The road back

I took my time getting back to activity after covid. Fortunately, I didn't really have any symptoms. I did the full quarantine for a bit, then got out for some walks. Then I started to go for easy bike rides and runs. I kept busy sorting through my old Lego bin, pulling out parts and building long lost sets from the mixture. It was time consuming enough that it kept me distracted. But I really wanted to see where I was at fitness wise because I wanted to get back to riding up mountains.

I've never really taken a long break from training that was enough to notice a drop in fitness. I've also tried to avoid pushing myself really hard while sick, hard enough that I would see how much the sickness has taken out of me. I have never found myself saying "that sickness/work trip/family trip took 10 Watts off my FTP!".

I was starting at my bottom. This wasn't a matter of some breathing obstruction disappearing. I had few red blood cells. But you have to start somewhere, so I did a ramp test. The result was about 80% of my pre-chemotherapy number. Not too bad, probably similar to the average recreational rider out on the trails. But the mountain was daunting. It was late April and if I wanted to get back to my pre-cancer levels to crush some big rides and runs by the end of August, I would need an improvement of 5W per week, 20W per month. Breaking it down like this made it seem unrealistic and impossible.

In Edmonton, the maximum height difference in the river valley is about 40m. It's not a lot to work with and serious racers only get their fix of high intensity by sprinting up them in under 1 minute. If I wanted to ride easier, I had previously been able to sit and spin up them, even if it took 2-3 minutes, it wasn't long enough to make me hurt. Now, that 2-3 minutes was pushing me over my threshold. It was eerily nostalgic of my earlier days cycling and something that a lot of recreational riders feel. It made me appreciate all of the training that I have done that has allowed me to not have to suffer up every climb. It seems weird that recreational riders are afraid of a little voluntary intensity, otherwise known as "training", and just accept that every hill they encounter will make their legs hurt!

I was at the level of the average recreational rider, but I was lacking endurance. Before, I would be able to ride at an easy for me pace for over 1 hour with little more than water and a couple of cookies. Now, I was bonking after an hour and those cookies weren't going to save me. Going for a ride now meant bringing more snacks! It was nice to encounter friends who had heard of my battle and encouraged me. Thanks for all of the messages!

I used to be able to go into a weekend, guns a blazing. Now, I had to stick to the plan, just making sure that I was putting in the right amount of hard work. Now was not the time to focus on the summits, because they wouldn't be anything spectacular at this point, but the process. All I cared about was getting back to my previous levels.

In May and June, I was actually able to manage to improve at about 5W per week. Week by week, I didn't seem to be making that kind of progress, but with regular periods of rest, my body was able to recover and produce those extra watts the next week. In early June, I was starting to feel strong again. I was the only one to complete 2 laps of the upper deck of Commonwealth Stadium (The Gristle) with the November Project, and I had a wonderful day where I ran up Opal Ridge in the morning, then cycled up to Highwood Pass in the afternoon. By Canada day weekend, I found myself back to being able to put in some solid days in the mountains. I finally felt like I was back in my element.

Then my progress stalled. I was still at least 5% short of where I was. But I was able to complete a goal that had been on my plate for a while: I ran the 55km Rockwall Trail. After a couple of years without races over the pandemic, this was the first day in a while to really take a lot out of me. It would take weeks to fully recover from, but it was so worth it.

In the fall, I experienced another setback: Reynauds syndome. My fingers and toes would go numb and white when experiencing slightly cold weather. It puts things into perspective because it is worse than not being as fast. I had to buy heated socks and mitts. I have to be careful going outside in the cold. It has taken away some enjoyment of winter.

It has been difficult to progress above the plateau. I was comparing myself to my previous all time cycling numbers, but these were from the pandemic, when I had little comparison to previous running and skiing performances at the same time. I was always a little hesitant to compare to my previous mountain running or skiing performances because I can't do such a test during an evening after work in Edmonton. I have to use one of my weekend days to test in the mountains. While I have been able to get within 5% on the bike, I seem to be a little further out on the run, especially with shorter efforts.

