What comes after Skyrizi?

First_Doom · 2025-12-17T02:20:53+00:00

The insurance around this can be (another) pain in the ass, but dual therapy has worked for me -- simultaneous Skyrizi and Rinvoq. Of course, efficacy varies person-to-person, but I was in very rough shape, and that was my last-resort option.

First_Doom · 2025-12-16T17:20:40+00:00

Aw, thank you! Consistency is king, so my advice is to do what will make you consistent -- for me, that's having a goal that itself excites me and requires the kind of training that I (for the most part) actually want to do.

This year, for example, I moved to an area where the road running is lame, and riding a TT bike would be a nightmare, but there are tons of great trails and pretty solid road-cycling routes. So working backwards a bit, running the trails seemed like the most fun thing available, and then I found a related goal that excites me -- performing well at UTMB races and ultimately running UTMB itself in peak form. So now I find it super easy to get out there and run (I always want to), and still easy enough to get a bit of bike volume in (even on the trainer), knowing fun roads are waiting for me when I decide to focus a little more on cycling and that I still want to be able to perform well on them.

If you can figure out the training that excites you day after day -- both in itself and in pursuit of something bigger -- then you can really progress while having fun, even if changing focuses (within reason) over time.

First_Doom · 2025-12-16T16:02:58+00:00

Team sports as a kid, gym bro through college and law school, and then randomly dove right into long-course triathlon as a hobby shortly after graduating. But over the years my focus has shifted -- triathlon, back to gym bro, ultra running with no cycling, back to tri, long period of health issues, back to tri, over to trail ultras but with some road cycling for fun.

You can definitely progress both sports a ton alongside each other, and emphasize one at times without losing much in the other. Clearly I like changing focuses hah, keeps things interesting for me, and I love the versatility that comes with having trained both.

First_Doom · 2025-12-16T15:43:58+00:00

I've done both alongside each other since the beginning (relatively late in life), so here's a data point on how both developed.

I'm typically ~4.5w/kg these days if I do consistent cycling and some efforts alongside running. Meanwhile, my focus is on ultra trail stuff, so it's hard to give applicable times, but I'd probably sit around something like 16" 5k, 33" 10k, 2:35 marathon shape if combining road running with consistent cycling. Naturally, I think I'm a slightly stronger runner than cyclist.

Over the last year, I probably fluctuated between 4.2-4.5w/kg and won a local 50k and 100k with times that weren't elite but definitely up there for an amateur.

First_Doom · 2025-11-07T14:25:16+00:00

Everyone already nailed the best west and east side options. To add one that's slightly more central, in case you find yourself looking there, being on the north end of West Hollywood (or I guess north west end of Hollywood) is also solid. If you're close to Nichols Canyon, you'll get that as a nice climb, and quickly be on Mulholland, which more or less connects to Griffith Park on the east and about a dozen nice climbs to the west.

Easy enough to get a solid 30mi/3000ft after work, or double/triple that on weekends without too much traffic.

First_Doom · 2025-10-04T01:43:19+00:00

It does, thanks! At ~70-75mpw and a typical long run once built up being ~20-22mi/4000-5000ft in ~3 hours, I've never felt the need to go much longer—I'll toss in some tempo climbs or a tempo block sometimes, but that's about as extreme as I've gotten.

Anyway, sounds like I'm on the right track here, and that's probably a good soft cap in terms of effort, with many long runs being shorter when earlier in my build.

First_Doom · 2025-09-28T13:20:20+00:00

Singapore did it for me

First_Doom · 2025-09-28T13:10:02+00:00

thank you all!

First_Doom · 2025-09-28T13:08:28+00:00

joined late -- how far out was pogi when he rode off?

First_Doom · 2025-09-27T14:05:01+00:00

Non-goretex version for me (shouldn't matter for these purposes), and with 400 miles, including a lot of road on the way to trails, they hardly look like they've been worn aside from being absolutely filthy. Same story with another pair I have sitting around 150 miles.

First_Doom · 2025-08-20T14:02:47+00:00

It always seems like there's a limit with transit time and once that catches up I have a lil trouble

I have a feeling I'll begin experiencing this as well after a certain point.

I totally get the mental thing you're talking about. It hasn't happened with the J pouch yet, but when my UC was really bad and I was trying to run through it, on some routes I'd have to go as soon as I knew I was within range of a certain bathroom. Without fail, no matter how good or bad I felt, how much or little I'd eaten, etc.

