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.

 

 

 

Moving on to Plan B

I went to the orthopedist today. He took x-rays of my back. The short version: my spine is about 20 years older than the rest of me. Bone spurs. Narrowing of discs. One slightly bulging disc. Arthritis. And curvature of the spine probably caused by the excruciating pain I was in during the x-rays.

As the doctor said, clearly Plan A failed. Plan B is an MRI (next Monday) and a referral to a physiatrist, a pain management and rehab specialist. She will be giving me a cortisone epidural in my lumbar spine. My appointment is for a week from Monday. (This allows time for insurance company hassles and other administrative whatnot.)

I actually had a reasonably comfortable morning. I have been putting ice on my lower back and hip and it does reduce my pain somewhat. I went for a very windy 25-mile ride without any significant pain. After getting home I did a tiny bit of PT, took a shower, and ate lunch without pain. Just as I was wondering whether I’d be going to the doctor with no symptoms, I walked upstairs and the pain came rushing back.

Despite all this nerve pain, the doctor noted that I still have plenty of leg strength. He  called a physiatrist and they chatted about my case. I can get an epidural before the MRI but it likely be more successful using the MRI for targeting the injection.

My doctor says I can have up to three epidurals. He says that for many patients, epidurals do the trick. Fortunately, I can still ride my bike which is as important for my mental well being.

If the epidurals don’t work, I’ll be moving on to Plan C. C in this instance stands for cutting.

Eek.

Not exactly an encouraging day

I was awoken by pain in my left ankle at 4:30 this morning. Apparently the acetaminophen I took had worn off. I relocated to the couch were I could more easily hang my left leg off the side. The pain abated after a half hour and I went back to sleep.

I made it through breakfast before the leg started barking at me. The ankle had calmed down but the calf ache was back, as was a new symptom that feels like a wad of clay inside the outer part of my left hip. Between the wad of clay and the nerve pain, my bio-mechanics are all messed up.

So I went for a bike ride. (You knew that was coming.) Within a mile or so my leg calmed down. I rode to the Lincoln Memorial and back on another exceptionally nice March day, except of course for the fact that it is mid-January. The CrossCheck and I are getting along very nicely.

I got off the bike a few times during the ride. As of two weeks ago, all the symptoms that bothered me during last summer’s bike tour had faded away. Today, when dismounting, the pain in my outer left hip came back. It feels like my leg is going to collapse. What fun.

After 30 miles I called it a day. If I couldn’t ride, I am pretty sure I’d lose my mind over this nerve problem.

I went to my second Feldenkrais appointment in the afternoon. The therapist observed my posture and my gait. She accurately noticed that in medical terms I am all kinds of messed up. Then she examined my neck and shoulders which seemed to be awry during my little walk across the room. Very tight.

Next she had me do some movements to loosen the muscles in that area. The movements actually work pretty well and are surprisingly simple. The idea is to learn or perhaps re-learn how to move making best use of the entire body. The best analogy I can come up with is learning how to throw a baseball. If you only use your arm, you can’t throw very well. If instead you involve the arm, the shoulder, the hips, the legs and the back, you can bring some heat.

After that, the therapist was going to examine my back as I lay in a prone position. My left leg decided to start barking again so I rolled on my left side and assumed a fetal position. The therapist spent ten minutes feeling various parts of my back and backside. She noted that my lower left back is very tight and suspects that this new symptom might be the result of a bulging disc. Oh joy.

Long story short, she said that I was a pretty complicated case. It probably has been developing over a long period of time and would take a long time to reverse (with, of course, no guarantees).

I have to agree with her. It seems like every day I get a new symptom. They all seem to conspiring to keep me moving like a robot and to keep increasing my pain and discomfort.

I have to say that I am disappointed. I thought the idea of these sessions was to teach me how to do a regimen of movements to alleviate my pain symptoms, but that didn’t much happen. I realize I can’t expect immediate results, but I feel like I’m treading water. In any case, we agreed that I would keep next week’s appointments on her schedule for now.