Typically, the Christmas break is a time when I can string together a bunch of really good skiing days to prepare for the rest of the skimo season. Unfortunately, this year the ski conditions were not very inspiring over Christmas and I felt I wasn't able to ski confidently or frequently enough. Conditions improved by the time I took my winter vacation later in February and I was able to put in some back to back days more characteristic of myself pre-chemotherapy. These days gave me the confidence that I lacked going into the later part of the race season.

Aside from some midweek bike and running races, my return to competition would be with ski mountaineering. It was 3 years since I last raced. The level of competition has increased since I last raced and I find myself in some deeper battles. I qualified for World Championships, but after lengthy contemplation, I declined because I wasn't feeling it. I wasn't feeling like I was downhill skiing very good yet. I wasn't feeling confident that I would have the ability to survive the back to back days of competition. Lastly, I wasn't feeling like I had the ability to launch myself into uncharted territory: to improve on my previous world championships results to race in the groups that are normally ahead. Instead, I would be in familiar territory and I didn't see the point. 

The last races of the season went well at Steep Dreams and Marmot's Revenge. I capped off the season with a win in the vertical and a hard fought 2nd in the individual at Marmot's Revenge. 

After successful treatment by chemotherapy, a 5 year monitoring process begins. In the first year, there are CT scans or chest x-rays along with blood tests for the tumour markers every 2 months. As the years go on, the frequency decreases. A failed test could mean additional chemotherapy is required, likely a different, more unpleasant treatment because the cancer was able to beat the first treatment. At the beginning, I was struggling to envision myself committing to any trips or long term goals, instead focusing on making the most out of more local adventures. Now I feel a little more willing to plan ahead, though I would prefer to ideally squeeze everything into the growing gaps between tests.

Before starting treatment, I had a phone call with another cancer survivor and he said "your body won't be the same, but that's ok". I ignored and still continue to ignore this while believing I will return to my best. 

I guess in a lot of cases, people who go through a health crisis see it as a wakeup call that they need to make major changes to their life. Because factors in their life directly led to the health crisis. Perhaps I am living in denial, but nothing about the lifestyle I have led has proven to increase the risk of cancer. Instead, I feel like some of the choices in my life have been confirmed and I wish to spend more time of what could be reduced life expectancy (because of the toxic chemicals that were put in my body) doing those things I love to do and not wasting time and money doing the things I don't want to do. People have asked me how I was so motivated to come back. I guess it's because I was doing stuff I wanted to do.

Rock bottom

 I have no symptoms other than a bit of a sore throat and a fever, but I take a rapid covid test. It shows a faint line. If you are on chemotherapy and have a fever, you are instructed to go to the emergency room because your immune system is weakened and can't fight infection. I "only" had to wait for just over an hour (compared to 12hr+ waiting times. I am admitted to my own room and a blood sample and covid swab (for a PCR test) are taken. Then I am started on anti-biotics to eliminate a bacterial infection, if there was one. 

The emergency room is a contrast from the CCI. At the CCI, there are fewer patients per nurse. When the infusion pumps beep, they are quick to be attended to, whether there is air in the line or if the fluid is finished. In the emergency room, the staff have to manage many more patients. Pumps are constantly beeping and I can hear screaming down the hall, but the nurses are already busy attending to other patients! 

I spend the entire day in a room in the emergency department and it becomes clear that this might be a multi-day thing. I call to let work know that I won't be in tomorrow either. I call the CCI to let them know that I'll be missing my final chemotherapy treatment, bleomycin. I get my dad to drop off some clothes, snacks, and a book. I meet with an infectious disease doctor who is actually very interested in something that showed up on one of my heart valves during a CT scan in January. Eventually around midnight, the results of the PCR test have come in and confirmed that I am positive with Covid.

At the time I was vaccinated 3 times (and have since been vaccinated 2 more times). It was my first time having Covid, I did not know how my body would react with a depleted immune system. Blood tests prior to beginning my final cycle of chemotherapy had shown that my white blood cells were below the normal range. 

