4 Weeks Post Crash...11 Days Post Surgery

4 Mondays ago today I crashed...and my life has done a 180 since then.  I've gone back to my "lazy" days not by choice but  under doctors orders.  In the past few days, my shoulder has become pretty stiff and sore, probably because it's sick of being out of service.  I'm in the Sling all day except for sleeping--I have to because I try to use that arm if it's not immobilized by the sling.  My shoulder is not ready yet...it's hard to judge the healing, but I know that moving at this point will only set things back, so I'm forcing laziness ;)  I've improvised at work and can work reasonably well with my all star assistants!   I did do some cardio (bike, stair machine) over the weekend with no problem...it's going to be a tough road back when the time comes...but first, I need this right arm to extend over my head!

So thats the update!  I took the tape off the site...nicely done surgery site!

Follow up visit is in 2 days..hopefully some post op x-rays to post.

I'm looking forward to making that full 360!

Looking good! 8 days post surgery

The future scar at day 8....I like it!

Day 24...I think I've turned the corner!

Today marks 1 week post surgery, and I am now amazed at the body's ability to heal.  I could literally go without the sling  at this point...I slept without it last night, then took it off for 2 hours during work, and now am sitting on the couch without the sling on, and plan on not wearing it until I head off to work tomorrow---and all this with no pain, no arm sag, and no increase in the pressure in my shoulder from the sling not "slinging" my arms weight.  My forearm is is sick of lying in that tight wrap to the point that the skin is getting a little irritated...it just needs to breathe!  I also noticed that the more I sat around doing nothing after day 5 post surgery, the longer it was going to take to feel better, because once I got active again, I saw rapid improvement in my recovery, energy level, and mentally as well.  All the same though, my arm is dead weight and doesn't move from it's "L" shaped position across my abdomen.

So at this point, traveling to SF only 14 days post-surgery is a go for sure.  The day before we leave I have my post op appointment, and hopefully we'll be talking about starting rehab, to include bike trainer workouts and possibly even some time in the pool doing creative swim workouts...but I'll hold my breathe until it's a go from Doc, and not get ahead of myself.

Luckily, I'm "keeping the fire alive" by "coaching" (sounds so official) our Team's track workouts on wednesdays.  We have some really great guys that are very much like me, with at least 4 of them set to do Ironman Arizona in November.  At least getting to hang out while they run is motivating me to keep me focused on the goal I set in November 2009.  With the race a little over 200 days away, I have made a decision that I have to look at the race one of two ways:  either I am competing for time, or I consider it to be a very long workout session not focused on my time at all---"all or none", except calling it a training day is not "none" by any means.

Day 22...The Long Road Back

I'm 5 days post surgery and my shoulder is telling me this is going to be a long road to recovery.  Since yesterday morning, it's felt extremely tight...to the point that I wonder how stiff it's going to be once I get the go-ahead to rehab it.  It feels so tight that in my mind I think if I move it just wrong, that I'll unset the fracture.  Also, there are muscle twitches all the time...which I think is a good sign for healing.  I have this feeling that the fiberwire is too tight, and that I can tear muscle/tissue if and when I move my arm---that's me just overthinking this though.  The swelling is gone, and thankfully there's no bump!  I can't wait to get to the point that the stitches are out and the wound is healed--I imagine I'll feel that way next wednesday at my follow up appt.  The problem is that we're on a plane the next day to SF for 5 days---I hope it feels more stable by then.

The front aspect of my deltoid is still numb to touch, but everything else has always been pretty good post surgery...my fingers and wrist are not affected at all, and beyond that, I am not moving my arm at all for the fear of slowing or misplacing the bone fragments while setting.  I'm praying for full range of motion somewhere down the road!
I just added a new blog to my following listFast at Forty by Joanna Zeiger...she's a veteran pro triathlete who had a nasty crash last year which was followed by surgery to repair her broken clavicle...she crashed while taking a handoff at a bike aid station (I'm taking notes on how people get injured!)

Day 20...and Day 3 post surgery

So I've made it through the roughest part...the 3 days after surgery where pain can be an issue.  It's actually been much more pleasant than I expected, with less pain post op than I was experiencing pre op.  Kudos to Dr Amit for a job well done and good surgical technique.  His goal, simply, was to stabilize my clavicle with the fiberwire I mentioned in previous posts anchored between my clavicle and the "head" of the humerus.  It's only 3 days post op (still inflammation!), but the "bump" is gone esthetically, and I can only believe that the clavicle is in a more stable and anatomically correct position because it is not as apparent!