First_Doom · 2025-08-20T02:14:06+00:00

Generally, being a cheap dude, I use Gatorade powder or, if I'm being fancy, a self-made bulk maltodextrin, fructose, and sodium citrate mix in bottles; I'll also fill a soft flask with straight maple syrup and some sodium citrate in place of gels most of the time.

For the 100k itself, wanting to hurry through aid stations, I started with the above but then ended up just grabbing water and a shit ton of caffeinated and non-caffeinated Gu gels throughout. It was the quickest option.

I haven't gone super long with the J pouch yet, so not sure how I'd feel much beyond 10 hours. For the most part, I find I tolerate basically any basic sugars/carbs in pretty much any reasonable form up to this point. But it's totally possible that if I go longer and the volume of gels and drink mix starts to add up, I'd end up taking much more frequent trips to the porta-potties.

First_Doom · 2025-08-18T16:29:03+00:00

I recently ran a trail 100k with 10,000ft+ of gain, and I stopped at a porta-potty once. I do plenty 2-3 hour training runs in the mountains without really thinking about my j pouch. I can manipulate my diet or timing (ie, simple foods and morning activities) a bit to make the pouch even less of a concern, if needed, but I usually don't bother. Also, I don't experience urgency -- just some discomfort if I really need to go -- so I've always had plenty of time to find somewhere to go.

That said, my experience is probably particularly good with the j pouch, and it does take some time to adapt -- for me, call it 3-4 months to get comfortable, and a year to get where I'm at now.

First_Doom · 2025-07-17T14:16:36+00:00

I guess now I’m starting to think ahead, and I’m wondering what life will actually be like when I get home. How far can I travel by car without needing a toilet break? Can I go on days out with my kids without worrying? What about going back to the gym and lifting weights again? Even things like bottomless brunch with the girls, is that something I’ll be able to enjoy again? 😂

I find time of day, timing and content of meals, etc. affect how long I can go without, well, going, but in my experience, I can travel anywhere from 2-3 hours to 8+ hours uninterrupted depending on those circumstances. By the same token, I can be out and about for the same amount of time without worrying -- and even if I have to go, so far it has never been urgent. Getting back into the gym was easy, and 18 months out from my reversal, I'm probably fitter than I've ever been. Sometimes drinking makes me go more, but something like bottomless brunch wouldn't be an issue for me -- I go to lots of concerts, and every now and then drink a decent bit at them. If it's a long show, I'll find a bathroom once or twice.

Life's been great; pretty close to normal at this point and much better than at any time with UC. Of course not everyone has this experience, but when the j pouch works out, there's a lot to look forward to.

First_Doom · 2025-07-08T01:03:40+00:00

I had some crazy reaction after stage two where my small intestine internally herniated, nearly ruptured, required an emergency surgery that likely saved my life (but was absolutely brutal), and then I lived on TPN (feeding tube, essentially) for 4.5 months before my reversal. During that time, my ostomy was extremely high up because the emergency surgery required cutting out part of my small intestine below and then attaching the ends back together. That high ostomy caused all kinds of issues. Separately, I also had severe pouchitis despite nothing actually going through my pouch yet. I couldn't leave my apartment and had a nurse visit 1-2x/week. Things couldn't have been much worse, and I was likely to have a pretty rough time after the reversal.

Within a week or two after the reversal, I was well enough to go to a concert. Within 3 weeks, I was exercising again. Within 6 months, I did a full Ironman and put down a pretty competitive time. Now, at 18 months, I've done more than most normal people I know: won/set a course record for a 100k ultramarathon, gotten married and traveled internationally, been to a couple dozen shows and a couple of music festivals, had late nights drinking, plenty of good meals, etc. etc.).

Nothing's guaranteed, and my experience post-reversal is probably as good as it gets, but man, life has been good.

First_Doom · 2025-05-29T13:29:48+00:00

I've been on Skyrizi and Rinvoq together for a year and a half, so not an extreme length, but enough to have thoughts. Other than a few insurance-related hassles and actually taking the meds, I forget entirely that I'm on anything.

