A change of focus

As I said previously, my intent in starting this blog wasn't to document my daily comings and goings, rather it was to chronicle my cycling life. Rides, bikes, etc., anything bike related.

But since early June (and periodically before), it's been more about my health, specifically, my back. The rather tenuous link to cycling has been my musing on whether or not I'll be able to continue riding at all, do long brevets, DF versus recumbent, etc.

Chronicling my infirmities is not what I set out to do here so I'm going to stop doing it. I'm going to change the focus of this blog back to what I'd originally intended when I started it. Since my riding has been confined to Zwift on the trainer there's really not much to say about that. So I'll probably go dark here unless and until I'm able to resume riding on the road be it on a DF or recumbent.

I continue to muse about what direction my future cycling might take. Options on the table include no more randonneuring, shutting down the region, etc., in other words, a change of focus. As I've noted in the past, I rode for a long time before I started randonneuring so I know there are a lot of alternative ways to enjoy cycling. It might be time to start exploring them.

In the meantime, if you want to know how I'm doing, you'll have to ask.

Stay tuned! (though there might just be static on the line)

Thoughts and clarifications on the surgical option

I've gotten several emails from friends saying (in so many words) that I should man up and have the surgery since that offers some chance of resolving the back issue completely. I thought I'd been clear about where I stand on the options but perhaps not so I've amended a few earlier posts to try and clarify where I stand on that and thought I'd summarize here.

I want to have the surgery. As I said, the idea of six more weeks of pain, surgery then recovery doesn't sound all that great but it does offer the possibility of resolving the problem once and for all. A microdiscectomy is minimally invasive, the success rates are high and the possibility of future problems is low.

However

There is the possibility that I won't have that as an option. I thought I'd explained that sufficiently but the messages I've gotten lead me to believe readers think I'm waffling over whether or not to have it done, which is emphatically not the case.

Here's the deal (explained by a layman - me):

The disc is like a jelly doughnut. The inner part (the nucleus) is the jelly, the outer part (the annulus) is the dough.What happens when you herniate the disc is exactly what happens when you smash a jelly doughnut: the jelly gets squeezed out and the area where the hole is sticks out (protrudes). In the case of the disc, it sticks out into the space where the sciatic nerve exits and presses on the nerve causing pain. The jelly (nucleus) also irritates the nerve.

If it "resolves" itself, that means two things: first, the body absorbs some of the nucleus and some gets sucked back into the disc; second, because there isn't as much nucleus inside the disc it shrinks back to its old position so it's no longer pressing on the sciatic nerve. As a result, you're no longer in pain.

So you're left with a disc in its correct place that provides some, but less, cushioning than it used to. It also has a weak spot (the hole) where it'll want to leak more if it's compressed too much.

As a result, once it "resolves" itself, were they to do surgery all they'd find is a disc that was where it was supposed to be. If they were to separate the vertebrae and inspect the disc they'd find that it wasn't as full of gel as a healthy disc would be but they won't do that because they won't even do the surgery. That's because there's nothing for them to do. While not fully healthy, the disc is in the right place and it's not pushing on anything so there's nothing to cut, snip, widen, relieve, etc.

The process of compressing/retracting will be repeated (as it has been with me over the years), gradually getting worse (as it has been with me over the years) until there's no "jelly left in the doughnut" at which time the vertebrae are bone on bone. At that point, they can either replace the disc with a synthetic one (not everyone is a good candidate for this) or fuse the vertebrae. This is something I want to avoid at all costs. It's a more involved surgery, success rates are lower, outcomes aren't as positive.

So I'm in the position of "hoping" I'll continue to hurt for the next six weeks so I can have the surgery done. Seems like a crazy thing to wish for but that's where I'm at.

So bring on the knife!

Knowing when to quit

You gotta know when to fold 'em

K. Rogers, "The Gambler"

Referencing my earlier post which enumerated what I see as the options in front of me, I was speculating about options 2 (no surgery) and 3 (give it up). In particular, I asked myself the question “suppose I’m on days 1-3 of a 1200K and my back starts hurting”. Do I quit at the first sign of trouble? Try to push through with the potential of REALLY hurting myself?

1200K’s aren’t easy. We ride on through aches and pains - to a point. If that point is such that there’s a high probability it’ll happen on day one it seems foolhardy to even try. Furthermore, I don't start brevets to "give it a shot" or "see how it goes". I start to finish. Given that, I'm as likely as anyone to continue to push on through pain, perhaps more than I should.

