"Runner's hematuria," I thought as my toilet bowl filled with bright red blood. I had read about the condition but never experienced it myself until that fateful day in October 2016. I was, at the time, training for the Turkey Triathlon in San Dimas, California, an event held the weekend before Thanksgiving. Each finisher earns a delicious wedge of pumpkin pie, motivation enough for getting through the sprint course.
The saga for me, however, started 10 years earlier when, for my 65th birthday, my children and their spouses bought me a commuter bicycle to replace my 40-year-old Univega, with its frame-mounted gearshift levers and extinct, hard-to-replace, brake pads. Shortly thereafter, I started commuting to work, a 10-mile round-trip, most of it along a river bike path that kept me away from distracted drivers and their 2,000 pound automobiles.
I soon noticed a change in the shape of my legs, with surprising definition of my calves and quadriceps muscles. Indeed, I referred to my thighs as "Baryshnikovs" (for the famous Russian dancer). This proved quite a change from my prior indolent existence. As a youngster, I was never much of an athlete. Indeed, I was a bit on the dumpy side (referred to as "portly" at the boys' clothing store). At summer camp, I was the last kid in my group chosen by the captains for team sports.
In high school and college, I smoked cigarettes, which left me short-winded during pickup basketball games and the like. I stopped smoking in medical school when, during pathology class, I first gained insight into the relationship between smoking, chronic bronchitis and lung cancer.
But, as you'll see, the damage was done.
I had little time for sports during my residency in orthopedic surgery or my subsequent subspecialty research fellowship. Likewise, I didn't allow enough time for sports as I built my private practice while, simultaneously, becoming academically involved in my profession at nearby University of California, Irvine Medical School.
Once I started commuting by bike, however, I felt that my hypertrophied legs should be aesthetically balanced by upper body development. So, I took up swimming at a local fitness center. When I started, I could only manage one lap in the pool (25 yards), but within a year, I could do 2 miles, with plenty of reserve for more.
Hence did I settle into a healthy routine: wake up early; bike to the fitness center; swim a mile; pedal to my office, put in a day's work; bike home.
The only minor inconvenience, if it can be called that, was that my partners grumbled that my bicycle occupied too much space in our supply room; it blocked staff access to splints and braces and slings, to casting materials and suture kits, to foot-pads and crutches. Reluctantly, I caved in and chained my bike to a water pipe in the public stairwell.
Thus, commenced act two of the saga. In the dead of winter, when the sun rises late and sets early, I commute in the dark. Under the circumstances, I was disheartened to discover one day that someone had stolen my bicycle’s headlight. Little did I know at the time — seething with anger — that this unfortunate event would change my life.
A new bicycle store had opened a couple of blocks from my office, so I headed over there to buy a headlight. I picked up a dandy-looking rechargeable unit with a powerful LED bulb. I noticed, however, that all their bikes were high-tech roadies — with neither cruiser nor mountain bike in sight.
Even more surprising, full body wetsuits hung on the wall, with adjacent display cases containing swim goggles and related gear.
"Hey, what kind of bicycle store is this, anyway?" I inquired.
The proprietor rocked back on her heels, puffed out her chest, elevated her head and proudly replied, "This isn’t a bicycle store; we’re a triathlon shop.”
“What’s that?” I asked stupidly.
“Our customers participate in races involving three events: swimming, biking and running.”
“You mean like the Hawaiian IRONMAN?”
“Exactly.”
"Are there enough people doing that to keep you busy? That's a grueling event."
She assured me, "Most races are far shorter."
I told her that I biked and swam every day, but I didn’t run. “Not to worry,” she said, “try aquabike, just swimming and biking.” She handed me a newsletter containing the scheduled events. I noticed, however, that aquabike races were few and far between, compared to the abundance of triathlons. So, I decided to take up running.
My first event was a reverse sprint at Fountain Valley High School in Orange County, a couple of months after my visit to the Tri-Zone store: a flat 5k run, 12 miles on the bike, and seven laps in a high school pool. My times weren’t great but I was exhilarated — and hooked!
I upped my training and tore my calf muscle. That set me back a few months, so I missed the Long Beach Tri, which should have been my first ocean race.
I recovered in time to participate in the Turkey Trot triathlon, my first USA Triathlon Sanctioned Event. I learned I must join USA Triathlon to participate, either by paying a one-race-only fee or joining for a year. I chose the latter.
