Slow progress, better than no progress

 I missed the 8 week update 4 days ago so here's the general rundown:

• My back still hurts, but not as much.
• I'm able to bend a bit more without "paying for it" later.
• The three smallest toes on my left foot are still tingly/numb. This might be permanent but perhaps too early to tell.

Under the category of "really weird stuff", I've started riding again (more below) and after each ride my left calf and hamstring are incredibly tight and painful. Doing the "wall stretch" for my calf literally feels like I'm going to tear the muscle. I also have kind of a weird "hitch" in my pedal stroke, sort of like a worn bearing in the bottom bracket. I've been focusing on trying to spin smoothly.

I've been using a foam roller to try to break up the knots in my hamstring/calf. After more than a week, I've finally gotten them to the point where I can do it without screaming in pain so that's progress. 

Since I was cleared to ride on 8 October, I've ridden 283 miles in 17 days, all on the recumbent on the trainer. My longest ride thus far is 34 miles. I've started doing a bit more climbing and pushing a bit harder.

I'm pathetically out of shape. I don't play the age card very often but I'll play it now: I hurt all the time and it seems to take forever to recover from even a moderately hard effort. All of the muscles involved in cycling really hurt. It's getting better but really slowly. It seems like three days riding in a row is about all I can manage and the sessions/distances have gone 10-11, day off, 16-14-19, day off, 16-24-20, day off, 34-26-22, day off. 

I've had some extended times off the bike in the past, usually due to accident or injury, but it is objectively taking me a lot longer to regain fitness now that I'm older. I've got detailed data 

going back 20 years and it is most definitely taking me longer to ramp back up and I ache a lot more after riding.

We have a Jacuzzi tub in the master bath and I've been using it with Epsom salts in the water to try and reduce the soreness and it does help. In addition to the aforementioned foam roller, I've also started doing more stretching. I've started some really easy core strengthening and have discovered I don't have any core strength.

I'm able to do more. I can e.g., bend a bit at the waist and towel off my feet after showering. Yesterday I put air in the tires on the car and realized I was bending to do it rather than kneeling. Although this probably isn't a good idea, the point is that I could do it and not have agonizing pain during or after. I also sat up in bed (lifted my upper body) instead of "log rolling" to get out of bed in the middle of the night. Again, probably not wise but not debilitating. I carried some 25 lb bags of water softener salt.

Things that I'd like to do in the next few weeks include riding the DF on the trainer and seeing how my back responds and riding outside, either on the recumbent or DF. It's cold AF (wind chill of 26 F as I write this) so I'm not in any hurry to go outdoors. I'm hoping for a bit of a warm spell, at least in the upper 40's, before venturing outdoors.

Stay tuned!

Back to riding, sort of

A lot of people (including me) don't really think of being indoors on a trainer as "riding" but "man's gotta do" and all that.

 Living here in this godforsaken frozen wasteland, a trainer is a necessary evil. Everybody who's ridden outside when it's -20, raise your (frostbitten) hands - I'll wait. Oh, and for what it's worth I HAVE ridden outside when it's -20. But when it takes longer to get ready for the ride than to do the ride it's just not worth it. I'll do it on occasion just to get out but not on a regular basis. Also, the secondary roads here are not salted and there are long sections that are always shaded so they're a sheet of ice. Even studded tires don't help. So this means the only place I can really ride is up and down the shoulder on a state highway.

I'm riding the recumbent on the trainer. As I've mentioned in the past, pre-surgery the recumbent was noticeably easier on my back and I'm assuming the same will be true now. Plus it's a more controlled environment and perhaps most importantly, if my back starts to hurt I can stop without having to worry about how I'll get home.

OK, rationalizations done let's move on.

I'm a long time Zwift user. Although it's a "game", I find it to be very motivating, much more so than grinding out miles while watching a movie, jamming tunes, whatever. The environment ("world" in Zwift parlance) isn't real but the other avatars you see on a ride represent real people and there are a number of ways to challenge yourself: 

1. Setting a PR on a climb.
2. Keeping your power level above "x" for some period of time or for the entire length of a climb.
3. "I'm going to catch that person in front of me" or "I'm not going to let that person behind me catch me"
4. Going for a KOM on a climb.
5. Alpe d'Zwift is a killer and there are a number of other really tough routes.
   

So as a result, I can do long rides on Zwift while staying motivated and engaged. I guess that says something about me that it takes a bit of competition, albeit with myself on occasion, to keep me interested. 

But right now I don't need to be pushing hard, what I need to do is easy spinning and slowly rebuilding the strength that I've lost. I don't need to be challenging PR's, staying in front of people, etc. For some reason when I use Zwift I can't help competing in some fashion. I don't know whether it's to stave off boredom, innate competitiveness (which strangely enough I don't really feel IRL on the road) or what but if e.g., I'm doing the "Epic KOM" and see that my PR is within reach I start to push harder or if I see that I'm gaining on someone I'll push that little bit harder to catch them. 

