Monday, May 31, 2010

S minus 37 hours

Yup, we're down to hours now. Not much new to report. Family has arrived (Mom flew in yesterday) and can't think of anything major that still needs to be taken care of.

Tomorrow I'll be going into work, but it's going to pretty much a perfunctory appearance. Not only do I expect a parade of well-wishers to keep me from getting anything done (which will be welcomed - I won't complain about that), but my mind will be elsewhere. I have to run to the hospital to take care of some last minute tasks (*another* x-ray, pre-op bloodwork) and I have to be back in the apartment for bowel prep by 5P, so it'll be a short day in the office anyways.

Ah, bowel prep. Nothing quite says fun like "bowel prep". What does prepping one's bowel involve? Well, I'll tell you. Bowel prep consists of a few Ducolax pills followed by a Gatorade-Miralax chaser. The prep instructions say that after the Miralax mix, "You can expect to have multiple bowel movements soon after." That's an understatement. The instructions also do NOT say when you can expect them to STOP. Having gone through this once before, I can say that it's not anytime soon. Seems like to leave that important tidbit out is a bit cruel to the unitiated.

Oh, hey, here's a YouTube clip of comedian Bill Connolly on colonoscopies. Killer stuff.


Got a package from one of my college buds in the mail a few days ago. It was a viking helmet that we gave to him for his wedding last fall. It's an inside joke with a bunch of the guys from college, but suffice it to say, it was great getting get it in the mail. Good to know that they're thinking of me, and that they've got my back. I called up my buddy who sent it to me and we agreed that it's now a traveling helmet that gets sent to one of the guys who's going through a major life event (wedding, cancer surgery, etc.)


One benefit to having cancer is that you have something in your back pocket that you can pull out whenever you need to a little something extra to tip the scales in your favor. It's the Cancer Card. The Cancer Card is great fun. When I was up in Seattle visiting another one of the guys, we had picked out two rental movies, were deciding which one to play, and I said "Well, the guy with cancer would like to see (whatever movie it was) first." That just killed my friend and his family. Them: "OHHHHHH! You didn't just do that." Me: "Yeah. I did." Them: "The cancer card? Really? You played the cancer card over a rental movie." Me: "Throw it in." Of course, the rest of the night was us going back and forth. Me: "The guy with cancer would like the volume turned up a little bit louder". Them: "Would the guy with cancer like another beer?" Loved it.

Of course, the Cancer Card can be used against you, too. Back in Madison, playing Euchre with the guys, I played the Card to give one of the other guys grief over trying to steal the deal ("You tried to steal the deal from a guy who has cancer? How do you sleep at night? Have you no shame?" (He gave me the deal)), and it came back to bite me a bit later("Of course, you realize that we let you win that game -- You have cancer.") I ate it up. That's why I love these guys so much. We know each other so well, that they knew that would just kill me. These guys crack me up endlessly. Our collective sense of humor is so irreverent, nothing is off limits, even cancer.

One of the best things about the Cancer Card is that it has an expiration date. At the end of post-surgery chemo, I plan to be NED. That means I can't use the Cancer Card, because I WON'T HAVE CANCER!!! Looking forward to that day. Looking forward to being just another guy in the crowd.


Tomorrow is nothing but clear liquids. No solids. Nothing. Then at midnight I'm cut off from everything. I'm gonna be starvin' marvin. Tonight's "last meal" - kick-ass lasagna at a great Italian with some good friends.

Sunday, May 30, 2010

S minus 3 days

Three days, eight hours, eleven minutes to be exact, but who's counting? I'm scheduled to check in at 9A on Wednesday and the show starts at 11A.

The past week has kind of flown by. Been keeping busy with work. Well, kinda. I mean, I've been physically at work for a good chunk of time, but I've hardly had any focus. Even though during the day I'm pretty cool and collected about the upcoming surgery, I've been having a bit of trouble sleeping at night. There were a few nights I was well up past 3A, and that makes for a crappy next day at work. Everyone says the drug ambien is the way to go, but I've been dipping into my stockpile of lorazepam from chemo, and that's been doing the trick. Anyways, with work, I've been pretty distracted with all the thought and research going into making my surgery decision, and, with the surgery decision having finally been made, with having the surgery to focus on. I had really been hoped to get a lot of stuff done this month (again, being productive is just another way of giving cancer the finger), but I've learned that physical health isn't enough. You've got to be there mentally too.

