Friday, October 7, 2016 – I sat down in a chair in a room with six other patients as a nurse inserted an IV drip into the top of my hand. The room was full of medical supplies and machines and seemed a far cry away from my life as a professional cyclist. This was my first chemotherapy treatment for stage IV cervical cancer.
It took nearly seven hours. I went home late that afternoon, supplied with medication to alleviate the nausea and felt dazed. The next morning I woke up feeling like I’d been hit by a bus. Little did I know that with each treatment over the coming seven months I would feel even worse. Whilst my stomach made a little flip of nervousness on that first morning, I remember thinking back to a horrific cycle accident I’d had in 2013. Then I’d been put in ICU for over a week and spent a further week in hospital. That experience, ironically, had prepared me for the endless scans, operations and tests I’d encountered during my cancer diagnosis. It meant I was more relaxed in a hospital environment and understood the need for patience and determination in the long period of treatment and recovery ahead. Mentally I knew I could draw upon the strength I found then to get through the chemotherapy treatment and associated side effects.
When I started my cancer treatment a number of people said to me they hoped my experiences as an athlete would help me face the challenge ahead. In the same way as I reflected back on that first morning of treatment, now, over six months into chemotherapy, I have had more than enough time to think about how true this has been.
Cyclists generally tread a fine line between being healthy and getting sick because hard training can depress the immune system. This is why you often see hand gels at the dinner table at races and many riders will avoid public places, young children and public transport before important races. Chemotherapy works by killing the fast dividing cancer cells but it also affects healthy body tissues, where cells are constantly growing and dividing, including the bone marrow. This means the immune system is seriously compromised. I’ve really struggled with neutropenia (a low level of neutrophils or white blood cells) following treatment, which places me a high risk of developing an infection. For this reason I haven’t travelled anywhere, been to the theatre, cinema or shopping and only on rare occasions have I gone to a café or restaurant. It sounds a bit boring – and it is – but in reality so can being a cyclist at times. As an athlete avoiding infection is critical so you can race your priority events. As a cancer patient getting an infection can be life threatening. I spent a night in hospital on a drip with a temperature of 38.8°C – fortunately the antibiotics kicked in and I made a quick recovery.
Nutrition and diet is a critical component of any cyclist’s training programme. Not only is it important, to ensure you are adequately fuelled to train effectively, you also need to make sure you are taking in the right food sources to recover and stay healthy. When I was racing I spent a lot of time focusing on my diet and this knowledge has helped me as I try to make sure I have enough calories and the right sorts of food to get me through the treatment. When I was racing I was always hungry so, one of the hardest things I’ve found with the chemotherapy is the loss of appetite and the change in flavour of many of my favourite foods. I still focus on a healthy balanced diet with lots of nuts, seeds, fruits, vegetables and fish. I avoid processed foods and try to limit sugar, which is not good for cancer patients. Ironically I’m a great weight for climbing now – just lacking the muscles I used to have.
Interval sets are, of course, part and parcel of training as it stimulates physiological adaptations and makes you fitter. I’ve tried to see my eight sessions of chemotherapy as ‘big intervals’. When I was training I had to accept that my intervals didn’t always go to plan and that sometimes I needed more time to recover before I could do another interval session. This has been the same with the chemotherapy and many of my treatments have been delayed by a week or more because my immune system has not recovered sufficiently.
One of the least glamorous parts of being a cyclist is having to pee in front of an anti-doping officer to provide a sample for testing. This can be after a race or during training when an official can arrive at your house unannounced (although usually during your allocated testing slot). During my treatment I’ve lost count of the amount of urine and blood samples I’ve provided. My blood is tested to see if my white blood cells have returned to a level suitably high enough to undergo treatment and my urine to check my kidneys are still working well. At least now I can pee in privacy!
Receiving your race schedule is an exciting time at the beginning of the season. Armed with colour pencils and a calendar I’d plan out the year ahead. Races, training blocks, times to see family and friends, short recovery breaks and the ‘offseason’. Invariably things changed but having a plan was important. Now my calendar is full of medical tests, appointments and chemotherapy treatment dates. I plan my life around these knowing that, for a week after treatment, I won’t be up to seeing people or doing very much. In contrast, two weeks later I know I’ll be feeling much more normal again and can plan some longer bike rides and meet with friends (so long as they are healthy!). Just like with cycling the goal posts always seem to shift, treatment is delayed and I have to cancel meeting people. Sometimes the timing is less than ideal – like the delay to treatment in December, which meant having chemotherapy two days before Christmas. I had toast for lunch.
Life as a professional cyclist is all consuming. It isn’t a job it is a lifestyle. From the moment you wake up your whole day is centred around doing what is right for you as an athlete; eating the right things, training the right way, resting and sleeping sufficiently and at the right time. It is, in many ways, incredibly self-centred and I often felt quite decadent but, in reality, an athlete’s body and well-being is essentially the equivalent of a business. You have to do what is right for it to enable it to run optimally and be successful. This often means missing social occasions and having to be quite selfish at times. One of things I was looking forward to in retirement was being able to be much less self-focused and give more time to other people and things. Unfortunately having cancer is just as consuming. It is the first thing I think about when I wake up. When I look in the mirror, a bald head and eyebrow-less face, which I don’t recognize as me, stares back. In the quiet times on the bike it is hard not to think about what is happening to me. When I’m with other people or on my phone or laptop I’m talking or answering messages about how I’m feeling. I still have to think about what I’m eating and doing and how well I’m resting in order to stay as fit and healthy as I can. When I go to bed at night it is hard to push the thoughts of having cancer out of my head.
When you consider how many cyclists make it onto UCI teams, how many cyclists are at a race and how few UCI races there are, it is clear that winning a UCI race is a pretty rare event. I’ve been given a poor prognosis of surviving my cancer because of the extensive spread and the type of cancer I have. Whilst, of course, there are times I just feel despair I try to look at it in the same way as I did my cycling career. I wasn’t a bike rider just to take part or to make up the numbers – I wanted to win and be successful. Every cyclist dreams of that moment of crossing the line first – with their hands in the air. It happens to very few but we never give up trying, training hard and seeking those elusive magic few seconds. Statistically I was unlikely to become a professional cyclist -let alone at the age of 34 with no background in cycling, go to the Olympics in my first year of racing and become National road race champion at 38. I never had a ‘big’ UCI win but I did once win a stage in the Tour of Ardeche and I did make the podium a few times. So in those darkest moments, when I feel like curling up into a ball and crying, I just think if you’d have asked me 10 years ago if I was going to be a professional cyclist I would have laughed. So I’m just hoping it is the medical profession that I surprise next.