The Ride (part 2)

There is this guy, George (my wife refers to all of her clients as George, or Georgette if they identify as female). He is definitely George, as will become obvious. And he’s not my wife’s client. I just borrowed the name.

George was planning a marathon athletic endeavor and thought he would visit his PCP (primary care provider) for a checkup, specifically to be sure he could embark on this months-long endeavor.

The good doctor suggested a PSA (prostate-specific antigen) test, as George was of a certain age. They discussed the pros and cons. (It is not a particularly reliable nor specific [despite its name] test and can result in unwarranted worry.) Please note that nothing in this post should be construed as medical advice. If you have questions or concerns, consult your primary care provider.

The result was worrisome (a greater than 50% chance of cancer) and the doctor thought George should see a urologist. The urologist ordered another test, which yields a ratio of free to total PSA. This shows a percentage chance of cancer if the overall PSA level is in the grey area. This again showed a high probability of cancer. Looking at the two tests, the doctor told George he had a >60% chance of having prostate cancer.

The next step was a prostate biopsy. This involves the rectal insertion of a small tool which snips out 12 pieces of tissue. If you imagine a clock face, one snip is taken at each hour mark. The theory is that, if there are cancer cells present, you’ll find some in at least one of those twelve samples. The test has a couple of side effects. George would likely pee blood for a few days and he might not want to sit on a bicycle seat for a while. If his marathon athletic endeavor were to include any time on a bike, doing this test while in training might not be the best idea.

George and his urologist talked it over and decided there were three possibilities: 1) George didn’t have cancer, and the test would keep him off his bike long enough to disrupt his training, possibly throwing his trip into jeopardy; 2) George did have cancer, but it would be a slow-growing cancer. (Hence the oft-heard “prostate cancer is a cancer you will die with, not of.”) Again, his trip would be in jeopardy for no good reason; 3) George had a fast-growing and aggressive cancer. He would need serious interventions which may include chemo, radiation, and surgery. His trip definitely would be canceled, likely forever.

George decided that what he didn’t know wouldn’t hurt him. If 1) he had no cancer, he didn’t want to lose the chance to embark on this endeavor. If 2) he had a slow-growing cancer requiring no treatment, he didn’t want to waste his training. If 3A) he was going to require extensive treatment, or 3B) he was going to die soon anyway, he didn’t want to miss out on this (now clearly once-in-a-lifetime) opportunity. His doctor agreed that he could go on the trip and come and see him after it was over. George told no one of this, not seeing any reason to worry others.

He went on his marathon athletic endeavor (which might be compared to a coast-to-coast bike trip), and went back to the doctor afterward. They repeated the PSA tests. It now showed a 20% chance that he had cancer. A year went by. The numbers were back up again. He had a prostate biopsy. He peed blood, he stayed off his bike for a while, and the result was negative. He didn’t have cancer.

Why did the test show he had a 60% chance of cancer before the trip and 20% chance after? Did a marathon athletic endeavor cure him of cancer? Not likely. The doctor said that inflammation could cause a false positive. Would sitting on a bike seat for two months make inflammation in that region more or less likely? Well, more, it seems. Evidence is inconclusive – the best evidence we have (a meta-analysis of multiple studies [Prostate Cancer and Prostatic Diseases, 2015]) shows no correlation between bicycling and elevated PSA. So why would he have inflammation before and not after? The doctor couldn’t say.

So what is this prostate cancer thing? And why is it so hard to detect? The symptoms look a lot like the symptoms of BPH (benign prostatic hypertrophy). That just means your prostate got bigger but isn’t harmful. BPH is considered a normal part of aging. The symptoms are things like: needing to pee more often (including waking up multiple times during the night); incomplete bladder emptying (therefore needing to pee more often – maybe even peeing, going back to bed, and getting right back up to go finish the job); urinary urgency – having to pee right now.

The National Cancer Institute says there were nearly 200,000 new cases in 2020, with more than 33,000 deaths. Prostate cancer is the second most common cancer in men (after lung cancer) (World Journal of Oncology, 2019). The incidence is higher for Black men.

Side effects of treatment may include urinary incontinence and erectile dysfunction. There continues to be controversy over whether men should be tested and, if cancer is detected, if they should be treated.

The Carbone Cancer Center performs research and treatment. One of the trials is known as the International Registry to Improve Outcomes in Men with Advanced Prostate Cancer (IRONMAN). Seems fitting for George, eh?

Prostate cancer tends to be ignored because it is “seldom” fatal – tell that to the 33,000 men who will die this year. In September I will be riding to support the Carbone Cancer Center to help people like George. Please join me in donating at: https://runsignup.com/half-fast. Thank you. (Since this is not a scholarly article, citations are incomplete. Ask if you want more detail.) (This post dedicated to KR2 and “George”.)

Why ride a bike?