Had a few more doctor appointments this week. After seeing the surgeon on Monday, I saw Natalie, the ostomy nurse on Wednesday. It was an education session about how to take care of ostomies and how to manage all the hardware (bags) that go around the ostomy to catch all the waste that comes out. She also marked me where the ostomy is going to be. The game plan is to get the LAR (short term - temporary bag, long term - no bag) and if things don't work out for various reasons, the surgeon calls an audible and proceeds with an APR (permanent bag off the bat). She drew two large dots just below my belly button where the surgeon will be putting the exhaust port -- one on the left, one or the right. The right one is where the temporary ileostomy will go if the LAR procedure works out. The left one is where the permanent colostomy will go if I have to get an APR. So, you can guess what the first thing is that I'm going to do in the recovery room - reach down to feel what side the bag is on. If it's right, I'll feel like happy roadkill. If it's left, I'll be dejected roadkill. Maybe I'll be so drugged up I won't be able to feel anything and won't know for a day!

I was a little bit disappointed in the placement because either way it'll be above my beltline. I wanted it below. It's not like I parade around with my shirt off all the time, but having a bag the sticks above your beltline, it just seems like it's going to be more noticeable, especially when I tuck my shirt in between the bag and the belt. But, they have stuff for this - there's a little cumberbund you can buy that holds the bag down a bit and makes it less noticeable. It also muffles any noises that come out. Yes, you can have ostomy farts. I was a bit concerned about this because you have no control over these farts. Natalie said that your clothes muffle the noise a bit, so people don't hear it too much. Really? You mean like pants muffle the noise of a regular fart? Uh ... I don't think so. We'll see how that goes. I would just hate to be giving a presentation at work or making a pitch to a potential client and then have this THPTPTHPTHTPHT noise go off. Man, that'd be embarrassing. Hopefully that LAR works out just fine and I have to worry about this for only a few months.

So, with surgery looming, you may be wondering how I'm dealing with it. Right now, I'm fairly calm about it (despite the insomnia). I'm having a tough time getting my mind around the idea of a 5-6 hour major surgical procedure, so right now I'm thinking of it as just "more TV" -- I'm treating it like it's going to be happening to someone else, and I'm just an observer. That's the strategy I used to get me to bunjee jump in New Zealand, and it worked. It prevents you from thinking of all the things that could happen (I wonder if the bunjee cord will snap? Will I splatter on the rocks below? Has this cord been tested for a person my size? etc.) and allowed me to voluntarily jump off the launching pad. Same with surgery - if I think about what's going to be going on in the surgery room while I'm under, I won't sleep a lick between now and then. I'm just putting my faith in the system and going with the flow.

The thing that's so weird or surreal about surgery is that, from my perspective, one second I'll be in the pre-op room with the anesthesiologist turning on the drip, and the next second I'll be awake in the recovery room.

(At least, I'm hopeful that's the way it's going to work. I've woken up mid-procedure before when they were working on my hindquarters (same surgeon as I have on Wednesday) and remember feeling them working on me and talking the doctors. Doc: "Doug, can you feel anything?" Doug: "Um ... yeah, it feels like you're poking around my butt with very sharp items." And then I went on to talk to the nurse for a few minutes about my recent climbing trip to Alaska. (I'm serious). Eventually, they had enough of my stories, jacked up the anesthia and I went back to sleep.)

It's like you're checking out of your body for a bit while they work on it. It's kind of like your mind is in a waiting room, waiting for the doctors to have your body ready.

Oh, if you're really, really, really interested in what the TATA procedure is, you can google TATA and Dr. Marks and you can find a VIDEO of the procedure. (Yes, a VIDEO!!!) It's an 18-minutes training video of the TATA procedure. (Why is the training video only 18 minutes long? It's a 5-6 hour procedure! Don't you think that just a bit worrying?) I thought by viewing it I would learn something worth knowing before making my surgery decision, but no, it was hardly helpful. Some things are just best left unknown. I made it 3:20 into it. The word that popped into my mind while watching the video, and I haven't been able to get them out of mind since, is "meat on a hook". Meat on a hook. I don't think I could ever be a surgeon.

