The Return of Dr. Pain

My Ow History

A couple of years ago, before and, especially, after my 2019 bike tour over the mountainous terrain of Colorado, Utah, Nevada, and California, I was in a world of hurt. My left knee and hip were screaming at me. I had some symptomatic relief from cannabis edibles I bought in eastern Colorado. Back home, I went to an orthopedist who gave me cortisone shots in both areas. After two rounds, my pain all but disappeared. But I was still in pain. Whenever I walked, my lower back and left leg became progressively more painful. The situation escalated to the point where I could not walk 100 feet without excruciating pain in my lower back and left leg. My orthopedist examined me and concluded that I had classic symptoms of spinal stenosis, a narrowing of the spinal canal that pinches the nerve roots emanating from the spine. The orthopedist referred me to a physiatrist, a medical doctor who specializes in pain management. I will henceforth refer to her as Doctor Pain.

Dr. Pain, I Am at Your Mercy

Step one in my treatment was an MRI. This helped identify pinch points and the interesting fact that I have six vertebrae, not the more common five. Step two was listening to my description of specifically where I felt the pain and what made it worsen or abate. Dr. Pain determined from this information the likely location of the irritated nerve roots.

I laid face down on a cushioned table. Using a needle, the doctor applied numbing medicine to the skin and muscle near the injection site. The pain from this was similar to having a novocaine injection for dental work. Not fun, but not the end of the world.

Next she and an assistant positioned an x-ray guided injection machine. This machine placed a targeting cross, like you’d see through a rifle scope, on the area of interest. Then the fun began. The doctor proceeded to inject anti-inflammatory and numbing medicine into the specific areas near the disturbed nerve roots.

Because my nerves were so inflamed these injections hurt like hell. With each injection an electric shock shot down a nerve in my leg all the way to my feet. Dang! I lost track of the number of shocks. Afterward, I waited a few minutes to make sure I didn’t grow a third leg or have other ugly complications and went home. Free to do whatever I wanted.

The injections worked pretty well. They calmed most of the pain and allowed me much more movement. I was going to have a second round of shots but the pandemic hit. Then Dr. Pain left her practice. So I decided to do daily physical therapy exercises to help calm the pain beast.

Shoot Me, Round Two

By January of this year I was starting to have increasing pain and discomfort, especially in my lower left calf, so I googled Dr. Pain and found that she was back in business at another practice. I saw her two weeks ago. She agreed that another round of shots would help. She reviewed the MRI and her notes from 2020, and we repeated the discussion of where my pain was located. She concluded that my leg pain was probably from stenosis but that the ache I was experiencing across my lower back pain was likely caused by arthritis.

We agreed to treat the stenosis first. Before continuing, however, she sent me for a doppler ultrasound to rule out a recurrence of a deep vein thrombosis (DVT), a painful blood clot that I had in my left calf in 2017. It caused me to develop dangerous pulmonary embolisms.

I had the ultrasound on Monday. It was painless. Since the tech did not send me to an emergency room, I knew I did not have a DVT. Today I went back to Dr. Pain for round two of the epidural injections.

We went over my symptoms again. She reviewed her notes from 2020. And we decided to move the injections down a notch in my spine. Again, I was placed face down on a padded table. Working with a technician, the doctor, as before, injected the muscle in my lower back with a numbing agent. Then she positioned the machine of certain agony and started the epidural injections. Not that I could tell. I could feel pressure from the insertion of the needle and feel the location on the needle but i experienced no pain. Hmm.

She continued until she made the money shot. BANG. She hit the irritated nerve. An electric shot when right down my left leg. I could feel it travel through my thigh and knee then into my calf. At their direction I did some deep breathing, then she injected me a few more times. These were painless. Thank you, Jesus.

Next Steps

After a short precautionary post-injection wait, I was sent home with no restrictions on activity. The leg felt a little numb but I walked without any pain back to my car. This afternoon, with temperatures nudging 70 degrees F, I went on a 30-mile bike ride, deliberately cranking big gears for the last ten miles. I walked a few hundred feet in my yard afterward. Only after going inside and crossing my legs at the kitchen table did I feel minor discomfort in my calf. I uncrossed my leg and it went away.

I’ll be keeping a pain diary for the next three weeks. I’ll be taking short walks to test things out. Then Dr. Pain and I will do a follow-up visit remotely.

Fighting the Winter blues

Gray skies and cold temperatures are not floating my boat. I find myself wanting to curl up and take a nap. All the time. And oddly enough my sinuses are acting up. Calgon, take me away.

