Thursday, July 29, 2010

my latest bizarre malady: bikers nodule or perineal nodular induration

So I've mentioned saddle sores a few times on this blog.  To be honest, as much as I am in love with bikes, my crotch has never had much  love for any bike saddle.  The list of the saddles I have tried reads like a who's who of elite race saddles:

WTB Speedshe
Sella Italia Trans Am
Terry Damselfly
Fizik Pave
Specialized Body Geometry 130mm
San Marco Aspide
WTB Rocket V
Fizik Aliante
Selle Italia SLR GelFlow
Selle Italia SLR XP
Selle Italia SLR Gel Flow LDY
Selle Italia Diva Gel Flow
Fizik Vitesse
Selle Italia SLR T1
Selle Italia SLC Gel Flow
Selle Italia SMP Evolution
Selle Italia Max Flite Gel Flow Team Edition

One day a few years ago I was talking to Colin about it and he suggested the Terry Liberator.  I purchased the saddle, and it was the most comfortable one I had tried.  After several rides with it, it did not hurt me in the front or the sides, so I went with it, on my road and my mountain bike. 

Our relationship was somewhat tumultuous (that is me and the saddle, not me and Colin)  I'm not sure if I was born this way, or if this is a result of my femur being deeper in my hip socket on the left side, but there is a tad more flesh on my left perineum than on my right.  This has caused a lot of discomfort on longer rides and a slew of saddle sores, always on that left side.  Usually my misery peaks in the spring and by the middle of the racing season it bothers me less, perhaps because I have beaten into submission I'm just not sure.

At any rate, suddenly this year the Liberator was not working anymore.  It was hard to get through even short rides, whether I was wearing the new improved Voler team shorts, or my Assos shorts.  It was all pretty miserable.  Going into Marysville I was wondering how I was ever going to get through 9 hours on the saddle. 

Marysville weekend: Saturday evening at the camp as I was showering off the grime off at the Oesterling's, as the water washed over my peach I let out an audible, "ouch."  I inspected the area and was pretty much horrified at the swelling I saw, I have never seen anything like it in all my years riding bikes and beating up on my peach.  Of course that did not stop me from racing the STXC the next day but it was a stage race after all, I could not get a DNF for the stage.  Almost unbearable pain during the race.  When this swelling got even worse in subsequent days, I called my gyno and made an appointment to have it drained.  Dr. Barsoum stuck a needle in it, then cut a hole in it, in an attempt to get it to drain.  But there really was very little fluid in it, it was more like hardened tissue, like a callous.  So a few days later I texted Steve Collina, MD, my sports med doctor who I pretty much could not live without at this point. We used to be teammates on the now defunct Biketopia team.   And yes, he is one of the docs I have on speed dial due to my various maladies.

He stuck it first with lidocaine, and then multiple times with cortisone.  Over the next several days the swelling went down, enough that I stupidly decided to race the Summer Sizzler (GCC) after all, as I had been off the bike since Marysville 9 days prior.  The day after GCC was the beginning of the Week From Hell, and the cyst was very angry so I saw Steve Collina and got it shot again.  We realized that we were buying time and I needed to think about two or three weeks off the bike if the shots did not elicit immediate improvement.  There was some improvement, but the hard capsule was still there even when the swelling subsided a bit.  I did ride Belmont with Nate Thursday and commuted to work on Friday, just to try and preserve my sanity.  By the end of the day Friday I could not walk without pain and riding was unbearable.

Nate had come up from Georgia to race Fair Hill with me.  He spent all day Saturday servicing and cleaning the bikes, and to be honest I never ever saw the Yeti so clean.  He then cut holes in my two saddles, as I got up on the trainer and gingerly tried to fit my cyst in the hole in each one, so that I could attempt to finish the 50 mile race. However, Sunday morning my dog was dying, and we skipped the race so I could spend half of the day at the Matthew J. Ryan Veterinary Hospital at UPenn weeping as I said goodbye to my poor suffering cancer-ridden Gryphon.  (Yes the worst day of my life, and that includes the day I got run over by the truck last July,  the day I crashed into the guardrail at 90 mph that night in 1998, the day my beloved grandmother died 2 years ago on August 1st, and the day I discovered that I had a rare disease of the conduction system in my heart that would eventually kill me if I did not let them rip open my chest and install my little black box.) So no Fair Hill for either of us.

