Author: gg@gordongregory.net

SBS again gave TV viewers great access to the Tour de France: 3,366kms in 21 stages;  6-28 July 2019.  The winner was Egan Bernal – the first Colombian and the youngest winner since 1909.

Tadryn was too busy to watch the TdF this year and wondered if I would write a synopsis. Having been busy watching the cricket World Cup, and the women’s soccer World Cup, and Wimbledon – not to mention weekly matches of the Canberra Raiders and Sydney Swans, – I tried not to watch it myself. But the temptation was too great. So I did. Lots.

It was on SBS. In my view the commercial opportunities it offered the broadcaster meant that, this year, there was such a proliferation of ads, marketing linkages, SBS cross-promotions related to it and ancillary activities that, as a piece of TV production, it was sometimes rather irritating. My recollection – perhaps misty-eyed and fond – is that in the old days it used to be a brief introduction by Mike Tomalaris, then 20 minutes to air from Matt Keenan, before settling in for the main course which was four hours with the incomparable Phil Liggett and Paul Sherwen.

Through an interview with a very subdued Phil Liggett, casual observers of the sport like me learned that Paul Sherwen had died of heart failure aged 62. There would be no more, then, of the gentle and expert information provided by Sherwen, with near-perfect French intonation and accent, about the chateaux, forts and natural wonders of the French countryside that passed beneath the aerial cameras in oh so perfectly-timed appearances with the peloton.

Certainly the new team of Matt Keenan and Robbie McEwen grew on me and provided plenty of information, expertise and theatre. For someone so experienced in the job, Mike Tomalaris seemed occasionally to be unsettled or perhaps just poorly produced: he sometimes seemed unsure of what was coming next or its timing or of his lines. Many of his pieces to camera were done jointly with ‘Macca’, who spoke well and pleasantly, sometimes giving the opportunity for Mike to catch up with the program’s live schedule

This year’s was the 106th edition of  The Tour. It started on 6 July in Brussels with 176 riders in 22 teams. One of the first things one notices year-on-year is the rapid turnover in the names of the teams. Some of this year’s were familiar to me, like Movistar, AG2R, Lotto-Sudal, Astana, Quick-Step and Dimension Data, but I have no idea of their nationality or commercial basis.

There is no more Sky, with that enormously well-funded team now working for Ineos. It strikes me as quite odd that, given the amount of money spent at the Tour by Ineos – which I assume is a brand of some sort – at no stage during the 21 days did I hear mention of what Ineos is or does; and the same applies for the other brands.

I came to the start line with some obvious special interests. Richie Porte, from Tasmania, was the GC rider for Trek-Segafredo. The Australian team, now called Mitchelton-Scott (still sponsored by Gerry Ryan who I’m told is a lovely man) included the two Yates twins from Manchester, with Simon Y. being the GC candidate. Then there was Geraint Thomas, last year’s winner (“overweight at the start of the 2019 season”) and, following Chris Froome’s dreadful crash a couple of weeks out from the Tour, now surely categorically GC leader for Ineos. (At that stage I knew nothing of Egan Bernal.) There was also the sprinter Michael Matthews (‘Bling’) whose dad is a butcher in Canberra.

I had seen some of the precursors to the Tour, such as Paris-Roubaix, and watched some of this year’s Giro, in which Richard Carapaz, Vincenzo Nibali and Primoz Roglic finished one, two and three. (Paris-Roubaix is The Hell of The North: 257 kilometres that includes 29 cobbled sectors (pavé) spread across 54.5 kilometres. Winning time: a tick under 6 hours!!)

Favourites for the General Classification (GC) included Romain Bardet (second in 2016 and third in 2017) and Thibaut Pinot (both carrying the deadweight of the expectations of France, which last won it in 1985!), Jakob Fuglsang, Steven Kruijswijk, Mikel Landa (fourth overall when riding one year for Froome), Nibali and Nairo Quintana. One of my personal favourites is Movistar’s Alejandro Valverde (39 years) – a sort of Marcus Trescothick of the cycling classics. Tom Dumoulin, second last year, was out injured and Cav wasn’t picked by his team (twitch muscles must have deteriorated). Peter Sagan was saddling up to win the green jersey for a record seventh time. (Robbie won it three times.)