The Pile

I spent three days earlier this month shoveling snow and cleaning up yard debris. The trees in our yard took some big hits from the wet, clingy snow. Our sole surviving cedar nearly fell over a power line. Our eastern redbud split one of its trunks. And the neighbors massive silver maple lost major limbs, one of which missed my wife’s SUV by five inches.

Big Nellie and The Mule

My bike riding isn’t setting the world on fire. The last time I rode so little was in the aftermath of my pulmonary embolisms four years ago. I suppose the good news is that I bounced back from that very strong, and rode 4,300 miles to the Pacific only a few months later.

About one-third of the time this month I’ve been doing 30 mile rides outdoors on The Mule; otherwise I’ve been riding Big Nellie on a resistance trainer in the basement. As is usually the case, I find that I can read faster with my legs spinning. I’m already done with my Christmas present books.

Stick Me Baby One More Time

What would winter be like without taking a ride on the medical merry-go-round. Although it was diagnosed only in 2019, I have been dealing with varying degrees of stenosis pain since at least 2014. That year I struggled to hike Sugarloaf Mountain in Maryland. The following summer I hiked Old Rag on my 60th birthday. The long hike downhill was unexpectedly difficult.

For the last two years I have been doing 10 to 15 minutes of physical therapy exercises every day. This allows me about 30 minutes of pain free walking and standing. If I wear Hoka shoes, I can walk a half mile with minimal discomfort, and using trekking poles, I can walk up to three miles. Still, walking is exhausting as my body tries to compensate for ever increasing tension in my back and legs. If I do anything more than three miles or walk in normal shoes, I am in pain city.

I had been seeing a physiatrist (pain doctor). In early 2021 she injected my back with multiple cortisone shots. Prior to the shots I couldn’t walk 100 feet without pain. I was supposed to get another round of shots but then the pandemic hit, I hunkered down, and she left her medical practice.

The other day I found that she is at another practice so I am going to see her to try to re-boot the injections. They are extremely painful. I am hopeful that one or two rounds of cortisone will set me right for a while.

Hike Test

I have a condition known as spinal stenosis. This is the narrowing of the pathways around the spinal cord and the nerves that branch off of it. Some of the nerves get irritated causing pain. My pain primarily shows up in my lower left leg. It is a dull ache that gets worse when I walk or stand. Last winter my pain was so bad I couldn’t walk across a room. As is typical of spinal stenosis, I can ride a bike without any pain at all.

To treat the pain I had cortisone injections in my back. The injections were very painful. The shot goes into the already irritated nerve and an electrical shock shoots down the nerve all the way to your toes. After a couple of days, the stenosis pain went away. The analgesic effect of my shot lasted about six weeks. Then covid hit and my doctor left the practice I was using.

When the dull ache returned this summer, I decided to wait a while to see if it would go away. My activities included riding my bike, reading, watching baseball, cleaning the house, and mowing the lawn. Mowing the lawn is not a problem because it involves supporter walking with a forward lean. The forward lean decompresses the spin so as not to irritate the Inflamed nerve. Only house cleaning and trimming the grass caused pain, both because they involve unsupported standing and walking.

I’ve also been doing physical therapy. I searched YouTube for appropriate exercises. Recently I added a few. They take about 15 minutes to do.

About three weeks ago, the pain became much greater so I called for an appointment. After a couple of insurance-related hassles, I ended up seeing a nurse practitioner.

Yesterday I mowed the lawn without pain. Then I used a trimmer and a blower. I expected that walking around with the trimmer and blower would cause my leg pain to flare up. It didn’t.

Going to a doctor without symptoms seemed pointless, so I decided to walk the half mile to her office. I brought a cane, just in case. About 100 feet into the walk, my left calf started aching. On a scale of 1 to 10, with 1 being mildly annoying pain and 10 being just-shoot-me, my pain was a 1. I expected it to increase as I walked but it either stayed the same or went away entirely, The only abnormality was a slight awkwardness to my gait.

I explained to the nurse that I made this appointment with the intention of getting a shot. Obviously, a shot was not necessary.

All was not wasted, however. We set up a plan. I will test my back by going for a short, east hike. Three miles should do the trick. If the pain returns and lingers then I call her and she’ll get the insurance authorization and set up the injection appointment with the doctor.

We also discussed how to deal with activities like vacations and such. If I expect to be doing a lot of walking, she will prescribe pain medicine as appropriate. Sadly, because I live in Virginia, she cannot prescribe marijuana edibles. With appropriate levels of THC, they work extremely well with little to no side effects.