In real life riding on the road if I see another cyclist up ahead I'll try NOT to catch them. Unless they're going significantly slower than me I'm content to back off and keep my distance. I do on occasion push hard on a climb or try and set a new PR but that's me versus me.

So I'm trying Rouvy. 

They do have assorted challenges but I've found most of the rides to be very lonely experiences where I'm the only rider. The routes, of which there are many, are beautiful and most of them are really well done. There is also a wide variety of routes ranging from flat and short (which I've been doing) to long and extremely hilly (Alpe d'Huez, the Stelvio, etc).

So I can roll along and look at the scenery.

Is this permanent or will I go back to Zwift once I've regained some semblance of strength? Hard to say at this point but I'm enjoying Rouvy thus far but I've only done two rides on it of less than 18 miles.

Stay tuned!

Clear the decks for action!

 Well, not quite.

Had my post surgical exam this morning. One mistake that I made going in was that I didn't summarize the last 6 weeks or review my notes. The first question was "tell me about the first two weeks post surgery"? Did the best I could from memory and after looking at my notes when I returned home I think I gave a reasonably accurate assessment but I wish I'd have been a bit better prepared. Oh well. D- on the exam.

I was obviously able to describe things in the last couple of weeks much more accurately sans notes. As I mentioned in my previous blog, I hurt my back two days ago. I was sitting down on the stairs so Marcia could put my shoes on and sat down too fast and too far back on the stair so I ended up hitting my back hard on the next stair up. It's really been hurting and I've only been getting a couple of hours sleep per night.

I didn't want the assessment overly colored by that though I did mention it. He said he would have expected more symptoms in my leg and less in my back, I'm hopeful that the back pain is simply a result of my carelessness and it'll dissipate. Before that, I actually had a couple of pretty good days so let's hope that's the trend and that it continues.

The good news is that although I'm supposed to continue to take it easy (no bending at the waist, no lifting) I'm cleared to ride indoors on the trainer or even outdoors if I want. Although he's an avid cyclist, he has a really weird mental image of what the position on a recumbent looks like. He seems to think your knee comes up to your chin on the pedal stroke. Fortunately, I was prepared for that and had pictures of myself taken from the side which showed the position of my back and my legs at various points in the pedal stroke.

So he said I could ride the recumbent or a conventional bike although by "conventional bike" I think he means like a beach cruiser where you sit straight up. I suppose this means I could ride a DF on the trainer (I do have one set up) and just not grab the bars. I might work up to that.

I did a very brief session just to check the setup. I'm experimenting with Rouvy vs my usual Zwift so I wanted to get the trainer and various sensors paired and make sure everything worked since I hate having to stop in the middle of a ride and screw with something.

I rode one whole mile. I. Got. Nothing. Hopefully better days ahead.My plan is to ride the trainer exclusively for at least a week and then perhaps venture out on the roads, all on the recumbent.

After the end of October I can "resume normal activities". I don't reckon this means resuming my Mr Olympia weight training but presumably does remove the 8 pound lifting restriction, I'll be able to bend, etc. He also said I could start core strengthening (planks and bridges). I may wait a bit on that and only "turn one knob" at a time.

Stay tuned!

6 weeks post microdiscectomy report

Despite the fact that I've wavered about whether or not to talk about non-cycling things in this blog I'm writing this mostly to chronicle my own experience but also because a few people that are considering similar surgeries have asked me to continue to post my experience.

As intro, here's my normal daily routine:

1. When I first wake up, I lay in bed for a while and do a "self-assessment". How badly do I hurt? Any sciatic symptoms? This seems to be the time of day when I can get the most consistent measure of how I'm doing. This also has the advantage of my being fully awake before I get out of bed so I don't inadvertently twist or bend.
2. Have breakfast then take my morning walk. This is usually my longest walk of the day and six weeks on I've worked up to 2 miles.
3. Take a second walk in the late afternoon, usually a mile or so.

Interspersed with this is normal (limited) activities: walking around the house, back and forth to my workshop, etc.  I typically walk between 7,500 to 11,000 steps per day. Aside from a small amount of stretching (calf and hamstrings) this is my only activity.

So how do things stand?

