Aftermath

For the last 31 years, I have lived within a mile of US Route 1 in Fairfax County, Virginia. Hereabouts Route 1 is known as Richmond Highway because, prior to the building of Interstate 95, it was the main route between the north and the Virginia state capital.

It has been the armpit of the county for most of the time I’ve lived here, lined with predatory lenders, run down motels from the 1940s (or earlier), trailer parks, a staggering number of truly bad restaurants (including the legendary Dixie Pig barbecue joint), and some rowdy clubs including the long-gone Hillbilly Heaven owned by Dan Ackroid’s in-laws.

For many decades, the county stupidly used the Richmond Highway corridor as a money pit for haphazard development. It became a crime-ridden traffic sewer, a road to avoid. People who live along the highway are disproportionately poor people of color. They rely on buses and shoe leather to get around and a disturbing number of them have paid with their lives trying to cross the six to eight lanes of vehicular mayhem.

In recent years, the county finally realized that this mess could be fixed with some long range planning including dense development and a bus rapid transit line that may one day, long after I am pushing up daisies, morph into a Metro rail line.

A big part of the redevelopment is to turn sections of the highway into mini-cities with mid rise apartments, street level shops, and such. The intersection of US 1 and Kings Highway was one such mini-city. Last week, an apartment and retail building that was under construction there caught fire. The five-alarm blaze burned for hours. It sent up a smoke plume that rivaled that of the Pentagon on 9/11. (I know because I rode under the 9/11 smoke plume on my way home.) The plume showed up on weather radar and extended well into southern Maryland.

The intersection is on the far side of Beacon Hill, the highest point between Richmond and DC. I decided to test my recovery by riding to it.

The ride up the hill proved to me that yesterday’s two-mile walk didn’t affect my recovery adversely. My lungs,on the other hand, could use some work. It’s one tough haul up that beast.

Below are a few pictures of the devastation. The construction site spanned a residential street. Along one side it was attached to a huge concrete parking garage. Note that in Virginia tall residential and mixed use buildings can be stick built above the ground floor. As you can see there is nothing left of the building above its first floor. On the other side of the street, the building is simply gone. Townhouses that were already completed seemed to have survived but they were closed, probably from smoke and heat damage inside. An new apartment complex (not shown) that ran the length of the project also seemed not to have burned but many of its units were boarded up as well. A few single family homes of recent vintage had significant heat damage to their vinyl siding.

How depressing.

I rode on afterward hoping to give my back a bit of a reprieve from the climb. I meandered north into the Eisenhower Valley, Old Town, and Del Ray neighborhoods of Alexandria city. Then I toured the sound wall along scenic I-395 to the Pentagon and past the 9/11 crash site. There’s a rather interesting memorial at the site but it’s hard to see because the Pentagon is building some sort of secure freight screening facility and there are fences and other obstructions between the highway and the memorial.

My ride took me to the Lincoln Memorial and down the National Mall. Big mistake. The joint was packed with Presidents Day weekend tourists. At a traffic light I chatted with two tourists from Boulder, Colorado. They were on rental e-scooters. They said I was brave to be riding in this traffic. (They’d really freak out during a weekday!)

I made a brief tour of The Wharf where there were hundreds of people milling about. Then I headed back across the river and down the Mount Vernon Trail to home.

The entire trip was 33 miles. Virtually pain free but for the lung sucking I did climbing Beacon Hill.

 

Taking Steps

So a week has passed since Doctor Evil injected my spine with cortisone. I shudder just thinking about the electric shocks ripping down my left leg. The after-care notes I was given at the doctor’s office warn that the effect of the medicine will not appear for a week to ten days. A friend told me of someone who didn’t feel any change for a full two weeks.

Not much had changed over the first four or five days but I decided to try doing some very gentle physical therapy exercises designed specifically for stenosis. I have my doubts about PT but my friend Ed told me yesterday that he did PT for stenosis without shots with success. (His nerve issues produced different symptoms. For example, I couldn’t stand for any length of time; he couldn’t sit. He said it took a year to get his pain under control. (One odd commonality in our cases is the fact that we both have asymmetric depressions in our leather saddles. This means that our sit bones push into the saddle more on one side than the other.)

I honestly can’t tell if the exercises are doing anything, but they are low risk and only take ten minutes to do. I do them twice a day,

Yesterday, I braved below freezing wind chills to ride to Friday Coffee Club. I had no troubles on the bike. I was very much aware that seven days had passed since the shots. And I am pleased to report that I stood for a half hour with no discomfort at all. I eventually ended up sitting but it was a choice not a need.

