My bike accident, like life, "came at me fast". Now, nearly 18 months since that accident, I am learning to adjust to a "new normal". In my last post, about 1 year ago, my recovery was progressing as expected, but things didn't continue as planned.
So that you don't have to review my prior blogs, I'll recap the accident; February 17, 2016, group ride, fast downhill paceline, tire rub, crash, level 1 trauma center, fractured pelvis, fractured left scapula, fractured ribs, punctured lung, collapsed lung, complete tear and detachment of Supraspinatus and Subscapularis left rotator cuff tendons, partial tear left bicep tendon, bigly left hip bursa, no brain damage, no spinal cord damage, bike totaled, two subsequent surgeries two months later (bursa and left rotator cuff).
By July of 2016 I was working my way through physical therapy and starting to feel some normalcy. But, gradually, I found myself increasingly challenged to perform simple movements, like lifting my legs onto the bed or holding onto a coffee cup. This in spite of religious adherence to the physical therapy routines. Thinking that I had undiagnosed lower back involvement from the accident, additional back therapy was added to the routine. I degenerated to the point where I could no longer get up off a chair, without assistance. Since I had an annual physical previously scheduled for October at MAYO, Rochester, I delayed a holistic medical assessment until then to give those experts first shot as my malady. During my October visit to MAYO I required the use of a wheelchair as even walking had become difficult. After three days of tests they determined that I had Polymyalgia Rhumatica, or PMR.
PMR is not common as evidenced by the lack of TV adds for treatment drugs. As a disease it falls under the care of Rheumatologists. Its cause is not well understood and there is no definitive diagnostic test; possibly hereditary, auto immune, or trauma induced. It basically is massive inflammation of the major large muscle groups. The most definitive diagnostic is whether you respond immediately (I responded within 24 hours) to prednisone, an anti-inflammatory corticosteroid. Prednisone is a banned substance by USAT.
MAYO was also suspicious of my right (apparently uninjured) shoulder, so upon returning to Arizona I consulted with my shoulder Orthopaedic and he agreed that an MRI of that shoulder would be wise. Turns out that my right rotator cuff also had a complete tear and detachment of the supraspinatus tendon. Apparently the complete tear combined with the PMR hid my right shoulder rotator cuff tear. Bad news was with the passing of time since the accident and tear, 25% of the muscle was lost forever. Good news was that enough was left to reattach with expectations of a reasonable result. I had another surgery in December 2016.
The surgery caused me to have a flare-up of the PMR, an expected possibility. This meant I had to increase my prednisone to higher levels to get the PMR under control. Prednisone has numerous side effects the most serious being elevated blood pressure, osteoporosis, weight gain, and diabetes. Fortunately for me, I started very low on all these measures, so the only other drugs I need to take to offset the side effects of prednisone are to combat the osteoporosis impact.
I started prednisone at 15 mg, which is considered a low-medium dose. The body manufactures its own corticosteroid to combat inflammation, equivalent to about 5 mg, depending on the individual. But, by taking 15 mg of prednisone, more than the body would nominally produce, the body shuts down its own corticosteroid factory. So, once the prednisone has "cured" the PMR, the plan is to taper the prednisone dosage down to zero and re-engage the body to produce it's own natural level of corticosteroid. Due to relapses, of which I already had one, it typically takes from 2 to 5 years to wean off prednisone following extended use. I am currently at 6 mg, right in the range of nominal body production. Monthly reductions by 1 mg are intended to re-engage my body's own corticosteroid factory.
I had previously tried to partake of water exercises in mid-2016, but had to stop due to the PMR and late 2016 surgery. I have attempted but not biked nor run since the accident. I have gained the expected weight due to prednisone and lack of exercise. I can walk but noticed that with the loss of leg strength, my bone-on-bone painful knees are now more painful. I have taken this exercise time off to try cortisone in the knees with no benefit. I have had two multiple sessions of viscus fluid with only a slight perceived benefit. My doctor is skeptical of stem-cells (how do you direct them to generate cartilage versus whatever), but maybe I'll try that prior to knee replacement.
This extended time off from training and racing has clearly provided me with time to reflect on life, way too much time for reflection. At a relatively young 71 years old I'm facing the prospects of becoming less active than I'm used to being, and challenged to fill the available time. However, during my extended recovery, I found that there were a lot of unfinished tasks that I have had the opportunity to finish. But, the enjoyment of these activities have been bittersweet compared to the multisport activities I enjoyed and felt fulfilled by. I have not put a "complete by" date on my assessment of what to do once I've exhausted these catch-up activities. I am positive that by being open to inspiration, and as I wean off this prednisone over the next 6 months, I'll be ready to "have life come at me fast again".
