Month: January 2020

January records

I set two personal records this January.

Record number 1: I rode the most miles for a January ever. This is almost certainly the result of climate change. My long ride was 51 miles on a 70+ degree day. It was preceded by 41 miles on a 70+ degree day. In all, I rode 711 miles, all but 66 1/2 miles out of doors.  I am off to a pretty good start. Now watch it snow like a bitch in February.

Record number 2: I complained about my health more than ever before. I even out-complained January 2018 when I spent the month recovering from pulmonary embolisms and a collapsed lung. Things are looking up though. My leg pain has been significantly less in the last five days. Yesterday, I even walked, albeit with a cane, around the block and had minimal discomfort in my left leg. It came back today but I’m still optimistic. Today, I found out today that my insurance company approved my cortisone injections. (Funny, they probably wouldn’t bat an eye at surgery.) In February I resolve to do less whining and more wining.

 

 

It’s Baaack

The Errandonnee is back!

Do a 12 errands over a 12-day period and you will be a hero, or something like that. And you get a prize!

I usually crush this little challenge but I am at a disadvantage these days. Prior to 2018, I could count two bike commutes as part of my 12 errands. I don’t work anymore so I’ll have to get inventive.

On the plus side, the Errandonnee coincides with my time on the medical hampster wheel so I get some benefit from being a decrepit person. Yay, aging!

This year participants get to pick their 12-day window. If you screw up and don’t get all 12 errands done, you can re-boot and try again. The window only has to fall in the 60 days (leap year, woot!) from February 1 to March 31.

If you haven’t tried this you should. These things are fun and fun is good.

 

 

The needle and the damage done

Today was the big day. I went to a physiatrist, a pain doctor, to see about fixing the stenosis pain I’ve been enduring for the last three months.

The doctor took my history. When I mentioned that, after inadequate pain relief from ibuprofen, I switched to marijuana edibles in Colorado during last summer’s tour. She was not at all surprised at the relief I experienced. She said that for most people edibles work for pain relief only when they contain a substantial amounts of THC. (In Virginia, CBD edibles have only trace amounts of THC and, therefore, tend not to work so well. Your mileage may vary.)

The doctor brought me to another room where she examined my MRI on a computer with her physician’s assistant. The doctor explained that I have a transitional lumbar spine. Transitional in plain English means abnormal. Most people have five lumbar vertebrae. Some people have four or six. I have six. (Thanks Mom and Dad.) This explains two things. First, the location of my previous back surgery is either L3-L4 or L2-L3 depending on where you start counting from, top or bottom. Second, the surgeon who did the operation cut too low and had to extend his incision. This is no big deal except that it means the recovery time, mostly associated with getting the back muscles to work together again, is a little bit longer.

That old surgery involved removing a disc in my spine. My pain doctor thinks this is the source of my problem. In the area around the missing disc, the spinal canal, through which the spinal cord passes, is narrowed. This stenosis is causing further problems downstream in my lower back. Thus, the pinched nerve root in my lower back, she thinks, is the product of the stenosis higher up. The stenosis in my upper lumbar region also likely explains why my lower back gets achy when I stand for a long time, as I do at concerts.

My physiatrist clearly loves what she does. She seemed quite confident and upbeat about my case, saying that one or two cortisone shots in the problem area should fix me for five or ten years.

Bring it on.

But wait. I have to get approval from my health insurer. So, I go back for the injection a week from Friday, or sooner if she gets a cancellation.

 

 

 

 

 

Pain again

Today was a lot like yesterday for my wonky left leg. No pain. No need for a cane.

The bright sunlight beckoned and I was out on my CrossCheck for a 35-mile ride to and around Arlington County. All but six miles were on trails. I did have some minor discomfort in my knees but it came and went with the hills.

Once I finished I put away my bicycling stuff and laced up some low top hiking shoes. I put my cane on my shoulder and went for a walk around the block. I made it about 100 yards before the pain came back to my left leg.

I guess I am not cured after all. I was beginning to wonder if the trip to the pain doctor was going to be a waste of time. No such luck.

Watson, the needle!

 

 

 

 

 

 

No cane. No problem.

Today was a bit of a breakthrough. Knock wood. Cross fingers.