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On the way home. Note the flags at the base of the monument. 

I rode home in even colder wind chills. The ride across the river had a nasty cross wind that cut right through my neck gaiter. The right side of my face was nearly numb by the time I reached Virginia. Fortunately, I had the wind at my back for most of the last 12 miles home. I could tell how tough it was for DC-bound riders by the look on my friend Joe’s face just south of the bridge. Then a few minutes later another DC-bound rider yelled, “Hi John!” as she rode past. She too was freezing, but a smile betrayed her Hoosier upbringing. (Winds in Indiana are often so strong they moan.) I said “Hi, Laura” back but she couldn’t hear me.

About five miles from home I came upon an e-biker. He was covered in black except for space age reflective goggles across his eyes. He looked like an extra from The Fly. He did not say “Help me!” in a high-pitched squeaky voice.

Last night I walked to and from a restaurant with no cane. No problems. Today I awoke and felt totally limber. I was standing straighter. My back and hips felt relaxed.

After puttering around the house all morning, I took the back by the cane as it were and headed over to Huntley Meadows Park to go for a walk. The park has a flat. unpaved trail that leads to a boardwalk through a marsh. It’s a great place to chill out. On a day like today the chilling was literal and figurative.

I brought my cane to be on the safe side. I managed to get over a half mile before I started using it. Again, it was not out of need. It was just seemed easier to use it than to carry it.

I made it about a mile before is started getting some very mild discomfort on the outside of my lower left leg. It never progressed into pain. I walked two miles in all and maintained proper walking mechanics. In fact, I had trouble keeping my walking pace down. My legs wanted to rumble. When I finished I noticed that my lower back didn’t stiffen up. 

I did feel a hot spot on my left hip and the continuation of discomfort in my lower leg when I got home but I still regard today’s walk step in the right direction.

 

Rosanne Rosannadanna phone home

I’m five days removed from the cortisone injections in my spine. I should start noticing some effects in a few days.

I’ve ridden my recumbent bike and my CrossCheck twice each. Until today I was having no problems. I have stayed off my feet as much as possible to let the steroid do its thing. So it’s not surprising that I have had no pain.

Today, about an hour into my indoor recumbent ride, I experienced a sharp pain in my left knee. It felt very different from the various kinds of knee pain I’ve had over the last year. I think it’s an iliotibial band strain, the result of doing no stretching for three weeks.

It’s always something.

The cortisone shots have some interesting side effects. I had a pretty good headache the night of the injections. And then my face turned beet red the next day. The illness that I had last week seems to be lingering, perhaps a result of transitory immune suppression.

Yesterday I went to the drug store. It’s transitioning from one national chain to another. I had to wait in lines twice, perhaps for a total of 15 to 20 minutes. I had no trouble with my lower back or left leg.

Tonight and tomorrow I am attending events in the city. I’ll be interested to see how my leg and back do. I’m bringing my cane just in case

The beneficial effect of the steroid injections should start kicking in this weekend.

 

 

 

 

Errandonnee Encore

My Christmas stocking contained a small packet of ground Texas Turtle coffee from World Market. Judging by the name I had my doubts about the taste but it turned out to be the best coffee I had in years. Today’s first errand was to ride 15 miles to a store in Bailey’s Crossroads, Virginia to restock.

I am easily spotted around town my the humongous saddle bag on my Surly CrossCheck. It holds a ton of stuff and easily handled two packages of coffee and a box of tea.

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I had planned to ride a long way but I dressed inadequately for even the warm temperatures so I made my way back toward home. I stopped at District Taco for lunch. I had picked up a $10 gift card at the Hains Point 100 and finally got to cash it in on a California Burrito.

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Muy deliciosa.

I hit 30 miles again.

To recap:

I’ve totally crushed the mileage requirement. Living in the suburbs has its advantages after all! And I’ve done four errands in three days. Not too bad. However, I can see that I will have trouble covering enough categories. (There are nine. You have to use seven.)  Life is hard. Then you get a needle in the back. Maybe I’ll ride to the pain doctor on Friday. It’s only a half mile from home.

The weekend, by the by, was brutal. My back went out in a big way Friday or Saturday. This was the worst stenosis pain in a long time. I couldn’t stand up straight so I spent a lot of time sitting with an ice pack on my back. I made it to a Super Bowl/birthday party and had beer instead of pain killers. I woke up this morning and my back felt much better. I highly recommend Koltsch as a stenosis remedy.

 

 

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.

 

 

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.