By the time I was paying proper attention there had been couple of bunch sprints, with young Australian Caleb Ewan in the first three in both but not having won a cigar. The commentators were excited by Stage 1 in which Mike Teunissen was in the lead-out train for Dylan Groenewegen. When the latter crashed with 2km to go, Teunissen was free to go for broke – and he did, and he won.

Julian Alaphilippe – apparently known to his growing number of French fans as Lulu – won the third stage and the yellow jersey with a solo attack off the front of a breakaway. He lost the jersey next day but then won it back and, with his popularity growing as his wings were sprouting, retained it right up until stage 19. Most unexpected was his victory in the individual TT over much more fancied specialists – attesting, we were again told, to the magic effect of having yellow on one’s back.

The first significant impact on leading GC contenders was on stage 6 when Nibali,  Porte and Bardet all lost time. One felt sorry for Richie who, when interviewed regularly of a morning by the SBS crew, had to remain positive and matter-of-fact and uncomplaining – which he did with considerable good grace.

Stage 8, which had 4000m of elevation gain, saw Thomas De Gendt staying off the front for what was a very popular win. The next day saw Daryl Impey win the first of four stages for Mitchelton-Scott. One thought how both Phil Liggett and Paul Sherwen, with their own African connections, would have enjoyed Impey’s success.

Stage 10 was an example of how a crosswind on an apparently easy (!!) stage can have a major effect. With 30kms to go splits appeared in the peloton and Team Ineos, presumably because they were better organised or more alert or in better communication, started riding hard to build their advantage. Those who were caught out and lost chunks of time included Pinot, Porte, Rigoberto Uran, Fuglsang and Landa. In terms of the GC podium, their goose was cooked after this Stage. Those who prospered as a result of this day included Geraint Thomas, Egan Bernal, Bardet and Alaphilippe – who continued to confound all doubters by retaining the yellow jersey for fourteen days.

By this time Peter Sagan was quite a way ahead of Michael Matthews in the sprinters’ green jersey competition.

Stage 11 saw the breakaway caught with 5 km to go, before Caleb Ewan finally won his first sprint. Apparently he was nominated to ride the Tour for Mitchelton-Scott in 2018 but was omitted at the last minute; thus his transfer to Lotto-Soudal as the Team’s nominated (and looked-after) sprinter.

The 12th stage was the first in the Pyrenees. Simon Yates, as if making up for his brother’s slide away from GC success, won after a long breakaway by a big group. It was at a feeding station in this Stage that Rohan Dennis mysteriously abandoned – the day before the individual TT for which (as World Champion) he was favourite.

That TT was a standout triumph for LuLu, not fancied as a time triallist, with Geraint Thomas second at 14 seconds down. During the TT there was an awful crash when Wout van Aert got too close to a barrier and ripped his leg muscles open. Horrible to see.

Stage 14 was the one in which Thomas lost some time to his team-mate Bernal. By this time casual followers of the sport like me had heard enough about him from commentators to understand what a terrific young talent he is. In the lead-up to the Tour he won three World Tour one-week races: the Amgen Tour of California, Paris-Nice, and the Tour de Suisse.

Meanwhile, the French audience (nation, probably) were getting revved up by the fact that Alaphilippe was exceeding all expectations, giving rise to the possibility, still unlikely, that he could do well enough in the Alps to win overall. But what seemed more likely was that Pinot would keep rising in the GC rankings and, as a tried and tested climber, prevail overall for a French triumph in Paris.

This, almost unbearably for any viewer, never mind for the French, was of course the making of tragic events four days later. On the second day in the Pyrenees Pinot won and on the third he finished second to Simon Yates. This put Pinot in fourth spot overall. Caleb Ewan won the bunch sprint on the transitional Stage to the Alps, perhaps enjoying that day’s Bowral-like heatwave. Thomas crashed again, and Fuglsang crashed and had to abandon. At this point Bardet, the other main French GC hope, who had a particularly bad day on Stage 14 and dropped out of contention for a GC podium spot, was eleventh in the King of the Mountains.

Trentin won the second transitional stage, making it four for Australia’s Mitchelton-Scott team. Luke Rowe, Geraint’s Welsh buddy and Ineos domestique, had a bit of argy-bargy with Tony Martin and both were expelled from the race. All we saw on the TV was a brief coming-together but apparently there was more we didn’t see which justified what many felt was a harsh decision.