I made it to the evening without leg or back discomfort. I even forgot to bring my cane to the movies and only felt a bit of leg discomfort when walking to the car in the theater’s garage.

One day does not a cure make but I am pretty happy to get through a day without pain.

By the way, we saw Parasite, a Korean movies that is up for best picture, best director, and best foreign film at this year’s Academy Awards. It’s about a family of Korean grifters who get their hooks into a wealthy family. They don’t make movies like this in America anymore and it’s our loss.

 

 

Sunrise and flexposts

Dark. Cold. Must have coffee.

So I rode to Friday Coffee Club.

I followed the white ball created by my headlight. If felt as if I were going fast but speed was an illusion caused by my small field of view.

I could see a burgeoning sunrise through a thin layer in the cloud cover.

When I arrived at the bump out of the Dyke Marsh bridge on the Mount Vernon Trail the sunrise was just beginning. The amber side light from my headlight dominated the view.

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I continued along until I came to a small cove just south of the city of Alexandria. The river was glowing red, reflecting the new day’s dawn.

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Ahhh. That’s more like it.

The rest of the ride was uneventful. I managed to get across the national mall and around the Washington Monument without running over the anti-abortion people who were walking en masse to their rally at the Lincoln Memorial.

Coffee Club was quite crowded. I noticed that my leg and back lasted about ten minutes before the ache came. Fortunately, I managed to garb a seat and staved off pain.

As most of the gang headed off to work, Rudi and Big Ed lingered. Chatting about the Beatles, national politics, the DC City Council, and testimony styles.

We adjoined at 10:30. I made my way back down 17th Street. At a stop light I chatted with a man who was putting on his coat as he waited to cross the street. It was such a good little discussion that he nearly missed his chance to cross.

I made it across the mall again respecting the protesters’ right to life despite the fact that they were walking five abreast on the paths near the Washington Monument. Near the Sylvan Theater, two priests were walking rather slowly toward the event. They seemed to think their Roman collars would protect them for the morning chill. Jesus, Mary, and Joseph.

The two padres would have really been miserable before the sun had done its thing. The temperature was about ten degrees warmer for the ride home. In Alexandria, I stopped at a hardware store to stock up on  chemical hand warmers. I put them in my shoes to keep my feet warm. (The toe and feet warmers aren’t nearly as useful.) They only had MEGA hand warmers. I’ve never tried them. Good thing I have MEGA feet. I hope they are MEGA warm.

The last seven miles were uneventful, but for some unsubtle new infrastructure on the trail. The entrance to the Mount Vernon Trail at Northdown Road has always been a problem. Motor vehicles would wander down the trail from time to time. Drivers would soon realize they were not where they belong. I’ve guided a few as they backed up to the entrance.

A single flex post was intended to keep motor vehicles out. It’s been replaced many times as delivery vehicles and the occasional wayward driver knocked it over. So now the National Park Service is getting serious. Two flex posts!

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Coming from the north (the direction of this picture) riders have to slow to squeeze by the posts without slipping off the trail. Trike riders will have an even tighter fit.

I give these posts about three months before they are lying on the side of the trail.

Nice try, though.

Freezing the rana

There’s this story about boiling a frog. Suppose you want to boil a frog. Why you’d want to do this is beyond me but suppose you do anyway. If you boil a pot of water and then toss the frog in. the frog will sense the intensity of the heat and hop out of the pot. Of course, you’d ruin the entire story if you were smart or, perhaps, sadistic enough to quickly cover the pot. Let’s assume you are neither.

If instead you place the frog into a pot filled with room temperature water, the frog will stay in the pot. Now turn the burner on the stove up to high. Bwa ha ha. The temperature of the water will gradually increase and the frog, oblivious to the change, will stay in the pot until it’s dead. It helps a lot if you have an intensely stupid frog.

Winter biking is a bit like this.

Yes, your knew it was going to have something to do with riding a bike, didn’t you?

Let’s suppose you are happily riding your bike, day after day, in warm-ish temperatures. Then a cold snap happens. You, a gutless wonder,  decide to do something else indoors – perhaps like riding your bike on a trainer in the basement or maybe stuffing your face with some quiche fresh from the oven. After a few days of being toasty, you decide that despite the cold you really need to go for a ride outside. You dress appropriately then hop on your bicycle and merrily ride away from home. Then a gust of wind hits, you realize it’s cold as fuck, and you turn around and rush immediately back inside.

