Another post-surgery update

Five days post surgery. Here's what's going on.

I've really been hurting. A lot. Initially it felt as though it was from the surgery itself, the wound and area surround it hurt. As an aside, if you were to examine just about every chair ever made and put an X on the exact center of the lumbar support, that's where the incision is. So it really hurts to sit in just about every chair ever made.

But five days on, it feels like more normal "back pain", it really hurts a lot worse than it did pre-surgery though. I also have some pretty significant sciatic symptoms, as bad or worse than pre-surgery.

I've been avoiding high strength pain meds as much as I can but there were a couple of days where I just couldn't stand it and gave in. I'm now on a more reduced regimen, only take the stronger stuff before bedtime so I can sleep. Ibuprofen during the day along with the other stuff I'm supposed to take.

I'm obviously a bit concerned about the back pain and sciatic symptoms. I do know that during the surgery they shove the nerve out of the way so they can get to the bulging disc. There's a fairly graphic video of someone doing the microdiscectomy so I know exactly what happened. So I'm hopeful that the symptoms I'm experiencing are a result of that and will fade with time.

In other news, now that 5 days have elapsed I can take a shower - yay! Sponge baths have their place but only for a while. 

I've been walking. Short distances (.5-1 mile) seem to be about all I can manage. I made a mistake and walked two miles the day after surgery - definitely too much, too soon.

Other than that, I've been puttering around the house. One project I finally got underway was to scan some old photos. I scanned our own photo library several years ago, more than 10K photos and it sure took a while! This latest batch is from one of my Aunts and includes pictures from when my Mom was young, my extended family and German ancestors. Here's one from the batch:

I think we can objectively agree on two things: (1) I was a cute baby. (2) It went south from there.

Here's a shot of my maternal Grandparents (on the right) on their wedding day:

Both now deceased. They lived into their 90's and lived at home until shortly before their deaths. My Grandfather died first and my Grandmother shortly after.

That's all for now.

Stay tuned!

Update post-surgery

Well, I didn't die on the table so there's that ;-)

I had the surgery yesterday. Even the morning of I was still having misgivings about going ahead. As I noted in my previous post, I still had significant symptoms and my left leg just didn't "work right" but it had improved significantly since the last episode on June 8.

I'd hit a plateau though where it was essentially the same for the last three weeks and "the same" wasn't particularly good. I had a discussion with the surgeon who, to his credit, emphasized "this is not an unstoppable train, you can decide right now not to go ahead". What ultimately decided me to go ahead was that he was confident that although it might continue to improve somewhat it wouldn't return to normal. He asked "would you want to live the rest of your life as you are" and the answer was an emphatic no.

So I went ahead.

Post surgery, he told Marcia that it went well (I wonder if they ever say "I screwed up"?) and that he'd removed several loose fragments and part of the disc. He said it should reduce, but not eliminate, the probability of recurrence and that should it recur I'd likely have a couple more microdiscectomies before I had to have a fusion. 

This is obviously a path I don't want to go down.

And by way of final medical update for now: I really hurt. I try to avoid narcotics because I don't tolerate them well but it's likely I'm going to use them for at least a few days. The RX post surgery is no aerobic activity until my post-surgical exam in six weeks, no lifting above 10 lbs, no bending or twisting.

Since the RX is pretty generic and encompasses massively obese people who are largely sedentary, I'm hopeful I can ride the 'bent on the trainer after 3 weeks but we'll see. In the meantime, I'll be walking.

I'm still pondering the DF versus recumbent question. Pre-surgery, the recumbent was demonstrably easier on my back. I rode it almost 700 miles since the episode on June 8 versus 70 miles on the DF. Every time I rode the DF my back and sciatica was significantly worse the next day.

So the question at hand is whether it will be the same post surgery. My plan is to ride the recumbent on the trainer, then return to the roads. At some point, I'll ride the DF and see how it feels after. As I've said numerous times here, in order of preference the possibilities appear to be:

1. Return to normal, brevets on the DF with the recumbent as an occasional diversion.
2. Return to riding brevets but on the recumbent with the DF as an occasional diversion.
3. Give up randonneuring, ride the recumbent and DF on rides of 200K or less.
4. Give up riding the DF and ride the recumbent.
5. Give up riding.

You may be asking yourself (I know I am) "if the track record is that the recumbent is easier on his back, why doesn't he just face it and ride that".

Good question!