To further illustrate the point: the worst my back ever hurt during a 1200K was on the 2016 Great Southern Randonnee in Australia. I rode well on day one but a few K’s into day two had the “OMFG lightning bolt of pain”. I rode another 100K like that then had to quit. I did everything I could think of to ease the pain including getting a hotel room, taking a hot bath, taking a nap, etc. It hurt so badly I couldn't stand it and I couldn't put any power into the pedals at all so I quit 600K into the ride.

However, and this is the key point: it was NOWHERE NEAR as debilitating as the first four days of the episode I'm currently experiencing. Not even close. Had it been that bad, I’d have likely needed an ambulance and extended stay before I’d have been able to fly home. There’s no way in hell I could have managed to get my bike, luggage, etc., together to make the return trip.

So with that as backdrop, when to pull the plug? Do I push it until I have an episode like this where I’m basically crippled? This seems unwise. Do I quit at the first little ache? This also seems dumb since aches and pains are part of the gig. The problem is continuing on once my back starts hurting and how long to push it.

I started the Colorado Front Range SR600K last year and quit at the halfway point. On that ride I had what I’d term an “analytic DNF” - my back didn’t hurt so bad that I was UNABLE to continue but it was getting progressively worse. I tried to gauge the rate it was worsening against what I knew I had left to do that day. This was made easier by the fact that it was an out and back route so I knew exactly what was in store. I also knew that once I started back from the turnaround there wasn’t any cell phone coverage so if my back did crap out I’d be well and truly stuck. Based on all that I decided to call it.

As an aside, I'd started the ride with Eric Peterson. He decided to stop at the end of the first day (horrific thunderstorm) and while I was riding day two he rode to Denver then got a ride out to his car which we'd left at the start. He was all the way back at the start (300K away) when I called him to say I was quitting. He drove out and got me then took me all the way back to the start, nearly 400 miles round trip, and I want to publicly acknowledge his generosity and thank him for that kindness.

Back to the SR600K DNF. It still haunts me. Did I quit too soon? Had I pushed it would I have been able to continue?

The same thing happened on the Mile Failte. I quit on day 3 with 300K left to go and 30 hours to do it in. I normally ride 300K in less than 15 hours. My back was getting progressively worse, I knew I had a lot of tough riding in front of me so I decided to quit.

I HATE to DNF but I can live with it if I feel like I did everything within my power to continue. Does this mean not quitting until I'm paralyzed on the side of the road? Or do I quit at the first little ache in which case I might as well not even start?

This is particularly relevant if I don't have surgery. Sure, I'll do more core strengthening and try to do everything I can to prepare but the back failures while cycling have been worsening both in terms of frequency and amplitude. Three episodes in the last six months and this last go round is pain like I NEVER want to experience again.

So in the words of Mr. Rogers, how do I know when to fold 'em?

Through a glass, darkly

OK, I'll preface this post by saying I'm rather down and seeing the world through crap colored glasses right now.

I've been considering my options and admittedly looking at all of them in their worst possible light but from that perspective none of them seem all that great. Here are the choices:

• Option 1: Hope that my back and sciatica continue to really hurt so I can have surgery on September 2nd.
• On the plus side, the success rate is high and the recurrence rate is low. This stands a good chance of resolving it once and for all.
  
• On the minus side, that means six weeks of pain, then surgery, then recovery.
• That's a pretty impressive set of drawbacks! Seriously, I don't want to be overly whiny but I'm really in a considerable amount of pain 24/7. I only sleep for an hour or so at a time before I hurt so badly I wake up. Six weeks is a long time. I've got assorted pain meds but I don't tolerate them well and don't enjoy throwing up as much as I used to.
  
• Option 2: Hope that my back heals between now and either my pre-operative visit (Aug 6) or the date for the surgery. If this is the case, they won't do surgery.
  
• On the plus side, no surgery and gradually decreasing pain with resulting increase in function
• On the minus side, let's face it - I've been down this path. OK, I'll admit I could have done MORE core strengthening but the fact is I was fairly religious about it so it seems pretty unlikely that with an increase in core work I'm suddenly going to be doing PR's on Mount Ventoux without any negative after effects
• So it's possible, perhaps even likely, that if I continue to do longer/hard brevets my back will crap out.
• This puts me on the repeat schedule I outlined in a previous post where it's 4-6 months of a significant amount of pain that MIGHT conclude with my having surgery but might also resolve itself in exactly the same way.
• So the most pessimistic view of this is:
• I gradually increase miles/intensity
• Next year I do my normal ramp up of a brevet series followed by one or more 1200K's somewhere in the world or perhaps an SR600K
  
• My back craps out
• 5 months from then I MIGHT have surgery or it resolves itself. In either case, I'll have blown another 5 months of my life
• Option 3: Just give it up. Assume my back eventually recovers and resign myself to JRA rides of 200K or less at a relaxed pace.
• Plus: no surgery, gradually decreasing pain, might never have a problem with my back again
  
• Minus: I'll never see the friends I've made doing brevets again (at least the non-local ones). Also, I'll miss the challenge of doing long brevets. I count these two minuses as a significant reduction in quality of life.
  