You dead frog, you.

If instead of riding inside when it first turns cold, you grit it out for a few days. You will gradually adapt to the realities of winter and ride outdoors with a smile on your face.

All of which illustrates why it is a bad idea to decide to bike commute as a New Years resolution – unless you live in Australia or Argentina. Then you only have to deal with suffocating in a brush fire or being bitten by a rabid capybara with razor sharp teeth. (What the hell is it with southern hemisphere animals anyway? It’s like a zoological freak show down there!)

If you ride every day, your body and mind acclimate to the cold. You become a champ at choosing the proper clothing (Cotton is bad. Wool is your friend.). You should feel slightly underdressed when you step outside. You’ll warm up soon. If you have a flat, you’re screwed but didn’t I tell you to buy tires with kevlar belts in them?

This week I spent two days riding in the basement. Yesterday I went outside to do my 30 mile constitutional. The winds were calm. Temperatures were in the mid to high 30s at the airport. I had left a water bottle on my bike overnight. It was as solid as a brick. Off I rode. It felt just like home, if home were Nome.  Somehow, I lasted 27 miles but I wasn’t happy. My noo noos nearly froze. 

Today it was ten degrees warmer at the airport. My water bottle was still rock hard. I was beginning to think that maybe I should move closer to the airport.

I managed to ride 30 miles. My noo noos may never be the same.

I came home to my copy of Adventure Cycling Magazine. The cover story is about bike touring around Puerto Rico.

Do they boil frogs down there?

 

Out of Doors and Network

Out of Doors

I waited for temperatures to rise above freezing so I could ride outdoors today. I went out to get my bike and the water bottle I had left on my bike was hard as a rock.

Luckily, most of the ice on the roads and trails had melted. There were a few icy patches on the Mount Vernon Trail on the way up to the stone bridge from Alexandria so tomorrow morning’s bike commuters should be on the alert.

The ride went fine. I was a little underdressed though. After about 20 miles I started to think about the warmth of home and hearth and headed back from Alexandria. I stopped to buy some things at a drug store. I stood in line for about five minutes. My lower back started to ache. Can’t wait until I get that needle next week!

My wonky leg continues to wonk. No big surprise but I don’t need painkillers as long as I stay off of it. This is perfect weather for a walk in the woods too. Dang.

The irony of all this stenosis business is that about five years ago I decided to increase my hiking specifically to offset the osteoporosis that can set in when you do only non-weight-bearing exercise like bicycling. Damned if you do. Damned if you don’t.

I am happy with 27 pain free miles on the CrossCheck today. The next few days will be warmer so I’ll probably ramp up the distance. (I’m over 500 miles for the month as it is.)

Out of Network

The day after my MRI I received a document from my insurance company agreeing that the procedure was medically necessary and would be covered. (The MRI center had already been given the green light.) I have been getting emails and robocalls from my insurance company telling me that hospital MRI centers are often not regarded as in network. The insurance company told me that I “could save hundreds of dollars” if I went to another MRI facility.

Funny. The hospital MRI center told me I was covered and had to pay only a $100 co-pay.

After the third communication from the insurer I went on line to check things out. The insurer’s website clearly states that the MRI facility I went to was in network.

My guess is that other non-hospital MRI facilities charge the insurance company less. So they are trying to steer me to a place that saves them money. As long as I go to an approved facility, I pay $100. If they didn’t want me to go there, they should take it out of network or charge me a lower co-pay to go somewhere else.

Am I missing something?

 

 

 

Darth Stenosis, an MRI Report, and a Clarification

Bad Genes

“My father has it. I have it. My sister has it.”

Yesterday I was talked with my sister who is 2 1/2 years younger than me. She said she’s having back pain. She does not read my blog. I asked her to describe it.

Pain in the outside of her lower left leg. Pain when walking that is reduced when she leans forward or leans against something like a grocery cart. Pain that kicks in after about 50 yards. She can’t trust her left leg; it feels like it’s going to give out.

Gregor Mendel, phone home.

