Saturday, September 22, 2007

Recovery - Weeks 4 to 8

Once I got home, the next 4 weeks were painfully monotonous.

Monday, Wednesday, and Friday I have been going to physiotherapy sessions that go for 1.5 hours. The first half hour usually involves some massage, stretching and range of motion exercises, especially in my knee. The last hour involves light weights and lots of leg exercise. Over weeks 4 to 8 we were slowly able to get the range of motion in my knee up to around 110 degrees. There was a lot of painful pushing and bending required to get it done, but eventually it got there.

The first couple weeks home (recovery week 4 and 5), Carol was generous enough to take time off work to look after my needs. With no way to walk on my own, no way to drive and no real capability of carrying anything I was pretty much dependent on her to keep me alive.

The third week (recovery week 6) my Mom came down and took over the role of caregiver. Rich and Christy were also down during the week, so while I wasn't up for any sort of big outings, we did get to go out for dinner every now and then and play some cards in the evenings. With me out of commission, Christy and Rich were able to visit all the local attractions on their own.

Week 4 (recovery week 7), Christy extended her stay an additional week and took over the role as my personal assistant.

Once I got to the start of recovery week 8, I was allowed to increase my max hip angle from 60 to 90 degrees, i.e. I could finally attempt to sit up in a chair. From there on out I started driving myself to the physiotherapist. At that point the biggest goal shifted to increasing the flexibility in my hip. My left groin was incredibly tight, my left hamstring a little less so. So each time I went to the physiotherapist, the first 30 minutes was a ton of pain as I was pulled and stretched well past what was comfortable.

Sunday, September 16, 2007

Recovery - Week 3

Week 3 was quite a bit different than my previous weeks in the hospital.

First, the rehab floor had a dining room. It was pretty common for folks to head down to the dining room for meals. Conveniently, the dining room was also right next door to my room, so I didn't have too far to go. I'm not the biggest morning person, so I didn't always make it down there for breakfast, but I was there for lunch and dinner most days. Getting up, into my wheelchair and out to eat meant that I spent a little more time sitting up and gave me the chance to be a little more active.

Second, as previously mentioned, the rehab floor has a dedicated staff of occupational and physio therapists.

In the beginning my sessions focussed mainly on trying to get some basic strength and motion back into my non-injured leg and upper body. Having been in bed for so long, I had a lot of stiff under-used muscles. As the days progressed, we began to focus a lot more on the range of motion in my knee. I had orders from my knee surgeon that would allow me to bend my knee up to 40 degrees.

When we first started working on range in my knee I was able to bend it about 10 degrees. Over the course of the week, we eventually got up to 40 degrees. If you haven't ever had a joint injury where you've had reduced range of motion, trying to get it back is pretty tough. In my knee, all my leg muscles were tight, tense and stopping my knee from bending. There was also a lot of scar tissue that had grabbed onto my knee cap, and that needed to be worked loose. One of the ways that I worked on getting motion back into my knee was via a CPM (continuous passive motion) machine. The machine I had in the rehab unit was mounted to my bed, so it was really easy to get on when I had time. I was supposed to put in 6 hours per day and go up by 5 degrees per day.

Basically you strap your leg in to the machine, set the speed and angle of motion, and it then slowly bends your knee up and down for you. If I did a good job of staying on task I could get 2 hours in before breakfast, 2 hours after lunch and 2 hours before bed. Pretty darn boring, but certainly no more boring that laying there like a lump as I'd done the first 2 weeks in the hospital.

Towards the middle of the week I began spending a lot more time taking walks on my crutches as opposed to my walker. At first it's a little intimidating going from the stability of the walker to crutches (especially when you're already a little tipsy from all the drugs you're on), but once I got going on the crutches I was able to quickly improve my balance.

By the end of the week I was able to make the entire loop of the 11th floor on my crutches (over 200 feet) and bend my knee up to 40 degrees. These were all conditions of me getting myself the hell out of the hospital, so things were looking up. The last thing I needed to work on with the physios was getting up stairs and into a car. Luckily for me, Carol has a pretty accessible Sante Fe. As long as I fixed my knee brace at 40 degrees, I was able to sit at the edge of the passenger seat, pull by hips inside, and swing my leg around into the interior. As for stairs, those were pretty easy to master. I learned that if I went up backwards with my crutches in my left hand and my right hand on a banister, I could make my way up and down stairs pretty safely.

