My leg is screwed

Last week when I visited with the orthopedic surgeon she gave me a bit more information on what she did, or more accurately what she inserted into my leg.  I have a device called a ‘sliding compression screw device’ in my right femur.   The ’screw’ helps to hold things together while limiting direction and speed of motion.  Apparently one of the strange feelings I have from the leg is the compressive device limiting how fast parts move in relation to one another.

On every visit to the orthopedic surgeon she points out my arthritis.   That is something I’ve known about for close to two decades.  Perhaps the reason she is pointing it out is to prepare me for one possible side-effect of the injury repaired with the ’screw’:  “over one third of patients w/ RA treated w/ a sliding hip screw (for intertroch frx) will sustain a major complication (AVN, nonunion, loss of fixation).”  AVN is avascular necrosis, or for the benefit of cyclists we will just refer to it as  ‘Floyd Landis syndrome’.   Here’s hoping that I am in the under 2/3 of patients with RA who do not suffer these complications.

Then there have been my own horror story experiences with doctors.  When I contracted malaria I knew what I had, and I conveyed that to my primary care physician.  The problem is he did not want to believe me and instead chased diagnoses of other exotic diseases (meningitis, encephalitis, and others) all the while failing to order the simple blood test that would determine whether or not I had malaria.  That was close to being a fatal mistake.  Finally my complaining resulted in a new primary care physician being assigned to me and  within hours we had a confirmed diagnosis and treatment started.   Then there is the case of my sensitivity to oats.   I knew something was wrong and I conveyed the physical symptoms to the physician.  He found anomalies in the blood tests,  also, but did not want to consider that it all might be food related.  Many, many tests later, looking for all sorts of exotic causes, the physician more or less gave up and told me to live with it.  So I started my own ‘process of elimination’ food testing and eventually came to discover that oats were the culprit.  As soon as I removed oats from my diet the physical symptoms went away and my blood composition returned to a more ‘normal’ state.

For the last few years I have been trying to put aside my past biases and to work with my physicians.  And that is what I was doing with the orthopedic surgeon in regards to my hip.  I have followed her orders, so far, to the letter.  But now it is time for me to consider going outside those bounds.    I was content until yesterday when I learned that she did not want to give me the extra leash I think I can use.  All I asked for was a referral for Physical Therapy.  I am progressing well, and think that I could use some help to guide my recovery.  But the orthopedic surgeon says no, and that if she decides I should have PT that decision will come after my next visit … 5 weeks from today.  Note that she may still decide against it, and from the tone of her message I take it that is a distinct probability.

So now it is time to go against doctors orders and to see about starting on a physical therapy plan.  A friend who is a DPT suggested the exercise I did in the swimming pool on Monday, and she is coming by tonight to assess my ‘walk’ (as it is) and to determine what I need to work on to get to the goal of walking without aids (crutches/canes/etc.).

There are times to be compliant and follow directions.  And there are times to decide that perhaps there are alternatives.

One thread in the milieu of thoughts has been of goals, short-term and long-term. The accident has had a great impact on many short-term goals and objectives. All remaining racing related goals for the year were immediately pushed into the mental bin marked ‘unattainable’, at least for this year. Who knows about next year. The Wife and I had a goal of doing some riding outside the US this year and had been planning on some MTB riding in South America to meet that goal. That, too, was swept into the ‘unattainable’ bin. Many more things will be pushed off this year’s calendar or seriously delayed. What comes back onto the calendar for next year remains to be seen and will be determined, in part, by how well the recovery is coming but also, in part, by considering and weighing the risk factors.

The long term goal thread has been dominated by concern about how accidents like this might impact what I want to do in the future. At some point in time, probably at the time I drop out of the day-to-day workforce, I want to take a few months and just meander across the country sampling a bit of the craziness that exists in this nation. Might want to try a couple of others, too. But to do so I must be healthy enough and able to physically stand the daily grind of pedaling many tens of miles. Got some other long term goals on the mind, too, and in general I need to be healthy to meet them.

So now I am sitting here with some work stuff cranking and waiting to finish so I am musing on how to balance staying active, doing what I would like to do, but staying healthy enough to continue to work towards what I want to achieve both now and down the (cronological) road. No answers at time, just part of what ye olde brain is trying to sort out at the moment.

