Sunday, August 10, 2014

Hip rehab status, plans looking towards 2015

I've been in physical therapy for two weeks now.  Since beginning weight bearing on July 22, following 7 weeks on crutches due to my pelvic (acetabulum) fracture, I've faced these challenges:

1.  Right calf and arch weakness from non-weight bearing;
2. Left Achilles irritated from having my left leg do all the work for 7 weeks;
3. Walking with a limp due to difficulty straightening out my right leg and hip  due a very tight hip joint;
4. Incredibly weak right hamstring and glutes.

To deal with 1 &2,  I began a program of eccentric heel drops on both sides (http://fredippides.blogspot.com/p/since-oct-31-i-have-been-doing-twice.html) particularly to strengthen the calf and arch of the foot on the right;  and at the same time to rehab the achilles on the left, and strength the achilles on the right to prepare for a return to running later this year.   The right calf muscles were really weak at the start:   I couldn't do a full set when I  started out.  Beginning with a set every other day, by the end of the first week the calf was extremely sore.  The second week I started one set each day;  the third week I began two a day sets.  This week I have begun adding weight-  25lbs in a backpack.  Its progressing nicely.

The more serious issue is 3&4- walking with a limp due to tight hip joint and weak/atrophied glutes and hamstrings.

My PT has had me doing the following exercise and stretches:

1.  Two-leg Glute Bridges, 3 x 10,  for the glutes, hamstrings and lower back:  (http://backandneck.about.com/od/exerciseandsport/ht/Lower-Back-Exercise-Strengthening-Your-Back-With-The-Abdominal-Bridge.htm)

2.  Standing hip clams with a rubber strap.  Started with 3 x10;  progressed to 3 x20;   2x daily.

3.  Standing hip extension exercise with rubber strap:   3 x 10,  2x daily.

4. Supine Straight Leg Raises (3 x10, 2x daily).

5.  Hamstring stretches-  lying on my back, using a strip of webbing to pull my straight leg up, 3 x 30 sec,  2x daily.

6.  Quad stretches lying on my stomach (prone), with strip of webbing looped around my foot to pull it up against my butt.  3 x 30 sec 2-3x daily

7.  Calf stretches on ramp, 3 x 30 sec 2x daily.

7.  This week:  Started 1-leg Glute bridges.

The most difficult of the exercises above has been the glute bridges.  It is somewhat akin to trying to wiggle my ears:   my right glutes don't seem to want to "fire".  The right glute is noticeably smaller than the left;  I suspect the issue has to do with the surgical wound required to access the acetabulum to perform the ORIF surgery.

My PT has therefore directed me to do glute squeezes:  Both glutes together, then one-sided. lying down --to keep the buttocks safely shielded from view for the benefit of all concerned -:).  This seems to have been working as I am finally getting the right glute to "fire" and the muscle is sore.  A good sign that I am finally getting access to the muscle to strengthen it.

I am no longer walking with a limp!

I will continue these exercises  and assuming things continue to progress I will start walking in a month.  My program will focus on walking through the fall and hopefully I'l  be able to start running by Juanuary in preparation for the 2015 ultra season.

Saturday, August 9, 2014

Volunteering at the 2014 AC100: A great consolation prize for my DNS

Idlehour A/S, Mile 84 of the AC100.  Photo credit to Scott Applebaum

Last weekend I had an absolutely  fabulous time as a volunteer with the Ultra Medical Team at the 2014 AC100.  Although I'd have preferred to be racing, and hated the fact that circumstances forced me to DNS, it was a heck of a "consolation prize" to be able to contribute to the race, to hang out with running friends,  and I made many new friends at the race.

I had been training to race again this year but on May 31, during a training run, I took a freak fall and fractured my pelvis  (http://fredippides.blogspot.com/2014/06/training-run-gone-bad-self-rescue-with.html).  I was fortunate in that I was able to hike out and get to the ER;  the next day I underwent surgery ("ORIF") to have by acetabulum (hip socket) screwed back together.  Three weeks ago I was given clearance to bear weight, so volunteering at the race was ON.  I used my crutches anyways since I'd been counseled to not over-do the weight bearing:  As I could walk about 15 minutes on the leg before it started hurting,  I was very careful not to overdo it.

My primary responsibility at the race was to arrange the logistics and set up of two new medical stations at the Cloudburst Summit (Mile 37) and Idlehour (mile 84) aid stations.  In addition I was detailed to Idlehour for the evening-  this being near the scene of my accident-  how ironic is that?

On 9am on race morning I rendezvoused with Nick Nudell, the Medical Director, at Vincent gap  to see how the med stations go together and to pick up the gear to set up Cloudburst Summit's medical tent.  Heading out to meet the medical team at Cloudburst, the Venture Scouts had the tent set up for us in no time.  My medical team-mates included Mike, an ICU nurse, and Melissa, a ultra running fire-fighter/EMT, and my good friend Brad Harris, MD.  Brad and I shared some of the best miles of my running career at last year's AC100, when we tore out of Three-Points together to Hillyer at a blistering pace, making the leg to Hillyer in 1:06, tying for second fastest split of the day, en route to  silver buckle finishes for the both of us.
With my pal Brad Harris at Cloudburst Summit

The weather was so unusual on race day.  Cloudburst was positively chilly and we donned windbreakers and jackets, such a contrast to the furnace that Cooper Canyon and Cloudburst usually shape up to be on race day.  It felt more like being in the Rockies prior to an afternoon shower.