MRI Report

My MRI report confirms that my spine is FUBAR. Most of the pathology doesn’t seem to be causing me pain. I have moderate disc bulging and thinning here and there. And there is some stenosis in various places in my mid to upper spine. Mostly this seems to be the cause of mild discomfort as well as numbness in my feet and hands from time to time. My lower back gets achy when I stand or walk for long periods but muscle spasms are rare.

Near my 4th and 5th lumbar vertebrae, however, the report said:

There is severe left foraminal stenosis with indentation of exiting left L4 nerve root. The right foramen is moderately to severely stenotic with indentation of exiting right L4 nerve root.

This is consistent with my recent left leg problems. My guess is that’s where the epidural will go.

The same MRI center had a record of my 2014 scan. The report noted that a disc extrusion (i.e., bulge) found back then no longer exists. This is one reason why back patients are told to give it time. Many of these abnormalities resolve on their own, as did my 2014 problem.

A Clarification

In yesterday’s post, I described a conversation with my friend Julie who is a Rolfer. I may have given the impression that she is reckless or aggressive in her methods. If I did, I apologize to her and want to clarify.

Recapping: a Thai massage therapist skipped past my thighs when I indicated that the therapist had hit a sensitive nerve. What Julie meant when she said she’d “dig right in” to nerve pain was that ignoring the problem as the massage therapist did is unhelpful. The objective of massage is to grant short term relief and reduce tension. Oversimplifying, the objective of Rolfing (and for that matter Feldenkrais) is to reduce pain and stress in the long term by improving how body parts interact. Rolfing focuses on connective tissue called fascia that wraps around muscles and nerves. The end result should be pain and stress reduction on an on-going basis.

For now, I am focused on getting the offending nerve to calm down. Once I get the pain under control, I can consider how to deal with the situation longer term. My guess is that I’ll be doing some combination of yoga, PT, massage, Feldenkrais, and Rolfing.

 

 

Advice from Alaska

For the last several days I’ve been staying off my feet and taking over-the-counter pain medication. When I walk, I generally use a cane (if I haven’t left it somewhere). As a result, my pain level has been greatly reduced. I have no intention of sitting around for the rest of my days, however.

I am still riding but the arrival of winter has nudged me into dialing back the mileage and intensity. On Saturday, I rode Big Nellie in the basement for 80 minutes. It’s a nice change of pace and infinitely preferable to riding while anxiously looking for icy patches on the pavement. Yesterday, I rode the CrossCheck outside. Temperatures declined into the 30s and winds picked up with each passing mile so I cut the ride short at 17 miles.

As I may have said earlier, I quit PT and Feldenkrais, at least until I give the pain doctor a shot (so to speak) at my problem. My friend Julie (a Rolfer, jewelry maker, proud momma, and Alaska backcountry bad ass hiker) said that I should give Structural Integration a try. (This should not be confused with Functional Intergration which is the basis of Feldenkrais.) In my current physical state, I will have to take a pass on her advice; Rolfing (one method of Structural Integration) can involve rather aggressive manipulation of body parts (in contrast to Feldenkrais which more closely resembles Reiki).

Julie’s Rolfing suggestion follows up on part of the conversation we had in Astoria, Oregon at the end of my cross country tour. I mentioned to her that a few years ago I had a problem with sharp pain in my right leg. While having a Thai massage, the therapist hit the problematic nerve in my inner right thigh and I flinched in pain. The therapist decided to skip over that part of my body. Julie said that if it had been her she would have dug right in.

It’s interesting that massage, Feldenkrais, Rolfing, and, for that matter, chiropractic, all profess to address the same body problems. Whether one method works probably depends on the pathology involved. At the moment, I know from x-rays that my back is showing numerous signs of age-related deterioration, complicated by my genetic make up, a previous back surgery, and a whole lot of wear and tear. Hopefully, tonight’s MRI will give an better view of what is causing the specific pain that I’ve been dealing with.

In a few weeks, I may be able to ramp up my activity level without pain.

I met Julie the day after I reached the Pacific coast on my 2018 bucket list cross country bike tour. I was feeling what I called afterglow. I want to feel that way again.

Thanks, Julie, for your suggestion. One of these days I hope to meet again. Come to think of it, I haven’t ridden a bike in Alaska yet.