The first bill I have received is from the hospital for my treatment in the ER (but not for the trauma doctors, all billing separately), the operation (but not the surgeon), and my 61 +/- hour stay.   The total is tickling, hard, the six figure range and some of the charges seem a bit excessive.  The 30 min or less with PT on my second day, basically them watching me get up and hobble on a walker then crutches, comes in at a bit over $500.  The OT person who followed along but did not really do much other than say ‘good job’ is apparently worth almost $700.  The PT person the next day, the one who took me for one lap of the floor and a couple of steps, is charged at $600.   There is a full body CT scan at $25K, and a separate head CT scan at $5K.  Isn’t the head part of the body?  Couldn’t they do it all at once for one price?

The craziest part of it all is how the numbers change due to my insurance.  There is a ‘contractual adjustment’ to the near six figure price, an adjustment that deducts 80% of the price from the total, with the remainder being allocated to the insurance carrier and to me.   Which is a bit scary; if I am John Doe without insurance I would be on the hook for nearly $100K just for the hospital, but since I have insurance yours truly and the insurance company together only have to come up with 20% of that amount.  Now that is truly ‘Sicko’.   And it really points to the need for healthcare/insurance reform with universal coverage.

• Ankle: pretty much destroyed in one of those ball sports back around ‘67, reconstructed in ‘68.
• Knee: off and on damage over the years, possibly more in the latest incident.  Will have X-rays and an assessment made in a couple of weeks.
• Hip: in the recent accident the hip end of the femur needed to be reconstructed using traction and a ‘box of hardware’ according to the orthopedic surgeon.  Interested to see the X-rays next week.
• Shoulder: definitely messed up after the recent accident.  So far the orthopedic surgeon has ruled out rotator cuff damage, but nothing else.
• Elbow: hey, no damage.  Yeah!
• Wrist: pretty messed up  when I was presumably drop-kicked by a car in 2002.  Have an “L” shaped titanium plate and 6 screws holding it together.

The left side has been relatively free of damage.  Some minor damage to the knee, and broken ribs from a car accident, but no joint reconstruction.  Perhaps I need to add additional padding and protective material to my right side?

For those not keeping up, I took a spill at Hellyer Velodrome on Wednesday night, leaving a fair amount of skin behind (nose, upper lip, both knees, both elbows), getting a fair bit of bruising (right ribs, shoulder, and knee), and breaking the end of the right femur. The femur has a hip screw (large screw into the ball of the femur), two plates, and several additional screws that were added on Thursday. I am one messed up guy.

The biggest thanks has to go to The Wife who has been doing yeoman’s duty helping out under what are, for her, difficult circumstances. She has such a tenderness to her heart and soul that it is hard for her to help me at times since helping causes some momentary pain. She fights through and has been solid in doing what she can, and more, to help me get around for now and repair so i can become independent again. I can tell how hard it is, and sometimes my pain may come across as grumpiness, but I can assure her that I appreciate all she does and I am working to keep my comments to myself. Thanks sweetie!! I can never repay in full, but I will work on that debt later.

Also a big thanks to those who helped at Hellyer and assisted in getting us to the hospital. I was pretty much out of it; I remember the start of the race (BxC points race) and I remember someone telling me to wait for the ambulance, but other than that my memory banks are blank until such time I was in the CT machine at Regional Medical Center being scraped along the wall of the device by incompetent techs.   Major thanks to Rick Adams, and to Michael and Sabine who helped to gather my stuff and get it to the Toaster along with the newlyweds Erika and Linda who continued to help transporting the Toaster to the hospital for the wife, learning my full legal name in the process.

A big thanks to the staff of Regional Medical Center who worked fast to get humpty-dumpty together to the point that I was able to go home about 64 hours post accident. And to the dozens of folks whose calls, e-mails, and blog posts have conveyed good wishes.

And a special thank you to the friends who have taken some of the burden off The Wife by offerering to plan, prepare, and drop off meals to keep us nourished, thereby relieving The Wife of that extra task

If I do not get a chance to extend the thanks in person, know that I want to and I greatly appreciate the tasks of the many.

Yesterday evening I took a fast 20 mile loop up into the Los Altos Hills to give the thumb a test. Still cannot shift the thumb lever on the right side, so Wente RR is now officially off the table, though unofficially I had been resigned to it being unrealistic for the past 10-12 days. The goal now is to work towards being ready for the EBC crit two weeks from tomorrow (10 May 2008).

