The Rule of Three

Yesterday-Thursday-did NOT begin well. 
Because of taking four different drugs Wednesday night, I woke up twenty minutes late from the most lovely dead sleep ever.  Why the drugs? I'll get to that.
No time to make my own breakfast.  No cup of French press coffee.
Instead I flew around the apartment like a maniac trying to find a piece of paper I needed, kissed Bob in a hurry while apologizing for my language and launched out the door.  A few more four-letter words might have slipped out.  Apologies to the neighbors.  I had to get to the bank, drop off prescriptions, go to physical therapy, to work.  No time to take the late bus when you have errands.  As I broke into a run I realized that running still hurt my, uh, recent surgical site.  A few people may have wondered why the young woman up the street was jogging down the road at 7am cursing while clutching her left boob.  Not a great moment for me.
What a hell of an exciting few weeks these have been.
Last Wednesday I had minor surgery to extract an abnormal fragment of breast.  I had every reason to believe that abnormality was benign.  But until you know, you don't KNOW.  And removal seemed the efficient and effective option.
Surgery went well enough.  I spent the following weekend in NJ with Bob, the kids, his sister and brother-in-law and their son (thanks for the hospitality, Laura and Frank-I'm sorry if I said or did anything weird but blame it on the Vicodin).
I got back on the bike.  Again.  Tuesday night I rolled along happy to start feeling good again. So what if I had two inches of stitches under my sports bra?  I felt better with every mile.  A couple of guys in a sports car slowed down and beeped.  They waved.  Did I know them?  I waved back then felt a sharp pain in my right thigh and saw a black wasp departing.
I said a bad word.  Maybe repeated it a few times.
I pulled over.  Yanked up the leg of my shorts.
I thought to wait a minute or two.  I've had three allergy injections per week for a year and a half now to desensitize me to bee and wasp stings.  This process has gone excruciatingly slowly (I've reacted three times to my shots) but it promises to work long-term.  The decision to start the treatment came after three anaphylactic episodes and a fourth sting that resolved safely without too much of a near miss (when honeybees get me, the reaction is slower).   Wasps are nasty-the reaction is faster, it's more dangerous.  BUT maybe I wouldn't need the EpiPen this time.
This could be dealt with.  But I would only wait two minutes to make a decision.  I checked my watch. I was on Route 327, not far from downtown Ithaca.
I watched the swelling develop fast.  Then the itching started on my neck.
And I began to have a bad feeling.  When you read about the symptoms of anaphylaxis, one is described as "a sense of impending doom."  Basically you have a very strong instinct that you are about to die.  And unless you DO something, you will.  That feeling came and I recognized it.  It isn't panic.  It's a deep knowledge of truth and a recognition of urgency.  Suddenly THERE IS NO TIME.  THERE IS NO TIME.
Decision made.  The EpiPen doesn't hurt going in.  It's FAST.  It starts to hurt the second after it injects, while you hold it to your quad and count to ten.  I called 911 and explained my location:  on Rt 327 south of Ithaca two miles off Rt 13, near the intersection of Gray Road and 327.   I took out my Ziploc bag, took 25 mg of Benadryl, a dose of Pepcid (has an antihistamine effect).   I called Bob, got voicemail, called back and got him in person, told him what happened.  He said to take my bike to the hospital with me.  Good call, Bob.  Hung up, sat down and waited.  The Enfield fire chief showed up first and started the paperwork.  The ambulance pulled up soon. With paramedics on site I feel fairly safe.  EMTs can only give you oxygen, take your pulse, and watch you.  Paramedics can use drugs and can intubate you if that has to happen.  Two young guys this time.  I joked with them, told them not to scratch the paint on my bike while they put it in the ambulance.  I gave them my used EpiPen to chuck in their sharps container.
They started the IV and I started feeling like I had something heavy sitting on my chest.  The backseat paramedic got radio permission from an ER doc to start the drugs.  I got IV Pepcid and 50 mg of IV Benadryl in addition to my prior 25, and they have to push it slowly because it makes you instantly feel sick.  But IV Benadryl is nothing compared to IV epinephrine.  I experienced that once and hope I never do again as long as I live.  No reason to think I'd need that this time.
Off to hospital.  Bob showed up very soon.  Then we waited.
No doctor showed up.  After almost two hours Bob and I were frustrated.  I just wanted the IV yanked out so I could leave and go to bed.  Forget seeing a doctor.  I could see the allergist the next day.  Finally I saw Sara Foster-one of our Corning teammates and a physician assistant who was on shift til midnight. She saved us by tugging on someone's sleeve.  In about five minutes a doctor came in.  Unfortunately he was a pompous ass and seemed to think that since he saw no hives and I had no other symptoms just then (hello?  The paramedics drugged me up?)  I must have unnecessarily used my EpiPen.  So with no knowledge of my prior medical history he launched into a lecture about allergic reactions and how you shouldn't use EpiPens if you don't really need them.  He ignored everything I said.  He prescribed a small dose of prednisone for two days which he said I didn't have to take if I didn't want to, and threw some Pepcid in on the side.
The swelling on my leg was baseball-sized when I got home.  I started the prednisone and Pepcid.  Wednesday morning I had a softball growing-hot, itchy, painful to touch, ugly.  I took more drugs.
First thing Wednesday I went to the surgeon for a post-op appointment.  First things first-she had my biopsy results.  My tumor was BENIGN, a hyalinized fibroadenoma, although it's normally in seen in older women.  GOOD.  RELIEF.
The surgeon observed me scratching my leg and other multiple itchy spots and asked if I was all right.  I filled her in on Tuesday night's events.  She asked the name of the ER doctor.  I couldn't remember.  She recommended "having at it" when I received my "post-visit patient satisfaction survey."  Cayuga Medical Center likes to send those out.  She took out my stitches quickly so I could get to the allergist, asked if there was anything else she could do, wished me good luck.

