INDIA EIGHTYTWO -- PAU

I cancelled Kona.  There, I finally acknowledged that this time my recovery from injury is going to follow a normal slow process.  No miracle bounce backs.  No finishing the Arizona Ironman 2 weeks following cracking some ribs and lacerating a hand in a fall in the desert.  No finishing Kona second in my age group 9 months following Achilles tendon repair.  No, this time its different. Finally, 12 weeks following "the accident", 4 weeks following rotator cuff shoulder reconstruction and only 5 months to Kona, I had to admit to the practical.  My healing prowess was average at best and not sufficient to make Kona an option.  I had held out hopes, holding on to the thought of at least participating in Kona, until it was no longer possible to ignore the obvious.

I finally had my shoulder surgery April 13, nearly 8 weeks following "the accident".  The delay was necessary to allow repair of my many other injuries not the least of which was the punctured lung and fractured hip, scapula, and ribs. During that delay I also had a plastic surgeon remove the soup bowl sized hematoma from my left thigh that had formed its own bursa.  The shoulder surgeon found a "mess" in the rotator cuff of my left shoulder including complete tears of the Supraspinatus and Subscapularis muscle   tendons, and a partial tear of the Long bicep muscle tendon.  In less than 2 1/2 hours I had the rotator cuff area cleaned out and anchors implanted in the humerus and the tendons sutured.  Surgery was performed under a general with a nerve blocker and Oxycontin prescribed for after surgery pain relief.  I weaned off the opiate as soon as possible.

5 HOLE SURGERY

Two days after surgery I was in physical therapy.  Why so fast?  I had developed frozen shoulder and the sooner the range of motion is restored to the shoulder the better.  The therapy was, and still is, horribly painful as the arm is moved passively to try to break down the adhesion's that restrict its motion.  Every day I go through two or three sessions of at-home therapy movements.  Three times a week I go visit the physical therapy folks where they manually force the arm further into where normal arm motion should be but mine doesn't go.  It is so painful that I now take Hydrocodone prior to these sessions so that I don't cry and thrash like a baby on the table.

The general level of pain following the surgery has been passable most days until its time to sleep. Then the pain level is enough to result in shallow and interrupted sleep. To try to help this issue, last week I started to walk or stationary bike some days, all low intensity. Unfortunately, with an arm in a sling your balance is off kilter which has led to non-injury related pains elsewhere in my body.

Following shoulder surgery I had my right hand index finger examined by a hand surgeon because the last digit no longer would bend.  Turns out the accident gave me a "jersey finger" injury, so named because it typically happens in football when the tackler tries to hold on to the opponents jersey only to have the finger tendon rupture.  If treated shortly after injury, the tendon can often be reattached. In my situation, the tendon has shriveled up into the palm of the hand and the "tunnel" it had traversed through absorbed.  The most practical options remaining are do nothing and adapt or fuse the last digit into a partial bend. I need to ponder these options a bit.

So there it is. All the literature and medical advice indicate a 6 to 12 month recovery is typical following surgery.  So, from now on its mostly therapy and unfortunately a slow process through recovery.  However, I will be following the Kona race and wishing all the best to the Minnesota and Arizona participants, as well as those friendly competitors in the M70-74 age group.  Mahalo.

INDIA EIGHTYTWO -- PART TWO

It's 4 am and I'm in the shower but not getting ready for an early morning race.  Instead I'm sitting on my granny shower stool with anti-bacteria soap getting ready for my early morning surgery.  The hematoma formed on my hip from my bicycle accident 5 weeks ago did not re-absorb as hoped. Instead it is forming a pseudo-bursa as the scar tissue encapsulates around it.  Time to remove it so I can get ready in a few weeks for the major surgery on my rotator cuff.

The surgery was performed under a "General" by a Plastic Surgeon, so it must have been a bit more consequential than I originally thought.  I now have another drain and bag and complication to performing life's daily rituals.  I did feel holistically better following the surgery. I had noticed that
the hematoma felt a few degrees warmer to me than the surrounding tissue, so maybe the body was working hard to defend against this unwanted bulge.  Glad it's been removed so I can get on to the bigger issues.

