About That Title...
Don't Worry; I Don't Really Want to Die
"May the lord take a liking to you - but not too soon!" - Old Irish Proverb
Fair Warning; This page consists of me whining about my various illnesses. I'd probably skip it if I were you, but I'm not you. If you do decide to read it, don't say I didn't warn you. Otherwise, this is the "why I had trouble preparing for a bike tour in 2020" discussion.
News flash; we are all going to die some day. We know this, but it's not something we dwell on as we go about the routine tasks of living. As we get older and suffer the inevitable ravages of time, it becomes obvious that we are approaching the end, even though it may be years away. I'm 68 years old, I have a couple of cancers and a recent issue with heart arrhythmia. The medical experts have told me that prostate cancer will prove fatal for me in the years to come. While the exact prognosis is a private matter for me and my immediate family, suffice it to say that my quality of life is expected to degrade in the coming years as I deal with the side effects from treatments and the devastation from the cancer itself.
I don't like to talk about my personal health issues, and most of my relatives and friends outside of my immediate family aren't even aware of my prognosis. My father survived WWII - he was in 5 major battle campaigns - he would have never discussed or admitted to any pain or illness; he was of the opinion that men just don't do that. I'm not him, but I'm a little like that too. I would be content to keep it all bottled up inside me until it's obvious that I have a problem, but She-Who-Must-Be-Obeyed is not happy that I have not shared the news below with my in-laws and extended family. I'm not the only one who has to deal with my future health decline, and my wife wants to be able to draw on the support of her family. So this is how I'm sharing the news; now that you all know, my lovely bride is no longer bound to protect my privacy. The miserable details regarding my health challenges follow - feel free to skip these if you like, otherwise you may get quite bored.
2020 Was a Memorable Year. Yes, I know 2020 was a "memorable" year for us all, and not in a good way as we all dealt with the COVID-19 pandemic. But it was an especially challenging year for me. I had 5 surgeries, was hospitalized for something akin to flesh-eating bacteria, endured some rather unpleasant home healthcare therapy while recovering from the surgery wounds, had to wear a wound vac for a couple of months, and was informed that I would eventually die from cancer. I missed a lot of work due to the surgeries and recovery time, hospitalization and sickness, numerous doctor visits (many requiring multi-day out of state trips), and vacation time that I had to take or forfeit. And, try though I might, all this medical nonsense interfered with my biking as well.
The Heart Issue; Atrial Fibrillation. I have a strong heart; really, I do. I've managed to do some form of aerobic exercise most of my life. But AFIB is a form of heart arrhythmia that occurs primarily due to age, regardless of how strong the heart may be. So while my heart's motor was strong, in 2019 it was discovered that the timing was off, and hard exercise or emotional stress could cause my heart to beat wildly out of control. There is a drug that helps prevent this from happening, and there is a procedure that can sometimes fix it. The AFIB issue was discovered in 2019 shortly before I was set to deploy to Germany to provide engineering support to the U.S. Army and our NATO allies. I used a drug to help control the AFIB while I was overseas. Unfortunately, it didn't work that well, and when I went on long bike rides along the Rhine River on weekends I would return with my heart beating erratically around 140 beats/minute for the next 12 hours or so. Once I returned home to the U.S., I opted for the procedure that could possibly fix this.
And so, in January 2020 I had a catheter ablation for AFIB; while under anesthesia, thin wires were inserted in the veins at each groin and ran up into one of the upper heart chambers. They then punched a small hole from that chamber into the other chamber, and then radio-frequency heating was used to cause slight damage to the heart muscle so that the electrical signal wasn't able to travel across and cause the short-circuit that leads to AFIB. In other words, they micro-waved the inside of my heart, and the resultant scar tissue blocked the errant electrical signal. This was done at the Arkansas Heart Hospital; I was only there for 1 overnight stay, then sent home for a couple weeks of rest. So I missed a little biking while recovering, no big deal. The procedure seems to have been quite successful and I haven't had any exercise-induced AFIB since. Oftentimes the procedure has to be repeated another 1 or 2 times to finally be successful, but so far it seems to be working for me. I commenced easy biking 2 weeks after the procedure, but that only lasted for a day until I became deathly ill.
