Bust a cap!

My old mountain bike has been misbehaving the past few months. First, there was trouble with the headset, and then I couldn't get it to shift right (probably due to bent chainrings). At some point I knew I needed a new frame, it was time to retire the Giant V1.

I picked up a Titus ML-1 on a closeout sale at Colorado Cyclist. This is a full suspension bike that is more aggressive than the Giant, and a couple pounds lighter to boot. After I replaced the cranks with a new Shimano SX (very stiff, very nice!), I only needed a new front derailleur and cables to get it on the trail. I love it when that happens! The Titus has more of an XC geometry, good handling and fast, I like it!

I've ridden it a couple of times but still hadn't gotten to know the bike as completely as I would like. Our family vacation in the Berkshires presented a golden opportunity to spend some quality time on the bike. With both of my boys out of the house the estrogen level at home is pretty high, but the girls indulge Dad in his biking as they know it ultimately gives them more time to shop or eat out or generally burn money. Life's little tradeoffs...

Our hotel was right on the edge of Beartown Forest, a state forest with miles of mountain biking trails and lots to explore. My expectations were high as I contemplated ride reports I found on the 'net and studied trail maps.

We arrived on Saturday just before the rain began, and Sunday passed with steady rain continuing. The Weather Channel promised sunny skies on Monday, but when I left the hotel it was still raining lightly. My arrival at the CCC camp inside of Beartown Forest heralded the end of the rain, although it was still overcast.

Everything was wet and there were puddles everywhere. Riding was challenging as my tires routinely slipped on wet rocks, but I thought it was a fun skill test and was enjoying myself. Within the first mile I rode into a smallish puddle that I would estimate to be 2 feet across and 3 feet deep; the depth was completely hidden from me, of course, until I saw my front wheel disappear past the hubs.

Inertia took over as the bike stopped in the puddle and I ejected over the front, whacking my left kneecap on the stem as I went by. Other than a lot of blood from the knee, I was OK so I pulled the bike out and kept riding. The knee was sore from the hit but I didn't worry about it. I rode the Turkey Trail and looped back onto the mountain bike trail, finishing on the road as I made my way back to my car. The bike gained 10 lbs or more of mud and it took several dunkings in a pond to get it off.

The knee wouldn't stop bleeding, which is inconvenient when your wife accuses you of getting hurt every time you go for a ride. For the record, I hardly ever get hurt; I bleed a lot, but it doesn't hurt! There was a lot of blood on my shorts, blood running down my leg, and blood on my socks, so no hiding this one.

I sliced my finger open last week and fixed it with super glue, but I didn't think glue would fix this guy as it looked like it could use a stitch or two to close. Had I realized this when I was on the trail I would have kept riding; stitches mean riding goes on hold. I cleaned it up in the shower and put a bandage on it, then informed my family that we were going shopping in Great Barrington, which had the closest emergency room.

I dropped the girls off in the shopping district and arrived at Fairview Hospital a few minutes later. Clean, relaxed, and very modern looking, I liked this place from the start! It didn't take long to see a doctor, who decided to X-Ray just in case I broke something underneath. Fortunately the X-rays showed no real damage, so we just needed to close the wound and I would be on my way.

Before stitching, the doctor started to explain what he was going to do as he was looking at the wound. At some point he must have noticed all the other scars on my leg because he stopped and looked at me and said, "...but you've been through all of this before, haven't you." Uh, yeah, more than just a few times. I was pleased he used the thick suture and took a wide stitch; sometimes you get these wannabe plastic surgeons who don't want to leave a scar, and invariably the suture pulls out or the skin rips and makes a big mess. Knees have a lot of pressure on them from a skin point of view, don't screw around; just fix it!

Two stitches is all it took to close this guy up, it hardly seems worth troubling the medical community for it. The stiches are in for 10 days and it may be two weeks before I'm back on a bike, but it's healing up fast and looks good.

My usual motto is that a good vacation is a great time, but a great vacation includes a visit to the emergency room!

Fairview Hospital in Great Bearington gets two thumbs up!

We have wrist-off!

Thursday, April 12 was a special day for me as I was hopeful that it would be my final visit with Dr. Jurist and the completion of the wrist saga. I arrived early at the doctor's office partly excited to see how my wrist is healing, and partly excited to read some of the excellent magazines that the staff maintains there.

I obtained the usual x-ray first thing, check it out:

The first thing you might notice is how much better I'm getting at photographing x-rays. I don't think this is a marketable skill, but I've had enough practice at it that my pictures are turning out pretty good.

You will need a trained eye and a good imagination if you think you can see a fracture! You can't tell anything was ever wrong with the bone, except for a chunk of titanium and a few random screws. Everything fit back together perfectly and has knit, this is my best picture yet!

Dr. Jurist was elated. He looked at the x-rays and was really impressed. He felt the hand carefully, checking it all out. Then came the moment of truth.

During my previous office visit, the good doc gave me some exercises to do believing I would work hard and not need to see a physical therapist. For the past two weeks I have been working the wrist almost constantly, making it hurt to gain mobility while I can. Diane has expressed something of a contrary opinion, pointing out that the doctor didn't talk about maniacal persistence of exercise, just some exercise every hour. Usually Diane is right about stuff like this, but I felt in my bones that working hard was the right thing to do.

Thank goodness I was right. Or at least not completely wrong. When Dr. Jurist had me move the wrist he was so happy with my flexibility that he almost cried. He had me move it over and over. In a long career of fixing wrists, he's never had one heal this well or this quickly. He was very pleased. Emotionally and deeply pleased.

He told me the bones are healed, the wrist is good, I can do whatever I want. No need to wear a brace any longer. I need to be careful because the wrist has no strength and I might hurt myself, and indeed I've observed that I can't even pick up my coat with the left hand. But by doing hand strengthening exercises and continuing to twist to regain more mobility, he felt confident I would heal fast.

'So the golden question is, can I ride a bike?', I asked.
'Looks like the weather is going to work against you this weekend, but sure, you can ride a bike', he replied, 'just be careful, it isn't very strong.'
'My question to you,' he continued, 'are you going to wander into terrain parks and take big jumps when you go skiing next year?'
'Yes, I believe I will,' I replied. 'I've done hundred of jumps like that before and only messed up once. I don't see why I would stop now.'
He gave me a big smile, 'I thought you might.'

I am truly grateful to the competence and skill of Dr. Jurist, and I thanked him profusely. I also thanked the good ladies at the front desk and once again complimented them on their excellent magazine selection, and they promised they'd get some new ones for me if I called ahead, I don't even need to get hurt again to come by and read.

The weather forecast for Thursday was rain and snow, but when I walked out of the office the roads were dry. When I arrived home it still hadn't started raining so I quickly changed and took off on my mountain bike; I figured the shocks would keep the hand from taking any hard jolts. It was just starting to rain when I left the driveway. When I turned around after topping the hill to Westford Center it was sleeting and coming down pretty hard, but I was having so much fun just riding a bike that I ignored it. At about 4 miles it wasn't much of a ride, but it felt great!

Before I bring this story to a close, there are a couple of loose ends to tie up, although you may not realize it.

Several people have wondered if I was able to work while my wrist healed. The people I work with know I missed very little work over this. In fact, just to help me be productive, Rob, my manager, got me a prosthetic:


This is a mechanical hand that came in a box labelled "The Pianist", so I tried to play the piano with it. You have probably already noticed that it's another RIGHT hand, so not as useful as you might hope. I also took a picture of the instructions:


Oh, the irony! The cruelty! Sure, it seems like such a noble gesture to provide an extra hand when I can't use my own. But requiring someone with a broken wrist to clap is just cruel!

In closing, we live in an age of wonders and miracles, and yet they are so commonplace that we hardly notice them. If an injury such as this had occurred when I was a boy, my arm would never have been right and would have caused me pain the rest of my life. Yet here I am nearly completely healed, only a short time since a serious-ish injury. And I continue to marvel at the human body, a serious bit of engineering with the ability to heal itself and recover from the abuse we give ourselves.

I'll update this blog again when something interesting happens to me. If the past is any indicator, give it 3-4 months.

Happy Cast-Off Day!

Today was the big day to get the cast off! What a glorious day it has been too!

When the cast was put on three weeks ago it was pretty uncomfortable. It became very tight if I left my arm below my heart and tended to cause my wrist to throb. Holding my hand above my heart caused the blood to drain out and restore balance to The Force, but it was tedious. Still, I've been able to type, which means I could go to work, and I've been getting along pretty well.

The second week of the cast was comfortable. The wrist needed the support and the cast was just loose enough to be warm and comfy on the arm. But the third week, well that's when the itching began. In the past I've had a good laugh at people in casts trying to scratch an itch, and now it was my turn. I found large flat spoon handles to work pretty well, but everyone seems to have their favorite method.

The other funky thing is the amount of skin that started sloughing off. It occurs to me that our hands lose a bit of skin all the time, but we use them so much we barely notice it. But with a cast, I noticed I was leaving small DNA samples everywhere I stopped, a veritable shower of small skin particles. I heard somewhere that you lose around 10 lbs of skin a year and I used to think that was remarkable; but after seeing how much came off my hands, I think it's a pretty conservative estimate.

Last night was Cast-Off Eve, and today was the big event.

I arrived at Dr. Jurist's office and wished everyone a happy Cast-Off Day. The nurses & women behind the desk wished the same to me and apologized for not having a cake. Oh well, maybe next year.

Taking a cast off it quick and painless. It is also loud. They use a power tool that is sort of part saw and part hand mixer; it vibrates really fast and will cut through stiff material quickly, but won't harm your skin. They cut the cast in front and back, then use a reverse-pliers tool to pry it off.

Seeing my arm again reminded me once again how much I love these body parts of mine! The wrist looks a bit worse for wear, but I recognized the little buckaroo and was pleased to see him doing so well!



The small tape-bandages have been on under the cast the entire time. I thought for sure they were curling and causing the arm to itch, but they were intact the entire time.

With the cast off, it was time for X-rays. Check these babies out:


You really have to look carefully to see the fracture lines now! Dr. Jurist was pretty excited about these pictures, everything lines up perfectly and it's really healing well. I told him I love the pictures, but I'm biased because it's me. He said he loves the pictures, but he's biased because it's his work. Big love fest for the pictures...

The doc had me move the hand around. I've secretly been moving it as much as I could over the past week, squeezing a soft ball with my fingers and trying to work it a bit. I've also been running, having a belief in the healing power of blood being pumped through the system. I think this helped.

My movement exceeded expectations. I can bend the wrist more than you would think. I can make a fist. And it will turn both ways. Things are looking pretty good at this stage in the game.

The doc and I agreed to try exercising it by myself without going to physical therapy. We'll try it for two weeks, then reevaluate. He thinks I could do it on my own and wants to see me try.

In the meanwhile, I need to wear a removable brace. I can't pull or lift anything, but I can move the wrist and do exercises. And type. I need to have the brace on whenever I move around just in case I hit the wrist, it won't take much of a hit to set it back.

So here's a picture of the arm today:


One of the most amazing things about this experience is how common this injury is. I will wager I've met more than 20 people who have a scar exactly like this one! If I started a club for people who have had this injury, we'd need a pretty big hall to hold meetings! Someone at work is even recovering from it at the same time, it really is common. As an aside, I told Greg that with my titanium plate I am going to start a second career with the X-men as Bottle Opener Man; he said he is going to be Set-Off-Airport-Security Man, but he thinks his secret identity will be blown every time he travels.

I still wish I would have gotten retractable claws.

Meanwhile, I'm thinking about a new project: Broken Wrist, The Musical. I think it has BIG potential!

I'll update this blog if anything interesting happens, but for sure will report in April 12, after my next appointment. I'm moving into the recovery phase, getting close to the time when I can take this baby out and open 'er up, and see what she'll do.

Central Casting

Today was my big day, or at least the day I have been looking forward too. The swelling in my arm has gone down steadily since the operation, and the half-cast ace bandage thing was getting loose. Every day my fingers move with less pain, and I've been able to sleep a little easier. Last night was the first night I didn't sleep like a baby: wake up every two hours and cry...

Because the back half of my arm was unsupported, I haven't been able to use it for anything. Not so much as hang a towel from it without incurring undue pain. The other day I really, really wanted to go for a run, as the sun was shining and the roads dry and I have been doing nothing since the accident. But even movement caused me pain, so no run. Pretty pathetic. It drives me crazy not being able to help my wife and family around the house. I'm not someone that likes to sit around and be pampered.

This morning I went to see Dr. Jurist and check progress, I was pretty excited. The office was very busy, but I finally tore myself away from a 6 month old Newsweek magazine was led into an exam room. A nurse used scissors to cut off my bandages, revealing a long scar with 25 stitches. She asked me to lay my arm down to remove stitches, but first I took a picture!



So you might think it looks kinda gross, but I haven't seen my arm in almost two weeks and I was pretty happy to see it is still there, and in fact it has absolutely been thriving under all of those bandages.

Before the nurse took any stitches out, she led me into X-ray to take some pictures. It just doesn't get any better than this, I was hoping and praying I could get an x-ray to see what had happened! Dr. Jurist saw me in the x-ray room and stuck his head in, "you're going to love these pictures!" he exclaimed. I'm pumped now!

Back in the exam room the nurse took out a single stitch, then Dr. Jurist came in and said he would do that if she would fetch the pictures, we're excited to see them. I didn't say much as I was counting: 25 in all. The doc joked that he probably could have done it in less, but wanted me to have a good story to tell.

I've been flexing my fingers a lot every day trying to loosen them up, and the doc is pleased. I can't do much with the thumb, but the bandages prevented me from moving it. Hopefully I'll be able to wiggle around more with the cast on.

Now we get to see the x-rays:



So the first and most obvious thing is that I didn't get retractable claws. I expressed my disappointment to the good doctor, and he apologized. Still, look at the way dem bones line up, pretty impressive! You can see the titanium plate and screws in the lower part of the arm, and the pins coming off of the plate in the upper. I also notice that the plate has an interesting cut out in the middle: it looks for all the world like a bottle opener. I have no idea how I'm going to get to it to open a bottle, but I appreciate the thought.

You can see in the picture that the bones are not knit, but they are in nearly perfect alignment and things are starting to fuse. Actually, the bones could only be aligned better if they were held using zip ties, I'm convinced that is a patentable idea.

The doc is very pleased with how things worked out. He says these plates are sort of a new thing, they used to have to really open the arm up in order to put the necessary supports in, and now it's all pretty simple. Just in time too, he says he was getting too old to be cutting on people like that.

Dr. Jurist thought it was cool that I was taking pictures of everything, so we threw the original x-rays up for easy comparison:



This picture was taken before the initial reduction, so you can see that the top of the Radius is pushed way down and the hand is out of place. Now that I've been looking at these for a while, I realize how messed up it was.

The doc told me that often at this point they often provide a removable splint, but given the severity of this break they will cast it for 3 weeks, then we'll go to the splint. I was able to chose from a number of cast colors, but they were all varying shades of ugly. I decided to go with black, it goes with everything.



Notice that I have a lot more finger showing. Yes, I can finally type with 2 hands again! It isn't completely natural as you typically twist your wrist to contact the keyboard, but I've typed this entire blog entry in roughly the time it takes me to do a paragraph or two! I feel like lightening on the keyboard, comparatively speaking.