I rode for a long time (almost 30 years) before I did my first brevet so I know there's a lot of cycling to be done outside of randonneuring. That doesn't mean I'm ready to give it up but given the above choices that might be the end that's in store for me.

But right now I'm going to go with option 1. Although hurting for six more weeks, surgery and then however long to recover doesn't sound all that great, the possibility of resolving the issue once and for all seems to me to be worth it in the end.

Stay tuned!

Not sure what to wish for

I had a conversation with one of the surgeons nurses today so I could ask my follow on questions. I had two questions:

1. If by the time of my surgery in early September my back has resolved itself and I'm no longer in pain, what, if anything would be done?
2. Will a microdiscectomy do anything for back pain?

The answers were:

1. If it's resolved itself by the time of the surgery, they won't do the surgery. I have no choice in the matter.
   
2. The microdiscectomy is primarily to treat sciatic nerve impingement. "They don't chase back pain".
   

One thought before I continue. My understanding of sciatic nerve pain was flawed. Impingement on the sciatic nerve can cause pain anywhere from the low back to the toes so it's likely that the microdiscectomy would in fact address that. It's rather mysterious really how it manifests itself. Regular readers will recall that early this year I had what I thought was a severe strain of the Soleus muscle (part of the calf muscle group). At that time I had zero pain in my back, it was all in my left calf. That was the sciatica.

In the six weeks since this latest round started I've had pain in any one or all of my hamstring, calf, lower back, foot. Some days the only thing that hurts/burns is my calf. Some days it's my hamstring. Some days it's both. Some days it's just my back. You get the idea.

So it's possible, even likely, that a microdiscectomy will solve my problems. I'm encouraged by what I've read both in terms of success rate (95%) and the low probability of recurrence (5%).

So given all that, do I try to keep my back inflamed for the next six weeks so I can have surgery? I mean really, all I need to do is dead lift a couple of hundred pounds and they'll have plenty to work on. This sounds neither wise nor pleasant - it really does hurt! Further, as I've often said, minor surgery is surgery on someone else. If it's on me it's by definition major and avoiding or postponing it seems like a good idea.

But if it resolves itself and I have another episode in the future I'm in the same cycle :

• 2-3 weeks to get an MRI
• 2 weeks calling and leaving messages to try and get an appointment with the surgeon
  
• 2-4 weeks for the appointment
• 6 weeks to pre-surgical exam
• 6 weeks to surgery
  

So if I'm doing the math correctly, from my next episode to surgery is 18-21 weeks. In other words, almost half a year blown. Again. Not to mention no small amount of pain.

So for right now here's what I'm thinking:

• Continue trying to limit my activities so it can heal. I do plan on continuing to try and ride but easy spinning and relatively short distances.
  
• If it does, forego surgery for now. Not really any choice here, they won't do surgery if I'm not experiencing any symptoms.
  
• If I don't have surgery, go on a major core strengthening program - abs of steel will be my goal.
• Resume cycling on the diamond frame and gradually ramp up miles and intensity. It's likely this won't commence in full until September at the earliest.
• Hope it doesn't happen again and that I'm able to resume the full gamut of randonneuring events which includes both 1200K's and SR600K's.
  
• If it DOES happen again then:
• Reevaluate whether or not I still want to continue randonneuring
  
• If I'm still feeling like I want to do long rides, reconsider diamond frame vs recumbent as a possible solution that might be easier on my back
  
• Reconsider whether or not to have surgery

The downside of all this of course is we're talking about "test until failure" where "failure" might involve any or all of incredible pain, being stranded in the middle of nowhere, perhaps in another country. That doesn't sound all that appealing.

Another alternative of course is to give up on randonneuring right now and consign myself to shorter rides at moderate pace. As I've said previously, I'm not there yet.

Stay tuned!

The universe is not without a sense of irony

Finally have a date for surgery - September 2nd. Six weeks away and twelve weeks after this all started.

But wait, it gets better.

I received a folder of information on what to do pre and post-op. It said no physical activity beyond walking until the post-operative exam which is already scheduled for six weeks after surgery in mid October.

