Tag: recovery

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.

 

 

 

Happy camper on a bike

For the last six days I’ve been taking a declining dose of the steroid prednisone to calm the irritated nerves in my back and legs. Prednisone pills taste gross but they are very powerful. My pain became tolerable after a day. Although I didn’t notice, they improved my mood and, my wife and daughter report, even made me chatty. As I said, it’s powerful.

Until I took prednisone, I couldn’t tell where in my lower back my nerve problems were coming from. Now I can feel tension above my left butt cheek. Hello, you little bugger. I’m coming after you.

The best part of this pill party is that I am riding my bike like it was the summer of 2018. I have nearly zero discomfort, I am accelerating like a boss, and can cruise 20 percent faster with practically no effort. In five days, I’ve ridden 159 miles. Each day I stop long before I get tired. I could easily have ridden 50 miles today but decided to err on the side of caution and quit after 36. The Mule abides.

My leg ache comes and goes and the hot spot outside my left hip is still there, but otherwise my body is so much happier. I go up hills without a care. My back, arms, and shoulder feel relaxed as I pedal.

All of this makes me wonder if my hip and knee problems have been a side effect of stenosis, rather than in addition to stenosis. If I’ve been in low level pain for months, it’s no wonder my riding has suffered. Not the mileage, but the enjoyment. Riding across Kansas this year was work; riding across North Dakota and eastern Montana last year was play.

While I have the pain at bay, I have been blending yoga with my physical therapy. Up until now I had been doing PT in a very regimented fashion. This many repeats. Hold for this many seconds, etc. The idea was to build strength in particular muscles, mostly in support of my hip and knee.

Now I am letting my body dictate what to do. I am flowing from one position to the next, concentrating on keeping my motions fluid.  The regimented aspect has been one of the reasons I hate yoga classes. (And don’t get me started on yoga teachers who physically move you into the “proper” position. Must not kill!)

Instead I’ll hold a position for as many seconds as seems helpful then go right into another one without stopping. If a posture causes something to ache, I stop and move on to another posture.

A typical sequence might be (PT exercises in italics):

  • Step over a horizontal pole for 25 repetitions (A warm up that helps me getting on and off the bike.)
  • Stretch hamstrings
  • Stretch quads
  • Stretch iliotibial bands
  • Runner’s calf muscle stretches
  • Shoulder scrunches
  • Add standing yoga positions
    • Rishi’s posture
    • Chest expansions
    • Deep breathing
    • Toe touches
    • Side bends
    • Trunk rotations at the waist
    • Neck rotations
    • Squats
    • Dancers posture
  • Lay on the floor and do
    • Open book shoulder exercises 
    • Pull knees to chest, first one leg, then the other, then both
    • Ankle over knee and pull legs toward torso
    • Sway back and forth with bent knees at the hip
    • Hurdlers stretches
    • Groin stretches
    • Neck pushes
    • Toe touches
    • Back bridges
    • Side planks with torso on ground
    • Side planks with legs on ground
    • Bird dog
    • Cat/cow pose
    • Planks
    • Cobra pose
    • Locust pose
    • Twist torso while lunging
    • Lunges
    • Child’s pose
    • Shoulder stand
    • Plough
  • Sit ups (or crunches)
  • Set of super six exercises on a foam roller

That’s over 30 different exercises. And I left a few out. I have all of  them written down but I tend to do whatever seems to make sense in the moment. If I’m doing a pose while lying on my back, I might pop into a shoulder stand, for example. Then I’ll gradually fall into a plough (legs extended over head while on my back) and roll out of the plough and do a back bridge.

I’m trying my best to be gentle and not strain. Some of the positions are a little beyond my ability right now but I’ll get there.

Hopefully, I can get this routine established quickly. I have only three more days of prednisone pills, and then the effects will wear off.  And they can wear off rather suddenly if my prior experience with oral steroids is an indication. Taking them for long periods of time results in side effects like osteoporosis, cataracts, and growing a second head. (Okay, I made that last one up.)

Cheers.

 

 

 

 

Recovery

Dang, that bike tour messed me up. Last year’s bike tour was invigorating. I was a lean, mean machine when I got back to DC. I did several 80 to 100 mile rides and they seemed easy. And it wasn’t just physical. I felt a wonderful mental afterglow. I was totally calm. And it lasted a long time, much longer than the physical benefits. (I wonder if this isn’t the same feeling that people get when they go on long meditation retreats. I’d go on one but I’d get so antsy I’d drive myself nuts.)