In exactly 3 weeks from tomorrow, I go for my next exam. They will remove the cast at that point and put on a removable brace. I'm still 6 weeks from starting physical therapy and regaining my full range of motion, but it's clear I'm making progress. The doc says I'm probably about 8 weeks from getting on a bike, but it's something we'll be watching. Evidently he had a patient last year who had the same operation and was able to do the Mt Washington hill climb
four months later. Cool! I've already missed registration for the hill climb this year, but wasn't planning on racing it anyway.

jump pic

Hey, I found a picture of the jump I went off at the Waterville Valley web site, check it out.

What's next?

I now have another cast, or at least another half cast with ace bandages. I have an appointment next Wednesday to remove the stitches and put on a real cast. I've included before & after pictures. Check out the evil condition of my hand in the 'before' shot. In these pictures they don't look all that much different, but there is at least 4 lbs & 30' of ace bandage separating them.

One other note: I've always heard how great Percaset is. I didn't like it at all, and didn't take it beyond one dose at home; I'd rather deal with the pain. It's been 48 hours since the operation and I still can't focus as well as usual and I blame the drugs. There are plenty of people who go through really serious stuff and I have little doubt that pharmaceuticals help them make it, I'm glad they are available; but I'll avoid them when I can, thank you very much.

operating operationally

I've heard a complaint that my story is too long, so my previous entry is the executive summary; and I lived happily ever after, the end.

For anyone else still reading: it takes a long time to type this in one handed, I hope you read it slowly... I'm still woozy in a woozened sort of way, so let's see how this goes.

Allow me to doff my hat to the very competent staff at the NorthWest Regional hospital in Framingham. I have never met a nicer group of people or felt more cared for. With the exception of nurse Ratchet (not her real name), these people exude confidence. I m grateful for their care.

I arrived in the Day Surgery waiting room dressed in my sweats. I was only there a few minutes before being ushered into surgery prep. I was instructed to remove all of my clothing and put on a 'johnny'. I looked the nurse in the eye and pointed out that I was wearing sweats, so surely they would prefer me to keep them on to keep me warm. She explained an emergency procedure that would require access to a thigh, so they require all clothing to be removed when using anesthesia, except for socks. So much for my Jedi mind-trick powers.

My johnny would have been a perfect fit if I was 9 years old. On my 6' 2" frame it was a mini skirt. And of course with only one hand I couldn't tie it in the back, so it was a bit breezy. I doubt anyone would admit to designing the johnny, it is a monument to utility and bad taste. You can bet it was designed by a man. The nurse came in and tied it for me. I hope that these good nurses get Danger Pay for having to see the backsides of middle aged men on their way to surgery; that and free trauma counselling.

They put an IV in , and soon someone came over and shot some Versed into it. Why the Versed? To take the edge off. What edge? You know, The Edge. Let's pretend I have no idea what you are talking about, what edge? All good questions, and she wandered off.

So now there is Versed, antibiotics, and standard saline dripping into me and things are getting just a little surreal. I meet a nurse who has heard about the 'ski guy' and asks me for details of my accident; turns out she is also in a 'mixed marriage', although in her case she skis and her husband doesn't. A woman that looks like she could use some sleep sits down next to me and announces she is my anesthetist;
'I assume someone has talked to you about what we do?'
'No, no one has.'
'We put you to sleep.'
She looks at me expectantly, then gets up and wanders off. I'm not sure that went so well.

Dr Jurist comes by to say hello, and I'm glad he does! He's alert, jovial, and the right guy for the job. He marks my left arm with a pen. I pointed out that if he gets in there and doesn't remember which arm, do the one with two casts and 400 yards of Ace bandages. He thanks me for this insight. I also told him that I've been thinking about my x-rays, and it occurs to me that putting big screws into the bone is not the best way to fix this type of thing.