Evil Spawn of Flesh-Eating Bacteria. In early February, just a couple of weeks after the heart procedure, I suddenly became very ill and wretched my guts out and within a few hours I was so weak I couldn't even stand. Off to the emergency room, I was admitted to the hospital, and thence began a week-long ordeal of tests while the experts tried to determine what was wrong. It was not fun at all - I didn't eat for most of the week because I was just too sick. Because of the recent heart procedure, there was a possibility that they had perforated my heart, and that possibility had to be eliminated by running several tests and imaging. Also, COVID-19 had just become a source of concern, and it just so happened that a few weeks prior I had dinner with a group that included a young man from a Chinese province that abutted Wuhan; so that was also a possibility. COVID tests weren't available then, but my symptoms didn't indicate it, and that was eliminated. Medical experts of many disciplines were involved trying to determine my illness, and each of them subjected me to a battery of tests. So for a week I was heavily dosed with a combination of antibiotics, tested, poked, prodded, scanned, invaded and humiliated in almost every imaginable way, and eventually sent home to recover once I regained a little strength. The best guess regarding what ailed me came from the infectious disease expert; he believed that I had a severe form of the strep virus that was 1 step below what we typically call "flesh-eating bacteria." There is no test that can verify this, but my symptoms were supportive of this diagnosis. All I know is that I remained weak for a few more weeks, and I didn't log much biking mileage in February.
The Little "C." In 2013 I was diagnosed with an extremely rare form of invasive melanoma which manifested itself as a blister on the bottom of my left heel. After 2 surgeries that removed most of the tissue on the bottom of my left heel, and removal of a couple of lymph nodes in my groin, I underwent wound vac therapy to help regrow the tissue on the bottom of my heel. That worked well, and by mid-2014 I had a more or less normal heel again and I could walk without limping and bicycle with no issue. I dodged a bullet there; melanoma can be fatal. I celebrated my continued existence by riding the Transam in 2015; see the journal on this site --> (2015 Transam Tour).
Unfortunately, the melanoma returned in 2020 in the form of "Melanoma In-Situ." This was discovered in early January 2020 when a biopsy was done during a routine checkup. Melanoma In-Situ consists of cells in the upper skin that will eventually become invasive melanoma if not removed; it's not an urgent situation, but it does need to be treated. And so, surgery was scheduled for mid-February, but that had to be cancelled due to my emergency hospitalization in February (see section above). About that time COVID hit big, and hospitals postponed most non-life-threatening surgeries. I was eventually re-scheduled for surgery in mid-June.
Surgery consisted of removing a 3.5 inch diameter circle of skin from the bottom of my left heel. There was some uncertainty regarding whether a portion of the melanoma had been able to invade beneath the skin, so a good chunk of the underlying tissue was removed as well. Similar to my 2013 experience, I was once again hooked up to a wound vac that provided continuous suction to help regrow the granulation tissue. I started a pool within my immediate family to guess how long it would take before I returned to cycling after the surgery - honestly, I had no idea how long it would take - the pool estimates were several weeks to several months, and those were reasonable guesses. The surgery was on a Friday, and I got back on a bike 2 days later on Sunday! To do so I had to wear a plastic Croc shoe on my left foot and use platform pedals on the bike - and I had to rig up the wound vac to come along as well. I managed to carry the wound vac in my handlebar bag and secured the tubing from the vac to my heel by taping it to the top tube of the bike. It worked fine - it would have been most inconvenient if I had a flat tire, but I was riding! My wife had gone for a walk that morning and I managed to get rigged up and gone while she was out - when I returned she was furious! I rode 13 miles that day, and my riding for the rest of June and July consisted of infrequent rides of 13 - 16 miles. Not much, but I was determined to not let the surgery and recovery inconvenience me more than it had to. I probably have some sort of record for distance cycled while connected to a wound vac.
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Unfortunately, the pathology report indicated that they didn't get all the melanoma with the surgery, so another surgery was done in early July. Same story once again, the margins were still not clear, so a 3rd surgery was done later in July. Once again, the margins were not clear. At this point, the surgeon punted and declared the issue to be a "field defect" that may not be solved with further surgeries. And frankly, they had made enough of a mess of my heel and were running out of room to whittle any more off. So the decision was made to let the tissue heal (my heel had to heal - a lousy pun, but it's all I got!) for a couple of weeks using the wound vac therapy, and to then cover the wound area with a skin graft. The area outside of the removed tissue that still had melanoma in-situ would be addressed by using a cream-based chemotherapy that would (hopefully) destroy the remaining melanoma in-situ.