I re-read some of my last blog posts and I really didn’t convey how worn out I was when I got to the Sierras. For the better part of two days, I had my head down and was just grinding out the miles. I remarked that when I looked in the mirror I seemed to have lost ten pounds. When I got back to DC I quickly realized that I had lost more than that.

When I started the tour, my pants were snug. I was so heavy that I really worried about being able to tour, let alone being able to handle mountains. After the tour, all those tight clothes fell off me when I put them on. It’s no wonder that for the next three weeks I had an insatiable appetite.

I also was thirsty. Constantly. I tried water, Gatorade, Diet Coke, seltzer water, diluted orange juice, and iced tea. Nothing worked. I guess that part of my thirst was caused by the humidity. After all, DC is incredibly muggy in the summer and I had spent weeks in a low-humidity environment. My body had a tough time adjusting.

I was tired. No surprise there. Even though my body wanted rest, I’d pop awake after six hours so sleep. This was not nearly enough so I took quite a few naps over the last month.

Then there was the mystery stink. For about a week after I got back (although Jessie and Mike or my seatmate on the flight home might beg to differ), I reeked. And it was a very unusual odor. You know it’s bad when you are grossed out by your own BO. It wasn’t associated with sweating either. After a few days, my wife brought it up. I’m sure she noticed it earlier. A few days later, the stench went away.

So basically I stomped on my body for seven weeks and it let me know. I feel fine now. Yesterday I did two bike rides. The first was 30 miles in the early morning to and from Friday Coffee Club. The second was 21 miles in the evening to a happy hour. Today, with lower (although still pretty high) humidity, I did 72 miles. I wasn’t riding fast but I managed to go 50 miles before stopping to eat. That’s not a bad back-to-back showing.

My wonky left knee and hip were all kinds of messed up when I got home. I had done a pretty good job of managing the pain using edibles with some mixture of medicinal marijuana in them. I stopped taking the edibles when I left Nevada. Once the chemicals left my system, the knee and hip started to hurt again. And my left shoulder, in which I had a cortisone shot last spring, joined the pain party.

Lately the hip has calmed down. The knee still barks at me, especially when I ride uphill. The shoulder is a lost cause. The only way to fix it is with surgery and a year of physical therapy. I’ll live with it as is and put up with some pain now and then.

I neglected to mention that while I’ve been recovering from the tour, I’ve had to deal with two stressful situations. One was a simple car repair that took four trips to the dealer to get done properly. After a week and a half, they finally got it right. I bitched up a storm and the dealer, to its credit, refunded my money.

And while that was going on we started a home renovation. We are 1 1/2 weeks into what is supposed to take 8 weeks. We are renovating one level of our four-level split-level home. The renovation includes a new bathroom, a family room with drywall and insulation instead of cheapo 1960s paneling. There will also be lighting and electrical upgrades. My wife is getting a sewing space in the basement. Although the project has hit a few bumps, it far less stressful than the kitchen renovation we did 20-odd years ago with a toddler in the house.

My wife keeps suggesting I go on a short tour or something. I might do that. Complicating things, however, is the fact that, on September 7, I am doing my 11th 50-States Ride in DC. (The 60-mile route meanders all over the city so that you can ride on the avenues named for all 50 states. It’s hilly, takes all day, and ends with pizza and beer.) I am putting together a posse that will ride with ferocious good humor. Scuba Michael, Science Dad, Science Dad’s college friend, and Hiker Cassie. I am hoping to rope in a few more gullible fools enthusiastic friends to round out the team. Watch this space.

Recovery – Done

I let the cat out of the bag earlier today on Twitter and Facebook, but, in case you didn’t hear the news,  I went to my hematologist today. Based on the scans of my lungs, heart, and left leg, I am totally clear of blood clots. My blood work looked totally normal.

So he took me off Xarelto, the blood thinning medication I have been on for nearly five months. He told me to take a small dose of aspirin every day and to wear compression socks if I fly. I can now drink alcohol again, too.

He wished me well on my bike trip.

Lift off in two weeks.

