Take The Lane

52 staples later, I'm back

I've been quiet for a while. A combination of several things. 

The Big Thing was the surgery I was facing to correct an arterial deficiency that was thought to be related to my "high-performance" cycling of 2001. 

I wrote tangentially about my iliac dissection here in 2009 and directly here in 2012, but really haven't spent as much time on the subject as I could have.

Since 2001, my ability to use my bicycle has varied, depending on changes in the diameter of the right iliac dissection and the associated aortic aneurysm. The folks at the Toronto General Hospital wold put me through a CT scan every year, and the consulting physicians prescribed heart-rate meds and lifestyle changes. Some years the aneurysm grew in diameter, and I'd be advised to reduce or stop the cycling. When the aneurysm seemed stable, I could return to a cycling "diet," of about 15K a day.

I used that 15K wisely: cycle commuting to work and taking training to become a qualified Can-Bike instructor. For the most part, my cycle touring and charity fundraising bike rides have gradually been removed from the activity list.

So, in November 2014, another CT scan and another evaluation. The vascular surgical service team headed by Dr. Thomas Lindsay, at the Peter Munk Cardiac Centre (part of the University Health Network), decided the aneurysm had to come out.

On Jan. 7 of this year, I went into surgery for an aorto bi iliac repair. A team including a surgeon and assistants, an anesthetist and assistants, nurses for scrubbing and circulating, and a perfusionist to re-route my blood, embarked on a 4.5-hour procedure to open me up (the scar runs from breast bone to pubic bone and was closed with 52 metal staples), cut out the bad bits and stitch in new sections of Dacron grafts, described as "off-the-shelf" pieces that cost a few hundred dollars each.

It took 4.5 hours because it was complicated. If you look at an anatomy textbook, you might think the aorta is right out front, easy to get at. But the aorta is placed more to the back of the abdomen, and the team had to work around intestines and organs to get at the aorta and the bifurcation of the common iliac arteries on each side where the common iliac divides into the external and internal iliac. They clamped off the blood flow, removed the diseased sections of my aorta and right and left iliac arteries, and stitched in a shiny new Dacron grafts that will probably outlast the rest of me.

Most challenging is the reconnecting of the smaller, branch arteries to the newly added graft. Steady hands are needed for the delicate stitching, as arteries the diameter of a ballpoint pen (one centimetre) are deftly secured to the new sections of aorta and iliac.

Dr. Lindsay said that double bifurcation resections amount to about 30 per cent of the aortic repairs done by the team. The story of my surgery and some of the recovery process is told nicely here on the University Health Network website, by TGH communications specialist Stefan Superina.

This week, Dr. Lindsay gave his approval to return to "gentle cycling," mostly on a trainer, and I have hauled my road bike out of storage.

So, was the dissection and aneurysm related to the extra kilometres I rode back in 2001? Well, my riding partner in that "contest" didn't have the same problem. Dr. Lindsay is guarded about cause-and-effect in this case, saying research is still being done. Cyclists with long and meandering iliac arteries — called a torturous iliac — do have arterial issues, but it tends to be endoluminal fibrosis, a narrowing of the arterial walls (here's a paper on it). My torturous iliac could have led to "abnormal forces being placed on the artery that may result in the narrowing (of the artery) or the development of dissections", Dr. Lindsay wrote. 

His advice to casual cyclists who want to ramp up their activity: See your doctor. Have a thorough examination. Have your blood pressure checked. Have a conversation before making major changes to your levels of physical activity.

I won't be chasing buses or doing day-long rides anytime soon. But when all this snow is gone, I'll be back on the roads in Waterloo Region.

Because I've been accepted into the Press Ops team for the Pan Am Games 2015 at the Mattamy National Cycling Centre in Milton (for the duration of the Games, to be known as the Cisco Milton Pan Am / Parapan Am Velodrome), I will be writing about some of the events leading up to this world-class event in July and August.