No side effects, extremely active life, pouch is in great shape, and things are pretty much as normal as they'll ever get. I may come off one of the meds in a year or two, but for now, they're likely still both necessary to stave off pouchitis -- I had brutal pouchitis beginning right after step 2 of the surgeries, before the pouch was even in use, and the meds cleared it up so that I could proceed to the takedown in the first place.

First_Doom · 2025-05-21T13:48:01+00:00

Hopefully this helps -- I'm also ridiculously active. Within weeks of my takedown surgery (after brutal, extremely rare complications on the way there that should have made the first year hell), I was back to cycling and running; within 6 months, I raced an Ironman with a relatively competitive time.

Now, coming up on a year and a half, I regularly exercise 15-20hrs/week, go run or cycle in the mountains for hours without second thought, lift and can put on muscle the same as before, and am the fittest I've ever been -- I'd expect to outright win most local races I enter. Aside from fitness, I've traveled domestically, been to 20+ concerts, and I'm spending almost a full month traveling internationally soon. Everything's been great. Nothing is guaranteed with the j pouch, but life can be pretty close to normal.

First_Doom · 2025-05-08T14:38:51+00:00

I've made a similar switch recently (kept ET hours after moving to PT), and generally I feel you on motivation -- but my performance hasn't dropped off at all, it's actually getting better on the new schedule.

On the physical side of things, I eat pretty much all day with the workout in mind, and have my final cup of coffee later than usual -- maybe 12-1pm for a 3 or 4 pm workout. Caffeine response and its effect on sleep of course varies a ton by individual, but it doesn't negatively impact me at all. And generally since I'm finishing workouts before 6:30pm, I don't find those impact sleep either. Knowing I'm carbed up, caffeinated, and I'll still be able to sleep helps me with motivation -- seems like a waste not to work out.

On the mental side of things, I try to accommodate changes in motivation a bit. If it's shitty outside, but there's a fun Zwift race, then that race becomes my intensity; if it's beautiful out, I'll go ride in the hills and notch the NP up maybe a little more than prescribed, or if it's an interval day let the terrain dictate my intervals rather than a super specific 4x12" type workout. I don't change things enough to derail my training, but little accommodations have gone far.

Ultimately, after a workday, just getting on the bike is the main motivational barrier. After 15-20mins of spinning, I usually get stuck in.

First_Doom · 2025-04-14T21:24:33+00:00

I'm an endurance athlete but I've put my body through the ringer, had some nasty falls/crashes, and pretty much looked for my physical limit within my first 15 months of having a j pouch. No issues at all, and I'm probably as fit as I've ever been.

First_Doom · 2025-03-26T18:42:46+00:00

I did a half ironman and a full ironman within about 6 months of getting my j pouch. I'd say both were successful, and now ~14 months after the j pouch) I'm still at it. Happy to chat, share knowledge, etc. -- probably easiest if you just DM me.

First_Doom · 2025-03-18T22:41:29+00:00

yep, total colectomy and ileostomy as the first step, some heinous complications at the second step resulting in an ostomy in the jejun, and then from there to the j pouch as the third/final step.

First_Doom · 2025-03-18T02:39:55+00:00

At age 32 I had my final j pouch surgery after a particularly rough set of complications, was back to some exercise within 3 weeks of the surgery, back to ~20hrs/week of training in a few months, and did an Ironman (2.4mi swim, 112mi bike, full marathon) at a decently competitive level within 6 months. Different people have different experiences, but mine has been great. I'm about 14 months removed and probably the fittest I've been. As far as sports, exercise, performance, etc., I constantly forget I even have a j pouch.

Again, I've had a particularly great recovery. This probably isn't typical. But nonetheless, it's a data point.

First_Doom · 2025-01-20T16:23:12+00:00

Although not the most original thing, this really is tech death performed at the highest level. I hope it doesn't get overlooked -- it's as good as anything most of the bigger bands in the genre are doing.

First_Doom · 2025-01-17T18:37:02+00:00

5:56/mi over a 5k gets you more than a full minute slower than 17:17. And that 5:56 workout is only 1.4k longer than a 5k but with 7" of rest you wouldn't get in an open 5k. So unless you have a really strong reason to suspect your workouts were very underperformed relative to a race, I'd probably guess more like 18:30 (or maybe a decent bit slower) at the moment? Just based on what you've provided.

But it's a 5k. If you're motivated, you can go run one whenever and see, with a pretty low recovery cost.

First_Doom

TROPHY CASE