It was a wise decision. Not only did I receive an attractive magazine containing motivating stories — chockablock full of insightful training suggestions — but there were also equipment discounts galore through numerous vendors.
The race, however, proved challenging. The organizer’s website spoke of "gentle rolling hills," but they didn't seem so gentle after swimming half a mile in a cold reservoir and 14 miles on a bike.
Nevertheless, at the end, I stood on the podium, second to the only other athlete in my age group.
Imagine my delight a couple of months later, when I saw my name in USA Triathlon Magazine rankings. So here I was, the schlubb of bunk 22, now 60 years later telling friends and relatives I was a nationally ranked triathlete!
What bothered me the most about the Turkey Tri, I must admit, was being passed on the hills. Sure, they were one-third my age, but I knew I could do better if I trained harder.
I bore down on my training thereafter. I biked metric centuries; I competed in local 5ks and 10ks; I swam in the bay.
And I started training on hills. That’s when the blood appeared. I didn’t think much of it at first, Googling “runner’s hematuria” as soon as I finished peeing. It’s usually a benign condition, thought caused by rubbing of the bladder wall against itself during a run. The cure: have a bit of urine in the bladder before setting out, to keep the bladder walls from contacting each other.
Nevertheless, I mentioned the hematuria to a urologist buddy of mine at lunch the next day. He asked two questions: “How old are you?” and “Did you ever smoke?”
He told me that both my age and tobacco-use history were known risk factors for bladder cancer and insisted on a look-see into my bladder with his cystoscope. He literally grabbed my elbow before I finished my burrito and dragged me to his office for the procedure.
Thus, began act three of this saga.
Sure enough, I had a 2-inch wide tumor on the roof of my bladder that wouldn’t have bled had I not been running on hills, which causes the intestines to bounce on the top of the bladder. He excised the lesion 48 hours later under general anesthesia at our local hospital. The pathology report confirmed my friend’s suspicion: early invasive, high-grade cancer of the bladder.
There are several approaches to this disease, but many colleagues suggested that I head to a university medical center for the latest therapeutic protocol. It proved rough going: first a month of heavy-duty chemotherapy, followed by complete removal of the bladder, prostate and lymph nodes. After that, depending on the age and health status of the patient, one of three urine diversion surgeries are possible: ureterostomy and an external plastic bag; ileal conduit (where the surgeon creates an internal pouch from a loop of intestine for urine and the patient thereafter inserts a catheter into his or her belly button to drain the pouch); or a “neobladder” made from a loop of intestine similar to the ileal conduit, except the bottom end is hooked up to the urethra, allowing normal urination.
The neobladder operation is a major metabolic hit for the body, so most centers have an age cutoff of 75 years old, after which they won’t do the neobladder surgery. They made an exception for me because of my fitness.
Sure enough, the ordeal was as advertised: I lost 25 pounds, had no appetite for weeks on end, and couldn’t even climb the stairs at home.
I got a blast of good news, however, when I returned for my first post-op visit: There was no evidence of invasion of the tumor past the shallowest level of muscle, no tumor cells in the lymphatic or blood vessels, and all 45 removed lymph nodes were free of cancer. In fact, the university’s pathologist downgraded me to carcinoma-in-situ, with a full life expectancy.
When I heard that, I decided to look ahead to the next Turkey Triathlon, six months away. At first, my maximum walking distance was half a block, I couldn’t stand up I the shower without leaning on the walls, and I lost my taste for jelly donuts, among other things.
During the next couple of months, however, I slowly regained strength. By having a target date for my next triathlon, I recovered faster than expected, according to my surgeon and his staff. I’ve already participated in a 5k run, although my time proved a bit embarrassing.
So, in more ways than one, triathlons saved my life. First, by being in good shape for my age, the surgeon went for the whole shebang, constructing for me a neobladder, even though, in general, my age group usually gets a lesser procedure.
Second, training on hills for the Turkey Tri brought my condition to light many months — perhaps even years — before it ordinarily would have appeared, allowing discovery at an earlier stage.
And third, by targeting a forthcoming race during recovery, I advanced faster than expected.
But for that stolen headlight, I never would have wandered into the Tri-Zone store and become involved in this challenging sport.
Thanks, thief, whomever you are; I owe you one!