I walked home without a problem. Then I went for a 30-mile ride.

Time will tell.

Catching Up with Myself

  • 180 miles in nine days + clouds and rain = day off. That’s the math.
  • I went to see Doctor Pain on Monday. Two days before the appointment, my pain subsided. I conclude that my back is afraid of the good doctor’s needles.
  • I went for a walk on Sunday, a day before the appointment, to see how my lower left leg would respond. It did fine, but my lower left back stiffened up even though I used a cane. Doctor Pain said there is a treatment she could administer but it would involve the approval of my insurance company. In the end, we decided to leave it alone. I asked if ibuprofen is okay to use. And she said the concerns about it making people more susceptible to coronavirus infection is overblown.
  • Doctor Pain seemed quite anxious about potentially exposing patients to the coronavirus. Her office follows strict disinfecting procedures and other protocols (e.g., masks for staff and patients, touchless disinfecting lotion dispensers everywhere) but there is always a chance that someone could transmit the virus. When I was checking out the receptionist advised me to wash my clothes when I got home as a precaution. I did.
  • I went for a walk today without a cane. I made it 1 1/4 miles and had only minor discomfort. In fact, I broke into a jog a few times just to see how my back and leg would respond. The discomfort, which was in my lower left back, went away, replaced by some stiffness in my lower right back.
  • A few days ago I brought Big Nellie, my long wheel base recumbent, out of the basement. It’s rather cumbersome so I was concerned that pushing it up the stairs (a half-flight of steps) might cause my back to go whacky. No problem.
  • Three of my last four rides were “bent”. I ended up riding over 90 miles on Big Nellie. My back and legs felt great afterward. My left knee not so much. I think I may be mashing the pedals too much. Riding a recumbent requires different techniques than a regular bike. One difference is that you can’t stand and use gravity and your upper body muscles to climb. This means that your legs have to work exceptionally hard when climbing hills. A second difference is that using high gears (the ones that are tough to pedal) can trash your knees. It takes a few weeks to adjust to spinning little gears. I’ll get there soon enough.
  • One odd effect of recumbent riding is that my walking gait is much more comfortable. Back in my running days, I found that running immediately after riding a bike is awkward. My legs didn’t want to function normally. (How triathletes deal with this is beyond me.) My quadriceps muscles (in the front of the thigh above the knee) were tight and I tended to bounce a bit as I ran. After riding a recumbent, my stride feels much freer. Pedaling a recumbent seems to distribute the workload more evenly among calf muscles, quadriceps, and hamstrings.
  • I retired in August 2017. Over the next 22 months, I did three bike tours carrying 40 pounds of gear and covering over 9,000 miles on The Mule, a conventional touring bike. From 2017 through 2019, I rode 30,000 miles, far more than I had ever done before, and only about ten percent of it was on Big Nellie. I think maybe the best treatment I can give my back and leg is to ride my recumbent for t he next month or so.
  • Finally, a shout out to fellow blogger Brittany. She’s an American who has been living in Bavaria for a little over a year. One year ago today, she bought a bike to explore the area around her new home. Mostly these have been modest rides of 10 or 20 miles. Today, she went a bit nuts and rode 55 hilly miles. She loved it. I fear she has contracted the cyclovavirus. Fortunately, there is no cure.

I’m just sittin’ here doin’ time

After a couple of weeks, even introverts get a bit stir crazy. I am out of new books. Each day I browse the bookshelves looking for something to re-read. It’s really the perfect time to revisit a tome from long ago like Richard Adams’s Shardik or John McPhee’s Coming into the Country.

Yesterday I got back on the bike but it wasn’t as warm as last week and my effort was halfhearted. A friend drove down from DC and he and my wife walked the 1 1/4 mile circuit at Fort Hunt Park maintaining proper distance as they went, while I rode laps. They did three. I did ten or eleven. It wasn’t at all crowded and people, with one annoying exception, were keeping their distance. The exception was a chatty woman in a group. She had zero situational awareness. We all did our best to give her a wide berth.

I am still doing a couple of sessions of stenosis physical therapy each day. I put on my headphones and play some meditative woo woo music so that I focus on what I am doing and take it slow. Each session lasts between ten and fourteen minutes depending on how closely I am paying attention. And I do 20 to 30 minutes of meditation while lying on the couch. Occasionally, this morphs into a nap. My mind doesn’t much mind.