The allergy office got me in to see a doctor fast.  The swelling on my leg had reached football dimensions and I'd begun breaking out in small patches of hives in other places.   The doctor reacted in outrage to what the ER doc said.  She stomped out of the room, came back and immediately dosed me with prednisone, Benadryl, Pepcid, and cetirizine.  She tripled my prednisone dose, extended it to three days and gave instructions for taking the three other drugs simultaneously.  She made me stay in the office for an hour to make sure I began improving.  "You did EXACTLY the right thing," she said.  "You know yourself and your medical history.  Your records here show everything and I remember your chart (she saw me the last time I reacted to my shots).  You are on the extreme end of the scale when it comes to reactiveness.  Don't ever let ANY doctor talk you into disregarding your own history."  She refused to say anything unprofessional about that other doctor but seemed pretty mad.

She also told me that given my history and the way my immunotherapy is progressing, not only will it take approximately five years or more for me to build up significant immunity to stings, but that the leading allergy experts in the world recently found that for people with my type of history and sensitivity, the most effective treatment requires a different approach.  Once I have enough immunity to tolerate the equivalent of four stings of all three types of venom at a time without reacting, I will probably be safest if I continue those three injections every six to eight weeks for the rest of my life, rather than stopping.
I said, "I could live with that."  She said, "Well, that's the point.  The point is that you LIVE."

So to sum it all up, Thursday just piled up on me like a ton of bricks.  You don't move too efficiently when you're on four different allergy drugs.  Thinking is slow.  But I got it done.  I ran all of the errands, paid the bills, filled out the paperwork, dropped off the mail, and got to physical therapy.   There I had to fill in one more person on uh, recent medical history-the physical therapy department likes to know all medications you're taking.
I found that while my shoulder is completely back to total range of motion and better strength, the rotator cuff is still being pulled partly out of alignment by the pectoral muscle.  No hand weights for me yet.  But I graduated to a green rubber band.
I spent the rest of the day at work, where alternately time slowed and raced as I tried to function productively while fighting drug-induced drowsiness and apathy.  Beats all that itching, though.

I woke up at 3:45 am with more itching and took more drugs.  I decided to do some laundry and type this.  Going back to sleep just wasn't an option.  Wide awake here.

As of last weekend I thought of jumping into a cross race as early as the 8th of September but I'm just not there yet.  Soon.  All of the medical stuff is resolving.  And the rule of threes has been satisfied.  I separated my shoulder.  I had a biopsy.  I had an allergic incident with a wasp.  That's three separate things.  Three.  NO MORE.  PLEASE.

Soon I hope to write race reports and stories of good times again.  No more medical stuff or doctors.  Can't wait to race again.

Thanks for reading.

Suck It Up

Six weeks post-crash my shoulder is fully healed and working fine.  Mostly.
Physical therapy has gone well.  Sure, certain muscles around the shoulder are engaged in a minor tug-of-war but they are stronger every day and will learn to get along again.  I've graduated to an orange rubber band, a step or two up from yellow.  I can pull on my handlebars with about fifty to sixty percent of my full strength.
I miss racing.

I've read race reports from teammates, friends, and-well, everybody-for six weeks. Margaret Thompson has been racing up mountains and setting more age-group records on her road bike.  David Yacobelli tore through the Leadville 100 in under nine hours on a singlespeed mountain bike.  Bob and a group of the usual suspects put in heroic performances to finish the 180K D2R2 last weekend-one of my favorite rides.  Ever.  Mariano Garcia finally landed himself on the winning Great Race team and his write-up nearly made me cry laughing.  

I'm about ready to start drilling cyclocross remounts again.

If I felt happy just to ride a bike, any bike, life would be golden right now.  And for a few weeks post-injury, rolling along on two wheels for any amount of time at any speed gave me all I needed to be happy as far as bikes were concerned.

Not anymore.

I want to go play in mud, dirt and grass again.  I want to get dirty.  I want to chase and be chased and wonder when and if my heart will explode.   