And because I hope to be involved with both Can-Bike and retired teacher Philip Martin's Cycling into the Future program, I will be writing about ways that adults and young people are being introduced to urban cycling.

Somewhere in all of that writing, I will be cycling. Again. It's good to be back.

Good news from the doc: I can ride again

After a year of waiting, I can ride my bicycle again.

I've been off my two-wheelers for the past year at the request of my doctor and spouse, to see what impact not riding would have on the aortic/iliac aneurysm I've been carrying around with me since January 2002.

The hypothesis was that my "industrial" cycling of 2001, when I put on 3,000 kilometres in the first eight months of the year and another 3,000 in the last four months, contributed to an iliac dissection and aortic enlargement. The notion is that riding on the drops and fast revolutions put pressure on the arterial walls, and my arteries had a wall separation. My cycling involvements have varied since 2002. I've dropped my touring and some charity rides, mostly focusing on cycle commuting and errand riding. Last fall, after a steady increase in the diameters of the two affected arteries, I was advised to stop riding altogether for a year.

Last Friday, I crawled into a CT scanner in Toronto (isn't it odd that Toshiba makes microwaves and CT scanners?) and felt the heat as the dye was injected into my veins. Monday, the vascular specialist gave me the news: No change in the size of the aorta in the past year, and though it seems unlikely, an actual reduction in the size of the iliac.

His recommendation for the next year: ride again, although no 20K or longer rides per day. Reduce the medication I'm on to control blood pressure. Live my life, but be careful.

Who could ask for more?

Time to take the road bike down from the hooks, and take the winter "beater bike" to the spa to get it ready for another season of riding. It feels good to be back.

 

Would you ride a FLIZ? (Or does the FLIZ ride you?)

I have mixed reactions to this German-designed FLIZ bike, as described on the James Dyson Award website, where you can view a short video and see stills.

A part of me is attracted by the "shiny keys" aspect. An other part says, "Why re-invent the wheel?" Or in this case, why re-invent the two-wheeler.

One of the reasons that the velocipede was left in the dust was because the cranks, chains and later, gears, gave a mechanical advantage. The average cyclist can out-travel the average runner.

And really, all the FLIZ does is support the body while running.

Having said that, the FLIZ does get around the problems of saddle compression of the groin area (and underscores how important the groin-saddle contact is controlling the bicycle). It's cool, and the 21st century is all about cool. And it does make us re-consider our concepts of what exactly a bicycle is.

Truly, an ideal Friday time-waster.

I'll know more about my future in September

As some of you know from earlier posts, I'm carrying around an abdominal aneurysm the size of a parsnip, likely thanks to my heavy-duty cycling of a decade ago.

I've been off the bike for the past year, to see if the growth of this aneurysm can be attributed to cycling. If no cycling means no growth, then I will be likely off the bike for the foreseeable future. If the aneurysm continues to grow in diameter, than cycling may not be the contributing factor and I can ride again, although some form of surgical intervention becomes more likely, with all its consequences.

So, my CT scan is set for September. I'll hear from the doc later in the month. If the news is "good" (which I interpret as, "well Bill, cycling seems to have had no impact on the growth of your aneurysm"), then I'll be riding around Waterloo Region again, and what a joy that will be.

If the news is "bad," (that is, "Bill, your aneurysm has not grown in size and we attribute that to you not riding"), then I will be off the bike for the foreseeable future. I have already begun checking out e-bikes as an option, because I believe in two-wheeled transport as a significant factor in our future transportation options, and plan to be a part of that, in any way possible.

For complete transparency, I should note that my family sees non-cycling as longevity, for me. So they are happy if I get an e-bike, whatever the doctor says.

I foresee an e-bike future. I'll keep you up to date. Keep your fingers crossed for me.

How to be healthy by not riding 23 1/2 hours a day

Here's a great video that makes the argument for an obvious "miracle cure" for many of society's health problems: simple, regular exercise.