I was wheeled (along with my pump, still pumping antibiotics) to the ward for Covid positive patients. It was dark, it was late at night. Over the door read a sign that said "Intensive Care Unit". I was wheeled past rooms enclosed in glass to my curtained partition room at the very end of the hall. The head of the bed looked a little more complex with switches, control panels and places to connect cables and hoses. Nothing was plugged into any of these sockets but I was freaked out. Why was I here?

As I lied awake, I felt my chest tighten, as if something was clamping down on my entire rib cage. I was sure that I was not going to die in the hospital with help not far away, but I was wondering if this was Covid's way of taking over my body. I thought of losing all endurance abilities, never being able to even manage skinning up for one lap. 

It was here that I thought about all of the wonderful moments in mountains I have experienced in my life and how the recollections of all the views, skiing powder, and topping out climbs dominated my memories.

A lot of stuff you do in life is maintenance stuff so that you can spend time doing what you love.  A life consisting purely of those activities that you love would be considered "hedonistic", so society has a way of pressuring people to conform to some standard that only breeds mediocracy and stress. Cancer doesn't care if I make my bed everyday, pick up clothes off the floor, or clean the baseboards in my house. It doesn't care if I live my life modelled off of a 90's sitcom and go out to restaurants 5 days a week. It doesn't care if  I follow the unwritten rules. All I wanted to do was to ski again. I wanted to strip the maintenance stuff down to the bare bones. I clean the previous day's dishes so that I can bake and make food for the next day so that I can be fueled for my bike or ski.

Fortunately the tightening disappeared, but the first night was sleepless. And it turns out, it was a former ICU that was being repurposed as a covid ward.

They didn't want us sharing bathrooms because we were covid positive, but being pumped full of liquids, the jug with the desiccant bag that I was provided was soon insufficient so I staked my claim for the washroom. The women in the partition next to me had a habit of walking around naked, so I made sure to keep my curtain closed.

Although I was in better spirits after eating and napping, I still felt vulnerable. I didn't leave the house for almost a week and yet I still got sick. How long will it take my immune system to recover from chemotherapy? When I am finally discharged, will I end up back here? Binge watching Tallboyz on CBC kept me going. I did a deep dive on Instagram and found some pictures of someone (I can't remember) having fun ski touring and that reminded me of how good the days can be. My hospital stay reminded me just how vulnerable I am, and how important it was to make the most out of those moments where you do feel strong.

I was to be there for 5 days until the run of antibiotics finished. 5 days of dragging around a beeping pump and no fresh air. 5 days in the hospital because people didn't want to wear a mask in the grocery store. I had to ask to get the covid anti-viral treatments which were approved for immunocompromised people. And finally, I received an injection which magically started to increase my white blood cells back to normal levels. My parents visited me each day, they had to wear disposable robes, masks and face shields, just like the nurses in the covid ward.

In addition to my last chemotherapy treatment, it looked like I was going to miss a CT scan scheduled in a week at CCI while isolating and I was able to reschedule that to happen during my hospital stay.

Finally, after 5 days, it was time to get released from the hospital. I was to isolate in my parent's master bedroom. Fresh air was brief but fantastic. It only consisted of a short walk to the car and sticking my head out of the window on the ride. For those that have been following along on Instagram, it is here that I opened up my childhood Lego bin and began building.

Into it

I go up to the 4th floor and into a room full of lazy-boys on wheels. There are windows on 3 sides and it is well lit and not too crowded. I take my seat. A nurse comes over to put in an IV, fortunately it goes in on the first try. The first 1L bag of fluid to be administered is connected to the pump. It is just saline, intended to hydrate me to avoid hazardous side effects from the first chemotherapy drug, cisplatin. It will be pumped into me over 1 hour. There are 3 chemotherapy drugs today. How long will I be here?

Cisplatin is in a 750mL bag administered over 1hr. Etoposide is in a 750mL bag administered over 1hr. Finally Bleomycin is in a small bag that is administered over 15 minutes. Bleomycin is described as being toxic to the lungs. Lance Armstrong opted for alternative treatments to limit the effect on his career as a professional cyclist. Before starting treatment, I have done a lung function test to define my baseline numbers if anything were to happen. 