Monday, May 24, 2010

S minus 9 days

Met with my surgeon today to discuss surgical options. I asked him a bunch of questions and he answered them all to my satisfaction. I haven't given him the official decision, but I'm going to go with the "take out less" option. I believe it is a smart choice. I shouldn't be sacrificing any oncological outcome (that is, the odds are local recurrence are about the same compared to an APR - the "take out more" option), and the prospect of not having a colostomy bag is pretty appealing. I asked the surgeon about all surgical points of concern, and for each one, he pretty much said that if something comes up in surgeon that puts getting all of the cancer out at risk, he'll switch over to performing an APR.

Even though I've elected an LAR (the "TATA" procedure), that doesn't mean it'll all be roses. As I read the literature, I get the impression that there's a better than 50:50 chance that I have a "good" functional outcome. I'll take those odds in this case. If things don't work out at all, like I've said, I can always elect to get the bag later. But, it'll be about a year after I finish post-surgery chemo (which will end around Thanksgiving this year). So, my course is pretty much set for the next 18 months.

I'm also electing to enter the surgical clinical trial that my surgeon is enrolled in. The trial is to see whether a laproscopic (fewer incisions, potentially quicker recovery time, use of tools to perform a portion of the procedure) or open (bigger incisions, everything is done by hand) is better.

It's nice to finally have the decision made.

Wednesday, May 19, 2010

S minus 2 weeks

Wait a minute ... did I just type "S minus 2 weeks?" Where'd that last week go? I was supposed to do a bunch of research and be closer to a decision. Oh, wait, that's right. I was out having fun visiting friends in Seattle (got two great rides in) and staying busy with work. I'll admit that I'm using work and play as diversions from having to make this decision. At the end of the day, I'm usually mentally tired and the last thing I want to do is more critical reading and thinking about rectal cancer. Can't I just watch the NBA playoffs?

Plus, there's an infinite amount of research you can do about this. For example, I sic-ed my Mom on the "bionic butt" procedure. She was a reporter for the local newspaper for so many years so long ago, she had the research skills to dig into this and really went at it. Turns out the bionic butt procedure is called the Electrically Stimulated Gracilis Neosphincter (ESGN) procedure. (That's your new word of the day - Neosphincter.) It's been done well over a hundred times (the British tabloid papers, where I first heard about this, made it sound like it's been done just once), and the functional results are mixed. Still, it's interesting. If I go LAR, and still have an external sphincter, and if this procedure continues to evolve, maybe there'd be a day where I could be eligible for this option. If I go APR, that's a one-way street. Internal sphincter. Gone. External sphincter. B-bye. That orifice is sewn up for good. (Now, that's something that I haven't really wrapped my mind around - a sewn up behind. I mean, I always kinda figured that's what happens when they removed the ol' sphincter, but the idea of it is just a bit ... alien.)

Anyways ...

Another thing I came across is this Vitala Continence Control Device manufactured by ConvaTec. It's a pouch-less device for people with an ostomy (colostomy, ileostomy, etc.) that provides temporary continence. It's a little device that covers a stoma and holds the stool inside for about 8 hours. No irrigation, no pouch. Sounds pretty nice. It's been available in Europe for a little while and has just recently been FDA approved. So, this might be something that makes getting an APR a bit more palatable.

So, doing the research is good - it shows that there are new procedures (ESGN) and devices (Vitala CCD) for people faced with rectal cancer surgery, or to help them manage their surgical outcomes. And that's the kind of stuff I want to know. It helps inform my decision. If getting the LAR precludes me from getting some procedure that hasn't even been thought up yet, that could help improve continence 10 years down the road, that's something to consider.

What option am I leaning toward choosing? Neither. And, actually, that's progress. All throughout chemo I resigned myself to the fact that I'd get an APR. That was good, because mentally, by the time I was done with chemo, I was willing to accept life with a bag. Now that I'm faced with the option, I've moved off the APR position and am seriously considering the LAR. I'm weighing having to deal with a bag for life with the APR option vs. the possible continence issues with getting an LAR. What's cool (and I that term in a very relative sense) is that if the LAR doesn't work and my quality of life sucks because I can't be more than 10 feet away from a bathroom, then I can always fall back to the APR position and get a bag. It would mean another surgery down the road, but I like the fact that I can take a more aggressive approach (LAR) and still fall back to the "nuclear option" if the LAR doesn't work. The "con" to this "pro" is that control could SUCK for up to two years before knowing that it didn't work. And to me, that's a touch of a gamble. The studies say 50:50, but I've got things like youth going for me.