I am also a fan of crossword puzzles. I do the Washington Post, The Atlantic, the New York Times mini, the New Yorker, and the New York magazine puzzles regularly. I only pay for the Post so access is limited. The Times also has something called the Spelling Bee that I find amusing.

I mowed the lawn for the first time the other day. The grass isn’t doing much these days but the weeds and wild onion grass were going gangbusters. I bagged the clippings which didn’t do my back much good.

I am also listening to music online. There’s so much good content. My fave are the daily “broadcasts” of Neil Finn and his sons Liam and Elroy live from their homes in Los Angeles. (For the uninitiated, Neil Finn’s most well known song is Don’t Dream It’s Over but he’s written scores or maybe even hundreds of others.) These mini-concerts happen every night at around 6 p.m. east coast time on Fangradio on an app called Mixlr. Unfortunately, this has become so popular that the connection gets overwhelmed. This leads to buffering and loss of connection sometimes. Luckily, the Finns archive the performances daily at the link above.

Mr. Fangradio

One thing I like most about these online versions of the songs is that they are stripped down if not quite unplugged. In many cases I prefer these to the recorded versions. Liam and Neil did an album last year that I really didn’t much like called Lightsleeper. When performed on Fangradio, however, the songs take on new life and I really enjoy them.

Not to beat a dead horse, a few years ago Neil recorded an album live online over the course of four weeks. It’s called Out of Silence and can be found on You Tube.

Another place for performances is NPR’s Tiny Desk concerts. Many radio stations, often NPR affiliated, have similar content. And there’s the You Tube time sink. You can blow entire days wandering around there.

Well, it’s time to hit the floor for more fun with back exercises. Stay safe, you all. Eat your vegetables. Go easy on the TP. Call your mama. Make good choices.

Return to Dr. Pain and other adventures

Yesterday, in anticipation of my appointment with Dr. Pain, I walked 3 1/2 miles. I experienced some discomfort in my left leg but it never amounted to much. In fact, several times I stopped using the trekking poles. I also found that I am no longer walking on the balls of my feet, which is really awkward. Oddly, I seem unable to walk slowly. My body is full of mystery.

I had a minor, split second twinge of pain in my lower back when I was taking off my shoes but I haven’t had any symptoms of nerve pain shooting across my lower back for a week.

I almost cancelled the appointment out of an abundance of caution about the coronavirus but decided to go and be super careful. No one was in the waiting room. I used hand sanitizer three times while in the office.

After a short wait in an examining room, Dr. Pain came in and sat as far from me as physically possible. We discussed what I’ve been doing (e.g., riding a bike like a boss, walking more than a mile, physical therapy exercises twice a day) and she said that she wasn’t giving me any more shots for now. “That first shot has allowed your body to heal itself. Don’t stop what you’re doing.”

The plan going forward is for me to come back to see her in early May, but only if I have pain. Otherwise I am good to go on my annual bike tour, coronavirus willing. One thing is very clear, I am riding much stronger than I have since my 2018 tour.

After the doctor’s visit, I went to the drug store to secure some shaving stuff and paper products. They had a few shaving things. I decided to buy the expensive stuff thinking the cheap stuff was more like to have been handled by virus vectors. (Great name for a sports team!) There were no paper products. Big surprise.

When I checked out, I didn’t let the clerk (who was wearing gloves) to touch my items. It pays to be paranoid.

Then I took off for parts north. I rode the Mount Vernon Trail 15 miles to Rosslyn and crossed the Key Bridge into Georgetown. Traffic on the adjacent GW Parkway was light as it was on the bridge. Georgetown lacked its usual chaos. Mostly, the people I saw were alone or in groups of two or three. I rode past the White House and made my way through Lafayette Park. There I encountered three teenage boys on scooters as I entered the west side of the park. When I prepared to use a curb cut to leave the east side of the park, the scooter boys cut in front of me. No problem. Then I let three people on Segways, a guide and two tourists, also go in front of me. As the third person started down the curb cut she turned and sneezed over her shoulder.

I had been keeping my distance and I am glad I did. Still I waited a few seconds before proceeding into her germ cloud. I saw no point in lecturing her about her hygiene as I was pretty sure she sneezed as she did to avoid losing control of the Segway on the curb cut.

I rode the 15th Street cycletrack back toward the Potomac River. At the Pennsylvania Avenue entrance to the Ellipse I saw a group of at least 25 tourists walking across the street. Normally there would be dozens of similarly sized groups all over the tourist areas but today they were the only big group.

