Friday, July 21, 2017

Carmageddon at the Eclipse

A traffic thought for you all.  ODOT is predicting carmageddon during the August 21st eclipse.  An estimated million people are on their way to see the event.

ODOT is staffing up and warning drivers to be prepared to be stuck in their cars for hours during the solar eclipse.

Oregon Department of Transportation spokesman Don Hamilton says the eclipse will cause "the biggest traffic event in Oregon history" on August 21.

I guess if you’re going, perhaps go early!  This map shows the path of the eclipse.

path of the eclipse

Wednesday, July 19, 2017

Appointment With the Orthopods

Yesterday we saw the orthopedic surgeon’s Physician’s Assistant, Chad Swaims.  He’s a very impressive medical professional.  The entire office was running late, but once it was our turn he made it clear we would get as much time as we needed. As you no doubt recall, Jim’s L5 vertebra is displaced and the disc is bulging.

Jim has pain down his leg, weakness in the leg as well as foot drop when he walks.  The pain is due to a pinched nerve.  It’s a double crush at L5.  The nerve from L4 that travels down to L5 is crushed by the displaced vertebra, and an L5 nerve is compressed by the bulging disk.  Leg weakness and foot drop are caused by the pinched nerves.  The nerves can not signal to the muscle fibers to contract.  Worse, the nerve receptors in the muscle fibers die when they are not stimulated.  Once they are dead, they’re dead; there is no regeneration.  No amount of exercise or physical therapy will overcome this.

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As the discussion developed, Chad wondered if the vertebra was fixed and displaced, or if it was moving when Jim moves.  Two more x-rays were ordered, one with Jim standing and one bent over.  The films done at the hospital were static.  Moving is bad.  Jim’s disc is moving.

What does that mean?  It means that the relatively non-invasive microdiscectomy (removal of part of the disc) is off the table.  We’ve now progressed to requiring spinal fusion to fix this.  For the life of me, I don’t know why it’s mobile.  Either he didn’t say or I can’t remember.  It’s a lot to take in.

Anyway, this is spinal fusion.  The disc is removed completely.  They screw into the vertebrae to anchor plates that hold the vertebrae in the correct position.  Cadaver bone which has been rendered totally dead is inserted as a spacer between the verterbrae.  Over time, Jim’s bone cells will migrate in to the cadaver bone, displacing those cells.  After a year or year and a half, the two vertebrae and Jim’s bone cells will fuse.

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Currently, Jim is scheduled for an epidural steroid injection on July 28, which seems like an eternity from now.  This will reduce the inflammation in the crushed nerve.  I’m hoping (unencumbered by facts and data) that inflammation reduction will allow the nerve to start firing again and will decrease any further receptor death in the leg muscle fibers.  Surgery will follow at least two weeks out from the epidural. We will see the PA after two weeks and Dr. Chris Howe six weeks after the procedure.  It’s looking like we’re going to be here for part of the rainy season again.

It’s a six week recovery.  During that period there will be no Bend, Lift or Twist.  There will be walking.  I doubt if there will be bicycling.

Interestingly enough, this entire progression started around November 2016, but we didn’t know what we were witnessing.  When Jim would ride more than 20 miles, the bottom of his big toe would go numb.  Over time, the numbness covered more of his left foot.  Damage was occurring then.  I tell you this, because:  who knew?  Spinal degeneration starts in 100% of the population at age 20.  Over the years the discs dessicate and shrink, the ligaments that run along the spine grow lax, the vertabrae respond by producing osteophytes to protect their edges.  Jim now has a small degree of scoliosis because he has degenerated more on the left than the right.  Hence all the pain is left legged.  Pay attention to your symptoms when they develop.  Toughing it out, aggressive stretching and all the positive thinking you can muster will not fix a significant problem.

Dr. Howe trained at Harborview Hospital in Seattle.  It’s a level one trauma center.  In 2006 Jim endoed on his road bike, and shoved his femur through his acetabulum.  He was fixed by Dr. Chip Routt.  Dr. Howe immediately recognized Dr. Routt’s handiwork in the x-rays they took.  Dr. Routt has since moved to Texas.  Apparently there was some sort of staff reorganization at Harborview, and Dr. Routt moved on in 2013.  I can not believe they let him go.  He has done more acetabular repairs than anyone on the planet in the history of time.  It’s all he did.  So- keep that in mind if calamity strikes in the Houston area.

So, that’s what’s happening with us.  I will close this out with a picture of a Bee Hummingbird.  They are the size of bees.  Cute cute cute.

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Monday, July 17, 2017

Cycling Washington and France

We didn’t ride this past weekend.  There was a large music festival in Carnation, and since the bridge was still closed, we knew the traffic in Fall City would be unbearable.  So we did stuff like get the dead bugs off the front of the bus, wash windshields, and polish the 3M film and the headlights.  The front of the bus looks much better.