Come Friday I was finally allowed to get the heck out of the hospital. I can't possibly express to you how good it felt to get out of the hospital, away from the crazy nurses, and into a nice comfortable home/bed.

Friday, September 14, 2007

Recovery - Week 2

Going into the second week of my time in the hospital I figured that things were going to start looking up, mostly because Tuesday the 24th was the day my hip was finally going to get put back together. The traction was to be done and I figured things would be pretty calm after the surgery, just continue on the pain medicine and life would be good.

It didn't really turn out that way. Week two was one of the toughest weeks of my life.

The surgery went pretty well. Dr. Smith, my hip surgeon, felt like he was able to put my hip back together to about 90% of the way it was originally. He put a number of stainless steel plates and 13 screws into my hip in order to get it all back together. He was also able to carry out his surgery without damaging my knee cap, which was one of the real concerns going into the surgery. I guess they need to put a pretty good bend into your knee in order to do the hip surgery. The concern being that my knee might not be able to take the bend.

Following the surgery it was back up to my home on the fourth floor. I remained in my 0 degree bend knee brace, but at least I didn't have to suffer with the traction any more. The pain following the surgery was pretty excruciating. I was normally taking 10ml of Delotted every 4 hours in order to take the edge off the pain. The night after the surgery they gave me 50ml of Delotted because I was in so much pain and that didn't even help. The bottom line for this evening was that I had to bear the pain. Nothing was able to mask how bad it felt.

A couple days later, the goal was to get me up, out of bed and onto my feet. In reality I should say foot, as one of my hip restrictions is that I'm not allowed to bear weight on my left hip until 12 weeks after surgery. My other restriction was that I wasn't allowed to bend my hip more than 60 degrees.

On the fourth floor there was a rehab guy who would stop by your room once or twice a day and try to help you get on with whatever rehab you were supposed to be doing. When he did arrive you needed to be ready to roll as this was the only chance you might have to work with him for the day.

Day 1 of getting out of bed was very, very tough. Having been on my back for a couple weeks had caused my body to stop pumping blood aggressively enough to get blood up to my head too well. The first time I sat up at the edge of the bed I nearly spewed my breakfast. That first day I was able to work my way over to the edge of the bed, get myself sat up, and get started in a walker. I walked to the door of my room and back and I was spent. Being used to riding my bike for four hours at a time, not being able to walk more than 20 feet was a pretty big let down. After I went on this tiny walk I was covered in sweat, winded and very, very light headed. The physiotherapist sat me up in a chair for 15 minutes or so (that was about all I could take) and then helped me back into bed. That's all that I was able to get done the first day of rehab.

Day 2 was a little better, but not by much. I was able to more easily get myself to the edge of the bed and get to a sitting position. We then took my walker for a trip down the hall. I probably got 40 feet down the hall and nearly passed out. I was leaning against a wall to try to hold myself up while the physio ran to go grab a chair for me to sit on. By the time he returned my eyes were rolling back in my head and the lights were starting to dim. After a 5 minute recover in the chair I got back on my walker and made it all the way back to my room. More promising, but it still left a lot to be desired.

Day 3 was a completely different day. My insurance finally agreed to pay for me to spend a week on the acute rehab floor, floor 11. So, around noon time I was moved up to the 11th floor. I was really liking the fact that I was going to get away from some of the incompetent nurses on the fourth floor; when I got up to the 11th floor however, I found out that the move came at a cost. The rooms on the 11th floor were all doubles and I now had a roommate. Secondly, there were actually less nurses on the 11th floor, so at times things could actually be worse than on the 4th floor.

On Day 3 I was able to walk a little further, something like 60 feet, but things were still pretty slow going. I'd get light headed each time I went for a walk. It was also pretty tough to sit in my wheelchair and be comfortable. Because I had to keep my hip at less than 60 degrees, I couldn't ever sit up straight. Instead I always had my leg sticking out in front of me, pulling me down towards the ground. It's pretty darn tough to relax in a chair when you're constantly fighting being pulled down like this.