On balance, I'm certainly better than I was in the first few weeks. Having said that, I'm most definitely not better than I was pre-surgery:

1. My self assessment this morning was some tingling in my toes and tightness in my calf.
2. As I write this, the tingling is a bit worse and my back aches both in my spine and my low back muscles. On the 1-10 pain scale I'd put it at a solid 2 - not debilitating but it hurts.
3. Experience says that these symptoms will get worse over the course of the day. I start my morning walk with a bit of numbness as described above but walk with a normal heel to toe stride. By the end of my walk, my forefoot is numb and I've got a slight limp.
4. Typically by the end of the day my back really aches, pain level has gone up at least to a 3 or 4 depending on what I've done during the day.
5. I've got nothing for core strength and I've gained 15 lbs in 2020. It's likely that the loss of core strength has at least something to do with my ongoing back pain, in particular the low back muscles. 
6. Bending or twisting even a small amount results in sciatic and low back pain. I still can't put on my own socks. Washing and drying my feet while showering always results in my foot being numb and my back hurting. I try hard when doing these things to "bring the work to me" and not bend but a small amount of bending is unavoidable.
7. Overall, I'm really fragile. It takes nothing to get my back really hurting or provoke more significant sciatica. For example, this morning I sat on the steps to put my shoes on and leaned back against a step behind me. I'm really hurting.
   

As I've said previously, overall I've been a "model" patient and have followed the post-surgical protocol mostly to the letter. I have done small amounts of bending and twisting but on reflection I think that was actually a good thing. I've looked at a ton of web sites detailing post-microdiscectomy treatment and they uniformly say no bending and twisting. It occurred to me though that if this were really bad they'd likely suggest or prescribe a brace and none of them do. My conclusion is that some movement promotes healing.

No, I've not been doing that. More like standing at the kitchen counter and turning to pick up the pepper shaker.

So that's it. Was having the surgery worth it? Hopefully it is still too early to make a definitive statement. If this is as good as it gets though, the answer is no.

My 6 week post-surgical exam is tomorrow. I'm hoping that I'll be cleared to ride on the trainer and will be able to start PT to rebuild some flexibility and core strength.

Stay tuned!

Clipping my wings?

Since I don't have much else to do, I've been thinking about what life might be like in the future. I've read in a number of places that people who have had back surgery put rather severe restrictions on themselves in terms of what they even try to do. Given the risk of recurrence and also the fact that other options (disc replacement, fusion, etc) are much more invasive with a much lower probability of success, this seems prudent.

Which brings me to my idle musing. When I travel with the bike, I always say that "it's all about the first mile and the last mile". By that I mean that once everything is loaded in the car or headed down the luggage ramp at the airport it doesn't really matter how long the trip is. Likewise, once you arrive at your destination the only segment that matters is the interval between arrival and your final location.

When I travel for a long brevet, if I'm flying I typically have three bags: my bike, my luggage and a small backpack. The bike plus case usually just makes the weight limit of 50 pounds. The luggage varies depending on the brevet, the time of year, what other travel I might be doing, etc., but typically weighs 40 plus pounds. The backpack is usually in the 5-10 pound range again depending on whatever else is on the itinerary and time of year.

So a "deep dive" into the logistics. 

Some of this can be handled with the suitable application of $$ but some can't. When I load everything into the car, I can have Marcia help so I'm only lifting about half the weight - 25 pounds with some associated bending and twisting. Likewise when she drops me off at the airport (assuming she's not coming with me). Alternatively, I can pay someone at the airport to handle my bags and take them to check-in. Money well spent.

But on arrival, especially internationally, I don't recall baggage handlers being able to be inside the customs area. Maybe they are but I don't ever remember seeing them. Let's be optimistic and assume there is someone to lift the bag off the luggage carousel at regular baggage and oversize and escort them and me to the customs area.

And then there are the occasional airport transfers. Arrival at LAX on an international flight goes: pick up your luggage, clear customs, haul it to the transfer area, put it on a luggage cart or carousel.

Then the vagaries of car rental or maybe even worse, being picked up by friends. Frankly, I'd feel like a total schmuck imposing on friends who've already driven to the airport to pick me up by standing by while they loaded my bags. So once again I'd most likely either help or do it myself. Likewise when we get to wherever we're going. I hate being that much of a burden.

Domestic rides are somewhat easier. I have only the bike to lift (no case) and can have help doing that if needed. 

And of course if I'm riding a recumbent life gets even more complicated. Bike is heavier, doesn't pack as well, case is larger and therefore heavier, you get the idea.

What does this all mean? I don't know really. Maybe the artificial limit I put on myself is just that: artificial and that with the appropriate post-Op PT and strengthening I'll be dead lifting VW's. 

I know at this point, I find the prospect of further back injury pretty terrifying. I've read accounts of people that go through one surgery after another gradually working their way up their entire spine replacing discs, having fusions, etc., ultimately to no avail as they're still in pain. Obviously these are "worst case" scenarios that I hope to avoid with a reasonable amount of caution. This doomsday scenario also seems unlikely for me because other than the L5/S1, MRI's show my back is in pretty good shape.

Having said that though, the L5/S1 microdiscectomy has been the first step on a slippery slope for some people. They re-herniate the disc and aren't candidates for a disc replacement (various reasons for this) so they have a fusion. Because of that, they're less flexible and put more stress on the next vertebra. Herniate that, microdiscectomy->fusion-> and so on up the spinal cord.

So is air travel a thing of the past? Am I being overly paranoid?

Stay tuned!