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Outside magazine, April 1998

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Tour de Revenge (cont.)


	(Frank W. Ockenfels)

The following week, surgeons operated for two hours to remove the masses from Armstrong's brain. By now he was entirely in IU's hands and proving himself an exceptionally resilient patient. With Stapleton arriving, like Jerry Maguire, to attend his prize client, Armstrong remained in Indianapolis for three more weeks to receive another round of chemotherapy. Over a period of two months he would undergo a total of four rounds the highest number prescribed for such patients, given only in the severest of cases.

Armstrong's treatment was tailored to help him to return to racing. IU's preeminence in treating testicular cancer results from its pioneering use of cisplatin, a highly toxic derivative of platinum, in combination with two other antitumor drugs. One of those, beleomycin, can damage the lungs. In deference to Armstrong's career, his doctors opted to substitute another drug, ifosphamide, that would be gentler on his lungs, but the treatment involved a therapeutic trade-off: Ifosphamide was known to be toxic to the kidneys and bone marrow.

It was after the third round of chemotherapy that Armstrong reached his lowest point. He was fatigued, dizzy, nauseous, vomiting. He lost all his hair. His hematocrit, the percentage of total blood volume comprising mature red blood cells, fell to less than 25 (46 is normal), an alarming drop for any patient but one that had special implications for Armstrong. Cycling has been ravaged in recent years by racers attempting to boost their hematocrit and thus their ability to deliver oxygen to their muscles by taking the red-cell-enhancing drug EPO.

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Numerous riders known to be taking EPO have died of stroke or cardiac arrest, their blood having become so thick that their hearts simply could no longer pump. Armstrong's oncologists gave him Epogen, a brand of EPO, to raise his hematocrit, knowing that this use of EPO, which is banned by the Union Cycliste Internationale and the International Olympic Committee, might raise suspicions if and when he returned to racing, though Armstrong himself had no qualms. "If anything, I've got a manhole cover attached to me," he says, dismissing the notion that his using Epogen might give him an unfair edge. "A year of chemo and platinum is hardly a boost." (It was perhaps unsurprising that Epogen's manufacturer, Amgen, was among the sponsors at the oncology meeting at the Four Seasons, along with nine other drug companies.)

By mid-December, Armstrong's treatment had run its course. His chest X rays were clear, and his blood markers were getting back to normal. Nichols told him he had a better than 90 percent chance of staying that way. He also told him that he expected Armstrong to "get back to 95 percent" of his former condition, though he conceded that doctors at IU had no experience with a patient at the "edge of capacity" like Armstrong.

Returning to Austin, Armstrong immediately started to ride. As a professional cyclist, he had never been off of his bike for two weeks, much less two and a half months, and though he was in pain, he was pleased to discover that he simply felt out of shape. "I didn't feel broken by the chemo," he said. "I didn't feel like a cancer patient anymore. I felt reborn."

Armstrong's recovery was genuine, and he was clearly impatient to get back on the career track from which he'd been so rudely derailed. But he had another, equally compelling reason to return to his bike: his Cofidis contract. He still hadn't ridden for the team, and as the 1997 racing season began, team officials wanted to know whether they could count on him. Armstrong's agreement with Cofidis was subject to a medical examination he had yet to take when he was diagnosed with cancer. Now Cofidis asked that he be examined by its doctors, a not unreasonable request, especially considering that the company was paying Armstrong $1.25 million a year. But Stapleton would have none of it. "They forced our hand," Stapleton contends. "No way were we going to let them subject Lance Armstrong to a medical examination in front of the world. At the end of the day, we struck a deal. If Lance didn't ride in four races in 1997, they had the right to terminate his contract."

Armstrong seemed determined to resolve the question of his fitness sooner rather than later. In early January, less than a month after leaving the hospital, he flew to France to take part in a media presentation of the new Cofidis team, surprising team officials who hadn't expected him to be there. He trained briefly with the team. Then he returned to Austin, riding hard for up to four hours a day throughout February and March. Piston-legged and sinewy at 165 pounds ten pounds lighter than before treatment he rejoiced in his regained strength. Eventually, however, he lowered his sights, saying he'd be happy just to compete in 1997 as an also ran and then, in mid-April, announcing that on doctors' orders he would take the rest of the year off.

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