Really, It’s Not About the Bike

“This is my body, and I can do whatever I want to it. I can push it; study it; tweak it; listen to it. Everybody wants to know what I am on. What am I on? I am on my bike busting my ass six hours a day; what are YOU on?”    Lance Armstrong

When Lance Armstrong dumped his wife Kristin Richard, who had stood by him throughout his cancer ordeal, for Cheryl Crow in 2003, I was not amused. Apparently I had not heard that being cured of cancer gives a person a free pass to cheat on his spouse.  Just call me old fashioned.  I began to have my suspicions that perhaps Lance wasn’t the nicest guy in the world.  Those ubiquitous yellow Livestrong bracelets made me slightly queasy, but heck, he was raising a boatload of money for cancer, especially for a cancer that no one dared speak its name.  I didn’t buy his memoir, It’s Not About the Bike, when it was first published in 2001.  Generally speaking, I feel the same way about cancer books as I do about cancer movies—I give at the office.  But one day, one of my patients was just finishing the book as he waited for me for his weekly on treatment visit.  I asked him how he liked the book, and he raved about it.  Then he gave it to me, so I read it.

As I said, I didn’t think Lance was the nicest guy in the world, but I didn’t think he was stupid.  At least, not until I read the book.  Apparently this grown man went around with a testicle the size of a grapefruit for nearly a year, thinking it was just from bruising himself on the bike seat. Then one day, while in the bathroom of his beautiful home in Austin, Texas, he coughed up blood into the sink.  This actually alarmed him.  He called his best friend and neighbor, who just happened to be a doctor.  In all fairness, the good doctor and good friend did not KNOW that Lance had a testicle the size of a grapefruit.  He diagnosed a sinus infection.  Lance was very relieved.  It wasn’t until he had a blinding headache from his brain metastases that he finally sought medical attention and learned that he had Stage IV testicular cancer.  After undergoing removal of the diseased testicle, he underwent chemotherapy at Indiana University by Dr. Lawrence Einhorn, who had pioneered curative chemotherapeutic regimens for late stage testicular cancer.  Following chemotherapy, he had what was left of his brain tumors removed surgically to complete his treatment.  Miraculously, in 1999 he came back to cycling to win his third Tour de France by over seven minutes.

Rumors of doping in the rarefied world of competitive cycling abound.  Floyd Landis was stripped of his 2006 Tour de France title after he tested positive for performance enhancing drugs, and began to systematically name his teammates who also doped.  Misery does love company.  Lance Armstrong was one of those teammates who got the Landis finger point.  In late October, despite his protestations of innocence, Lance Armstrong was stripped of all of his Tour de France titles, and other dishonors followed.  Still, those of us who spend our lives caring for cancer patients were not convinced of his malfeasance.  J. Leonard Lichtenfield, deputy Chief Medical Officer of the American Cancer Society wrote back in October: “Let us never forget that for me and the many others he has impacted through his accomplishments on behalf of cancer survivors worldwide, Lance Armstrong will always be a hero.”  I may have had misgivings, but I “liked” that on Facebook. And then, finally, there was Oprah.  On January 13, Oprah Winfrey asked if Lance took banned substances.  He said, “Yes.” She asked, “Was one of those substances EPO?” “Yes.” Did he do blood doping and use transfusions? “Yes.” Did he use testosterone, cortisone and human growth hormone?  “Yes.”

EPO, or erythropoietin, increases the red blood cell volume, thus increasing the oxygen carrying capacity of the blood.  It also is now known to be associated with a higher risk of cancer treatment failure when given to cancer patients.  Testosterone is known to fuel prostate cancer growth.  Human growth hormone is still a huge unknown—now being used to improve the height of kids with short stature, there are concerns that a possible side effect could be tumor induction later on in life.   In the end, it was Oprah Winfrey who elicited Lance Armstrong’s fall from grace.  And in the end, hearing about what he was ingesting and injecting after a stupendous victory over advanced testicular cancer, I can only conclude one thing:  Lance Armstrong is really, REALLY stupid.