One of the really nice things about the 11th floor was that each day you got at least 1 hour of occupational therapy and 2 hours of physical therapy. Because I'd arrived on Friday afternoon I got some really limited therapy sessions in. During that time they were able to teach me how to use a grabber to get my shorts on by myself and how to use a lifter to pull my leg around. So I was starting to get a little more self sufficient.

A long week of physiotherapy awaited in week 3.

Thursday, September 13, 2007

Recovery - Week 1

The day of the accident (July 15th) Dr. Cohen put my knee cap back together. Prior to the surgery his outlook was that I'd be lucky to walk again. When he went into my knee he expected to find my entire patella (knee cap) in tiny fragments. Instead, what he found was that the outside of my patella needed to be removed. There however were two pieces, about 1/3 the size of my entire patella each, that remained. So he pinned and wired them together and sewed me back up.

When I woke up from the surgery there was a traction pin sticking out each side of my knee; Dr. Cohen had drilled a hole through my knee and inserted the pin during the surgery. I was also equipped with a catheter, which I have to say is pretty darn handy. It's great not having to bother with urinating, with the catheter things just drain as necessary.

Once they moved me up to my home on the fourth floor an orthotech quickly arrived and attached a traction unit to my bed. Basically I had some metal rigging at the end of my bed that contained a pulley. Cables were then attached to each of my traction pins, threaded through the pulley, and 30 pounds of weight was attached to the other end of the cable. I was required to remain on my back, in traction until my hip surgery, which was scheduled for July 23rd. The goal here being to hold my hip relatively in place, allow things to calm down a bit in my leg, and prevent any further damage.

Here are some pictures that my mother took of my traction pins and traction weight during my second weekend in the hospital:

Being in traction like this is pretty darn difficult to take, especially when it's in place for 9 days. First of all, every muscle in my left leg was stretched continuously. It would start out where my hamstring was the muscle being stretched, then my groin, quadracept, etc., etc. This continued non-stop for 9 days. Secondly, the constant pull from the weight slowly pulled me towards the end of the bed. When combined with the fact that I was continually warm and pretty much always lying in the same position; I started to develop blisters on my butt.

When the blisters developed, my surgeons specified an air bed for me. Once it arrived, the air bed made a world of difference. Why it wasn't specified right from the start was always a mystery to me.

The other obvious issue during the first week in the hospital was pain. It took a while to get things dialed in as far as pain management went. In the end I found that a steady diet of Percocet, Oxycontin, and Deloted did the trick. The biggest challenge in the hospital however, is that they won't just give you a bottle of medicine and trust you to take it each four hours. Instead you need to page your nurse each time and then hope that she responds in a timely fashion. With each nurse managing 6 to 8 fairly high maintenance patients, it wasn't always possible to get my medicine exactly when I needed it. That got to be a little tough to take.

The good news for the first week was that the Tour de France was on every morning to keep me busy. I also had an incredible line-up of folks who stopped by to visit. People from work, friends, family and members of my bike racing team all stopped by and phoned numerous times. Having as much support as I did made a big difference. So, I again want to thank everyone who visited or called. It definitely kept me motivated to concentrate on my healing as much as possible.

The other big thing that happened during my first week was that I really came to grips with the fact that this injury was not going to be overcome in a steady progression of success, on a time table, or possibly even at all. All I could do was deal with what was going on with my recovery as it happened, day by day. Some days could be going very well, only for something like a blister, pain, fever, etc. to pop up out of no where. When these sorts of set backs occurred I learned that I had to simply deal with them as best I could and hang in there.

Tuesday, September 11, 2007

San Marcos - Down for the Count

As many are aware, the July 15 San Marcos Circuit race didn't end too well for me. I crashed, breaking my left hip, knee and toe. My entire left leg suffered an incredible amount of trauma.

Over the next week or so I'm going to try go get this blog up to date by adding some posts that'll take you through the crash, surgeries, and recovery.