When I went to see Dr. Colina Monday the 19th, he took one look at the cyst and said, "I cannot believe you rode on this."

The nurse, who is also a cyclist, turned her head when he stuck the needles into the body of the cyst, which by this time basically had its own zip code it was so large.  I tried not to jump off the table.  I try not to move during these pain situations, like the time they stuck a needle in my neck in an attempt to find the nerve bundle that when stuck would make my arm go dead before they opened up my shoulder in December for surgery #5.   I like the challenge of showing no pain in these situations, but this was my peach after all, so I did wince a bit.

So basically the plan was now to use ice to try and diminish the localized swelling.  The cortisone would hopefully help shrink the hard capsule, but if it did not I needed to be off the bike for at least three weeks. I iced it for 3 days straight.

So Steve finally gave me the name of this little atrocity: perineal nodular induration, which is  rare complication that usually only affects elite or professional male cyclists.  Of course, since apparently the "W" in Walheim  stands for "worse-case scenario", and my season after all had been going pretty well from my comeback after 2 years of medical problems, I was overdue for some rare malady to show up and rain on my parade. 

The perineal nodular induration is sometime called the biker's nodule, or, when it occurs invariably in men, the "third testicle."  Yeah, I swear, gross.

At this point I have been off the bike for two weeks, and the nodule has grown larger, not smaller.  It now hurts to walk, and it is painful to sit in my chair at work.  I have been going to the gym and running to preserve my sanity.  It completely sucks, especially since Nate is coming up to the the Wilderness 101 and I get to go up there for the weekend without my bike to support him and whine about not being able to ride.

The nodule looks like something out of the x-files.  There is no broken skin; which is the scariest part, because it looks like it's part of me, but it's not.  I made an appointment with a urogynecologist-surgeon so I could get an idea of what would happen when they cut this thing out.  The problem is it is so large there won't be anything left on that side to cover my bones so I have no idea how I'm ever going to ride a bike again. In the literature I have read it usually presents as 3 centimeters and this one is 7 and growing.  It is likely infected, so I see a gynecologist tomorrow to see what her recommendations are.  Colin thought I might want to go to the ER tonight but I think I can wait it out until Friday.   This one is really scaring me.

So here is my new ride:  A sweet recumbent model with a built in HRM.  Yeah, it's not carbon, but at least I don't have to drag it up any hills.


Anonymous said...

Hi there, my partner is currently suffering from the same problem - the nodule had been there for about 4 yrs (left side, like a third testicle), and recently became infected. He was treated with a godawfal double-dose of Augmentin which reduced the swelling. Drainage didn't work either and so he's off to the urologist today to plan the next step. Hope your problem gets resolved soon and thanks for the post - took us ages to figure what on earth the "egg" was and your blog helped.

andrea walheim said...

Problem got resolved with 2-3 months off the bike and some abx. I'm super careful about saddle adjustments (a few mms off and you can develop this) and I do spend less time in the saddle as I do more cross-training now. The fastest way to heal is to stop all riding until they are gone. Good luck! A

John said...

Would you like to try one of our saddles? They don't appear on your 'Who's Who' list of tried saddle brands and they're quite different...... specially designed to relieve any kind of perineal trauma. See
John, Proprietor, RIDO, England

Anonymous said...

Bikers nodule isn't anything life threatening right?

Ion-Christopher DiMeglio said...

Nice Wrighting! Sharing from your life. And, I hope you are doing amazingly well.

So, this might be a help for some saddle-friction maladies. I have found two layers of rayon or silk come pretty close to eliminating friction, while one layer will still cause irritation. The difference is hard to quantify because you have to compare it to something specific - there are some pretty good shorts and undies out there. In any case this can probably save some money over stocking up on $20 under-wear.
I just cut a cheap rayon scarf into three and fold a piece in half and tuck it acoud the package and pull cotton briefs up and it works about as well as my best ever did.