But, given the location of my tumor, there's really no getting around the fact that things ARE going to get worse, control-wise. A lot of the papers give all the objective data saying how many more times a person's gotta go if they get an LAR, etc., but all the subjective data shows a fairly high level of satisfaction. One of the papers hit the nail in the head when they said the reason so many people were satisfied with their reduced functioning is that they knew what the option was - a freakin' bag. I can just see a doc telling a guy, "Now, after this procedure, you're going to poop 4-5 times a day instead of 1-2 times. And when you gotta go, you gotta go. You may poop in your pants once a week and you may have to wear a pad every now and then." Guy: "That sucks. What else ya got?." Doc: "A bag." Guy: "Ya know, I can handle pooping more. Yeah, let's go with that." It's all relative ...

So, what's going to make me make a decision? Besides the short time frame, it's not going to be one thing in particular. I'm not going to read some magical study that reveals some data I haven't seen anywhere else, or talk to some surgeon that's going to offer some magical new procedure that makes me poop better than new. Both options sucks, both options are worse than the fully functioning sphincter I have right now ...

(sidebar: well, an almost-fully functional sphincter. After radiation, I'm happy to have my sphincter back, all healed up, but I really can't trust it like I used to. It's different. It's like an old friend that's come back after having been away for awhile. You recognize them, but you can tell that they've changed. The sphincter and rectum are amazing organs. Think about it. They can tell solid from gas from liquid and can do things like letting gas out but not the solids. About a few weeks after chemo, my sphincter punked me - I thought it was telling me it was going to let out gas and keep the stool in, but no. I sharted. Same thing thing a few days later. Shart. Now, I know better. Just can't trust it, I feel that coming on, I head to the restroom just to be sure.)

... but I have to choose between the two. It's just going to be the cumulative effect of reading all these papers, talking to the doctors and bouncing my thoughts off my friends (they can't seem to decide either). I'm going to set aside some time this weekend, read a bunch more stuff and go into my meeting with my surgeon on Monday armed with some "final" questions and then make a decision. Monday is fish or cut bait time.

Now it's 12:40A, darnit. This is why I've been falling asleep at work in the afternoons. I come home late in the day, walk the dog, take care of house tasks, and then I stay up late reading cancer studies. Gotta split ...

Wednesday, May 12, 2010

S minus three weeks

Three weeks now. Part of me wants surgery to be tomorrow so we can just get it DONE with already.

Monday, May 10, 2010

S minus 23 days

Three weeks two days. Surgery is getting close. Real close. Starting to realize that there's a lot I want to do before surgery and that I'm not going to get to it all. I want to go out on and the weekends and just ride, ride, ride. Burn off all the nervous energy, get the blood flowing and just ... be.

But, I'm going to have to spend some of that free time tying up lose ends. Lots of things, some big, some small to think about and take care of.

I've come across more white papers about the functional results of LAR procedures for ultra low rectal cancer tumors, but haven't been able to scour through them yet. But, I've got a lot of good stuff. I found the name of the surgeon at the Royal College of London who performed the "bionic butt" surgery (Google it) and he has a bunch of interesting papers about his own intersphincteric resection approach (called APPEAR) that looks interesting. I'm not going to London for surgery, but it's worth looking into other approaches and seeing if they promise better outcomes. If there's something out there that looks real good, maybe I can find someone in the U.S. who is trained to do it here. But honestly, at this stage of the game, I can't see myself changing surgeons at this point. I'm pretty happy with who I have.

I'm a bit more invigorated/inspired to dig into the research, get additional opinions and explore other options. Why? In the Milwaukee airport yesterday on the way home from Wisconsin I stopped in one of my favorite book stores and picked up copies of both of Lance Armstrong's books - It's Not about the Bike and Every Second Counts. I read It's Not About the Book years ago and, like most people, that it was an amazing story. Here's a guy who has it all, gets Stage IV testicular cancer (at 25!!!!) that has metastasized to his lungs and brain, undergoes aggressive chemotherapy and brain surgery, and then wins a bunch of Tour de Frances. I had a whole new interest in the book now that I was reading it from the perspective of a cancer patient. And I just devoured the book. I starting reading it at the gate in Milwaukee and finished it at 2:00am in my apartment in Portland. The story is still inspiring, but it was also comforting in hearing him go through a lot of the emotions and thoughts that I am going through / have gone through.

