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.

Sunday, July 8, 2007

Sunday Ride

I downloaded the latest version of GoogleEarth the other day. In the past I don't recall them allowing you to draw paths using the free version. This latest version however allows you to do so.

People often ask me where I ride on Sundays. Here's the answer . This route is about 65 miles. Depending upon how much wind is out there it normally takes me around 3.5 hours of riding time (not including the odd water stop) to complete this tour. There are a few really dandy climbs on this route; Del Dios Highway, Bandy Canyon, and Black Mountain Road. The one really nice thing about the ride is that there are a couple 15 to 20 mile stretches of road where you literally don't have to stop for a single light. It might not sound like a big deal, but it makes a big difference when you can ride uninterupted for and hour or so.

If you've got GoogleEarth on your machine you should be able to follow the link above, open the file with GoogleEarth, and play it.

Monday, July 2, 2007

Something a Little More Relaxing


A few months ago the parental units were down in San Diego. Anyone who knows my mom knows that any time is a great time for gardening. Put these two things together and what do you get? A trip to the nursery and a new garden.

Both my parents really put their knowledge into this vegetable garden, and it's really kicking ass. I've got a ton of peppers and tomatoes on the way. As you can see below, the herbs are thriving. The biggest contributor to the success of this thing appears to be the soil mix (peat and planting soil) and multch that they specified when putting it together.

Here are some pictures of the tomatoes, peppers, herbs and flowers:







Sunday, July 1, 2007

Manhattan Beach - I'm still pissed off!

As mentioned previously, my team went into this race trying to work together to achieve the result of putting someone on the podium. Call me naive, but I actually went into this race believing that we would work together; and furthermore, would achieve a top 3 result. The plan was pretty simple, protect a few riders (make sure they didn't need to take pulls on the front), get the key people to the front when we were down to the final moments and let them do their thing.

In general the course wasn't as tough as I expected it to be. The course itself is shaped a little like a lower case "r". The race basically heads up and down both sides of a large boulevard/green space. See here. There's a small steep hill just before you reach the northeast corner (corners 1 and 2) and some rollers down the back side of the course. Other than that, the course was pretty simple.

My job was to get key people to the front on the last lap. With a 120 racer field and two tight corners, we knew that there was going to be a massive premium placed on positioning during this race. Throughout the race our team was doing quite well. We stayed out of trouble and were able to hang near the front. I was constantly talking with the guys on my team who we'd designated as the guys we wanted to put at the front at the end. One in particular continually communicated that he was doing well and didn't need any more help than what he was currently getting.

With one lap to go four Helen's riders took off about 300 meters before the hill. It's a big enough problem when one guy gets a jump on the field. When four guys who are all on the same team try to get away, there's a strong potential that they might never be caught. At the moment this happened I was on the outside in about 20th place. There were 3 other key guys on my team who were up near the front with me, one in particular was about 5 spots ahead of me and was one of the guys we wanted to make sure had a chance to contest the final sprint. With things unfolding before me I knew that now was the time when we needed to respond and get a guy up to the front. So I yelled out the guys name, he heard me (I could see him look back), I pulled out from the field and started to crank it up. I was fully expecting him to jump on my wheel as I went by. As I continued to accelerate towards the hill I looked down at my computer and I saw I was going at about a 33mph clip. Pretty good, this was exactly what we needed.

As I reached the hill I was pretty much up to the leaders. Knowing that getting our guy to the front was all that mattered, I was completely unconcerned about whether I blew up well before the finish. As I ground my way up the hill I began to start to really feel the burn. By the top of the hill I was pretty spent. As I began to slow I expected to see our guy roll right on by me, having successfully been delivered to the front. Nope, he was no where to be found.

Once again in a big race, the same guy had screwed over both me and the team. At Del Mar I got him to the front for a couple point primes, both times he didn't even come close to winning (he basically packed it in half way through the sprint even though I'd given him a 10 foot jump on the rest of the field). This time he completely disregarded the opportunity to execute the plan we'd laid out.

As the race went into turn 1 and 2 I was pretty much done. I was in something like 15th place and my legs felt like they were full of lead. As we went through the turn, some clown managed to crash in pretty glorious fashion right behind me. This broke up the field, leaving 25 or 30 guys clear to run to the finish. Apparently my team mate in question finished well, well back in the field. Whether this was due to the crash, or because he'd apparently broken a spoke and had problems with his wheel, I'm not sure. Even more infuriating however, was that after the race, it became clear that the spoke was in fact broken early on in the race and was now being used as an excuse.

Having repeatedly asked this guy how he was doing throughout the race and gotten a reply of "good, no issues", I was rather surprised to hear that he knew all along that he had a problem with his wheel:

1. He could have taken a free lap and gone to the wheelpit to get a new wheel.
2. One of the weaker riders on our team could have given him their wheel.
3. I wouldn't have burned myself up trying to help him if I knew he had a mechanical problem.

The bottom line here is that once again we didn't even come close to achieving our team goals. And even more so, one individual who the team does so much to help, sabotaged the effort. At this point I'm seriously considering trying to find a new team, or even just go about it on my own. I certainly am not going to be a part of another one of these SDBC "team efforts".