Cyclocross is hard.  Hard is not easy.  Neither is relocating your willingness to make yourself suffer when you've given due diligence to pain-avoidance behaviors for a month and a half.

But I'm learning to suffer again, slowly.
I realized this last Saturday while mentally struggling through a set of intervals.  While I harbored notions of backing off, an oncoming car flicked up a small pebble that smashed painfully into my left shin hard enough to leave a small dent.  Not even thirty seconds later, a bee fwapped into my upper lip and ricocheted off without stinging.  Oddly enough, a bruised shin and slap in the face made me just angry enough to suck it up, finish that second interval and mentally commit fully to the third one.

I'm going in for surgery later today to remove the lump from my left boob.  No, Don, I'm not going to have any, uh, enhancements made while I'm in there.  Yes, Paul, I will stop on my way to the hospital, find a marker, and write NOT THIS ONE on my right boob with a handy arrow pointing to the left one.  I think my surgeon is pretty good and she's with the program, but I might as well play it safe.

As soon as that heals, it's time to get out the cross bike and start walking around slowly putting a leg over the saddle.  Over, and over, and over.  I'm tired of having the lamest remount ever, and damned if I'm going to spend another whole season doing it the wrong way.

Tape and Boobs

Five weeks into my four-to-six-week recovery I'm on a bike most days of the week.

 Last Tuesday I started physical therapy.  Courtesy of Eva at Cornell Physical Therapy,  I have a yellow rubber stretchy band for doing my homework.  For the first week I do three exercises, one set of ten twice a day. This involves looping the rubber band around a doorknob and pulling on it in ways that teach the smaller muscles in and around my left shoulder how to work again so that my pectoral muscle stops trying to take over.  If I don't rehabilitate all those little muscles enough to force my pec to mind its own business, it will pull the shoulder out of alignment and cause rotator cuff problems down the long-term road.  With luck I can progress to three sets of ten twice a day before my next PT appointment.

I'm learning to use tape.  I'm already proficient in Scotch and Duct but Athletic is new to me.  Eva gave an instructional demo because she said the tape works more directly and effectively than my gladiator brace.  Her tape job and the concept both held true on my road ride later that night, and I'll keep using it.  Just maybe not the brand Eva had.  When peeled off later that night it removed the top layer of skin from my shoulder.  So I'm upgrading to Kinesiotape:  high-tech tape intelligently designed and manufactured for JOCKS.  Waterproof tape you can wear three to four days at a time.  Tape you display on your body in bright aggressive colors that say "I'm a jock!" Wearing this makes me feel:
a)  Prepared. 
b)  Less damaged.
c)  Colorful (though hidden by a jersey).
d)  Relieved to have the support.  It lessens the pain!

Road riding continues to become easier.  Last Saturday I put in nearly three road bike hours with minimal pain but still couldn't pull on the handlebars when sprinting or climbing out of the saddle.  Eva pointed out road riding may not be a heavy load for the shoulder but is still prolonged load-bearing activity, so "listen to your pain level."  PT exercises should take priority over long road rides if I want to get back to full strength sooner rather than later.  I asked if I should continue icing after every ride.  Emphatic yes.

As of Saturday morning my shoulder felt stronger.  Bob felt a bit under the weather but still helped tape me up.  I increased to two sets of ten on the PT exercises, then took the road bike out for a roundabout country-road loop to Watkins Glen and back. I couldn't remember my last LONG ride and exactly a month ago couldn't even get on a bike.  I didn't plan to stay out four hours but the shoulder held up well and I really needed to just get out and spin my wheels.  Yes, I know what I just said a paragraph ago-about PT exercises taking priority.  But at times you have to clear your head.  And I had to quit thinking about boobs for a while.

Yes.  I said boobs.  Very recently I concluded my left breast had grown and my right hadn't.   I found a big tender lump.  Shortly after getting rid of my sling I tried on some bras while shopping.  So much for bilateral symmetry.  The left-hand one filled a larger cup than the right.   

My primary care doctor found the lump all too easily.  She thought a fluid-filled cyst would be the most likely explanation, but it needed investigation.  So the day after starting PT I had an ultrasound.  A doctor came in afterward to tell me the lump was not fluid-filled or a cyst but solid and very likely a benign tumor called a fibroadenoma.  Given its size and continued growth he recommended surgically removing all of it and precautionary biopsy after removal.  He called my doctor, she called me, and I will meet with a surgeon in a week and a half.

The key fact to mention is this:  the chances of a malignant fibroadenoma are fewer than one in a hundred.  Until I have it cut out, biopsed and know for sure I'll keep that in mind.  Not many people want to have surgery but even fewer would want to leave that in there to grow.

So by the time 'cross season comes I'll still be a shoulder ligament short as well as cut, stitched up and taped together.  But I can resume occasionally browsing the ladies' lingerie rack at TJ Maxx-and know I can find a symmetrical fit for a change.
It could be MUCH, MUCH worse.  Right?

Right.