Chemotherapy drugs kill cancer by limiting cell division in the body. This prevents cancer cells from dividing rapidly, but there is collateral damage inside the body. Division of white and red blood cells and skin cells in the body is also affected by chemotherapy drugs. This is the reason for side effects such as fatigue (from lack of red blood cells to transfer oxygen through the body), being immunocompromised (from lack of white blood cells) susceptible to infections (like COVID), and cuts that heal slowly outside and inside of the body. 

4 hours later, I get back to my bike to ride home. My body feels swollen from having taken on 3L of fluid, so much that my knees hurt when I crouch down to unlock my bike. The first day, I go for a fatbike ride in the evening on the flatter Oleskiw trails. Mostly I feel bloated from the fluids. So far, side effects are excessive hiccups that keep me up at night (fortunately I can watch the Olympics on TV), the odd headache and that the couch starts to feel like it has a gravitational pull.

The first weekend, my taste buds are shot. A carrot becomes inedible. After that, just try to eat pizza and pasta, foods I enjoy. I eat waffles every morning as they are softer on the gums. I call it "living my best life" so that I don't lose weight because of a poor appetite. Fortunately, my taste comes back after a day.

One cycle for me was 3 days in a row of cisplatin and etoposide with bleomycin on the first day of those 3. Then bleomycin on 1 day of each of the next two weeks. Some blood tests to make sure that the kidneys are still functioning and blood cells are at reasonable levels then the next cycle begins. I did 3 cycles total over 9 weeks.

 In each cycle, the 3 days in a row hit hardest, but the effect is delayed until the weekend and early the next week. For instance, the Tuesday following always brought a headache and nausea, relegating me to the couch for the day. In the following weeks with just the bleomycin infusions, I start to feel better, but then the next cycle begins. 

The message throughout the treatments is to try to continue my normal levels of activity. Well, I know better than that and definitely dial it back, limiting things to 1.5 hours if I am having a particularly good day. The weekend before the beginning of the 2nd cycle, I do a 3 day stage race on Zwift. I am curious how much fitness I have lost. The first day, I start at about 95% of my pre-chemotherapy numbers, but blow up and finish at an average of about 85%. It doesn't seem like much, but it is striking how much just 1 cycle has taken out of me. The next day, I smarten up and try to pace at 85%. I'm at the back of the pack, and I see someone using the sticky-watts (exploiting the game by surging for 2-5 seconds, then easing off) cheat pass me. How pathetic. I finish the 3 days, but decide that it's not worth pushing myself for such meagre numbers.

I start to lose my hair just before the start of the 2nd cycle. The hair on the side of my head is starting to fall out, there is hair all over my pillow and my toques, so I shave the rest of my hair off. Other parts of my body and my finger nails are becoming extra sensitive.

I arrive the morning of the next cycle and there has been a bit of a mix up. After my initial weigh in, someone along the way interpreted my weight as being 90-something kg instead of 70-something kg. That means that during the first cycle I was given a much higher dosage of chemotherapy than proposed. There is a bit of a delay as they have to mix new bags at the lower dosage but I am glad that error has been caught!

After the first treatments of the 2nd cycle, I discover that the gravitational pull of the couch isn't because it has suddenly gained a large amount of mass. It is the nausea. It's not like the nausea you get when you've had a few too many beers. It feels different, but it has the same effect: it makes you want to lie down. I have been provided with prescription anti-nausea medications, but they only work so well.

I start to notice the effects of having less red blood cells. I get head rushes if I get up too quickly. My heart rate races even if I go up a flight of stairs. The stairs on my bike ride to the CCI is starting to require more from me. One day it snowed and it was a really difficult ride to get to the CCI. On the way back, the final hill out of McKinnon ravine up to 142 street always required some strategy to be able to make it up: resting on the flat section.

I didn't mind sitting on my indoor bike and grinding it out at 35-45%. Besides the Tour of Watopia group rides were going on. But I found that if I exerted myself too hard or for too long, I would get a bit of a sore throat. Nothing that couldn't be soothed with some tea, but I was always worried that that would be the precursor to something more serious.

In February and March 2022, we are still in the midst of a pandemic. Being immunocompromised from the chemotherapy makes me exceptionally vulnerable to Covid. So I've had my partner do all of the grocery shopping and I didn't go to any indoor public spaces aside from the CCI, where I've been wearing an N95 mask. 