So for having just gone through surgery, I'm thinking this was the best approach, and am encouraged!  My secondary concern now is what Dr Amit had told Jenny post surgery...that it will be 3 months before it is healed...I guess I need to get that clarified!   I could honestly jump on my bike tomorrow with how I am feeling, but we gotta follow doctors orders/rehab to know that my clavicle has fixed itself.

Surgery was thursday morning, I took my final Percocet on friday night, and have taken 2 Motrin once or twice for "twinges" that went away almost immediately.  I'm finishing out the Keflex (qid till gone).  Piece of cake!!!

I also took off the bandages today..check out the picture...the incision was from the superior position of my clavicle to the head of my humerus, allowing Dr Amit to attach the fiberwire to the humerus and clavicle.

Day 18...and Day 1 post surgery

Made it through surgery!  The Interscalene Nerve Block that kept my shoulder and arm numb for 24 hours has now worn off and I wonder if I had surgery or not because so far, the only sign of surgery is the bandages---no pain!  I am keeping a diary of pill taking...it's probably the Percocet working wonders!  The key is always taking the pain pills in a timely fashion..I took two when the nerve block started wearing off, and zero pain!  If the rest goes this smoothly, I'm a happy camper!  So for the next 5 days I am going to do absolutely nothing except watch tv and drink a ton of milk!!  I already feel better than pre-surgery, but that again may be the drugs talking!

This is a link that describes more or less what Dr Amit did for me yesterday:Fiberwire Fixation for Distal Clavicle Fracture.
Aside from healing concerns, I'm hoping my recovery is faster than what I heard coming out of surgery: 3 months!  I feel like I can jump on the trainer today!  Let's hope a) I heal fast , and b) 3 months meant I can get back into training sooner, but at 3 months my shoulder should be back to 100%.

Day 15...Riding, Working, and taking a step back to go forward

So this past weekend I was able to get back on the bike trainer consistently...with 4 hours over the past 3 days.  I mostly rode with no hands on the handlebars, and I also placed a 3 inch "step under the front tire rest, so that the seat position was more comfortable...that worked like a charm!  I've been back at work for the past two days, and outside of some shooting pains in my deltoid from time to time, I've been just fine.  The pain was not severe, but enough to make me take 4 advil and 2 tylenol to  successfully get rid of the pain.  Sophia has landed on my arm a couple of times in the past couple days making it a bit more painful, but I just can't stop playing with her---she's a piece of heaven and lights me up every time she looks at me...I'm in trouble as she gets older!
Surgery is in 36 hours, and oddly enough, I am looking forward to moving on with this...it seems to not get any better pain wise (maybe even a little worse), and looking at the skin "tenting," I doubt this break would form a union on it's own anyways.  My plans are to be back training full steam by June 1...let's hope for that, but I understand that setbacks are possible.  We'll take it as it comes!

Paying Homage...

I'm at Day 13...lucky number!   While I'm waiting for this thursday's surgery, I want to pay homage to Jenny...in my somewhat selfish goal of not only competing in an Ironman, but hopefully excelling at it, she has been there to shoulder (great pun!) the burden of the training pre-accident, and now, nursing me along the way.  I am 100% aware that chasing this goal would not be possible without her support.   Tying my shoes, fastening my belt, cooking, cleaning,...the list is long and distinguished.  This individual sport is very much a team effort, and Jenny and Sophia have undoubtedly joined the team I established 10+ years ago when I was racing in the 1990's---my mom and sister Inta!
Jenny, thank you for everything...I hope someday we can celebrate my goal together, and perhaps set new goals along the way whether they are personal or together.

Love, your husband

Day 12

It seems like I'm getting used to this...probably a sign that I could just let this heal, but the displacement is too much to deal with.  It feels almost like my arm/shoulder is dropping, and as it does, the "bump" is becoming more obvious, and putting pressure on the skin (think of it like an extra elbow!).  I'm able to get around pretty well and even use that arm a bit...I'll be on the bike trainer an hour a day max, watching movies as I go!  Otherwise, just waiting for this surgery to make me anatomically correct...everything else is "A" okay and the crash and it's acute problems are behind me!

Day 10...tough road ahead!

New News:  My arm feels like it's going to tear off with the loss of muscle tissue from inactivity...the tissue tenting is progressively getting worse and I start to get my "little boy" arm back.  I haven't taken any meds for pain since day 3, but I think I'll be taking at least tylenol later today to help.

Yesterday I did a PT session with Brandon at Endurance Rehab...sounds like my body is holding together well based on the level of exercises I was able to complete---a good sign at least!  We focused on core and legs, well, because, we can't do anything else!