Things like wondering if you're going to be one of the people who makes it through, knowing that good, strong people who do all the right things to beat cancer still die from it, and that others who don't do a damn thing about it and don't take care of themselves beat it. How success can be a matter of blind luck. How cancer can be something that totally changes your life.

How there is pre-cancer life and a post-cancer life. My Mom said this to me (she fought and BEAT breast cancer), and the deeper I get into treatment, the more I believe it to be true. For me, my pre-cancer life ends the second that anethesia kicks in the day of surgery. When I come to, things will never be the same for me physically, and that physical change is going to effect me emotionally. I can't same that I'm dreading the physical change, because I know I need it to give myself the best chance of living. But ... I like my pre-surgery body (sans cancer), and, frankly, I don't wait to give it up. That's what really pisses me off about the cancer. It's going to leave a mark; It's taking something away from me - my rectum and my sphincter. And that gets me pretty mad. Here I am, enjoying life and out of the blue, for whatever reason, cancer comes along and takes these things away from me. Not fair.


My trip to the homeland over the weekend was great. It was a bit of a whirlwind -- I figured I visited with 46 people in about 48 hours. It was good to spend time with everyone while I'm healthy during this intermission between treatment phases. Sure, we talked about the upcoming surgery a bit, but after tackling that subject, we just hung out and enjoyed each others' company. It was great hanging out with friends and family - Euchre with the guys, playing catch with my nephew, meeting another one of my nephews for the first time, playing Wii with my Dad, etc., etc. ... it was just what I needed. I feel incredibly fortunate to have such great friends and wonderful families.

So much more to write about, but I have some papers to read ...

Tuesday, May 4, 2010

S minus 29 days

Shit. Tomorrow it's only four weeks to surgery. Started digging into the literature and got a bit overwhelmed. The guys who developed the TATA procedure have one of the crappiest web sites I have ever seen and was completely useless. So, I'm searching on the more generic term of "intersphinteric resection" and having more results. There's a guy on colon talk who is facing the decision and he's really done a lot of good research that I'm piggy backing on. He pointed me to a study done by Sloan Kettering in NY that showed recurrence rates of LAR intersphincteric resection to be quite low. I liked that. It didn't really go into the functional outcomes of surgery (that is, how often you crap and how well you can control it), but it did say that nobody who had the IR procedure asked for a permanent bag due to continence issues. The study cites a bunch of other functional studies, which I have to dig up.

Speaking of digging up papers. Google is great and all, but I you can only get abstracts of most papers on line. Sucks that you have to pay $20-$30 to download most articles. I mean, I get it. These publications need to pay their bills, but there should be an exception for patients who really want to read these studies. But, I manage to make do ...

So, the LAR procedure is looking much more promising than it did 24 hours ago. I'd say I'm leaning a bit toward LAR right now.

Monday, May 3, 2010

S minus 30 days

Greetings readers,

So, today I saw my surgeon to see how my tumor responded to chemo and radiation. After poking around my behind for a bit (which hurts a LOT less when you don't have a big ol' cancerous mass in your rectum), he told me that the tumor has shrunk "substantially" and that "there's very little left". So, I responded to chemo/radiation pretty well. Nice.

That's good news and all, but it doesn't really change anything. Large or small, the tumor still needs to be removed, which still means surgery. The surgeon did lay out the odds of NOT having surgery. He said the survival rate is about 1 in 5. Not the death rate, the survival rate. A 20% chance of living is too low for me, so I'll take the surgery. Anyways, the good response to treatment has me hoping that any cancer cells that may have been cruising around my body got dusted as well.

Anyways, even though the tumor shrunk, he said there's a little bit of it that's still extending into the anal canal. Bummer. And, as expected, I get to choose whether I want an LAR or APR procedure. (See, didn't I tell you that was going to happen.)

Because the tumor still extends into the anal canal, the specific LAR procedure he's offering up is called radical transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis, also known as TATA. (Love it - a TATA could save my asshole.) In this procedure, they remove the internal sphincter muscle and leave the external sphincter muscle in place. See picture below. I'll bet you didn't even know that your sphincter comes with internal and external muscles, did you?

So, problems with this procedure? Well, as you may guess, removing the internal sphincter muscle can cause a reduction in the control one has over pooping. The studies put the odds of having "OK/pretty good" control at about 50%. What is OK/pretty good control you ask? I'll tell you. It's still going to the bathroom a fair number of times each day and when you've got to go, you've got to go. Can't really hold it back for too long. Not terribly appealing, is it. Technically, you have saved your sphincter, it's still there, and more importantly, you don't have a bag. I had a lot of this during chemo/radiation. When the urge hit, I literally had less than 30 seconds to get to bathroom. You can try to hold it back, but that's like trying to stop a freight train with a piece of gauze.