And thus it came to pass that in late July I had surgery to affix a skin graft to my heel. They typically get the donor tissue from the upper groin area (lower part of the belly area) - in my case, due to the size of the wound on my heel, they would need to obtain tissue from both sides of my groin. I convinced them to get the tissue from only 1 side of my groin, and to get the remainder needed from my left chest - by doing so I would have a nice scar across my chest that I could use to convince my grandkids that I had been in a sword fight with pirates. And so they did. Seriously. The grandkids were greatly impressed, until my wife cast cold water on the story. Here I am with my COVID hair and scar;
Skin grafts are delicate for some time after surgery, and one must be very careful to give them time to bond to their new location. My surgeon was aware of my wound-vac-on-bicycle exploits, and was concerned that I wouldn't allow adequate healing time for the skin graft. And so it came to pass that I had to promise her I would "behave" following this surgery for at least a month afterwards. The graft had some difficulty healing and became infected. I was unable to bike for all of August and half of September.
The graft slowly healed - at least most of it did - the area that earlier became infected created a hole in the graft and underlying granulation tissue. Eventually I had to see a wound care specialist for it, and the hole is being healed by stuffing it with a collagen mesh that dissolves in place. The graft requires daily maintenance; I have to wash it, remove tissue that tries to grow over it from the surrounding skin, stuff the collagen mesh in place in the damaged area and cover it with a bandage, and apply a chemotherapy lotion to the area immediately outside of the skin graft. I apply the chemotherapy at night before bed, then wash the skin the next morning to remove any remaining lotion. I will be doing this until late July, so I will have to deal with this during the bike tour. It's no big deal, but it means I have to carry the supplies (chemotherapy cream, vinyl gloves, collagen mesh, bandages/bandaids) along and I have 1 more thing to do at night and in the mornings before setting off. I like to get rolling early on tour, so any extra requirements are unwelcome.
The Big "C." This is the one I really don't want to discuss, but the wife says I must; I'll try to just present the facts and get it done. In March 2018 I was diagnosed with high-grade prostate cancer, Gleason score of 9. I had surgery to remove the prostate in August 2018, and they were hopeful that they could get all the cancer. But not so, the cancer remained. I then had 7 weeks of radiation therapy in October and November 2018. I was the only patient they had ever treated who bicycled to the appointments - it wasn't hard for me to do so, because the radiation center was located in the building complex where I worked and I commuted to work by bicycle anyway. The radiation treatment helped keep the cancer under control during 2019 and most of 2020, but it is steadily increasing in what is termed a "biochemical recurrence." From the time shortly after surgery in August 2018 when it was confirmed that some cancer remained, I have known that my long-term prognosis wasn't good. I tried to set this aside in my mind while deployed overseas in 2019, but it was always hiding somewhere in the back corners waiting to jump out and go "boo" as a reminder that I was no longer fully in control of my health. In November 2020 I was told by my doctor that I would eventually need to commence aggressive therapies to fight the cancer, and that the cancer was destined to cause my ultimate demise in the years to come. I confirmed this prognosis by getting a second opinion from an expert at MD Anderson in Houston. Soon enough, I will have to commence aggressive treatments that may prevent me from cycling - and even if they don't totally keep me from cycling, it will be difficult/impossible to go on a long tour while undergoing these therapies. Bicycle touring certainly isn't the only important thing in my life, it ranks far behind relationships with my wife and family and friends, but travel and adventure has always been a significant part of my life. Okay then, it is what it is; I'll tour when and while I can, and in future years my tours may need to become somewhat less epic than riding self-supported coast to coast.
A Warrior's Death For Me, Please. I don't want to wither away and die slowly from the inside out as cancer consumes me. Like my Viking ancestors, I'd much prefer a warrior's death - let me die in battle while pursuing some noble quest! There are many noble quests worth pursuing, and not all battles involve soldiers killing each other. Climbing one of the many 14,000 foot peaks in Colorado is a noble pursuit, and it's a real battle to get to the top (at least, it's always been a challenge for me). Likewise, an epic bicycle tour is also a noble pursuit, and it's a true battle to climb mountain passes and ride through forests, plains, and deserts while carrying all that you need on a bicycle. I have done a couple of self-supported cycle tours, and I have never felt more alive than I have while battling adversity during those trips. So I seek a bicycle warrior's death, but not too soon please! You can't die a warrior's death if you don't fight battles; perhaps I have a few battles left in me. Follow along and we'll see...
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2 years ago
2 years ago
2 years ago
Thanks for the kind words, truly appreciated. But many folks have it much worse than me - hey, I'm actually bicycling across the country! Best wishes,
Bud
2 years ago
1 year ago