Tomorrow I go back to the orthopedists to get his take on my situation.

In for a nickel

Today I did a one-on-one Feldenkrais session. It was mostly an evaluation of my physical situation. We only did about 15 minutes of movement, but I felt less pain when I was done.

After a long discussion of my physical abilities and disabilities. I walked across the room from corner to corner. It hurt and I had a pronounced limp.

Next, I assumed a fetal position on my right side on a padded table. My head was supported by a pillow. I looked at a spot on the wall, put my left hand on my head and raised my head up. Slowly. Just a few times.

Next I raised my left arm over my head as if I were doing a layup. Then I raised my feet. Then I combined the layup with the feet.

All of this was done gently.

When I started back was tense. When I finished it was loose. I walked across the room with only very minor discomfort and no limp.

Interesting.

We discussed next steps. I’m going to do 2 of these sessions each week for four weeks. They are not covered by insurance so it’s going to be expensive but no less so than three months of ineffective PT.

No guts. No glory.

Riding with the Climate Devil

Something is definitely not right. Yesterday and today we had temperatures in the 70s in January in DC. I could ponder the fact the planet is going to hell. This would be depressing. Instead I went for a couple of bike rides on my CrossCheck.

Before I left the house, something really unusual happened. My bike had a

flat rear tire. The CrossCheck came with nobby tires that offered little flat protection. When I had my first flat, I decided to swap them out for something more robust. I put Schwalbe Marathon Plus tires whichIMG_3328 are advertised as flat free tires. When I took of the rear tire, I noticed that the tread was nearly gone. In spots the green puncture underlayer was exposed. There were several large gashes in the tire, but only one small, very sharp piece of glass made it through to the tube. I am guessing this tire had over 8,000 miles on it. Not bad.

Yesterday’s ride took me downriver from Mount Vernon. I rode 20 miles to Mason Neck. On the way there I took a hilly route that avoided US 1. After about 14 miles of ugly suburbs, the remaining ride to Mason Neck seemed rural. A new bike trail made the ride fairly peaceful too. My return route used the bike lane on US 1. I do not recommend this. The speed limit is 50 miles per hour and the bike lane is nothing more than paint.

I didn’t get killed. I left US 1 to ride to Mount Vernon. In the circle in front of the entrance were two EMT vehicles and a police SUV. A police officer was stuffing a bike into the back of the SUV. The bike didn’t seem to be in bad shape so maybe the EMTs were called for some non-bike-related calamity.

Today’s ride was a bit more ambitious. I rode from Mount Vernon to Bethesda, Maryland and back. The round trip was 51 miles. The route there involved the Mount Vernon Trail, the new smooth sidewalk over the Memorial Bridge, the Rock Creek and Potomac Trail (basically a sidewalk), the Water Street cycletrack in Georgetown, and the Capital Crescent Trail. Of the 26 miles, I spent about 3 on unprotected’ low traffic roads.

On the way back I took Rockville Pike to Jones Bridge Road. This would be suicide on a weekday but on a Sunday it was nearly pleasant. Jones Bridge leads to Beach Drive in Rock Creek Park. On weekends most of Beach Drive is closed to cars. That and the new pavement make it perfect for riding a bike or rollerblading.

Once out of the park I rode down Ohio Drive to the 12th Street Bridge, crossed into Virginia and rode home on the MVT.

The weather made me feel like a cheat.

I didn’t feel any discomfort to speak of in my left knee or hip for either ride. Even the sore spot on the outside of my hip was calmer than usual. I declare my bike tour injuries to be a thing of the past.

Unfortunately, after about 30 minutes on my feet, my stenosis pain came back. I have taken to using a cane to get around. This allowed me to go to the movies and dinner last night. Unfortunately, the aching came back at bed time.

So it goes.