After Cloudburst Summit A/S closed we broke down the station and packed it up in Mike's truck to ferry it around the front range to drive up the Toll Road to Idlehour Aid Station.  Joining up with a fresh crew of first aiders (Ty and Dorothy) Mike and I arrived around 8pm and got the medical tent set up in the waning daylight and settled in for the evening shift.  The Idlehour station was amazing:  What a great, fun, and well-prepared crew:
Idlehour A/S crew.  Photo credit to Scott Applebaum
I had a blast helping the runners as they came through through the night amid the intermittent rain squalls.  I saw my friends Jason Emberger, Vincent Juarez, Tim Hendricks and many others.  It was terrific to see Ruperto come hauling through in the lead, in a front row seat up at Idlehour!   My friend Larry Rich came in in the early morning paced by John Chin -- it was so great to be a part of their race:

The vast majority of the runners showed great respect for the race volunteers.  All in all, a wonderful time and a great way to take the sting out of my DNS this year.

I find myself reflecting on the fact that the majority of the aid station volunteers I met at the race were not ultra runners let alone AC100 vets.   The acrimony that occurred on the AC100 Facebook page this week  really stood out, conveying a bit of a sense of entitlement by us runners.   (For the record, I too would like to see some changes like a waiting list, so that I could have handed off my spot when I pulled from the race in early June).  By contrast I saw all weekend a quietly selfless attitude of service among the many  volunteers that I met out there giving their entire weekends to support us ultra runners in what really must be acknowledged to be an  immensely selfish quest to run the race.  Most of these volunteers have never run AC100 nor can ever hope to do so.  How Ken and Hal have assembled such a group of good hearted, selfless and committed volunteers, just amazes me.   These people seem to me, after this wonderful weekend, to be the true heart and soul of the race.

For this insight I have my accident to thank and I am grateful for the new perspective.    In the future if I am shut out of the sign up process I hope I will find the grace to show up again as a volunteer to continue to be part of this wonderful institution.  It was (almost) as fun as racing.

Friday, August 1, 2014

Good luck AC100 runners!

 Tommorrow at 5am the gun will go off in Wrightwood starting the 2014 Angeles Crest 100 mile Endurance Run.    I wish all the runners good luck and if you should chance to read this I hope you run to the best of your potential this weekend!

 I have a race number waiting for me up in Wrightwood but I won't be claiming it, having fractured my pelvis in a freak accident while on a training run back on May 31 (http://fredippides.blogspot.com/2014/06/training-run-gone-bad-self-rescue-with.html).

Instead, this year I will be helping out the Ultra Medical Team with logistics and set up.  I'll be the guy out there handing out water wearing a silver buckle (!) and walking with crutches.  (While I am cleared for weight bearing, I don't want to overdo it;  long periods standing or walking tend to irritate my hip so I'll be playing it safe).    I'll be setting up at Idlehour, my favorite wilderness sports injury site.  How is that for irony?

   A year ago today my crew was gearing up to help me with my AC100 race,  and I was wigging out up in Wrightwood.  But it all came together and God graced me with one of the best days of my life: http://fredippides.blogspot.com/2013/08/angeles-crest-100-race-report-.

It is amazing how fast a year goes by, and yet its sobering how much can happen.  Today, my good friend Richard Peck is on my mind.  He was so excited to come up and crew me last year.  Just last February he was diagnosed with cancer and he passed on July 1.

All this reminds me how ephemeral life can be.  There is an ecstatic aspect of life, as exemplified for me by my experience last year of running 100 miles across the San Gabriel Mountains in a day.  I look back on some of the best miles I ran in that race, like the blistering stretch out of Three Points with my pal Brad Harris, the last 25 run with my pal, pacer Joe Tholt, and the experiences sharing that ecstatic race with my wife and kids and crew -- it was so fantastic!   I am mindful that one day one can wake up and find such opportunities severely circumscribed -- so grab onto it while you can!  Enjoy it with your friends and loved ones!

A friend asked me earlier this year if I might pace him at a different 100. I waffled due to various commitments and then the opportunity was taken away by my injury.  I'm sobered by this and  hope that next time I will have a right perspective and seize such an opportunity without hesitation.

I am getting preachy so its time to stop writing.

Good luck runners!  I hope I see you out there!

Tuesday, July 29, 2014

Let the PT begin....

Having been given the clearance to put weight on the fractured right leg last week,  I was cleared to begin physical therapy to restore range of motion and general conditioning to restore muscles weakened by 7 weeks of inactivity.

I immediately set out to make a PT appointment but backlog made it impossible to secure an appointment until yesterday.

This one week delay was probably a good thing.  Initially, simply walking on my right leg tired the weakened calf muscles, quadriceps, and the bottom of the right foot.  Despite all the isometrics exercises that I had done,  it turns out that there is simply no substitute for weight bearing to maintain leg strength.  So, for example, whereas before the accident I was routinely doing sets of 25-30  heel drops on one leg with 85pounds on my back;  last week I could not raise my body weight once on the right leg, my right calf having become so weak.

In any even,  after assessment the therapist gave me a home program of:


  1. