2018 Rossini Festival

This weekend I went to the 17th annual Rossini Festival International Street Fair.  It’s a celebration of the performing arts in downtown Knoxville.

The proximate reason I attended was because Knoxville Community Band had a short concert in the morning.  We played the following songs:

My vantage point:

Getting ready to play “Napoli”:

This was our first performance of 2018.  Overall, I think we did well.  There was a bit of a rough patch in “Napoli,” but a casual listener might not have even noticed it.  Our director, Mr. Larry Hicks, seemed pleased with our efforts.

I spent the rest of the morning/afternoon roaming about catching the sights, sounds, and smells of the festival (though frankly, I thought much of the fried food smelled and looked disgusting).

Performance by Pellissippi State’s vocal ensemble, Variations:

Thousands of people pack Gay Street.

It was great to see so many people out enjoying music on a pleasant spring day.

The festival is wonderful because you can conveniently sample many different musical genres.  Ordinarily, I probably wouldn’t go through the hassle of attending stand-alone concerts to hear all of this music live, but this day makes it easy.  I enjoyed a brass ensemble, a string quartet, interpretative dance, a choral group, opera singers, kids playing violins, and a jazz band.

Rossini Festival is one of my favorite Knoxville events.  I look forward to experiencing it again next year.

Palindromic Rheumatisms

So far 2018 has been a physical challenge for me.

The year got off to an inauspicious start.  On January 10, while I was riding my bicycle, I felt a sudden pain in my left knee.  It subsided for the rest of the ride, but over the next day it became apparent that something wasn’t right when I bent my leg.

You may wonder–how could someone injure a knee peddling a bicycle?  It’s a non-impact motion.  But in 2016 I fractured upper tibia, near the knee.  Moreover, due to long-term glucocorticoid use, my bone density is below average (osteopenia).  I’m more prone to get bone fractures.  The discomfort I felt was reminiscent of that previous injury.

So, to be prudent, I decided to keep weight off my left leg.  I used crutches and a knee brace.  My knee started feeling better.  After a couple weeks of “rest,” it felt solid enough that I shed the crutches for a couple days.

Bad call.  I re-aggravated it either through overuse or by carrying extra weight.  It felt worse than before.  I resumed using crutches/knee brace and finally made an appointment to see the orthopedic doctor.  The knee felt so fragile I was worried there was a crack and I’d need surgery to fix it.

Surprisingly, at two exams (first using X-ray, then an MRI) the doctor didn’t find any fractures.  My knee was basically intact (the MRI did reveal a tear in my meniscus, but this alone could not have been the cause of my discomfort).

I was relieved to learn that my knee was “okay.”  But the good fortunate I felt from my positive diagnosis soon evaporated in the face of my greater nemesis: rheumatoid arthritis (RA).

Although my knee movement continued to improve, the swelling did not go away.  To the contrary, system-wide, my joint inflammation was getting worse.  Why?  Because the Enbrel I was taking to combat RA was losing its effectiveness.

At my rheumatologist appointment on February 22, we decided to stop the Enbrel treatments and try a different bioloic drug, ACTEMRA.  It’s now been almost six weeks since I started taking Actemra and I have yet to see much of a reduction in inflammation.  Typically, in patients where the drug does work, symptoms improve in 2 – 12 weeks.  So the jury is still out on whether it will help me.

In the meantime, I’ve been relying on ~20-25 m.g. of prednisone (per day) to maintain my joint flexibility.  It’s not a great option–the drug carries a host of side effects.  I’ve gained weight, become moodier, more easily frustrated, and can’t sleep for more than a few hours at a time.  It’s disconcerting to be wide awake after only two or three hours of rest.  I’m operating on about half the sleep I was getting in the fall.

But by far the biggest problem I’ve had in the last month is the emergence of painful hip flair ups.  I’ve had roughly ten episodes, mostly at night.  My rheumatologist said they may be palindromic rheumatism. They have a distinctly different character from my normal RA joint inflammation.