Recovery Update

To recap, on December 20 of last year, I had a backache while having dinner with my family. The pain increased so we went to the emergency room the next night. The doctors discovered that my back pain was caused by blood clots in my lungs, pulmonary embolisms. These clots had come from a larger clot that had formed in my lower left calf. This larger clot is called a deep vain thrombosis.

The clots blocked blood flow to my lungs. My right lung collapsed.

To keep additional clots from forming I was prescribed Xarelto, a powerful blood thinner.

In early February, about six weeks after my trip to the ER, I had a CT scan of my chest. My lungs were free of clots.

Today, I went to have an ultrasound examination of my left leg. The scan showed that the DVT was dissolved and there is no apparent residual damage to the veins in my legs.

Next week I go back to the hematologist to discuss next steps.

From where I sit, I am now back to normal health. My bike tour starts in 20 days.

It’s Hard to Like April

Mostly, April 2018 will fade from memory, because nobody wants to think about cold, wet, windy weather. April did have a few high points. For a start, my pulmonlogist was pleased with my recovery and backed off the prospect of leaving me on blood thinners for years or maybe even forever. She also lowered the dosage of my asthma medicine. And hopes to further lower it when I get back from my bike tour.

My bike tour planning is going along very well. I received several bike maps from the Adventure Cycling Association a few weeks ago. This allowed me to plan my trip as far as Missoula, Montana. There are numerous options for the rest of the trip to the coast. The southern route goes through central Oregon and follows the Adventure Cycling Transamerica Route. The middle route follows their Lewis and Clark route down the Columbia River gorge, through Portland, and on to the coast. Both these routes are encumbered 50 miles on road construction through the Lochsa River valley. In this corner, Felkerino, who is a man of many miles, advises that this road is awesome and contains a continuous downhill stretch of over 90 miles. In the opposite corner is Andrea, a woman of many miles too who rode the Northern Tier from Seattle east. She (and some commenters on this blog) both say the Cascades are awesome.

Two more maps arrived today from Adventure Cycling. One is for the missing segment from Missoula to the western edge of Oregon on the Lewis and Clark. The other is the segment of the Northern Tier that goes through the Cascades. To get to the start of that route, I’d need to ride a truck route along the Flathead River. I’ll plan both routes out and wait until I get out west before finalizing the way to the coast.

Getting back to my health, I did an acupuncture treatment last week that has done my left arm and shoulder a world of good. Yesterday I rode a 52-mile event ride called Breaking the Cycle. It was cold. The first 28 miles were uphill into a headwind. I rode The Mule as a test ride for the tour. It did fine except for some chain skipping on the cassette (which I had tended to today). At Friday Coffee Club last week, I bought a Brooks Flyer saddle from Felkerino. I mounted it too flat and spent much of the ride sliding my butt back to the rear of the saddle. This caused pain in my bad shoulder. Today I tipped the nose of the saddle up just a bit and my shoulder is happy again. So happy in fact that today’s visit to the gym involved two machines that I have avoided for over a month. So I cancelled tomorrow’s physical therapy session in a fit of optimism.

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The Mule at the Turn Around Point

A word of warning about acupuncture, if you don’t want to look like a junkie, you might want to avoid acupuncture if you are on blood thinners.

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The Golden Arm

Near the end of April, the sun came out. The trees and grass did their thing and we got to enjoy a shit ton of pollen. This is my car today.

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There was one excellent thing that happened in April, I went to three baseball games! On my bike, of course. I missed catching a home run at the first game. The Nats lost. At the second game I nearly killed my buddy Kevin with a nacho bomb. The Nats lost.

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At the third game, I avoided batted balls and gut bombs but the Nats still lost. I sense a disturbing pattern.

Despite its crummy weather, April did give me my biggest mileage month of the year. I rode 27 out of 30 days for a total of 789 miles during the month. For the year, I’ve ridden 2,743 miles. That’s a pretty decent foundation for what lies ahead.