At the Washington Monument, DC’s famous cherry blossoms were starting to put on their show. A few trees at the Tidal Basin were also putting in a decent effort. Here’s a view looking back toward the Washington Monument across the Tidal Basin.

As I began crossing the Potomac on the 14th Street Bridge I spotted a whopper of a cherry tree in bloom. This tree is quite old and, for some reason, seems to be the first to reach peak bloom. The ramp to the bridge puts you right on top of the tree. You could go snow blind looking at it.

The ride home was uneventful. When I got home I put my clothes in the washing machine just in case Madam Segway was packing coronaheat.

Greetings from Elbownia

Here at the Rootchopper Institute we’re social distancing our butts off. Of course, my preferred SD method is to ride my bike alone. I’ve been grinding away at it for nine days in a row. Rather than getting worn out, I’ve been getting stronger. This is exactly what happens on a bike tour. It makes no sense either on tour or at home but it is what it is.

Yesterday’s ride took me over the Woodrow Wilson Bridge, down the corkscrew ramp on the Maryland side, and up the long hill past the casino complex to Oxon Hill Road. From there I made my way into DC via the streets of Anacostia. I rode past the derelict buildings of Saint Elizabeths (no apostrophe) Hospital and down MLK Jr. Boulevard. Eventually, I made it to the Anacostia River and took the Anacostia River Trail to Benning Road. There I crossed over to the west side of the river, rode south between the river and the rotting hulk of RFK Stadium all the way to the Navy Yard. Soon I was passing Nationals Park, Audi Field (soccer), and the Wharf eventually making it down to Hains Point to check out the not-ready-for-prime-time cherry blossoms. (I did managed to shag three golf balls from the rusty spring hackers on East Potomac Yard course.) Then it was up the Potomac River past the Jefferson and Lincoln Memorials, across the Memorial Bridge to the Mount Vernon Trail and back home. A nice 43-mile spin in 70-degree temperatures.

Today’s ride was a recovery ride. I made it six miles, nearly to Old Town Alexandria, before I realized that I had forgotten my water bottles. I used the Wilkes Street tunnel to turn back home. On the way I passed my local bike store. The plan had been for the store to re-open in March, but from the looks of things it’s going to be quite some time before that happens.

Within a mile or two of this bike shop there have been two other large fires in the last month. And sometime in the last few months a hotel was struck by lightning. Coincidence?

After fetching my water bottles I made my way down to Mount Vernon, home and burial place of George and Martha Washington. I can’t remember the last time I saw it closed, but such are the “circumstances” these days.

My ride home took me to Route 1. As I waited at the traffic light I took note of the remarkable fall in gasoline prices since the financial and commodity markets went haywire.

There were long lines at this station and the one next door. Of course, the handles on the pumps may be a fine place for the Covid-19 virus to hang out but you take your chances when you can save 40 cents a gallon.

The ride home was brisk. I don’t know what got into my legs lately but I was accelerating up small rises in the road and I didn’t have a tailwind.

After the ride, I spent 20 minutes scraping loose paint from an exterior wall on the house. During dinner, I had a slight and very brief twinge of nerve pain in my lower right back. Oddly, this is good news. I am scheduled to have a new kind of injection in my lower back on Monday, but I haven’t had the slightest bit of pain in six days. Tomorrow I go on a six-mile hike. If that doesn’t bring about some serious pain in my back or my left leg, I am declaring myself cured and cancelling the injection.

Now if only I could do the same for the coronavirus. I guess I’ll just have to keep bumping elbows for a while longer.

Introvert’s Delight

Ah, social distancing. It’s right up my alley. I can ride for hours all alone and know I am doing the right thing for my community.

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Sadly, this pandemic didn’t happened while I was working. It would have put an end to the extroverts trying to push everyone into this meeting or that. Brainstorming get togethers? Not any more! Three-day office retreats. Fuggetaboutit! Teambuilding exercises. Pshaw!

I do feel like I’ve fallen into a creepy science fiction movie. Here I am riding along on the prairie when I stop for food. Is the clerk at the register infected? Do the old men sitting around the table at the truck stop carry the dangerous contagion? Will I get out of this gas station alive? AYYY!

I am one of the high risk folks. I have compromised lungs in three ways. I have mild persistent asthma. I have had a lung infection in the last five years. And let’s not forget those lovely pulmonary embolisms. Also, I am 64. Take me out to the ballgame? I think not.

