The Ride (getting closer)

Carol was the Nurse Case Manager for Trauma. At daily rounds, she was often the only one who got my jokes. Everyone else looked puzzled. In turn, I was the only one who got her cultural references. Everyone else looked at us blankly.

She turned in her resignation on short notice. It was whispered that she had cancer. Soon I saw the notice for her funeral – on a Saturday, so I had to remember her the way I knew her – by working. In her obituary I noted that she was 3-4 months younger than I; thus the same high school graduation year. Not only did we think alike, but we had the same cultural touchstones. Like Geoph, it was pancreatic cancer. Like Geoph, it was fast.

My first personal encounter with cancer (that I recall) was my favorite singer. The call went out for a bone marrow donor and platelet donations. While donating platelets I was tested but not a bone marrow match. Kate Wolf died soon after. She sang of cancer (not her own) in her cover of Muriel Hogan’s “Agent Orange”.

I will be riding to benefit the Carbone Cancer Center on September 26; 100 miles or so. If you can, please add to my donation at: https://runsignup.com/half-fast I ride to remember the friends I have lost and I ride to try to keep that list from getting any longer. Thank you. If you have stories you want to share, please add them in the comments.

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”.)

The Ride

Geoph lived in a comfortable home in San Francisco with his family of nine, some biological and some otherwise chosen. He left that home and family and hit the road in his tan Mazda pickup truck, with carpentry tools in the back, to visit intentional communities around the US.

He spent time at EastWind in Missouri (purveyors of fine nut butters), Twin Oaks in Virginia (makers of rope hammocks) and The Farm in Tennessee (foremost trainer of lay midwives), among others. He became known as “The Peripatetic Communitarian” and wrote extensively for Communities Magazine and produced films about the world of intentional communities. (Image from ic.org)

One of his communities was Co-op Camp Sierra, where our paths crossed every summer. In the summer of 2007 he stopped in San Francisco to visit his daughter on the way to camp. He wasn’t feeling great and she thought he looked worse. She convinced him to go to the doctor while he was in town. He never made it to camp that year, or ever again. He died that fall of pancreatic cancer.

Jerry was a carpenter. He built the steps in front of my house. He built his house. I was doing a bathroom remodel and called him to help hang some drywall. At nearly 80 pounds per sheet, lifting them overhead and holding them in place while screwing them into the studs required two people in my book. He came over, picked up the first sheet by its top edge, lifted it into place, held it with one hand, and screwed it into place with the other. I was just in the way. He had more strength in his fingers than I had in my whole body. When I tried to pay him, he said, “You just owe me an hour of labor next time I need an extra pair of hands.” He never got to collect. A misstep walking into the garage shattered a hip weakened by leukemia and he never recovered.

Lloyd was one of those people who made this town my home. I never knew him well but we had many friends in common. He walked into the hospital for a bone marrow transplant and was carried out when his weakened immune system could carry him no longer.

Karl was a weightlifter, a writer (at least one novel and one true crime book), a cook (which is how I met him) a runner, and a purveyor of fine running shoes. He autographed his novel for me during the first of many hospital stays, when he famously said to his surgeon, “I didn’t know you were going to make me look like Mr Potato Head.” [Ed. note: now known simply as “Potato Head“.] Head and neck cancer eventually claimed him but didn’t seem to slow him down before that. (photo by Rob Kelly)

On the other side of that coin, in my work I see women (and the occasional man) the morning after mastectomy pretty much every week. They have a cancer which is curable and often cured. I am no longer surprised by the ones who look great and are ready to move on after a few weeks to recuperate.

Cancer is one of those words we have learned to dread. Once it was seen as monolithic. Eventually we came to understand that there are many types of cancer. Some we can cure, some we can control, others are pretty universally killers. So why am I talking about cancer in what is, ostensibly, a bike blog?

During this pandemic, life has been confined to going to work five days a week and staying home the other two. I used to go on a weekly ride with friends and acquaintances. I used to ride on Sundays with a local club. I rode centuries, I rode across the country. Now I ride alone.

I have now registered for The Ride, a fundraiser for the Carbone Cancer Center. I hope to be able to ride 100 miles with others by late September. Even if the ride is canceled, cancer continues. Please consider visiting my fundraising page and making a donation in hopes that your friends don’t have to join mine in this list of stories. And if you have a story to tell, or a friend’s story to tell because they are not here to tell it themselves, please add it in the comments below.

Adopt-a-Highway

Due to the lack of motorized transportation (the van brakes broke and no longer brake), the cleanup of our adopted highway is postponed to Sunday, October 13 and will honor the birthday of one of our riders who will be off to Spain and miss all the fun. Come and join us to clean one of the most beautiful miles of road in the county.

The next day will be the Half-fast Fall Ride. We’ll miss our weary traveler off in Spain but hope for another great ride, great food, and some fall color. Great camaraderie goes without saying. We’ll let you know how it went.

The reports are in and The Ride (the benefit for the Carbone Cancer Center) had its best fundraising totals yet. One might say this is remarkable since we didn’t even ride (canceled due to thunderstorms with torrential rains), but maybe that’s why it did so well – no day of ride expenses (but they must have had a lot of bananas to donate to the food pantry). Thanks to those who donated on behalf of the Half-fast Cycling Club, and all other donors.

The Ride 2019 Fundraising total

Floods are back. We usually have spring flooding here, if at all. Last year the river was out of its banks in August. It looks like tomorrow the banks will no longer hold. We know someone who had to sleep overnight in her office due to flooding last night.

Full service Hotel