So the big news is my business partner is having some very serious eye issues that started a couple weeks ago.  They attempted laser surgery to reattach a detached retina, but at his follow up today, things did not look good at all because the laser surgery failed to re-attach his retina (and he is losing vision in his right eye).  So he is out for surgery tomorrow (the same surgery Amar'e Stoudamire had last year) and has to lie face down 24 hours a day for 7 days as it heals.  So I am back to work tomorrow, but also have a over filled schedule for monday, tuesday, wednesday for next week before I go in for surgery thursday morning...with the pain I'm starting to experience--I need all the luck I can get!

Day 8...Making some headway!

Todays Milestones:  It was a good day!

1. Ortho Doc Appt:  New Surgery Date on Tax Day April 15...17 days post accident...I can't wait to be anatomically correct again!
2. First day back to work: saw 3 patients...this one-handed thing is gonna be tough for my assistant...I will owe them big time!  As long as I kept my arm in the SlingShot 2, all was good!  The bone "edge" causing the skin to tent lets me know its there whenever I move just wrong.
3. Drove all over town today no problem...it may seem little, but baby steps!
4. I rode the bike on the trainer for 25 minutes (no touching the handlebar of course)...big step, as I still have an unfixed broken bone and less than 10 days out from the crash---3 days ago I wondered if it would be months, and it was just days to getting back on the bike...awesome.  I do feel some loss of fitness, but that was an obvious side effect of the last 8 days.  Right now I'm thinking that all I need is clearance from Dr Amit post surgery to be out in the hot summer heat training for AZ IM!  Don't worry, I won't rush it.

I also talked with a new friend of mine Marc Rubin, a local traithlete and co-founder of Tri Scottsdale.  He's battling some major knee issues, more specifically, a full thickness articular cartilage injury to the medial femoral condyle.  The condition is as bad as it reads, and i wish him the best in his battle with this condition that has taken him from elite triathlete/Kona Qualifier/spokesman for the sport to literally searching the world for a solution to his condition...his website/blog is www.10-hours.com...he's just an all around great guy!

So, next up for me is surgery on April 15...stay tuned!

Timeline Summary

Here's Week One Cliff Notes:
Accident: 2 p.m. on Monday March 30, 2010
Drugs: Vicodin for 3 days, stopped April 2
Pain: Gone April 2 except for twinges when I move just wrong.  Felt like the bone was going through my skin for 3 days, but that subsided 3 days out as well.
Sore/Tight: Still Sore/Tight, but getting better every day
Surgery: was scheduled 3 days from the accident...seemed ideal but didn't work out...now the motivator isn't to fight off the pain
Arm condition: Could not move anything until Saturday, April 3.  April 4 I could put on a shirt by my self. April 5 I drove for the first time.
Work:  I was in the office today, April 5, and will visit with some patients tomorrow who need evaluations.
I couldn't wait any longer, so I called Dr Amit's office and made an appointment for Tuesday April 6--I couldn't wait until April 14th to re-eval.  Let's hope he says we can schedule surgery as soon as available.  I also want to jump on the trainer and ride the bike...lets see what is said tomorrow.  Finally, we're going to start some rehab at Endurance Rehab ASAP to keep the rest of me from wilting away.

Next post: report from my visit with Dr Amit tomorrow about new surgery date.

SURGERY DAY! so I thought...

SURGERY April 1, 2010

Should known better for scheduling on April Fools Day...was admitted, prepped, sedated, interscalene nerve blocked, in the OR, intubated...and no surgery today because of redness in my armpit--considered a fungal infection (note: if your armpit is basically sealed shut with a sling, it's gonna get messy!  20 20 hindsight: clean armpit all the time to avoid all of the above without getting what you came for.  

Pre-surgery, it was all I could manage to keep my mind off what was about to happen--the surgery, the post op pain, the rehab, and the limitations I am to face...100% is what my mind wants, but I have to plan for less than perfect psychologically.  It didn't help that the hospital has decided to cross train their nursing staff, so I seemed to be more in a learning environment than a private setting....including the nurses lack of knowledge of what Dr Amit needed to be done...the checks and balances are there for a reason (like making sure they are working on the right shoulder)...thankfully Dr Amit re-reviewed with his fine tuned comb and crossed their t's and dotted their i's, including his marking on my right shoulder to confirm the correct side.