Meanwhile, my stenosis pain is in rapid retreat. Lord knows why. I am scheduled to be treated for lower back pain next Monday but that pain, too, is gone. Do I even bother with the treatment? I even tested my lower back by riding Little Nellie, my wee wheeled Bike Friday, yesterday. Normally, this bike beats up my back. Today, no pain.

The only problem I am having is a sore left knee that woke me up at 7 this morning. I have lowered the saddle on all my bikes and I suspect this is the culprit.

My thoughts are with Gio and Cristina, the Italian bike tourists I met on the side of the road in Eureka, Nevada. They are back in Italy. Stay well.

As for the rest of you all, don’t panic. Exercise good hygiene. Bump elbows. This too shall pass.

 

Igor and the Dead

I went back to Dr. Pain today. I only dealt with her assistant Igor. We talked about 20 minutes. We decided that my left leg is in reasonable shape, but that a more pressing issue is the random, sharp pain I’ve been getting across my lower back. So rather than get another set of injections for my left leg, I am getting a different kind of injection for the lower back pain. Igor assured me that this injection will be significantly less painful.

The process has three steps. I get an injection next Monday. Wait a couple of weeks and, if it helps, I get another. Then if that works I get one final injection.

There is no guarantee if any of these injections will work or, if they do, how long the relief will last.

(Note: I am totally kidding about Igor in the sense that my doctor’s assistant is not some deformed man who says things like “Yes, master” and “Brains!” Igor is in fact a not-at-all deformed woman in her early 30s (a guess). She’s smart, conscientious, and considerably better looking than Dr. Frankenstein’s assistant. )

After the appointment I jumped on The Mule to enjoy the 70-degree weather we had today. I rode to the Congressional Cemetery on the east side of Capitol Hill. It’s an old cemetery that is still accepting new permanent guests, so to speak. It also is a bit of an oasis for Hill East residents who jog, take a stroll, or walk their dogs there.

I wandered around for about a half hour. One thing that struck me is that no matter how important you may have thought you were in life, in death you end up in the same place as a clerk at the 7-11, pushing up daisies. You likely will be forgotten no matter how ostentatious your grave is. That said, here are a few pictures.

Four weeks

Today marked four weeks since I received epidural injections of cortisone. My condition continues to fluctuate. The referred pain in my left leg and hip is mostly gone. I can’t tell if this is the result of the cortisone or the fact that I am wary of doing much on my feet.

I had a nasty back spasm in my lower right back and pelvis earlier in the week. It left me doubled over and in considerable pain. Ibuprofen and rest fixed it but obviously this shouldn’t be happening.

I get little stabbing reminders that feel like the same sort of spasm is about to hit then they go away. Much of the time I feel like my lower back or my leg is about to go haywire but it doesn’t. It’s as if my body is taunting me. To say that this is frustrating is an understatement.

One thing I did do this week was ready my lawn mower for spring. In the process I found out that the blade wouldn’t come off. I tried force, WD40, and a solvent. Nothing worked. So I lifted the mower into the trunk of my car and took it to a repair shop. The point here is that I lifted this ungainly metal thing and moved it around without totally messing up my back. I think if it had weighed five more pounds I would have regretted my decision.

I also went for a flat two mile walk in Huntley Meadows Park. I made it about five minutes before my lower back started to ache. After another five minutes I started using a cane. I stopped a few times to take in the view. This helped my back quite a lot. I made it the entire way without problem but my walking mechanics are still not quite right.

I go back to the pain doctor on Monday. I’ll be interested to see what she says. Do I get another injection or not? My plans for the spring and the summer are on hold until I have some idea what my body will be able to tolerate. Can I sleep in a tent? Can I ride long distances day after day? We’ll see.

One thing to keep in mind is that steroid injections can cause a temporary decrease in immunity. Normally, I wouldn’t give this a second thought but it would be bad news to be exposed to the coronavirus after having another shot.

As far as biking is concerned, I’m back to averaging about 30 miles per day (with one day off per week). I feel strong except for the fact that winter’s weight gain isn’t doing me any favors on hills. I’ve ridden a few days in shorts which seems to help my mechanics, not to mention my frame of mind. My knee and hip problems from last summer are gone.

This morning I rode to and from Friday Coffee Club in DC, a 29-mile round trip. As I got underway, I saw the edge of a storm front that looked like a mountain range in the predawn light.

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This brought to mind the gradual approach to the Rockies in Montana in 2018. I sure hope I can get back out on the open road this summer.