I set out on one of my beautiful rural road bike routes on the early evening of Monday April 22.  The next memory I have is waking up in the Emergency Department of the University of Tennessee Medical Center- from which I pieced together how I arrived there.
I ride with my cell phone and use the Beacon feature of the Strava app which allows my wife to follow my progress on her phone - which stopped about half way through.  She called my phone and reached a very  kind Good Samaritan (actually one of at least two) who found me unconscious by the side of the road and called the police who in turn called an ambulance.

The police report indicates that I stated that I fell off my bike on West Bull Run Valley but could not describe why.  I'm told I was repeating myself a bit.  I was happy to see that the UTMC documents at least referred to a " very pleasant 67-year-old male" and "a good historian". 
I had a series of physical and mental examinations which yieled no remarkable suprises to attend to.  At 10 PM a CT's of neck, chest adbomen and pelvis were unremarkable - however CT of the head revealed:
      Subarchnoid hemorrage
      Subdural hematoma
in addition to face lacerations and scraping of the hands and side.  I was scheduled for a follow up at 4 AM to see if my situation would stabilize and allow me to be discharged.
On return to my room - my wife and I settled down to a long series of "Murder She Wrote" episodes on my TV.  I was then wheeled in for a second CT without contrast:

I was then discharged and Kathy drove us home.  I had a bit a room-spinning when rising from sleep which is subsiding.  My wounds are scabbing over.  Soon I'll bring my bike in for a once over and see if I'm ready to get back in the saddle.

In January I drew blood for a new molecular residual disease test - Signatera . The test detects circulating tumor DNA.   The first results take about 8 weeks because genetic analysis of your tumor is needed to inform the analysis.  The predictive power for treatment response appears quite impressive.
I was informed today that my test results are negative - which combined with the news from the previous post would indicate that my first line treatment is working very well.
I am scheduled to begin a 6th cycle of treatment (Keytruda/Padcevv) next Friday and will discuss next steps with my medical oncologist.
In addition to hair loss, I've started to have a runny nose and a bit of taste change.  Claritin did a fine job of clearing up the runny nose.

On March 6, 2024 I had a first PET/CT follow-up after 4 cycles of treatment with a combination of Keytruda and Padcev.  It took a bit of courage to press the button on my patient portal to bring up the radiology report which was available the next day.  My first PET/CT on November 11, 2023 showed very active pelvic  lymph nodes and changed my staging up to Stage 3 or 4 disease.
The news couldn't have been much better - the lymph nodes were no longer showing evidence of disease and there was no evidence of further spread.  As noted in the previous post when I had surgery in January no evidence of recurrence of the primary tumor was seen inside the bladder.

I attribute this to God's grace:
By the skills and persistence of those who developed my cancer treatment.
By those who participated in clinical trials to motivate accelerated approval of this treatment by the FDA.
By Medicare which allows me to afford and take advantage of this treatment
By my care team at the University of Tennesse Cancer Institute who arranged for and guide my treatment.
By my fasting regimen which I believe minimized adverse effects of treatment and may have contributed to treatment efficacy.
By the privilege to participate in the development of PET/CT at CTI/Siemens which found and monitors the presence of my cancer.
By prayers offered for me by so many family and friends and my church family.

I will continue treatment to see if my response is durable.  In January I gave a blood sample to run a new test - Signatera.  The first test uses DNA from resected tumor to inform bloold analysis which detects circulating tumor DNA to identify if there is any molecular evidence of residual disease.  This will complement my next follow up PET/CT.