I've also started Physical Therapy to reduce the chance of the dreaded "frozen shoulder" which can follow shoulder trauma, or just occur out of the blue, as a bodies natural protective defense.  It seemed odd to me to be doing PT prior to surgery, but I've been assured it's the right thing to do.  In my case, I do have very restricted range of motion.  I thought it was just due to the fact that some of my muscles are no longer connected to where they are supposed to be connected, and my scapula was broken.  But no, it's due to the rotator cuff capsule clamping down on the ball of my shoulder bone. Adhesion's had developed, but so far they have not called it frozen shoulder.

This rotator cuff PT is range-of-motion only, no physical loading, as all my shoulder parts are not connected or in the correct place.  Already my left arm is about 3/4 the size of my right due to inactivity.  The range-of-motion PT is more painful than anything I have ever experienced even when I pre-load my body with Advil.  Having run marathon's at sub 6 pace, ultras as long at 100K, and numerous Ironman races, I know a bit about pain. Or so I thought.  And, un-reassuring, doing this PT prior to surgery is just a precursor of the pain I'll have with PT following surgery.   The normal recovery time following surgery is 6 months, putting mid-October as my back-to-normal target.

Its now approaching 6 weeks since the accident and the enormity of the emotional and physical constriction is making itself clearly felt.  Only to be able to do any kind of workout, to repair small things around the house, to do anything but read, watch TV, second guess, and try to figure out what to do with the rest of my life.  I am an active person, as most of you reading this are, and this type of long-term confinement is beyond frustrating.  I've had bouts of self-pity and questioned whether being active after 70, at the level of intensity I've carried to this date, was part of god's design for the human body. Quash that thought, quash it, quash it.

I've found that having a race as a goal, I'll train more consistently and focused.  Consequently I'm thinking about what year-end goal I should plan on tackling if I'm to progress out of this mental and physical confinement. Since it's my shoulder that will be the last to heal/recover, triathlons are not realistic racing goals for 2016.  But maybe a running race?  It's not an optimal goal for me as my knees have been my limiting issue in the past 10 years, but it's where I can realistically have a chance of developing fitness given my slate of injuries.  My son has already registered for the Javelina 100 mile desert trail race in late October. It's just 15 miles from my house. They have a concurrent 100K race.  Am I nuts?

......to be continued.....

INDIA EIGHTYTWO

INDIA EIGHTYTWO.  That was the name given me by the EMT and put on my wristband prior to me being loaded on the ambulance following my bicycle accident.  At 30+mph a small rub on the rear wheel of the rider in front of me in the pace line and things changed forever.  Never, Never, Never cross wheels in a group ride.  After 40 years of competitive bike riding I made one mistake, and there is no do-over, and it really hurts both physically and mentally.

Broken Scapula, broken hip, broken ribs, collapsed lung, torn rotator cuff, huge hematoma, toe to head road rash.  All on the left side.  As a triathlete, I prided myself on having pretty decent pain management skills.  Exercise induced pain management that is. Trauma pain is another dimension.

The group I was riding with was not into risk taking, we were following all the rules-of-the-road and behaving with courtesy.  On the downhill returning leg of a Saturday morning ride Feb 20th it was pace line time and with the group now down to about 8 riders, not a cumbersome size.  Just a split second of overlap and whoosh.

My helmet did its thing and I had the EMT call my wife from my functioning cell phone and we met at the trauma hospital following my being patched up.  I received the cursory stitches for the gashes that were deeper than road rash and a vacuum hose (it was only about 3/16" in diameter but felt like a garden hose) was inserted through my ribs into my lung to assist in removing as much fluid as possible and aid in re inflation.

I had the normal scans for head and spine injury and passed.  My bone breaks were not dislocated so surgery to align them was not required. The torn rotator cuff would have to wait until later.

It's still settling in, but my 2016 goal of winning my age group at Kona was dashed in the accident.  I had previously qualified with a sub-12 hr race on a tough course and the M70-74 winning time in both 2014 and 2015 was 13+ hrs, so I knew I had a good chance if I stayed healthy.  I cannot have the required surgery to repair my torn rotator cuff until my other trauma injuries have healed in about 2 months. Since recovery from rotator cuff surgery takes 6 to 12 months, the math is indisputable.

I was home from the hospital after 10 days and off pain meds after 14. This week I start the process of follow-up examinations to see how the trauma recovery is going.  I will try to be a good patient and resist the temptation to "over re-hab" thus re-injuring the repairs.

So my blog this year will not be one of race experiences, but rehab and reflection.  Only a fool would not acknowledge that this type of accident in this sport at this age requires serious reflection.  I don't believe I am a fool..........

.........TO BE CONTINUED............