And so to the Alps. Could Alaphilippe possibly hang on? Would Pinot continue his charge to the top? The answers were ‘No’ and ‘No’.

Alaphilippe seemed to be cooked on one of the climbs in Stage 18 and it was now obviously a qestion of whether he could keep a spot on the podium. Everone hoped he would. Nairo Quintana, Movistar’s leader, had been under-performing and was in effect criticised by his team-mates for lack of condition.  However he won Stage 18, the first in the Alps. Bernal gained a small amount of time on other GC favourites. Speculation mounted about whether Thomas would ride for him over the next two days. He did.

Early on in Stage 19 it became clear that Pinot was done for. The French TV producer gave all of us looking on plenty of vision of Pinot in pain, Pinot being distanced, Pinot in tears and being comforted by team-mates while still slowly climbing, and then, finally, Pinot climbing into the team car.

With one descent and then one final climb to go, Bernal was leading the stage with Simon Yates second. Because he is such a good descender, the question was how much time would Alaphilippe make up on the Stage leaders. I think almost everyone watching thought that he would get back seconds on the descent but lose minutes on the final climb. But we’ll never know; way down ahead of the dry descent the leaders were on there was a sudden mud-slide, and snow and ice on the road, and a snowplough pushing aside water and ice. The race was ‘neutralised’ with everone given the time they had at the top of the previous climb. The yellow jersey passed to Bernal.

The next Stage was also shortened because of the weather and road conditions. The ‘ageless’ and popular Vincenzo Nibali won off the front. The GC contenders followed him together close behind, with Alaphilippe being dropped again and slipping from second overall to fifth.

All was not lost however for the French: by being close to the front on several of the scored climbs in the Alps, Romain Bardet came from way back to win the Polka Dot jersey. Caleb Ewan made it three with his sprint win on the Champs-Élysées.

Egan Bernal, 22-year-old Colombian, became the youngest winner since 1909, the first Latin American winner ever, and the fifth rider to win both the general and young rider classifications in the same year.

Thomas was second overall, with Kruijswijk third. Sagan won a record seventh points classification,  with Ewan second. Movistar won the team classification (the best three riders per team on each stage). Julian Alaphilippe won the overall super-combativity award. How could he not.

As usual, the scenery was inspirational (“must go see it again”.) The level of human endeavour still astounds; average speeds on bumpy Stages of over 45 kph; someone did 100kph somewhere along the way. The teamwork – now that one understands it better – is rich in sporting meaning and poignancy (the poor sprinter who couldn’t keep on the wheel of his last lead-out rider coming along by the Place de la Concorde!). It is of course very commercial and TV viewers pay some of the price. But it is so worth staying up and around for!

Vive le Tour indeed!

Although every case of Parkinson’s is said to be different, there are some general symptomatic states which occur quite commonly. They include dizziness and mild cognitive impairment. This piece will help those affected, either directly or through a friend or relation, to understand the nature of these two symptoms.

Finding the right word

My own written record shows that I have been complaining for at least three years about my inability to make clear to clinicians and friends the nature of one of the main ‘states of upset’ I have been experiencing.

In November 2016, in the record of an appointment with one of my attending health professionals, I wrote:

I asserted that the matter responsible for the majority of the debilitation I have is what I call my 'undiagnosed condition'. It consists of light-headedness, impaired vision and the need to bend forward and gaze at my knees after even the slightest exercise - but not all the time, just now and then.

I frequently referred uncertainly to the condition as ‘dizziness’ with no confidence that the word connotes the reality. A report I wrote on 23 March 2017 for my neurologist included this:

Since mid-January my symptoms have been those normally associated with low blood pressure (BP): dizziness, blurred vision, light-headedness. My normal BP is c.140/80. Several times it has been in the range 90-110/60-70 (seated) and 60-70/45-55 (standing).

The severity of the low BP symptoms varies from time to time and from day-to-day. When the symptoms are more serious, simple acts like walking a few paces, standing at the sink, or hanging a wash on the line become difficult.

Imagine my relief and delight, then, at discovering a webinar online in which one of the expert presenters deals specifically with the issue of Parkinson’s and the dizzy patient. It was held in the lead-up to the World Parkinson’s Congress (WPC), 4-7 June 2019, Kyoto, Japan.