So assuming I follow that guideline and further assuming I can't ride between now and when I have surgery it'd be just about five months of no riding.

As I write this, my back is still hurting, my left hamstring and calf are burning and three toes on my left foot are tingling/numb so the miracle cure I've been waiting for hasn't arrived yet.

But screw it, I'm going to start riding again anyway. I've done a couple of short rides (less than 30 minutes) on the trainer so far. One on a regular bike and one on a recumbent. There was no perceptible difference between the two in how I felt afterwards so I don't know whether my best strategy is to pick one and ride it "to failure" (or hopefully, not) or alternate between the two. I've got both of them set up on trainers so I can switch easily. Not sure how to decide.

I'm not going to be going for any PR's or hard efforts. Just easy spinning with gradually increasing duration. I'll probably start off at 30 minutes to an hour and see how it goes.

It's been really hard to get up in the morning with nothing to look forward to. You can only read or do non-physical chores so much and after a few weeks of that the little tasks are all done. I've been gradually doing more physical chores and I have to say it's not gone well. I really hurt after and I usually pay for it for a couple of days.

I'm not doing anything overtly strenuous, things like sitting on the mower cutting the grass, packing bikes I've been selling, etc. Grass cutting involves a fair amount of bouncing around and twisting (it's hilly) and other things necessitate a lot of bending. But I've been doing them anyway just out of boredom.

And here's the ironic bit.

Marcia and I are long time motorcyclists. For years our vacations were long motorcycle trips and we've covered all of North America on the motorcycle. Our longest trip was 6 weeks, 18K miles. We bought a new motorcycle in August 1999 and by that November it had 35K miles on it.

We bought our current motorcycle in 2012. It's got 9K miles on it.

And randonneuring is totally to blame. Since I started doing long brevets I've been reluctant to take more than a week off to go on a motorcycle trip. On our trips we generally hit every brew pub between here and there and a week of not riding, eating pub food and swilling beer isn't exactly the right training program for riding a 1200K.

But now, I can't ride a bicycle. It'd be the perfect time to take an extended trip and would give me (us) something to do that we both enjoy doing. There'd be some amount of risk of hurting my back managing a heavy motorcycle (two up, with luggage the motorcycle weighs about 1000 pounds) but like most things riding a motorcycle is technique rather than strength. There are very small women who ride big motorcycles and I've been riding them my whole life (I learned to "drive" on a motorcycle).

Except for that coronavirus thing. Travel is definitely out.

Ironic no?

More thoughts on blogging

After corresponding with a friend, I've continued musing over whether or not to carry on writing about my infirmities as opposed to sticking to my original intent when I started this blog and just writing about cycling.

Here's the thing: I enjoy corresponding with friends I've made around the world, hearing about their adventures and yes, their non-cycling activities. I look forward to hearing from them and think about what they've said and done for a long time after.

But a blog is a "broadcast" medium. As a result, everyone hears how I'M doing so they don't bother to let me know what's going on with them. So I never hear from them.

Selfish person that I am, I miss that. But I'm neither that Machiavellian nor clever enough to consider stopping my blog so people will write to me. I was really only questioning whether my vast audience (both of you) would be interested in following my travails as I document my non-cycling woes. I also feel as though I'm turning into a bit of a whiner since all I ever write about is "I hurt", "my back hurts", "I can't get an appointment", "I can't sleep", "woe is me". I know were I reading that I'd pretty much feel like slapping the shit out of the author and saying "get over it".

But, apparently there's interest so I'll persist. At least for now. But you've got to drop me the occasional line in return. Fair enough?

One interesting, non-blog related thought. The initial Dr I consulted who ordered the MRI and referred me to the Orthopedic surgeon is a local guy who among other things consults with the Trek racing team and is a cyclist himself. During my visit with him, I asked him if I should ride the recumbent or diamond frame pre-surgery if my back eased up. He said the recumbent would be easier since the angle for my back is less acute and the normal position on a DF has you bending right at the L5/S1 joint which is where my herniated disc is located.

I asked the same question of the surgeon and he said without hesitation I should ride the DF.

Sigh.

So I guess I'll "exercise to tolerance" and see how it goes. Bear in mind that I rode 1200K with a fractured coccyx. Over cobblestones. Not those decorative cobblestones in front of your local Starbucks. Farm cobblestones made for pulling a horse drawn wagon hauling a few tons of vegetables to market. So my "tolerance" might be a little bit skewed. 

Stay tuned for more updates (but only if I hear from you ;-) )