We also refilled the windshield wiper fluid container in the bus.  This is what we saw this morning.  Apparently there is a hole in the bottom of said container.  Caulk will be necessary after it gets through dripping.

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The music festival went on for three days.  There were camping options available for attendees.

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The yurts were across the river.  I’m not really clear on where they found enough level ground to install these things.

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Today the bridge was open.  Yay!!!!!!  Life is so much better.  Apparently the county decided to reopen with weight restrictions.  Commercial trucks are forbidden to drive across it.  This guy is about to take down the closed sign.

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That’s the foot traffic suspension bridge in the background.  See how steeply the land moves away from the water?  That’s why we’re perplexed about how yurts and other camping sites were available for the weekend.

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In 2002 and 2003 Jim and I did fully supported bike tours of the Tour de France.  They’d take us out on the course and leave us to climb something.  As soon as the publicity caravan came through the road was closed and we’d have to stay put and spectate.  We did a LOT of climbing.  We were younger, lighter, and much stronger than we are now.  They were both vacations of a lifetime.  If we ever went back, we’d need electric bikes.  My friend, Greg de Respino has put up an album of pictures from when he was there.  The photos are good, you should check them out.  This is Jim and me somewhere in France.

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This is Greg and me on the lower slopes of Le Col du Columbiere.  I was not using a digital camera then, so it’s nice to see photos of that trip, mine are all in photo albums in storage.  Thanks Greg!

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Jim’s doing better with the Prednisone.  It still hurts, but he’s not yipping.  His mobility is now much better than it was.

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Mike, who runs the park, just came by to ask us not to dump any tanks tonight.  Apparently there is a broken pipe in the sewer system, and things are not good.  I’m pretty happy that we dumped the gray this morning! It is always something.

Friday, July 14, 2017

Back, Bike and Lunch

This morning we got the MRI results.

The MRI was not surprising, but it was disappointing.  L4 and L5 seem to be the primary scene of the crime.

The disc is bulging out about 1/3 of an inch.  There is also a pinched nerve, and there is some question as to whether it's the nerve that goes out the side of the vertebra or out the bottom.  The reflex when the doc taps the knee is significantly less in the left leg than the right, and the leg is weak.  So, we'll have 10 more days of Prednisone to get him through until when he gets an epidural steroid injection.  An interventional radiologist will do that and it takes awhile to get on the schedule.  Aaaaaaand they don't use any pain meds when they do that.  The GP wants to give the epidural a chance rather than going straight to surgery because sometimes discectomies lead to more discectomies because the change in the one disc weakens the others.  I must have missed medical school that day because I had not seen that on the interwebs.  However, given the size of the bulge, it may be inevitable.

Here is one of the views from the MRI.  The bright white stripe down the middle is the spinal column.  If you look towards the bottom of the photo (about a quarter of the way up from the bottom) you can see where it narrows. That’s where the bulge is pushing out.  This is a photo of a screen print, so resolution is not great.

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After that bracing conversation with the doctor, we went to a very nice bike store in Renton, Center Cycle.  We’re thinking about buying new bicycles.  Thinking, not doing.  We’re not riding mountain bikes all that much anymore.  McDowell Mountain is really the only place we enjoy.  They’re Goldilocks trails, not too hard, not too easy, they’re just right.  We’re also not that fond of riding with cars on road bikes.  The problem with riding the Serottas on flat paved trails is that we don’t get enough work.  So, we’re considering owning heavier bikes that will make work for us.  Today we learned something about endurance bikes (designed for comfort on long rides).  Road bikes are migrating to disk brakes.  Along with the disk brake migration, they’re moving to through axles.  Here is an excellent article on the subject.  Quick release brakes on bikes with disk brakes are going out the door.  The advantage to the through axle is preventing torsion at the hub and of the left fork leg during braking.  However, here’s the down side of the disk brakes.
… the disc caliper must be aligned precisely with the rotor otherwise the brake pads will rub and slow the bike down. The clearance between the pads and the rotor is tiny (<1mm) and very sensitive to minor variations in the position of the rotor, which occur often even for otherwise identical wheels.
Changing a flat is going to be a bear.  You must have the tool that is required to get the wheel off with you.  And forget bike racks that use a fork block to secure the front of the bike.  I think I’m not too happy about this latest technology.  This would be the end of putting the bikes in the back of the truck.  So that is my technology update for today.

Then there was lunch.  We went to the Red House in Renton.  It was a glorious day, and downtown Renton was looking particularly nice.  It makes a person think, maybe we should come back to the GPNW.  Then one remembers it rains nine months out of the year, so maybe not.

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It’s an old boarding house that has been remade as a lovely restaurant.

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We ordered too much food.  The crab cake sliders would have been plenty.  The hummus and pita were good, so we were obliged to eat them, as well.  It was very pleasant after the morning’s discussions.

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That’s it maties, that’s all I have.  Back, bike and lunch.