farm highways. We even almost got crop dusted by a helicopter. After only a few miles I was really dragging. Even though I was drafting off of Jeremy I could barely keep up. I attributed my lagging to the rough roads and all of the extra gear I was hauling. I pushed on for probably 20 miles and at a quick break discovered that my rear wheel was bent and rubbing on my brake. The combo of the rough roads, heavy weight and my bike not being made for touring did it in. We once again pulled out the pliers and did some spoke work to true the wheel and pushed on. After a big climb we dropped down into Lompoc where we had lunch followed by a final big climb and decent back down to Highway 1. Once we hit the coast things fell apart. Within a 10 miles span we got 3 flat tires. I had a CO2 air pump with enough cartridges to fill two tires and Jeremy had a worthless air pump that only offered us a false sense of security, as it could get the tire pressure high enough to prevent the rim from hitting the ground. The 3rd flat tire in combination our bent rims and we just couldn't make it the last 20 miles!!! We were sunk! Luckily a friend living in Santa Barbara was available to come and pick us up at El Capitan State Park. It was a pretty unrewarding feeling, although relieving, knowing that we made it so close. 

So close but yet so far.....

We spent this night with friends and Kimber was kind enough to come down and pick us up the next day. It was a great adventure and felt oh so good to push our limits. It was rewarding to know that it wasn't us that broke down but our bikes. Better planning in the future.

4 Day Total
384 miles ridden
30hrs peddling time
23,000ft elevation gain. 

The Scoop on Toenail and Foot Fungus.

Tinea is a fancy name for fungus. There have been shown to be more than 80 different strains of fungus on the average person's foot with the highest concentrations being on the heel. These fungi live in a balance that isn't a problem until that balance is disturbed. People at risk for fungal infections include those with:

• Compromised immune systems (HIV, Diabetes, Oral Steroid use)
• Advanced age
• History of trauma to the toenail.  
• Poor blood flow in their toes. 
• Frequent use public/locker room showers (thus the term athlete's foot). 
• Poor pedal hygiene (improved hygiene has even shown to cure 35% of existing fungal skin infections).
• Genetically prone.  

ANATOMY INVOLVED

While tinea can get into the blood and cause systemic infections it most commonly affects the most superficial layer of skin, the epidermis, and the nail plates. The areas that are most resistant to treatment are the plantar foot and the nail plates due to the high amount of keratin which makes it difficult for topical medications to penetrate the structure.

THE EXAM AND DIAGNOSIS

Signs of a fungal infection of the skin, also known as athlete's foot or tinea pedia can include:

• redness (erythema)
• itchiness (pruritus)
• foul odor 
• macerated (white over-hydrated skin) or hyperkaratotic (dry callused skin) scaling
• fissures (cracking)

They present in three main patterns; interdigital, moccasin, and vestibulobullous(fluid filled blisters). Interdigital infections are usually more macerated while the moccasin pattern in more hyperkaratotic.

Research has shown that the most common fungal strains resulting in tinea pedis are Trichophyton rubrum and Trichophyton mentagrophytes (more aggressive strain). T. mentagrophytes has been shown to be more common in the younger healthier individual.

Signs of a fungal infection of the toenails, also known as onychomycosis, include:

• nail discoloration; yellow, orange or brown patches or streaks. 
• nail detachment from nail bed (onycholysis).
• subungual (under the nail plate) debris. 
• nail thickening
• nail crumbling

The "gold standard" method for diagnosis of pedal fungal infections is microscopic examination of skin subungual (skin under the nail plate) scrapings prepared in potassium hydroxide (KOH). The examiner can see hyphae. Today's podiatrists send these scrapings to a lab where they are read.

TREATMENT

Treatments for fungal infections include topical powders and creams for less severe infections and oral medications for more sever or resistant infections. Due to the resistive nature of onychomycosis (toenail fungus) the most effective treatments are oral medications. The downside of oral antimicrobial medications are that many have been shown to cause liver damage to a very small percentage of individuals. The internet is full of many home remedies and other remedies for treatment of toenail fungus (Vick's Vapor Rub, Colloidal Silver, Tea Tree Oil....). Due to the high number of these types of treatments and the low level of effectiveness I am not going to discuss all of them. The below list of medications that have been proven with varying degrees of effectiveness which I have put in order of effectiveness.

Topical Treatments:

• 2% Miconazole Nitrate Powder - Available Over the Counter
• 1% Clotrimazole Cream - Available Over the Counter
• 1% Clotrimazole Solution (better penetration into nail plate) - Available Over the Counter
• 1% Terbinafine Cream (Lamisil) - Available Over the Counter
• 1% Terbinafine Gel - Available Over the Counter
• 0.77% Ciclopirox Cream/Gel
• 8% Ciclopirox Solution (Penlac Nail Lacquer)
• 20% Urea Cream*
• 40% Urea Cream*
• Salycilic Acid*

*can be used with topical medications to soften the nail plate and callused skin improving penetration of medication.

Oral Medications:

• 250mg Terbinafine (Lamisil); liver enzymes from a blood test are also monitored while this medication is given to ensure that there is not irreparable damage occurring. 

Other Treatment Options

• Cleaning feet daily has shown to cure about 35% of cases. 
• Laser Treatment (for onychomycosis) is available and is very expensive. Its efficacy is still being investigated. 
• Toenail Avulsion (removal of toenail). In sever cases the complete removal either permanently or temporarily, is always an option. This options will prevent spread to other toes and is a sure cure. Toenails serve no real purpose beyond their aesthetic appeal. 

PREVENTION

The best option is to take proper precautions to prevent fungal infections from getting out of control in the first place. Most toenail infections begin as athlete's foot that has been neglected and the fungus gets into the nail. Once in the nail it is extremely difficult to cure and the fungus can damage the cells that cause the nail to grow making the nail thick and disfigured. Once a nail has become thick and disfigured the chances of being able to return to nail to its appearance prior to the infection if very low. Here are some suggestions as for prevention:

• Wash your feet daily with soap. Fungal spores are EVERYWHERE and washing them will decrease the amount on your feet and will remove the dirt and grim that harbors colonies. 
• Alternate shoes to allow them to dry out. The environment in your shoes (moist, dark, warm) is prefect for fungus to thrive so allowing your shoes to dry out will inhibit growth. 
• Wear well ventilated shoes, synthetic socks and use shoe powders occasionally to keep feet dry. 
• Treat fungal skin infections early on to prevent them from getting out of control and into the tissue that is more difficult to get to with medication like callused skin and toenails. 
• Avoid going barefoot in public area such as showers and pools. Fungal spores and live on for months to years. 

Hsu AR, Hsu J. Topical Review: Skin Infections in the Foot and Ankle Patient. Foot & Ankle International. 33(7):612-619, 2012