 

Seven to Seven

I’ve don’t like being idle so today was my kind of day. I was running around and doing stuff from 7 am to 7 pm. After breakfast and reading the newspaper I did this:

  • 15 minutes of physical therapy exercises
  • A visit to the pulmonologist. She has pretty much decided to let the hematologist determine whether I should stay on blood thinners indefinitely. This was quite a surprise to me. This assumes that my lower leg is free of the deep vein thrombosis that dispatched the clots to my lungs. When I get back from my bike tour, she’s going to experiment with lowering the dosage of my asthma medicine.
  • Checked out patio furniture at Home Despot. It looked crappy.
  • Took my car to a state inspection station to find out if it would pass inspection with a ding in the windshield. He said “yes”.
  • Bought bird seed coated with hot pepper powder. (Alas the neighbor’s squirrel appears to be adapting to the stuff.)
  • Got my haircut so that I don’t look like I am undergoing electric shock therapy
  • Meditated for 30 minutes
  • Ate lunch
  • Rode Little Nellie to DC for one last look at the cherry blossoms. Okay, I might go tomorrow and Friday buy this is peak bloom and there’s no telling when it will end. The Tidal Basin was crowded so I skipped it and rode through the tunnel of blossoms in East Potomac Park instead. If you still plan to go this year, tomorrow or Friday before work would be best. Walk around the Tidal Basin and go snow blind. Then take a bikeshare bike (the dock was full when I was there) to ride the tunnel.

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    To be honest, this picture doesn’t do the road to Hains Point in East Potomac Park justice.
  • Rode to the gym to lift weights lamely. I tried some free weights today.
  • Rode home feeling tired.
  • Ate dinner
  • Turned on the Nats game right about now

 

 

Marching to Recovery

As my body heals from the blood clots that invaded my lungs, I find myself getting stronger by the day. In fact, I feel stronger now on the bike than I did at the end of my tour or, for that matter, at any time in the last three or four years.

Some of this is from working out on a daily basis, either at the gym or doing physical therapy exercises. Some of this may be from the fact that, while I am on blood thinners, I can’t drink alcohol. Some of this may be the result of the recent tweak to my saddle position on my Cross Check. Or maybe it’s just the warmer weather. Or my the lower dose of my asthma medication. Or maybe it’s the anabolic steroids I sprinkle on my Cheerios in the morning. Whatever it is, I’m crushing it on the bike.

In the last seven days, I rode 240 miles, including a 57 mile day followed by a 41 mile day. I feel like I can go forever and climb any hill. And I am riding about two miles per hour faster than I did last fall.

For the month of March I rode 750.5 miles, 24 miles per day. I took four days off. On the one of those two days, I did a six mile hike. On another I stood on concrete for 5 hours at the March for Our Lives in DC.

So far this year I’ve ridden 1954.5 miles, about 80 percent of it on my Cross Check. I have ridden 281 miles on Big Nellie in the basement, just to make sure I didn’t crash on icy streets.

And I completed the Errandonnee.

And I did two interviews with the local newspaper. The first was about plans for a new bike trail in our area. (The article is on page 3.) The second one, which happened yesterday, was about my bike trip to Key West.

April has lots of fun in store, including the first event ride of the year, my first ride to a Washington Nationals baseball game, a visit to my pulmonologist, and (I hope) finalizing plans for my summer bike tour to the west coast.

Recovery Update – Normal

About a month ago I had a bunch of tests done to determine if I had some blood or DNA abnormality that caused my body to form a deep vein thrombosis (i.e., big blood clot) in my left calf. This DVT at some point became disrupted and send blot clots to my heart which sent them into my lungs where they stuck. Had they continued on into my brain, I might not be pushing up daisies.

I went to the hematologist today for the results.

“You are normal.”

In truth, the tests revealed a couple of genetic mutations, but nothing that could have caused the pulmonary embolisms last December.

So after hundreds of $$$ we have a definitive answer to the question: “What caused these PEs?)” Answer: “Dunno.”

My hematologist says that unless he finds a specific cause for my illness he is inclined to discontinue the blood thinners and put me on an daily aspirin instead.

I go to see my pulmonologist in mid-April. She’s probably going to vote to keep me on the thinners.

In early May I have an ultrasound scheduled to see if I my DVT is gone (the body absorbs DVTs). Then another hematologist visit to discuss the findings. With any kind of luck, this entire medical mess will be in my rear view mirror by the time I pedal out of DC for the west coast in late May.

One other interesting thing happened since my last update. Yesterday, I was riding my bike with my head down and a tree branch whacked my helmet. A blow to the head while on blood thinners can cause run away bleeding in my skull. This would cause my brain to get compressed and displaced. The chances of dying from this are high.

I described the incident to my hematologist. He told me that since the branch deflected off my helmet and didn’t cause so much as a bruise, I should be fine.

And so it goes.

We’re having fun now.