A full-bore attack is rapid and debilitating.  In the span of six hours, I’ve gone from normal walking to barely being able to move with crutches.  The pain is brutal and I lose my ability to move the affected leg.  It takes all the willpower I’ve got just to get in and out of bed.  When it hits, all I’m able to do is find the least painful position possible and wait for the drugs to start providing relief (two hours+).  I recommend avoiding this experience, if at all possible.

Not every day in the past month has been bad.  There are hopeful signs.  The “palindromic rheumatisms” are less frequent than they were.  After a two-month hiatus, I’ve resumed bicycling and have done several rides in the last three weeks.  A few days I’ve almost felt “normal” again.  And then, the next day, I don’t.  The uncertainty of not knowing what I’ll be able to do from one day to the next takes a toll.

Which brings me to the psychological challenge this presents.   At times mental obstacles are more daunting than the physical ones.  The biggest trap I fall into begins when I start to compare myself to other people.  This thinking leads to the inevitable human response: Why me?  I live a lot more healthfully than many other people.  I have a good diet, I exercise, I don’t smoke, I don’t drink, none of my close relatives have rheumatoid arthritis.  What did I do to deserve this?

It’s pointless question.  There’s no medical explanation for why I have this disease.  No one knows why.  I might as well just view it as bad luck.  Moreover, even if I could divine an explanation, it wouldn’t change my well being–I’d still have the disease.

It’s much more productive to focus on what I can affect.  The Greek Stoic philosopher Epictetus wrote:

We should always be asking ourselves: “Is this something that is, or is not, in my control?”

Beyond seeing a doctor and taking drugs, I have little, if any control, over the disease itself.  Some days I can barely control the symptoms.  All I can really control is how I react to them.

That being the case, the best response for me is to accept the disease, and its limitations, as matter-of-factly as possible.  When the symptoms aren’t being managed or are behaving erratically, I must adapt daily to overcome any problems they present.

To illustrate this in practice, here’s an example from last week.  On Wednesday I attended a seminar at the law school.  I parked several blocks away, where it’s free.  Due to procrastination and traffic, I reached campus later than I should have (something I could control with better planning).  My hip was recovering from an aforementioned “palindromic rheumatism,” so my walking was slow and labored (something I couldn’t control).

In short, I couldn’t walk fast enough to make it to the meeting on time.  I caught myself becoming aggravated at how long it took me to climb the hill, how haltingly I went down the other side, and how I could only go up the stairs one step at a time  (my attitude, which I do control).  As I limped along, some students passed me.  I had to stop myself from wistfully thinking about how I, too, once rushed about campus between classes (a change I can’t control).

Comparing my walk to that of others, or my healthy self, doesn’t get me to my destination any faster.  Nor does it improve my mood–to the contrary, it’s depressing.

All I can constructively do is to keep pushing forward, at whatever speed is possible.  Some days it will be faster, some days it will be slower.  Such is the ebb and flow of life.  We each march to the beat of our own rhythm, as we journey along our unique path.

This isn’t an easy lesson to learn, but it’s one I must master to maintain my equanimity.

“Sleepers, Wake!” [J.S. Bach, BWV 140/4]

Here’s a video of me playing trumpet with an instrumental ensemble at church.

We played part of Johann Sebastian Bach’s Wachet auf, ruft uns die Stimme (BWV 140), commonly known as Sleepers Wake.  The church cantata is based upon Philipp Nicolai’s 1599 hymn Wachet auf, ruft uns die Stimme, which is about the parable of the Ten Virgins.

The English coral lyrics to this movement, sung to the tune of the trumpet line, are as follows:

Zion hears the watchmen singing,
Her heart within for joy is dancing,
She watches and makes haste to rise.
Her friend comes from heaven glorious,
In mercy strong, in truth most mighty,
Her light is bright, her star doth rise.
Now come, thou precious crown,
Lord Jesus, God’s own Son!
Hosannah pray!
We follow all
To joy’s glad hall
And join therein the evening meal.

I enjoyed performing this with a group of talented musicians.

2016 Cherohala Challenge Ride Report

On June 18, I completed my 10th Cherohala Challenge. It’s an organized bicycle ride hosted by the Smoky Mountain Wheelmen. [For previous ride reports see 2007, 2008, 2011, 2014, 2015.]

