Thursday, August 20, 2009

Breaking Free

A lot has happened regarding my arm since my last post four months ago. I always had it in the back of my mind to update on what was happening, and admittedly it would've been handy to have a journal of events to look back on what was going through my mind. In all honesty, though, I fell into a mild depression after I broke my arm and really didn't feel like writing anything. It was tough going from an active lifestyle, riding 25 miles a day commuting to work, to mostly sedentary activities and driving, with even the most tame of exercises causing discomfort. I am sure the narcotics I was taking didn't help.

Deep down I knew that I was really fortunate I was not hurt more in the crash, and that a broken arm simply requires time to heal. I knew I would likely return to 100% and be able to participate in the activities of my choosing. But it can be tough to convince our superficial, everyday person to believe what we want to believe. Additionally, my ulna was refusing to grow and I was stuck with a 6mm gap in the bone, held together by 316L stainless steel and maybe some scar tissue.

In late June, my original surgeon officially declared my ulna as an atrophic nonunion, meaning that the bone hadn't shown any signs of growth in 90 days and I would likely need a bone graft surgery. My radius, the bone that did not exit my skin during my accident, was showing healthy signs of healing. I was frustrated and confused; it's not easy to hear that your body won't heal when you considered yourself a young and healthy adult. Lots of questions were floating through my mind. Did I do something wrong during recovery? Should I have eaten better? Slept more? Did my surgeon mess up? In addition to the news that I'd need surgery, my original surgeon said she was going out of town for 6 weeks and due to insurance issues, I'd have to wait until she returned in mid-August to get the surgery. This meant that I was stuck in a cast with a bone that was not healing.

I waited a couple of weeks, then decided sitting around in a cast was pointless and I was wasting time. I was done being patient and decided to visit a couple local surgeons to get their opinion on my arm. My original surgeon was located about 2-2.5 hours away in San Diego, and at first I was determined to continue care with her despite insurance issues and communication difficulties with her staff. After visiting the local surgeons, however, there was no doubt in my mind that I was leaving my original surgeon and switching to these local docs.

I visited two local orthopedic surgeons, one more experienced with sports trauma and the other more of a hand/wrist/arm specialist. Both seem extremely confident and have excellent bedside manner, something that was lacking profusely with my original surgeon. I actually spent over 45 minutes discussing my situation with the hand/wrist/arm specialist and was surprised to learn I am 10-12 years past the age where a gap such as the one my ulna has would be expected to grow. Both surgeons were concerned that I'd been left in a cast for 4 months, and both suggested that we remove the cast and start physical therapy. The purpose of therapy was multi-facted, primarily to regain range of motion and strength in preparation for a bone graft surgery, but also to increase blood flow to the nonunion site and see if we couldn't convince that bone to grow without surgery.

On August 3, nearly four months after I flew over my handlebars in the Sagebrush Safari, I had the cast cut off and felt a sense of liberation words cannot describe. Initially I was very apprehensive about my arm, feeling that it was fragile and that a simple bump against the wall could break it. As it turns out, stainless steel and 6 screws do a pretty good job of holding a bone together. Re-breaking the bone is certainly possible, but I am able to go about my daily life with almost no notice of my arm other than the occasional aching pain and lack of rotation. It's very odd to consider that my arm is still broken.

I started physical therapy with a fantastic therapist who has been a joy to work with, despite the pain she puts me in. I've learned that physical therapists often give the best advice, as they see the work of all different surgeons and basically are around to fix what the doctors mess up. The good news is that my bones near the fracture site look healthy and my strength is returning at a quick rate. The bad news is that I have a lot of hardware in my arm, and it's getting in they way of my rotational movement. Supination, the rotation of the wrist to palm up, is extremely painful and I still have about 90 degrees to get through. I'll go to PT for 2 more weeks, then we'll get updated x-rays and decide what to do next. Likely I will receive a bone graft in September, taken from the Iliac Crest bone in my hip. Using my own bone will give us the best chance of the bone growing.

In addition to physical therapy, I have started commuting to work on a recumbent bike and have started doing some serious hiking and running. I would venture to say that I'm in better overall fitness at this moment than I was before my crash, when I was near the peak of my biking fitness. I've been spending a lot of time in the local mountains around 8,000-10,000' elevation, and hiking with a pack seems to be more of a whole body workout than biking.

Most importantly, I feel fantastic both mentally and physically. That feeling of being fortunate that my injury was not worse has finally surfaced and become reality, not just something I'm trying to convince myself of. I love waking up in the morning, I love going to work, I love mundane tasks like going to the grocery store or sweeping my floor... I think you get the point. My attitude reminds me of a Radiohead song, "Fitter, happier, more productive," without the cynical part that follows, "a pig, in a cage, on antibiotics".

So, now you're up to speed. Hopefully from this point forward I'll start updating more regularly. For those of you who read multiple blogs, might I suggest that you start using Google Reader (or a similar RSS reader). It allows you to follow any number of blogs without visiting all these different websites -- each update appears similar to a new email in your inbox, for you to peruse at your convenience. Very handy and very cool.

And with that, I'll leave you with a few pictures from the past four months.

Climbing Mt. Baldy for the first time, highest point in the San Gabriel Mountains

Driving up to Big Sur along the Pacific Coast

Fourth of July trip to Mammoth to visit Katie

Backpacking with Katie in the High Sierra

Hiking Islip Ridge in the San Gabriel Mountains above Los Angeles

Bighorn sheep along Islip Ridge

My "new" 1983 Toyota pickup

Hiking with Sheba (coworker's dog) up Cucamonga Peak

Morning hike near Mt. Baldy

On Pine Mountain Ridge, with Mt. Baldy in the background (right)

My new recumbent

The San Antonio Ridgeline, a future hiking goal

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