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

The Ride

The night before The Ride, the forecast for ride time is a 90% chance of rain. During the course of the day, that dips to as low as 75% briefly. If this were a ride just for fun, I’d bail about now. But this is a fundraiser, and folks have donated on my behalf. I feel a responsibility toward them. Besides, 70 degrees and rain is way better than 40 degrees and rain. So I readied my gear, with some choices for weather: do I wear a rain jacket and pants to stay dry from the outside, or do I forgo the rainwear, figuring at that temperature I’ll get wet from the inside if I wear waterproof clothing? Do I wear the raingear so I’ll stay warm, or will it be warm enough to be a non-issue? Maybe if I just wear shoecovers to keep my feet dryish and warm. Regular jacket? Long sleeve jersey? Leg warmers? I tossed them all in the car. It’s not that far to the ride start, but do I want to add 18 miles to a 102 mile ride, arriving at the start already wet, and riding home wet? No; I’ll drive to the start and be able to dry off and change clothes before I go home.

Four nights in motels, four days sitting in conference rooms, not in the saddle for more than a week – probably not the ideal training, but I can say I was tapering so as not to be over-trained. Yeah, I can say it.

After a quiet night, the first thunderstorm rolls in at 4:30 AM. A flash flood watch is in effect. The forecast has been revised to 100% chance of rain most of the day, dipping to 80% from 10-11. The time comes to leave the house. No lightning at the moment, but the rain is coming down so hard I can barely see the car parked at the curb. I’m not so sure I want to drive in this weather, much less spend 8 hours out in it. And it’s still dark out, which does not make it more inviting. Decision made: I wouldn’t let a knight go out on a dog like this. Responsibility is one thing. Foolishness is another. As I said in a post a month ago: “I mostly want to ride that day”. Well, that day is here. I mostly don’t want to ride. The money I spent to register and the money donated by others will go to cancer research whether I’m on the road or not. [See below!] Since I’ve already had a double espresso, I probably won’t be going back to bed.

The half-fast fall ride is just around the corner. You can pretend you’re donating in honor of that, if you’d like. It’s still a long bike ride, just no support unless you count the resturants we’ll be stopping by.

It rained for 12 hours. Only a bit of flooding, at least from where I sit. I stayed in all day to prove I’m half-fast. I didn’t just lie around and drink beer and watch football (or eat bon bons). I have a short-term job. I’ll work for 14 hours later this week. To do that, they required 4 hours of computer-based training. I spent the morning staring at a computer screen for courses on data security and workplace harassment. At 6 pm I finally went out and got my stuff from the car. The sun was shining.

The first day of fall dawned beautifully, with clear sky, crisp air, 55 degrees (13 degrees C). A perfect day for a ride; just a day late.

The PBS country music series is back on. Last night was a reminder of the social consciousness of country music in the 60s. Loretta Lynn wrote the song “The Pill”, in which she stated her refusal to be a brood hen anymore. (She had four kids by the age of 20, six by the time she wrote the song – which the label refused to release for a few years.) She also addressed the issue of marital rape (though not in so many words) with this song:

Merle Haggard sang of turning “21 in prison, doing life without parole”. (He was actually in for 15 years and did get out on parole.) People know him for “Okie From Muskogee”, far from his best song. He also sang of a man on death row. On his way to the gas chamber, he asked to have a buddy sing his last request – “Sing Me Back Home”. He sang of his “Mama’s Hungry Eyes”, growing up as a dust bowl refugee. But among his most poignant was the song of a single parent, pretending that the birthday gift for his daughter was from the absent spouse who didn’t bother to remember.

And in 1964 Johnny Cash released the album “Bitter Tears” about the mistreatment/genocide of First Nations people by the US Government.

Breaking News

Call me a wimp no more. I just checked my work email and The Ride was canceled. It wasn’t just me. (Interesting: at 1:01 AM they notified me the ride was canceled, at 6:01 AM they reminded me to sign up for Live Tracking and at 6:23 AM they notified me again that the ride was canceled. And I’m always checking my work email at 6 on Sunday mornings.)