The Ride (waiting 2 years for this)

I’m supposed to be in another town teaching for two days. When we canceled this course a year ago, we thought it would be safe after a year. No dice. In-person and hands-on training is not in the cards again. Too many metaphors for that paragraph, though all about gambling.

I request vacation time a year in advance. When the days come up and I have no plans, there is no sense in giving them back. Two days without plans, followed by a day on the bike. I could get to like this. When the word “septuagenarian” not only enters your vocabulary but starts to impinge on your reality, it’s time to think about how to spend a life without going to work every day. As the folksinger Charlie King reminded us “Our life is more than our work and our work is more than our job.”

I was going to do this ride two years ago but it was canceled due to thunderstorms. Last year was canceled due to the pandemic. The ride is a benefit for the Carbone Cancer Center. By the way, you can still donate at https://runsignup.com/half-fast

I’m starting this post before the ride and I have to add one COVID-19 related piece. My employer has now mandated the vaccine. We have until October 1 to get the first shot or be “placed on unpaid leave and terminated by October 11.” There are both medical and religious waivers. The medical waiver is very specific and must be signed by your health care provider. The link to the religious waiver is restricted – as an employee I can’t see it. Maybe my boss can. [Update: I can now see the religious waiver and it just asks me to attest to a religious, moral, or ethical anti-vax stance. – nothing like the Arkansas hospital below.] Most of us were vaccinated in December and January 2020-21. There are a few holdouts. A hospital system in Arkansas is allowing religious exemptions on the assumption that people are objecting to the use of a 40+ year old fetal cell line in the research and development. The CEO of the hospital chain, Matt Troup, had this to say:

“‘(W)e provided a religious attestation form for those individuals requesting a religious exemption,’ The form lists 30 medications and asks employees to ‘truthfully acknowledge and affirm that my sincerely held religious belief is consistent and true and I do not use or will [not] use any of the medications listed as examples or any other medication … that has used fetal cell lines in their development and/or testing.‘” (From Becker’s Hospital Review, Kelly Gooch, 9/16/2021)

“The list includes Tylenol, Pepto Bismol, aspirin, Tums, Lipitor, Senokot, Motrin, ibuprofen, Maalox, Ex-Lax, Benadryl, Sudafed, albuterol, Preparation H, MMR vaccine, Claritin, Zoloft, Prilosec OTC, and azithromycin.” (from Ars Tecnica, Beth Mole, 9/16/2021)

So if you are objecting to the vaccine on religious grounds due to your anti-choice stance, stop taking anything in the list above; and be sure to check the full list for the other 11 medications you shouldn’t be taking. And if you are truly religious you will (of course, this goes without saying) check to see that there are no other substances you use which benefit from research involving that fetal cell line, as it sounds like that list of 30 is incomplete.

If you object to vaccines on principle, be sure to NOT get a tetanus shot if you step on a rusty nail. If bitten by a rabid animal, avoid the rabies vaccine on both grounds. A Darwin Award could be in your future!

Big Ring Ride

Wednesday night’s warm up for the century was a fairly easy ride. Part way through I realized I had not yet used the small chainring, so decided to make it a big ring ride and stay on that ring the whole way, just for the hell of it. Saturday was going to be a short ride just to stay loose. Minutes after I changed back into regular clothes, I got a call for an emergency errand so I changed again and did a second ride of the same length. So 30 miles;”just to stay loose”.

The Ride

Sunday dawned chilly so required tights and a jacket for the first couple of hours, then shorts and a short-sleeved jersey for the rest. The wind was supposed to pick up around noon, by which time it would be a tailwind. Right.

We headed into the sunrise, so it was bright until the sun got higher. There was a mass start, complete with a countdown by the MC over a PA and the option to download a tracking app so folks could know where you were at all times. I considered tearing the sensor out of my ride number. All a bit much for me. There were mile markers every mile for the first ten and again at the end – they were from the 25K route, so mile 101 was announced as “Mile 16”. Cruel. All distances were generous (since 25K is 15.5 miles.) The forecast was for early sun, then clouds. The temperature hit 80 (27 C), the clouds didn’t come until well after we finished, and the wind was a factor by 9:30 – by “factor”, I mean “not a tailwind”. The canopies at the rest stops were blowing over, trash receptacles blowing away, the signs (despite being weighted) were falling down, flags were snapping (and shredding) in the “breeze”; and that’s not to mention the effect on the riders. As usual, a great day for a ride; just a bit harder than last week (and despite being only two miles longer, it took a half hour longer).

Religious diversity in Rockdale – two Lutheran churches within shouting distance

Thanks to all the donors for the ride! Shouts out to Mark (California Alps Cycling), Tim, Candice, Celeste, Patti, Vikki, John (A Midnight Rider), KR, all anonymous donors, and anyone I forgot, missed, or couldn’t identify. Thanks to blogging friends I have met only online. Thanks to 50th reunion classmates who are partying while I am riding (stay safe and have an extra beer for me).

The last miles contained tributes to people with cancer. RIP Jerry, Carol, Geoph, Kate, Lloyd, Mary and the rest of you. This ride is to stop that list from growing.

High clouds appeared around 3 PM.

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You want proof? You got proof!

Woolly Bears

Around here, the woolly bear caterpillar is said to predict the winter weather. This caterpillar is generally brown in the middle and black on the ends. More black is said to mean a harsher winter. I saw four on the ride – two with narrow black bands and two that were all brown with no black on the ends. That is supposed to mean a mild winter. I had to look this up, because I thought it was the other way around. One source said a small study confirmed the folklore. Another said the relative sizes of the color bands actually shows what last winter was like. A third source claims no correlation. We’ll see.

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.