As far as the difference in local recurrence rates, my surgeon says there's "no huge difference" between the two. There hasn't been a direct head-to-head comparison study between APR and LAR procedures in an attempt to quantity the difference in recurrence rates, so that's his assessment of comparing a bunch of APR studies to a bunch of LAR studies, and there's a bit of an "apples to oranges" comparison going on because of differences between the studies. I'm not surprised no such study exists because I can't see many people leaving the decision of whether to get an LAR or APR to a computer, which would be the case in a double blind randomized clinical trial. It's a difficult, personal decision.

Nothing I heard today has really has pushed me off my position that APR is the way to go. It's what my gut says, and I trust my gut. But even if I didn't have a gut feeling about this, I still think I'd come out the same way. With an APR, more tissue gets removed, and, to me, this provides a better local recurrence rate given that you're removing more tissue. Plus, you don't have to worry about a leaky bottom. So, advantage APR. But, look at LAR. You don't have a bag to deal with (a HUGE plus) and you get "OK" control in about half the cases. Plus, if things don't go well and you never really gain control of your bowel movements, you can get a bag later. So, things shift toward LAR a bit. However, it takes 1-2 years before you know how good things are going to get with LAR, time which I could spend out having fun in the outdoors instead of being tethered to a bathroom, waiting for my colon to train to act as a rectum. So, the balance swings toward APR again. Given that there's a 10/30% chance of local/recurrent cancer, if this stuff comes back within two years, I would want to spend that time doing all the stuff I love doing, with a bag, instead of being held back, waiting for things to work out with an LAR. I would be so PISSED if I wasted my cancer-free time waiting for a leaky ass to heal. I want to get amongst it as soon as possible.

But, I'll do my due diligence on the LAR stuff ...

I asked about where my new exhaust port will be placed and he said I did get to choose a bit. That was very good news. I don't want it to sit right at the belt line, and I went it to work with cycling and with thick backpack waist straps. I don't think any placement is going to be perfect, but nice to know that we can do what we can. Gives me a little bit of control over the outcome of the process.

That's it for now ...

Sunday, May 2, 2010

S minus one month

Tomorrow I see my surgeon to see how the tumor responded to chemo and radiation. It's not going to be particularly enjoyable. He sticks his hand up my behind, along with a couple other tools, and generally just pokes and prods for what feels like an eternity. Not a whole lot of fun. But I don't know who has it worse - me, for having someone's hands up my behind, or the doctor, for being the owner of said hands.

Anyways, like I've said before, if the tumor has shrunk or is gone, great ... but it doesn't really change my surgical options. Part of me is almost wanting the tumor to have NOT shrunk enough so that there's no decision to make and I have to get the APR. It'd be easy, and a bit of a relief, regardless of the consequences, to just have the decision taken out of my hands. If I do have a choice, then it's back on-line to read and learn everything I can in a short period of time to make the decision. And I already have enough to do before surgery. Ugh.

My prediction? I think the tumor is still there. Even though it completely goes away about 15% of the time, I think I can still feel it. But, I think it's shrunk enough (it's just a feeling) so that I *will* have the APR/LAR decision to make.

Went out riding both Saturday and Sunday. Logged about 75 miles. Man, I felt so good after riding on Saturday that I was amped up the rest of the day. I was just high on life. It was a good, solid, brisk ride and I had lots of energy. Today's ride was with one of the local riding groups, a 42 mile ride in the Willamette Valley - Oregon's wine country - and it was a great ride. Since I'm fairly new to the group, a few people were asking what other groups I ride with and if I'd be doing more rides with them, and I told them that I'd love too, but that I had a surgery coming up that will put me out of commission for awhile. I didn't go into any details, and said that I'm just getting out and enjoying my health while I can. I certainly have a renewed interest in taking advantage of every day between now and surgery to get out and do stuff physically because I'll be roadkill a month from today. And I do appreciate it, more than I enjoyed this kind of stuff before. The exercise is great for physical reasons, but just getting out there and cruising along for the enjoyment of it - that's not something I've always done before. Days like today and yesterday ... you want to keep on riding.

I'll blog tomorrow after my visit ...