To summarize, surgery on April 1 was not meant to be.  The good news was the Interscalene block, which kept me numb from the base of the right side of my neck down my entire right arm for the 24 hours.  When that wore off, there was tightness, but at this point, 3 days post-accident, what I thought would be with me for weeks was now gone (of course, until surgery). I started using Nystatin Cream twice daily for the armpit issue.  I was also in a fancy "slingshot 2 by BREG which keeps my shoulder completely stabilized---a huge improvement over the ER piece of crap I was living in.

ER Radiograph---Ouch

My clavicle is broken in the lateral 1/7 and is displaced superiorly, almost like it wants to poke through my skin...it feels like it looks...ouch!  The shoulder joint that dislocates in a shoulder separation is intact at least.

Week 1 Summary

So after getting home, I was on Vicodin for 3 days, during which I gathered what had happened and what was next. I realized that while I miss training, I am not feeling like my life is over...yes, the challenge of seeing how much I can do with the body I was given may have to be modified, but let's focus on the positive! After scouring Google and Slowtwitch, I think a full recovery with full range of motion is possible--with surgery. Everyone out there that delayed surgery on a broken clavicle states that the one mistake they made was not having surgery sooner. I've never had surgery, so I'm very nervous, but the thought of settling for a shoulder that looks and feels less than it could is more frightening. And so began my search for a good shoulder Orthopedic Doc. After a lengthy search and recommendation from Nate at Endurance Rehab, I was off to see Dr. Amit at Arizona Sports Medicine Center.
Consult was wednesday, March 31, and went great, and he gave me confidence that we can get this behind us with very close to a full recovery and an anatomically correct shoulder. Surgery scheduled for the next morning...1o a.m...lets get it behind us asap so I can start healing!
Jenny and Sophia were both sick (March 31st was her 2nd birthday and she was vomiting everywhere--our bed, her bed, in the car, in the garage--poor thing) and our house was not the place to be rolling me into that equation! Regardless, at home the night before surgery I actually felt okay---Vicodin aided.

March 29, 2010...Crash Day!

It's 6 days post-bike crash, but I'm going to catch up here on the events since March 30, 2010...a day I now call Judgement Day as it is causing me to make solid decisions about my future in triathlon, in sports in general, and in life in general.

So here it goes: Monday March 30, 2010...just another awesome day here in Scottsdale...80 degrees, beautiful. I started the day hanging with Jenny and Sophia...breakfast, fun family time, relaxing. A "lazy" day of training was ahead: my first workout of the day was a 3K swim; just a great day to be outside in the pool. Then off on a 3 hour recovery ride...what I call the backwards Rio Verde loop.

After loading up and rolling out, I could tell the recent adjustments to the bike felt "new" (meaning: not comfortable/normal)...we had just fine tuned the aerobar position as well as adding the awesome "RTC" shifters made by Zipp. But what was feeling uncomfortable was the wheel alignment...standing up while pedaling was causing a "rub" in the front wheel. I stopped to adjust it but the problem did not disappear (note: when you think something is wrong with your front wheel on a Tri Bike, make sure it's not wrong for long).

Heading into Rio Verde after the "rollers" section, I came down the hill to a stop sign. Noticing 3 cars approaching from behind, I slowed a bit as I left the stop to let them through, as Rio Verde is a retirement community full of questionable drivers, and this section of road has no shoulder. Counting as they passed, one-two-...I put on the gas for some speed, and this is where things went terribly wrong.

I'm sure I hit road reflectors at least 5 times a ride...they are everywhere and placed inconsistently, and I've had some close calls because of that. My memory is a bit foggy, but as I either stood up to accelerate or crouched into the aerobars (regardless, I moved my weight forward to put more power on the cranks), one of those reflectors through my front tire into spasm, and whatever we call it, my front wheel locked, I flipped over the handlebars, landed on the back of my right shoulder, and bingo, I have my first broken bone, my first major bike crash. Was it something mechanically wrong with my front wheel? Was it my carelessness? Probably, a bit of both.

No one witnessed my crash, but one passerby looped around to make sure I was okay...she must be a very sweet lady as she said that all she could tell was that something was not right---good to know people are still observant! I took inventory of gear and injury--outside of a scrape on my left wrist...no blood! For a moment I felt like Tom Arnold in that scene from "True Lies."

I called Jenny to give her the news without scaring her, and she dropped everything to come get me, take me to Scottsdale Healthcare @Thompson Peak ER, pick me up some clothes from home, and without a bat of her eyes, become my nurse from that point on. X rays confirmed the break, I went home with an Rx for Vicodin and some serious thinking to do. A brief phone consult from the ER Orthopedic MD on call mentioned the probability of surgery...it must be pretty bad! At this point, I knew nothing about anything to do with clavicle breaks.