Washington teen has upgraded heart and upgraded cycling expectations

Any cyclist with a cardio-vascular deficiency might enjoy this story from the Tacoma (Wash.) News Tribune, about an 18-year-old heart valve recipient who is celebrating his successful surgery with a long distance charity ride through the Cascade Mountains.

 

I'm racking my bikes, but still writing about bicycling

I had my annual checkup last month to monitor the status of my abdominal aneurysm. I’m still sorting out my reactions to the results.

In the short term, I’ve racked my bikes. Probably, they’re racked for the next year.

For those who have been following my relationship with my right iliac arterial dissection, I have racked my bikes once before, following the diagnosis of this condition back in 2002. The year that I did no cycling at all was the year that the aneurysm did not increase in diameter. Every year since 2002 that I have ridden, it has slightly expanded in diameter.

If it increases in diameter enough, the stretched and weakened arterial walls could rupture and I could have a "blowout." The solution is surgery, but there are risks (Paraplegia? Death? Yikes!). Managed with medication and modified behaviour to reduce the blood flow and blood pressure pushing at those weakened walls, I could continue on for years without surgery. Over the years, I have cut my annual cycling distance in half, put limits on my speed and reduced my daily distance. This past year, my limit was 15K a day.

But, even at 15K a day and with no chasing trucks or charging hills, the aneurysm has expanded since the previous CT. It's a slight expansion, but enough that the vascular surgeon agreed with my offer to consider some modifications to my cycling behaviours. And last week, he called me back to offer some further information and reaffirm that some changes would improve my long-term prospects.

Clearly, I would prefer to be a live husband, father and grandfather, rather than a dedicated, but dead, cyclist.

So, I am going to rack the bikes for a year and go back for another CT. If the aneurysm continues to expand, then cycling wasn’t the issue. If it doesn't expand, then maybe cycling was the issue, and maybe the bikes stay racked for another year.

I’m still sorting out my reactions, and my options. Part of my earlier discussion with the doc was the suggestion of retrofitting one bike with an e-bike motor, to “flatten” the hills on my regular commute. After the subsequent discussion with both the doc and my spouse, flattening the hills didn’t seem like enough. Walking is apparently OK; pedaling, not so much.

I’m thinking about simply getting an electric-assist bicycle, so I could continue to travel the region’s bike lanes, challenge roundabouts and continue experiencing life in the cycling community. Or maybe I’ll sit on the sidelines for a year and offer my opinions from the cheap seats.

However this goes, I’m going to keep sharing my ideas about cycling and invite you to share yours.

It's aneurysm monitoring time

The Livestrong Foundation has added several posts about aneurysms and overall health, with surprisingly little direction discussion about cycling and aneurysms.

Still, if you are interested in some general information about aneurysms and strength training, click here.

Not surprisingly, I end up doing a lot of Google searching just before I'm about to go in for my annual CT scan. One observation: several of the articles I've seen refer to getting an ultrasound ordered to check for abdominal aortic aneurysms.

None of the three doctors who have treated me -- two of whom lead this field in Canada -- have recommended ultrasounds. I was even accidentally booked for an ultrasound one year, and the doc was most annoyed, saying the ultrasound would not precisely depict the size of the aneurysm.

Every year (and sometimes twice a year), I have had to have a CT scan (aka CAT scan) to get an accurate reading of the diameter and length of the aneurysm.

If your doctor recommends an ultrasound, ask again about a CT. Perhaps that tool is not available in your community. Then ask about where it is available.

So this is what happiness is

I've been in a state of stunned happiness today, after digesting the news that I can ride my bicycle again.

I had posted about my iliac aneurysm back in September 2008, when it looked like I might never be able to ride a bike again. On subsequent meetings with my vascular specialist, we talked about intervention (surgery) versus non-surgical management (not riding, drugs, etc), and since August 2008, I've basically been off the bike. A CT scan this month showed that the aneurysm has essentially been stable for more than a year now, and the doc gave me the OK for some limited cycling: about 15K a day, which allows me to join the ranks of the noodlers, and to cycle commute again.

