Cancer fails to put brakes on bicyclists

THE BALTIMORE SUN

Ted and Colleen Garringer had always dreamed of cycling cross-country when they retired. So two weeks before Ted was to leave his job, he visited his doctor to get clearance for the trip. A blood test would soon turn up shocking results: The fit, 55-year-old cyclist was suffering from a form of non-Hodgkins lymphoma, a cancer that kills 23,000 people a year.

"We were called into the doctor's office on the day Ted retired," Colleen says.

But rather than hunkering down in a hospital, the Garringers followed medical advice from cancer specialists and proceeded with their eight-month, 5,000-mile bike trip.

Surprising? Maybe not. An estimated 9.5 million Americans are cancer survivors -- individuals who have been diagnosed with cancer at some time during their lives. Another 1.3 million people will be diagnosed with cancer this year. Some are undergoing treatment, others are cancer-free. Still others are living with the disease.

"It used to be that cancer was a death sentence," says Eric Miller, of the American Cancer Society in Atlanta. "But that's not the case anymore."

Many cancers such as lung, colon and breast cancer require immediate, aggressive treatment, and early detection is one of the biggest factors in curing patients. But with some low-grade cancers like Garringer's, and others including leukemia and prostate cancer, doctors take the opposite tack. They advise a "wait and watch" policy to monitor the diseases, treating them like chronic conditions rather than acute illnesses.

A study published in the medical journal The Lancet in August gave credence to this approach. The study found that delaying treatment is an appropriate strategy for some advanced, low-grade non-Hodgkins lymphomas, if symptoms have not developed or health has not been compromised. (Some low-grade prostate cancers are also being treated this way. Doctors use blood-screening tests to determine which prostate cancers are slow-growing, enabling them to hold off on unnecessary treatments.)

"There is a point at which we do consider aggressive treatments with curative intent" for lymphoma, says Dr. Lode J. Swinnen, an oncologist with Johns Hopkins Kimmel Cancer Center who consulted with the Garringers. "But we don't want to subject patients to these higher-risk treatments if they aren't justified yet. We usually wait until we have a better sense of how the disease is behaving."

"Your first reaction is that you should be doing something about the disease," says Colleen. But after consulting with their doctors, the couple decided that waiting made more sense.

The road ahead

The Garringers are currently based in Smithsburg, near Frederick in the Catoctin Mountains. Ted hardly looks sick. He has a few swollen lymph nodes in his neck and an occasional night sweat. But his 5-foot-11, 190-pound frame is muscular, and he maintains a healthy appetite from all that cycling.

As with other lymphomas, some of his white blood cells -- called lymphocytes -- have undergone a malignant change. Eventually they will start to crowd out healthy cells, creating tumors that enlarge lymph nodes or form tumors on places such as the brain or bones. Fortunately, Ted's type of lymphoma is extremely slow-growing, and his doctors are closely monitoring him.

The couple named their cycling trip Fools on a Mission because they're hardly adventurous. In fact, they claim to have never done anything daring. They married young. Ted was 20, newly enlisted in the Navy. Colleen appeased her mother and held the wedding one day after her 18th birthday.

They eventually settled in Mystic, Conn. Ted was a drawbridge operator. Colleen worked her way from secretary to marketing director at a mail-order film company. They raised a daughter, Corrie.

"I always wanted to travel," says Ted. "Of course, watching boats all those years, I wanted to stay on land."

He took up cycling with his daughter. When she left for college, Colleen got a bike. That was about 10 years ago. Somewhere along the way, Ted got the idea to cycle cross-country. Colleen started to plan the trip; they saved $30,000, and as Ted's retirement neared, they sold their house and made plans to move to Colleen's mother's home in Smithsburg.

Then they learned about Ted's cancer. Worst case, his doctor said, he had anywhere from two years to 10 years to live.

"I went in there thinking I had been bitten by a tick or something," Ted recalls. "I didn't even know what a white blood cell count was."

The couple went ahead with the move to Maryland, contacting doctors at the John R. Marsh Cancer Center in Hagerstown and at Johns Hopkins. In both places, specialists advised them to hold off on treatment.

"People can go for years with an excellent quality of life," says Dr. Michael McCormack, of the John Marsh center, "if they don't go crazy about the cancer. That's the biggest hurdle."

For Ted, the illness deepened his resolve. "I figured it was all the more reason to go."

Adventure begins

In January, he and Colleen drove to Savannah, Ga. They set out on their 21-gear Trek bikes with three changes of clothes each, a laptop computer, cell phone, digital camera, tent, two sleeping bags and only a vague idea of where they were headed. Their only commitment: a promise to family members that they would update their Web site, foolson amission.com, each night.

The Web site took on a life of its own. As they biked south through Florida, Colleen wrote nightly updates online. Ted provided the pictures.

They developed a following as they traveled north along the Natchez Trace Trail from Mississippi to Tennessee. They met a teacher on the road who had her class click on foolsonamission.com daily to learn about geography.

In all, 175 people signed up to cyber-ride along with foolsonamission, receiving automatic e-mail updates. The Web site received about 100 hits a day.

In April, the couple took a break to drive home for a doctor's visit. Ted's blood looked good. They filed their taxes and then hit the road again. This time, they traveled west through West Virginia, Ohio, Indiana, Illinois and south to Arkansas. In July, Ted got clearance from his doctor to continue pedaling.

The couple returned home earlier this month. Colleen, the numbers cruncher, says they covered about 45 miles a day and spent an average of $85 daily on food and lodging. In all, they cycled 5,821 miles.

The couple will be in Smithsburg through January, in part for their daughter's wedding. Then they will leave for another cycling adventure, to tour the Western United States. They expect to be gone for a year, with trips back for blood work and doctors' visits about every three months.

Ted shows a visitor how he and Colleen will pack for a year on the road, in two panniers on Colleen's bike. He'll pull the rest in a trailer behind his bike. "You hardly notice it's there," he says, "unless, you're going up a hill."

The Garringers know they face inclines ahead.

But for now, they're looking forward to cycling through the Badlands, seeing Mount Rushmore, standing at the edge of the Grand Canyon.

"The best part," Ted says, "you never know what's around the next bend."

Blood cancers

According to the Leukemia & Lymphoma Society, an estimated 670,000 Americans have blood cancers, which include leukemias, lymphomas and myelomas.

There are more than 30 different types of lymphomas, including non-Hodgkins lymphoma, the fifth most common cancer in the United States. Non-Hodgkins lymphoma represents a diverse group of cancers, classified as low-grade, intermediate-grade and high-grade. The distinctions are made based on the characteristics of the cancer cells. The "watch and wait" policy is used only with low-grade lymphomas, which progress very slowly.

The Leukemia & Lymphoma Society operates an Information Resource Center, staffed by social workers, nurses and health educators, to answer questions about blood cancers. Contact the society at 800-955-4572; www.lls.org.

Contact the American Cancer Society at 800-227-2345; www.cancer.org.

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