'Really?' he asked, 'do you have a better way?'
'Zip ties,' I respond. 'Put the plate in and zip it down.'

He's kinda taken back by this, his mouth is working like he's going to rebut the idea, but then he shakes his head. 'Medical grade zip ties, what a great idea!'

Next, a jovial fellow sits by me and announces he is my anesthetist. I told him I've already talked to an anesthetist, and she said she was going to put me to sleep. He seems surprised by this and asks if I remember her name. Nope. So, what's on the menu today? Protopol; it replaced Pentathol 10 years ago. Gas? No, strictly through the IV, although there is an oxygen mask.

We are good to go, so a nurse wheels me in to the OR. On the way we stop at a cupboard and hot blankets are put on top of me, they feel glorious. It must be 15 degrees colder in the OR.

When we arrive inside I see Dr Jurist poring over a trail map for Alta. Kinda scary that I've skied there enough to recognize it by trails alone. I told the doc to come over with a pen and I'll tell him where my favorite runs are; he's got to hike up to The Apron, you can almost always find powder there, if you don't have an aneurysm hiking up in the thin air of 10,500'.

'So doc,' I begin, 'I've figured you orthos out. You re' just itching to put a cast on me, 'cause that's how you mark your territory.
He smiles wickedly and replies, 'Not me. I'm signing your body with a metal plate and a scar.'
Oo, good point!

I asked the doc what kind of metal he's going to put in me. Titanium, why? A friend's father is a doctor and has been campaigning against stainless steel because it corrodes in the body. He responds that could be true in a socket or something, but not in a simple structure plate.

'Let me level with you,' I say.
'What?'
'Adimantium. I want adimantium.'
'Hmm, and why is that?' He's humoring me.
'I want retractable claws like Wolverine,' I say with a straight face.
'I'll see what we can do.'

The anesthetist walks over and puts something in my IV. 'See you later, Steve.' I wait a few seconds and I'm still awake, so I say 'I'm still here, you guys need my help with anything?' The anesthetist puts a little more in the IV and says 'nighty night, Steve'. I wait a couple more seconds and say 'I think you'll have to carry on without me'.

Next thing I know someone is shaking my gently, telling me to wake up. My hand feels different, I can move my fingers without pain. And it doesn't feel so heavy, I must have a different cast. A nurse tells me to wiggle my fingers and toes, it will help me wake up. I comply.

The doc comes by and tells me things went really well, he is very pleased. Everything fit together perfectly and tightly, it is the best possible outcome! He'll call and speak to my wife.

A nurse comes by and asks how I'm doing, and I reply I'm fine. She comes by a couple more times and we have the same exchange. Then she asks how my wrist is doing and I tell her it really hurts, but I'm OK. She rolls her eyes and asks why men need everything spelled out all the time. I'm not sure what she is talking about. Someone gives me a pill and says it is Percadan, for the pain.

I'm wheeled out of recovery into post-op. The nurse wheeling me says 'check this out!' and shows me a long scar on her wrist. 'You had the same operation? I ask. She nods her head. 'Cool! We could start a club or a user group.'

Thus far, everyone I have met has been wonderful. But now they deposit me with Nurse Cratchet, and it isn't so nice. She moves me into bed roughly, then yanks one of the fingers on my broken hand and places a heart rate monitor on it such that it pinches. This really hurts. She comes at me with a cuff for blood pressure and I ask her to please put it on the arm that isn't bandaged, she rolls her eyes but does it. She asks if I want Coke or Sprite; neither, just some water please. No, she doesn't do water because people throw it up. And she sits down across the room. My throat is extremely parched.

Fortunately, it is the end of the shift for Cratchet and she leaves. Her replacement is nurse Linda, a self labelled eXtreme Talker. Linda is an angel and takes good care of me.
We talk about all kinds of things, although with the chemicals running through me I don't think I'm keeping up. Diane picks me up at 8:00 and we head home.