I felt, I don't know, powerful I guess, when I reclaimed the bike cage key that I had surrendered at work back in 2008 when it appeared I wouldn't be needing it any longer.

And my partner, who has always thought my winter beater bike was too heavy for any mortal to lug around (I don't carry it, dear, it carries me...) has been very firm that I get a new bike for my winter commuting. How can I refuse her request? I'm shopping for something lightweight, with disc brakes and a more upright, head's-up in traffic attitude.

Your advice on an urban warrior machine is welcome. I'll post a pic when I get it.

Arterial aneurysms can hit any cyclist, sometimes more than once

I’ve had some interesting e-exchanges with Jeff Webster, a hard-riding cyclist living in Arkansas whose own experience with arterial aneurysms has some parallels with my own. Webster is mountain biker who discovered in 2005 that he had four (count ‘em, folks, four) iliac arterial aneurysms and one dissection. He was also the former CEO of Carmichael Training Systems, which was the organization that trained endurance athletes such as Lance Armstrong. A cyclist since childhood, Webster was a fan of century rides, biathlons, 24-hour events and some serious mountain bike racing.

So, here’s a guy who, at 47 years of age and recording up to 6,400 kilometres a year on his bike, gets blindsided by this bombshell found during a routine physical. Initially, he faced immediate emergency surgery, mostly because the medical team hadn’t seen anything like this in their careers. Once the doctor and radiologist calmed down a bit, Webster began a voyage that took him to the Mayo Clinic in Jacksonville, Fla., then to the Mayo in Rochester, Minn. and then to vascular surgeon Dr. Roy Greenberg at the Cleveland Clinic in Ohio.

After much talk about surgery, stents and grafts, the experts have decided to monitor his condition. He has undergone genetic testing for Marfan’s syndrome, Ehlers-Danlos and other factors (all negative) to see if there are underlying conditions that might have caused the problem or could contribute to complications during surgery. It was suggested to him that perhaps he had had these aneurysms all his life. (I’ve had various people wonder the same thing about me. It usually goes something like, “If you had never had the CT scan, you would never have known about the problem. It’s better not to know.” I, of course, disagree. I believe everyone should have knowledge about their own bodies. The trick is controlling the response to that knowledge. Don’t freak out … try to figure out how to manage the problem.)

Anyway, for a couple of years, he backed off the riding to about 2,400 km a year, and none of the aneurysms have grown. He has resisted taking beta blockers to reduce his heart rate and blood pressure.

Although my own vascular advisers seem convinced that my iliac aneurysm is directly related to cycling, Webster’s doctors aren’t so sure. But, he writes, “the more I read on this, the more I am convinced it is.”

The big downside in all this is the weight gain of his reduced exercise. After adding 10 pounds, he decided to start some hard riding again: about 640 km per month, mostly on a trainer, since January.

So, right now, it’s a wait-and-see situation. If there is surgery, the stents will come from Australia, which is at the leading edge of stent manufacture.

Webster hopes that sharing his story will raise awareness about cycling and arterial anomalies: “I think the more info there is out there, the more people are informed and the more experts may be able to make linkages.”

As a part of that linkage, here’s a link to the MRI images of Webster’s aneurysms. This shot shows the arteries in the context of the rest of the abdomen. Share this information with your hard-riding cycling friends, and with your doctor.

My own vascular surgeon, Dr. Thomas Lindsay, was quoted last year on behalf of the Canadian Society for Vascular Surgery as saying that every Canadian man and many high-risk women over the age of 65 should be screened for abdominal aortic aneurysms. It’s a matter of saving lives, and health-care dollars, he said. I wonder if the same consideration should be extended to cyclists, who may be putting unusual stresses on their lower abdominal arteries in a high-energy activity. A simple ultrasound screening would cost the system less than $60, but might detect a problem before it turns into a major medical issue.

Webster will keep me informed of developments, and I’ll pass on what I learn.