Think about the political background at the time. February was marked by anti-mask and anti-vax, and anti-whatever (progress) occupation of Ottawa and blockades of border crossings. Basically selfish people who were fed up with having to do the bare minimum required to participate in a civilized society. I felt like I didn't have a choice about whether to put toxic chemicals inside my body and get several needles a week and these people were scared of a little vaccine. The government caved and mask mandates lifted. There goes another level of protection.

Near the end of the 3rd cycle, with one last treatment to go, I didn't have to leave the house all weekend. My parents dropped off some food, I was happy to spin for 1.5hours at a time on Zwift. My partner had gone away for the weekend to go skiing, only stopping for gas and a short grocery shop. The Tuesday after she got back, I woke up with a bit of a sore throat...and a fever.

Prelude

 I didn't know much about cancer. It didn't seem to affect those close to me. Sure I had heard words like "tumour" and "relapse", but I had never even heard the word "remission". I didn't know that it typically spreads very fast and also more commonly affects older people. 

In the fall of 2021, I was coming off a summer of being in perhaps the best shape I had ever been in. A winter and spring and summer without the distraction of races (or travelling to races) and other commitments meant that I could focus on executing a training plan and more importantly prioritizing proper rest weeks and progression. The result was that I punched through plateaus, at least with my cycling, setting PR's and KOMs. I was excited to take what I had learned in that year of the pandemic and apply it as races returned to the calendar for 2022.

September 29, I was sitting in my desk at work and I experienced some severe pain in my left testicle. It was hard to focus on work and I made a couple of trips to the washroom to sit on the toilet to examine what was happening. This was the day before a long weekend for the new Truth and Reconciliation Day on September 30, and as someone who works 40 hours a week and lives for those precious weekends, I didn't want this to ruin my long weekend at the emergency room, I had big plans. Eventually the pain went away and I was able to enjoy my weekend. 

The pain would come and go. Kind of like a stomach ache. Except the state of your digestive system is constantly changing. I don't think your testicles go through cycles. My testicle seemed bigger and had some flappy things poking out of it. But nothing I would call a "lump". TMI, but besides, my other testicle seemed to be weird for my entire life and it didn't seem to cause issues. I had a busy fall with midweek races and training for skimo season, so I didn't think to book a visit to the doctor until mid November, when my girlfriend finally twisted my arm. 

I had not been to a doctor very regularly at that point. I went to a walk-in in early 2020 because I had noticed some 200+ bpm heart rates now that I had a watch I could wear during a skimo race. And before that I had found a new family doctor in 2017 who had had me do the battery of tests, but his clinic moved to an outlying suburb. So I had to find a new family doctor.

"Oh, by the way, my testicle has been giving me some pain, seems swollen"

"We'll have you book and ultrasound"

I got the ultrasound done in the morning and not even in the afternoon, I already got a call to go see the doctor. He tells me that it doesn't look good and that a urologist will be in contact with me soon, and gives me a requisition for some more blood tests.

The urologist calls and I am to meet on Wednesday. He gives me the rundown of what is going on, how the blood tests show that it is likely cancer, what they are going to do, what the recovery time is going to be like, and that they could even do the surgery that evening...or on Saturday. It's kind of gross, a lot of information to process at once, and I am already really hungry so I decide to schedule it for Saturday with another urologist. Because they cut through the abdomen to extract the testicle affected by cancer, the recovery time can be long to avoid putting too much strain on the incision. It becomes apparent that I might miss skiing over Christmas break, and I feel silly for holding off so long in the fall only to potentially lose out on a week of skiing.

I spend the rest of my week going for some last bike rides and cross country skis and have some pizza at midnight the night before surgery. Although the urologist went EXTREMELY into depth on the side effects, I am not too nervous because I am excited to get that thing out of me.

The day arrives and I head to the hospital. I wait around the entire morning but eventually the surgery takes place in the afternoon and I am wheeled off to the operating room. I remember shifting myself onto a different bed in the operating room and then counting down as I am put asleep, then I wake up in the recovery room. I ask the nurse there if it was a boy or a girl, referring to my testicle, I don't think she got the joke. Then I am transferred back to the room from the morning.