Here are the reasons, some of which I've enumerated in the past and some new ones:

1. The recumbent has a different performance profile than a DF so it's likely that I'd ride most brevets solo. Although I'm prepared to do this it's always more fun when you encounter someone who is simpatico in terms of pace, stops, etc., and can have some company.
2. Traveling with a recumbent is much more difficult. It's heavier, it requires a lot of disassembly to fit into a case the airlines will accept. 
3. I'm a DF guy. Although I like riding the Cruzbike, I love my DF's. I've spent a lot of time and money over the years acquiring my current stable of bikes. I've whittled them down to ones that I really love and would hate not to be able to use them.

And finally, there's the question of performance. Although I'll admit I'm probably not fully acclimated to riding the 'bent, I did ride it 700 miles in the last 60 days. I was concerned about my back and had sciatic issues so I wasn't doing super hard rides but the difference in my performance on the DF versus the recumbent is significant. 

As a case in point, here is the last ride I did on the recumbent. It includes a 12.2 mile segment that those who've ridden my Fennimore Frolic 200K brevet will be familiar with. It's right after you turn off of CR-K onto Green River Rd and goes to Hwy 60. It's generally uphill all the way and gets steeper as you near the Hwy.

I should note that on the day the temperature was pretty warm (near 90F) and it wasn't anywhere near an all out effort but I was trying to maintain a steady pace. Having said that, when I've ridden it in the past it's usually been a middle segment of the Fennimore 200K. Here's a Strava scattergram of my historical efforts on the segment:

As you can see, my PR is 43:42 and this ride was 59:04, 37% slower. This ride wasn't my all time slowest but on the slowest one (in May) I stopped and took a lot of pictures. Discounting that, there are only 6 times I rode it slower.

So the bottom line is, as most people say, I climb slower on the recumbent. I'll also say that my legs were really tired at the end of that 38 mile ride.

But who knows, if I were to go "all in" on the 'bent and train hard on it perhaps it'll even out. I'll get faster on the climbs and be able to take advantage of the better aerodynamics of the 'bent on descents and flats.

Stay tuned!

Tick tock

 OK, the pendulum is still swinging...

Had my pre-surgical exam today which actually went pretty well. The PA that I saw and I had a good discussion about the options, surgery pro and con, etc.

Here's the current state of my infirmities: 

• The three smallest toes on my left foot are pretty much continuously numb.
• Any activity (riding the recumbent, walking, etc) generally results in my calf hurting or feeling "tight"
• I have fairly continuous pain in my lower back which ranges from mild to very uncomfortable. It's enough to keep me awake at night.
  
• Prolonged activity generally causes pain from my piriformis to my toes.
• My left leg just doesn't "work" correctly - when I walk I have a slight limp which gets progressively worse the further I walk. When I ride the recumbent my left calf gets progressively more painful and my toes/forefoot get increasingly numb.
  
• I'm not able to stand up on my toes with my left leg, at all. I can raise my heel perhaps .5".

Although the PA said it would get better, she was also fairly certain that I'd never lose the numbness in my toes without surgery nor would I regain full (normal) functionality of my calf muscle. She also said there was the possibility of nerve root degradation of the sciatic nerve if I didn't have the surgery.

 On the downside, the surgery won't make me any less likely to herniate the disc again in the future. Core strengthening, gradual adaptation to stress (climbing, distance, etc) would lessen the likelihood of recurrence but not eliminate it. Also, when they snip away part of the disc (which wouldn't retract to its normal position anyway) that's impinging on the sciatic nerve there's that much less disc providing cushion. As I get older and the disc shrivels up naturally I could end up bone on bone and this could lead to a more involved surgery (fusion) but that could happen regardless of whether or not I have the surgery.

So, I'm having surgery. I'm hopeful that if I do I'll regain normal function in my leg and will be no worse off than I was before. I'm also hopeful that with additional core strengthening I can resume "normal" activity which for me means 1200K's on a diamond frame. The jury is well out on that.

In practical terms, here's what it all means:

• Surgery next Tuesday 8/25
• Three weeks of no activity beyond walking. Don't pick anything up that weighs more than 10 pounds. No yard work, no mowing, no anything really.
• After three weeks, I might be able to ride the recumbent on a trainer at low levels of intensity.
• Six weeks I can resume riding but shorter distances and easy level of effort.
• Gradually increasing until 8-12 weeks I'm riding near normal.

 I'm hopeful that I can do a bit of riding outside before the weather turns to crap and do ever increasing distance/intensity on the trainer after that. We're not currently planning on going to Texas this winter and are instead staying in the godforsaken frozen wasteland this year so I'm going to be putting in some serious Zwift (or Rouvy) miles.

After that, I'm hoping that I can start riding the DF outside next spring, ramp up and do a series then do several grand randonnees. Current wish list is: Hokkaido, LEL, SBS, Cracker Swamp and Great Southern.