Part One, The Practical Reasons:

  • A bike is faster than walking.
  • A bike is faster than taking the bus (especially if you consider the time spent waiting for the bus and walking to and from bus stops – you can’t just walk out the door and have the bus magically arrive).
  • A bike may be faster than a car (when you consider getting stuck in rush hour traffic and the time spent parking/getting to and from your parking place).
  • A bike is cheaper than a car:
    • cheaper to buy – you can buy a phenomenal bike for $10,000 – like a Ferrari but $2-300,000 cheaper (depending on the Ferrari model). A bike for basic transportation is maybe $15,000 less than a car for basic transportation. (Comparing a Trek FX or Zektor to a Toyota Yaris)
    • cheaper for daily use – no gas or electricity to buy, no parking fees to pay.
    • cheaper to maintain – a bike is much easier to work on yourself – no sheetmetal in the way; if you pay for maintenance, it is still way cheaper
    • cheaper to insure
  • A bike is cheaper than a car for society:
    • fewer resources used to produce them
    • no fossil fuels burned to power them
    • fewer urban acres devoted to parking, which makes more land available for other development (at a higher use-value) or open space, which creates less impervious surface, thus decreasing urban runoff:
      • this means less pollution of waterways
      • fewer urban floods
      • faster recharging of underground aquifers
    • less wear and tear on existing roadways, less need for ever-larger roadways
    • A bike is the most efficient form of human transportation in terms of energy usage per mile traveled.
    • I’ve never fallen asleep riding a bike.

Part Two, The Health Reasons:

A picture is worth 1000 words. So two pictures must be worth 1000 words plus a whole lot of data I therefore don’t need to cite.

  • riding a bike burns fat
  • riding a bike leads to greater aerobic fitness
  • riding a bike causes minimal stress on joints
  • riding a bike leads to lower stress levels, reducing mental health costs
  • as obesity and cardiovascular disease lead to greater societal health costs, riding a bike has public health, as well as individual health, benefits

Part Three, The Fun Reasons:

  • Riding a bike can be done alone, with family, with friends, with strangers – whether you like your fun in solitude, with loved ones, or as a way to meet new people, you can do it on a bike
  • Riding a bike lets you observe the little changes in the world around you – you can see your surroundings more easily than in a car so you can see wildlife (whether urban or rural), watch seasonal changes (seeing flowers bloom, trees bud out and leaves change color, watch and hear waterways freezing and thawing) [We won’t repeat pictures you’ve already seen here – scroll back through old posts for more.]
  • Riding a bike gives you time to think and reflect – or to stop thinking and just feel the rhythms of your body and your interactions with the bike, the road, and the world around you.
hoarfrost
Half-fast Fall Classic, Devil’s Lake
Sunset, stormy night (NOT a fire in the distance)

Part Five, Because Frazz Does It:

Short subjects (or, in Herb Caen parlance, three dot journalism…)

Ice fishing season started before deer hunting season. That is not normal. To continue weather weirdness, I saw all of this within a couple of minutes, on the same small bay:
* piers dismantled and stacked neatly by the shore
* piers frozen into the ice, likely destined to become scrap metal by spring
* ice fishers
* shoreline fishers working a 30’x30′ opening in the ice
* someone fishing from a boat…

I just watched “The Donald Trump Story” on television, but under its original title “Gaslight”…

I hope to answer the question “Which is harder – the Death Ride or the Horribly Hilly Hundreds? ” I rode them 27 years apart so it’s not a fair comparison so far. Both are about 200 km or 125 miles. The Death Ride climbs 15,000 feet, the HHH about 11,000. The Death Ride climbs to over 8700 feet. The HHH never reaches 2000. The Death Ride contains five epic climbs; the HHH about 40 short and steep ones. My experience is that a long steady climb allows one to settle into a rhythm. A short steep climb tempts one to charge up it, only to have to do that 39 more times – so my current hypothesis is that the HHH is harder (for me), as long as you hang out at elevation before Death Ride…

If I fail to answer the question, at least I plan to have fun and tell you about it after. Now I just need to get the time off work and make the arrangements for the 40th anniversary Death Ride.

I got two STDs. The Death Ride is July 11, 2020. The HHH is June 20,2020 -doing them three weeks apart wouldn’t be a fair comparison, either. Save the dates…

I just earned my last badge.

At work I was invited to try lovetoride.net. We formed a team and recorded all of our riding for a month. At the end of the month I won a dozen tamales, so I did it again the next time. In addition to tamales, one can earn virtual badges for things like encouraging others to ride, riding a century, commuting by bike… Last year I noticed the badges were piling up but I was missing two: “Legend”, for recording 10,000 miles on the app, and “Super Commuter”, for commuting by bike 200 times in a calendar year. So rather than just recording rides for a month when they were running a promo, I started recording all rides just before the coast-to-coast trip. 10,000 miles came soon after. 200 days came in November 2019. No big deal. That’s just doing what I normally do for the first 40 weeks of the year. But now I have a fake badge to show for it…”Badges? We ain’t got no badges. We don’t need no badges. I don’t have to show you any stinking badges!”

If you’re not blazing a trail, you’re just breaking wind.” Frazz, by Jef Mallett