The ride follows this route:

My 2016 mileage is way down from recent years, partly because I had a rough winter/spring with rheumatoid arthritis.  But I’ve done this event enough times to know what it takes.  When I registered I was confident that I was fit enough to conquer it.  And it turned out that I was.

Here’s the start/finish line (Tellico Plains visitor’s center).  The cyclists pictured are waiting to start the metric century ride.  I got a late start, departing about ten minutes after the main group of full century riders left.

As a result, I didn’t see very many other cyclists the first 42 miles.

Cruising Tellico Plains.

Leaving the Plains.

About ten miles into the day, not far from this photo, I came across a group of cyclists huddled on the road.  Unfortunately a female rider had wrecked, in an incident that may or may not have involved a dog (I heard conflicting reports afterwards).  She was taken to the hospital, but I don’t think her injuries were extremely serious.

Frankly, I’m surprised I haven’t seen more crashes over the years.  The Challenge’s curvy roads and fast descents aren’t suited for inexperienced or distracted cyclists.  A brief lapse in attentiveness can result in disaster.

The first 20 miles are mostly country residential with a small dose of farmland.  I went several miles without seeing a vehicle on the road.

The route’s brief flirtation with civilization at Madisonville.  Pictured ahead, if I recall correctly, is the only traffic light in 113 miles.  I got a red light.

Crossing the Little Tennessee River.

Heading southeast toward the mountains.

If it looks like a beautiful day, that’s because it was.  You couldn’t have ordered more ideal weather: sunny (most of the day), a high of about 90F in the valley, not much wind.  Perfect.

When I got to Chilhowee Lake, my camera indicated the batteries were almost dead, so I severely rationed picture taking thereafter.  Thus I missed a number of good shots.  For example, I didn’t get photos of any of the”underwater” things that have been exposed by the lake drawdown.

I was feeling pretty good at mile 42 when I reached the Tail of the Dragon, with its famed 318 curves in 11 miles.  I finally started seeing/passing more cyclists.  It now felt more like a bicycle event rather than me riding solo.

There are several photographers who sit along the Dragon and shoot passersby.  Here are some of their captures of me:

Following a fancy car.

Do you think I caught these motorcyclists?

Nope.

My only complaint about this year’s Challenge regards rest stop #2, at the end of the Tail of the Dragon.  Usually they have a large array of food here–in fact, the last couple years volunteers served hot food.  But this year the station was dramatically downsized.  There were packaged snacks to meet my energy needs, but I was bummed because that stop is usually where I eat my “lunch.”

After entering North Carolina and passing Cheoah Dam, the road shadows the Cheoah River for about seven miles.  I used to view this section as just a stretch to get through on the way to something more exciting.  But in the last few years I’ve come to enjoy it more and more.  It’s so quiet in the river gorge.  There’s very little traffic, and the nearby ridges seclude you from the outside world.  This gradual climb is ideal for contemplation/reflection.

The last 43 miles of the ride are on the Cherohala Skyway.  Here’s what the climb looks like near the start of the 12-mile uphill slog.  It takes almost two hours of 6-8 m.p.h. grinding.

This is a high-effort, high-reward ascent.  There’s a particularly tough stretch (8-9%) leading up to rest stop #4 at mile 75, and this year did not disappoint.  Once again I was sweating so profusely that I could barely see when I pulled off the road to refuel and regroup.

I love this experience so much.  Many times throughout the day I looked about and thought, “I wish I could capture this moment and save it forever.”  Sadly, I could not.

Mile 82, the high point of the ride.  It doesn’t take much wind at this elevation to make me chilly.  But on this afternoon it was nice.

The last 30 miles are mostly downhill, but not completely.  There are two steep, mile-plus climbs for added suffering.  They’re elevated cramp-risk zones.

It clouded over when I got back into Tennessee.

To my dismay, my computer blanked out near the end of the 113-mile trek, so I didn’t get my riding time.  I finished at about 4:45 p.m.  Here I sport my finisher medal at the end of the day:

I’m glad I got to do this year’s Cherohala Challenge.  It’s epic.  And, with my joint issues, I no longer take being able to do this kind of physical event for granted.  I hope to cross the finish line again next June.