Stay tuned!

The pendulum swings

 As is customary for me, I've continued to research all of the various options in front of me with the most important being whether or not to have surgery. I've come across the following from a number of sources, this one from Harvard Health Publishing, a publication of Harvard Medical School, called "When is back surgery the right choice". Among other things it says this (emphasis mine):

The telltale sign of a disc problem is sciatica—pain that radiates down the buttock, thigh, back of the leg, or calf. For new disc pain, conservative care is the best first step. If sciatica persists or worsens despite conservative care, you might consider discectomy to relieve pain by removing the portion of the disc pressing on nearby nerves.

However, studies suggest that a year of conservative therapy is about as effective as discectomy. Therefore, the decision to have discectomy depends on whether you prefer more immediate pain relief.

OK, I'm not the most patient of patients but given Covid-19, inability to travel, etc., I've found myself asking "what's the rush?" especially if the end result one year later is the same.

So based on that, the pendulum is swinging toward not having surgery.

I have a pre-surgical exam this coming Thursday. I'm hopeful the person I'm seeing (a PA) will be knowledgeable and that we can have a discussion about the various options. We'll see.

Since I previously said I wasn't going to write about my health woes and would restrict myself to writing about riding, I'll add some updates there.

I continue to ride the recumbent exclusively. As noted previously, I've found that the more acute angle created when reaching for the bars on a DF is definitely harder on my back. I don't know at this point if this will pass when my back is fully healed or whether that means I'm going to be on the recumbent forever.

Also in the unknown category is how much to ride, even on the recumbent. I've found that 30-40 miles is my current limit. As a ride goes past 25 miles or so the sciatica starts to take hold (forefoot gets numb, calf gets "tight"/crampy feeling, hamstring starts to burn). Stopping and stretching a bit helps but no matter what I do when I finish the ride my foot is numb and I've got pain the full length of my leg. It subsides after a while but this does seem to be consistent.

I'm not sure what about riding the recumbent is irritating my back. As noted, it is better than the DF but 30-40 miles seems to be an absolute limit. I can make it worse by pushing harder but that limit seems to be pretty absolute even for easy rides. I did 30 miles today with hardly any climbing and I did what little climbing there was in a really easy gear. My average watts for the ride was 100 which is pretty darned easy and yet at 25 miles or so the sciatica flared and I had the pain described above post-ride.

So the question is: am I prolonging the injury by continuing to ride, even on the recumbent? Would I be better off not riding at all for a period of time? To put this in perspective, were I to have surgery I wouldn't be able to ride for somewhere between 2-6 weeks (I've seen both ends of that range in the literature). The "upside" if you want to call it that is I probably wouldn't want to ride for a while if I had surgery.

So continue to keep the back at a low boil or stop riding for a while?

For the moment, I'm going to continue riding. Mostly because I'm so damned limited in what I'm able to do that the notion of just sitting all day, every day, would drive me mad with boredom. I'm hopeful that the back will continue to heal even with a relatively steady diet of 30-40 mile rides.

Stay tuned!

More on the DF vs Recumbent

Following my successful outing on the recumbent a couple of days ago, I did 20 miles on the trainer (Zwift) on the DF. I did one of the new Paris routes on Zwift that included one longish climb - 1.66 miles at an average gradient of 4%. Didn't kill myself on it, kept the wattage at 200+- 20. There was also a short sprint that I got out of the saddle for and pedaled a bit harder with a max wattage for the whole ride at 393 watts. Not soft pedaling but not Peter Sagan level watts either.

Post ride, my sciatica and back were significantly worse. Foot numb, left calf and hamstring burning. This lessened somewhat over the course of the day but as I write this the following morning, my back is still sore and my toes are numb.

So I'm going to stick to the 'bent for a while.

I don't know what this means for the future and have more questions than answers right now:

• Will I still have the surgery?
• Certainly if having symptoms is a requisite, all I need to do is keep riding the DF
  
• Is riding the DF a mistake, even for JRA riding?
• My hope (and plan) regardless of whether or not I had surgery was to attempt a series on the DF next year and, if it goes well, continue life as before with riding the recumbent as an occasional event either to recover from a long ride or just to do something different.
• If the series on the DF didn't go well, my fallback was to do randonneuring on the recumbent and ride the DF for shorter, JRA rides here.
  
• Recumbent only, forever?
• I'm still not mentally "there" for this alternative but it might well be the reality I face. As I've noted in the past, this leads to a bunch of follow up questions:
• Continue randonneuring or just give it up?
• If I continue randonneuring, given the difficulty of transporting a recumbent (or any bicycle for that matter), domestic brevets that I can drive to only?
• Given the consequences of an "episode" do I restrict myself to domestic only?
• Even if I decide to continue randonneuring, if it's 'bent only do I restrict myself to flatter rides?