So here we go with the San Marcos race report:

The monthly SDBC club meeting was held the Monday prior to this race. The guest speaker for the meeting was a sports psychologist who spent his time talking about having a plan and executing it during the event. One of his biggest points was that if you had a plan and were well trained, it was important to let your body do what it needed to do to achieve the goals; rather than trying to speak to it the whole way. In the past I can definitely say that I would spend most of races arguing with myself as to just how much more pain I could take and mentally telling my body what it needed to do, rather than letting my body physically take over and do what it could do to meet the pre-determined goals.

So I went into this race with a new approach; try to let my body, rather than mind execute the plan. Here's what I had in mind:

First 15 minutes – take it easy in the middle of the field.
Second 15 minutes – ride up near the front and try to make/get in a break
Last 15 minutes – If in a break, ride as hard as my body would let me and try to hold on for a good result. If in the peloton, make sure I took advantage of my ability to grind up moderate grades to sprint for a good finish. This course finishes with a drawn out 100 foot vertical climb (probably about a 3 or 4% grade), so I knew I had a bit of an advantage if I needed it.

At San Marcos, things started out well enough. I rode in the middle of the pack for the first 15 minutes, often slotting in right behind one of my teammates, Jeff Dingler, and keeping it smooth.

With a little over 15 minutes gone people’s desire to set the pace up the hill appeared to be waning. I found myself coming out of turn 3 with a couple guys already up the road. The pack was moving a little slowly, I was maybe 10th from the front and Troy Huerta, a strong rider from the Swamis team, was right in front of me. I didn’t even bother to think twice, I picked up the pace a bit, encouraged Troy to come with me and we started to grind our way up to the break. By the start/finish it was now Troy, Josh Gruenberg (another strong rider), me and a couple other guys out in front. We all quickly talked about working together and got on to trying to make some distance from the field.

As we came down the hill to turn 2, Josh pulled off the front, I scooted by and started to lean into the corner. Unfortunately I had totally blown it coming into the turn. I was going way too fast and was unable to get my bike turned into the corner. As I quickly headed towards the traffic cones on the outside of the turn I knew I was about to be in big trouble. I continued to slam on the breaks, went through the police tape and cones and was now one lane away from going over the median. I seriously thought about trying to bunny hop my way over the curb, but before I could react I was into one of the large cement dividers and launched off my bike. I guess I took the impact on my left knee and foot.

As I lay there on the ground assessing where I was messed up a couple things were obvious. Firstly, I could see that there was about a 3/4" diameter hole at the top of my knee which you could look into and see the inner workings of my knee. Secondly, my left hamstring, quadriceps and groin were amazingly tight. My leg felt like it needed a really good stretch. It didn't take too long for the ambulance to arrive. They scooped me up and carted me off to the hospital.

Net result:

1. Broken big toe - not the end of the world
2. Shattered knee cap. What’s left (2 pieces equal to about 2/3 of the total size of my knee cap) have been wired back together. At this point my knee seems to be functioning pretty well. At the time of the accident there was a lot of concern that my knee cap might need to be removed entirely and that simply being able to walk again would be a major challenge.
3. Dislocated and fractured hip. They "relocated" my hip when I got to the hospital (a couple guys pulled on my ankle to get this done), but with my joint still broken it wasn't really in place. I then spent the next 9 days in traction waiting for hip surgery. The traction was required to keep my hip relatively in place.
4. Possibly broken hand - it turned out to not be broken, just very swollen
5. Nerve damage. I am still unable to dorsiflex my left ankle (i.e. I can't raise my foot).
6. Extensive leg trauma. My entire left leg was like a giant sausage

I guess the bottom line here is that I’m a little lucky to be alive. I could have easily gone over the median and been run over by a car. It remains to be seen if I ever ride a bike again.

This accident has been very disappointing on a lot of levels:

1. Obviously it was incredibly painful, both from an impact and recovery perspective.
2. I was really starting to perform in races. After a year of hard training I was able to hang with just about anyone in the category 4 fields (with the exception of steep climbs). If I would have held it together in this race I really felt like I would have been on the podium.
3. I really miss riding my bike. More over, If I can't ever ride a bike again, that's going to be pretty tough to take.

More to follow tomorrow.