I don't know what is wrong with the roommate in my room, but his breathing sounds labored and he doesn't want to eat his hospital food. It sound like he has diabetes and COPD and I hear him promise to his partner that maybe he will quit smoking. I can't help but be pissed off. Here I am, I have made much healthier choices in my life and I still end up in the same hospital room... Before I am allowed to leave I am supposed to demonstrate that I can pee, I guess to make sure that everything works. I drink up knowing that if I am able to pee, I will not have to spend a night listening to my roommate whine and wheeze.

Recovery from the surgery happens step by step. For the first week, I try to get outside and walk 2-3 blocks every day. Don't want to over-do it. In the 2nd week, I return to work from home and work my way up to longer walks, sometimes 2 hours at a time. In the 3rd week, I feel up for some indoor cycling and I do a bunch of 2.5 hour rides because I was bored. My heart rates seem high for small amount of power I am producing, but I see quick progress. 

Throughout this time, I went into the depths of google, looking at what the treatment will involve, options, and outcomes. Podcasts, blogs, publications from regional health services. The stats are interesting. 9000 Americans a year are diagnosed with testicular cancer. By extrapolation, that's probably 900 Canadians, and 30 from Edmonton. The 5 year survival rate for testicular cancer is 95%. 95% might be a good result on a test, but a sobering way to look at that is that 1 in 20 die...

I meet with the urologist at the end of the 3rd week for a follow up. Contrary to the warning from the first urologist, I am able to return to activity a lot quicker and it looks like I'll be able to ski during Christmas break. Yay. I am provided with a requisition for a blood tests and will be referred to the local cancer clinic, the Cross Cancer Institute (CCI). The blood test is to see if the levels of tumour markers in the blood are dropping after removing the testicle or if they are increasing, indicating that the cancer has spread.

I went to the CCI to pick up more weekly test requisitions. Upon my first trip into the CCI, it felt welcoming and close knit. I would jokingly refer to it as "Hogwarts", although instead of having magical powers, I had cancer.

So with a more official go-ahead from the doctor, I was able to start playing around more outside. I went cross country skiing, Klaebo-running up the smaller hills. I did a massive ride on Zwift. It was extremely cold over Christmas break, even with some highs of around -30C, but I didn't care, I just did warmer activities like cross country ski and run. When it did warm up, I was able to put in some big days. I was not expecting to be able to race the skimo race at Castle Mountain, but things were looking good.

The first weekly blood test looked good, with tumour markers decreasing dramatically compared to pre-surgery.

And the racing did go well. I skipped the sprint because I had not done any hard efforts since the surgery. The vertical and individual were affected by trailbreaking that kept the group together making things more tactical. I didn't feel like I was at the top of my game, but I got a couple of podiums.

The next weekly blood test showed some increase in the levels of tumour markers. I had a meeting with the oncologist. to discuss the next steps. More blood tests, another CT scan, and likely chemotherapy starting in February, finishing up in May.

Chemotherapy treatments are almost synonymous with cancer. The image of hair loss, weakness, and nausea are what you think of when you picture a "cancer patient". I wasn't sure how I would recover from losing a body part that literally produces performance enhancing drugs (testosterone), now I had to worry about how I would recover after nuking my body with chemicals. 

In order to enjoy my body while I still could, I went to Canmore to go skiing every weekend until I began chemotherapy. I was able to put in some great days on the skis. I even snuck in another race on a Saturday night at Norquay. Interestingly, blood tests showed my red blood cell count took a hit from surgery and was not quite back to pre-surgery levels at Castle, but by the Norquay race, they were back, and I would say that I felt pretty good. 

I also took a week of vacation to get the most out of more days in the lead up. Near the end of my vacation, I schemed up an "event". A grande course worthy skimo race at Rogers Pass: Peter's Mental, a play on the famous Pierra Menta. There was an amazing turnout. 

Peter's Mental!

I then nervously pedaled my bike to the CCI. I had no idea what to expect.