Lots of unknowns right now.

Stay tuned!

N.B. I've been asked a couple of times what "JRA" means. It's Just Riding Along

On the road again

 I said I wouldn't post anything until I was off the trainer and riding on the road again.

I'm posting.

You do the math ;-)

My regular readers will recall I was restricting myself to the recumbent on the trainer mostly because as rides got longer (10+ miles) my sciatica started acting up - calf would burn, forefoot would get numb, etc. This wasn't a problem on the trainer since I could just get off without worrying about how I was going to get home. The sciatica gradually lessened and the distances I was able to ride on the trainer increased to 36 miles so I thought it'd be OK to head out onto the roads.

I've ridden both the DF and recumbent on the trainer (I bought a second "smart" trainer - a Tacx Neo which I highly recommend if you're in the market) and the 'bent seems easier on my back so I decided I'd ride that. This wasn't entirely without incident since the Cruzbike is so different and I don't have a ton of actual road miles on it (527 to be precise) so I decided to put it on the car and headed over to Twin Bluffs where the roads are generally really quiet and I can loop around without having to do any weird maneuvers like starting from a dead stop at a traffic light, uphill, into a turn that take more skilz than I currently have. Well, I can do it but I'm generally of the opinion that mixing it up in traffic with marginal bike handling skills isn't a good idea.

So off I went to Twin Bluffs. As expected, getting underway was pretty weird but I did manage it on the first go. As an aside, I'll wager $10 to anyone reading this who hasn't ridden a recumbent that they can't get underway on the first try on the Cruzbike.

The ride was mostly uneventful. I went back and forth a few times (for those familiar with the area, from Twin Bluffs over to US-60) then headed over toward the Big City and a little bit busier road (CR-O) which also has a nasty little 8% climb on it. I then turned onto CR-RC which has a couple of 8% climbs before getting onto the bike trail and riding back to Twin Bluffs.

I did make one bike handling faux pas. Turning onto the bike path involved a greater than 90 degree turn and I took it too fast for my limited skilz. The Cruzbike has a tendency to "dive in" to a turn if you turn the front wheel and lean too hard (a lot of wheel flop) so I overdid the turn but there was a flat, grassy area there so no worries. I didn't crash, just rolled onto the grass and stopped.

One downside of riding the 'bent on the road versus the trainer is I need to keep my speed up on hills in order to maintain control. Below about 5 MPH I start to weave and have a hard time holding a line which is obviously problematic if there's traffic. I was pretty good at this when I was riding the Cruzbike exclusively for a few months in Texas earlier in the year - I climbed a 14% hill there while holding my line - but my skills have lessened somewhat with no practice. It'll come.

At any rate, because of the need to maintain my speed, my max wattage for the ride was 583 watts which is pushing pretty hard. My back seemed to tolerate it OK. It was sore post ride (this was two days ago) but "proportionally sore" with the rest of my out of shape self. It feels OK today.

And on the back topic while I'm here I'll give a brief update.

I had a pre-surgical exam scheduled for August 6th. Drove in to Madison (75 miles one way) and was on time for my appointment but it was the wrong location. When I did the scheduling, I first told the person I'd take whatever was available first so she scheduled me for a place that was another 45 miles further away. It was only one day earlier so I said never mind, schedule me for the Madison location which she did for my other appointments but didn't change this one. They were waiting for me at the other place which was obviously too far away for me to get there in time for my appointment.

Sigh.

Rescheduled for later in the month.

Having said that, at this point were I betting man I'd say the surgery is unlikely to happen. In fact, there's a reasonable probability I'll just cancel everything. My back is improving, still very slowly, but it is better. As I write this, the only symptom I have is a little bit of an ache in my low back and my toes feel "funny" - not numb or tingling, just a bit different from the ones on my right foot. This is obviously a vast improvement from two months ago.

I've also been wanting to restart the core strengthening but my tentative restarts in the past few weeks have resulted in a bit more back pain so I'm going to hold off for a bit.

In other related news, I'm on a diet :-( 

I put on 12 pounds in the last two months and this was on a "base" that was already higher than I would like. So no beer (sad trombone) and very small meals. My "dinner" last night was 1/2 bagel toasted spread with peanut butter and an apple. 

Sucks being me.

But I've lost 4 pounds so far and will stay with it. I'm hoping that I can ramp up the distances a bit so that'll help. 

Stay tuned!