Madera Madness

Wow, sometimes by ignoring on-line discussions you miss out on some good cat-fights. There was some real head butting about the Madera Stage race over on the ncncaracing list. Some folks get fairly dogmatic that they have seen the truth and cannot understand when others do not agree. Sheesh. Oh well, hopefully now that the full moon has come and gone that little battle is finished.

Last Saturday I was at a birthday celebration for Mintie Linsey, who finished 3rd in the GC for the Women 4 at Madera, and I was asked when the photos I had taken at Madera would be on-line. Ooops, apologies to Mason and others who have been waiting. I finally retrieved the camera from the bag last night and will now go through them and post some to the gallery RSN (Real Soon Now).

A quick scan of the photos provided some evidence of what I had suspected. Not long after The Wife completed her ITT I noted that the rear wheel was flat. That raised questions about if it was going flat during her event which would have increased rolling resistance. No longer supposition; it is clear that as she crossed the finish the part of the tire beyond the tan sidewall is compressed down and barely visible. The replacement tires will be glued onto those wheels this weekend so The Wife can get accustomed to them before the Women’s Stage Race at Kern in three weeks.

I decided to test out riding with the damaged thumb on Saturday but I was not quite ready to tackle the thumb lever of the Campy shifters. So I grabbed the TT bike, with the bar end shifters, and headed to the west. I found it easy to operate the right shifter with a combination of two fingers and the hand. After a nice warmup in the flatlands I made my way into the Los Altos Hills and started some VO2Max intervals, and I was feeling good. I put in a bit over two hours with no problems whatsoever.

Sunday ridin’

If one day of riding is good, two is better. The Wife was heading out to lead a team workout and asked if I wanted to carpool northward to ride in that area. Sure, but what bike? I had torn down the TT bike to clean and prep for Madera this coming weekend and did not have time to get it together. So I threw the Colnago in the Toaster and headed out to Woodside. While The Wife and her teammates did their review of what was ahead I did some loops of the parking lot and found I could use the finger next to the thumb to shift the thumb lever, just not smoothly or quickly. I did a warmup then cruised north on Cañada road for a fast tempo ride. There was heavy drizzle and stiff headwinds, but I did not care. The legs felt great and I rode hard, minimizing gear changes. I got in a big gear and powered up, doing 22-25MPH even on the uphill sections, all the while keeping the cadence above 95 rpms. I was shooting past groups of riders, the only one’s who were matching me were two guys in DBC kits. If I had felt that good, and had that much drive, last Sunday then I think I would have been in the front group all day. Maybe the extra rest did me good, or maybe the somewhat hard workout on Saturday. Need to sort that out, but it was fun and I was feeling it.

Glue and tape

One of my teammates had a tubular tire roll of the rear rim while he was cruising for an almost certain 2nd place at the Rondee von Brisbeen crit a week ago. The race official noted there was very little glue on either the tire or the rim. The teammate says that the tire was mounted by a local bike shop owner, one whom some folks claim tell them that they use too much glue when mounting tubulars. I do not know about that, but that shop owner has told me that I should be able to swap tubulars faster than I can repair a flat clincher. Never been able to, mostly due to the time it takes me to peel the old tire off the rim; maybe if I used less glue I could peel them off faster.

The incident has led to a lot of on-line chatter about gluing techniques, etc. Basically it is a religious war as to whether to glue or tape, if glue which one, etc. With Madera a week away, and The Wife wanting to ride the TT with the high zoot carbon trispokes, with tubulars, I decided to peel and remount the tires just to make sure they were on well. I glued on the front, using the Continental glue. For the rear I tried Tufo tape. When picking up the tape I did a quick check: regular or extreme? Extreme is for ‘extreme’ conditions of low or high temperatures, with the ‘extreme high’ meaning above 74 degrees F! Where is the world is it that 74 degrees F is an extreme high? Antarctica? I know Tufo is a Czech company, but the Czech Republic is not that moderate in their temperature range. Upshot is I went for the ‘Extreme’ stuff. While I was at it, I got a new tubular spare and needed to stretch that. All I can say is that gluing tires and stretching new tires onto rims really calls for having two good thumbs. I got it all done, but it was not easy.

New track wheels

While looking at the website of the manufacturer of the carbon trispokes for gluing recommendations I found that they sell a road to track kit for the wheels. For a couple of bills I can get the parts so I can swap them back and forth between road/TT duty and use at the track. Sweet! A lot more friendly on the budget than a new set of wheels.