To view the pre-Congress webinars, use the link below. You will need to register but there is no cost.

• Webinar 1: Non-motor complications and treatment
• Webinar 2: Surgical advances and infusions
• Webinar 3: Motor complications and treatment

Professor Tim Anderson is one of the speakers in Webinar 1. He holds the Cas Van Der Veer Chair in Parkinson’s and Movement Disorders at the University of Otago, Christchurch, New Zealand.

My thanks to Professor Anderson for expanding for me on a couple of points in his presentation.

The non-motor symptoms of Parkinson’s are less  obvious or visible than motor symptoms such as tremor, troubled gait and freezing. They include symptoms resulting from changes to the autonomic nervous system and psychological complications. The autonomic nervous system controls things such as blood pressure, sweating, and the function of bowels and bladder.

The dizzy patient

Dizziness can of course occur in people who do not have Parkinson’s and on its own and with no other symptoms it does not indicate Parkinson’s. And when it is experienced by people who do have Parkinson’s it may be caused by other conditions such as problems with the inner ear, anaemia or low blood sugar.

But it is clear to me from the details given by Tim Anderson that my particular dizziness is caused by Parkinson’s. He reports on the sort of exchange he has had with some of his Parkinson’s patients, which rings true with me:

Patient: I feel dizzy.

Clinician: What do you mean by dizzy?

Patient: Well I just don't feel right.

Clinician: Can you describe it?

Patient: No I can't really describe it; I just don't feel well.

About half of people with Parkinson’s report some kind of dizziness. For them it is most commonly caused by low blood pressure on standing (symptomatic orthostatic hypotension). When the systolic blood pressure (the first number) falls by 20mm or more of mercury, and/or the diastolic falls by 10mm or more, it is defined as neurogenic orthostatic hypotension. ‘Neurogenic’ means that BP falls on standing and the pulse rate does not increase by at least 15 beats a minute when one stands up. It indicates that blood flow to peripheral areas is affected; the noradrenaline system is deficient.

Another type of dizziness in Parkinson’s is post-prandial hypotension, caused by pooling of blood in the gut circulation causing dizziness within an hour or so of eating.

Tim Anderson provides a number of tips to help people manage the condition. They need to consider the possibility that one of the medications they are taking may be implicated. They should have extra salt and water, and avoid alcohol, caffeine and sugary drinks during the day, and avoid high carbohydrate meals before bedtime.

Exercise is important and for people with orthostatic hypotension exercise done in a seated or supine position may be best: swimming, rowing or cycling. Some relief can be obtained by doing muscle exercises when standing: clenching the buttocks, crossing the legs and standing on tiptoe.

The amount of blood pooling in the lower extremities or abdomen can be reduced by the use of stockings or abdominal binders. And it may be useful to raise the head of the bed up so  that there’s pooling in the legs when the person lies down at night.

Mild Cognitive Impairment (MCI)

Another cluster of non-motor symptoms experienced by people with Parkinson’s is given the name Mild Cognitive Impairment (MCI). The general case sees patients becoming aware that they are not thinking clearly, they are becoming forgetful and struggling to be decisive. People close to the patient may note that they have lost confidence and seem unable or unwilling to make decisions about family matters. They don’t want to socialise as much as before, and find conversations in large groups of friends difficult.

Having observed such issues as these, the Parkinson’s specialist is likely to dig a little deeper and administer some cognitive assessment tests to establish whether the subject has MCI. A diagnosis of MCI does not necessarily mean that the person will later develop dementia. In fact in some cases later tests may indicate that normal cognition has returned.

If they do have MCI the affected person should do everything in their power to combat it. Exercise is the most important thing – physical activity every day. They should choose exercise they enjoy because that’s the one they’ll stick with.

The same applies to brainteasers. To date it has been difficult to prove scientifically that doing brain exercises (sudoku, crosswords) is efficacious in improving wider cognition in someone with Parkinson’s. But it can be said with confidence that a key to the maintenance of cognitive function is to do as much reading and learning as you can – in particular, challenging the mind to learn new things.

It is also certain that keeping up social contacts and social activity of all kinds is vitally important to preserving general cognitive ability.

So I’ll be round to see you.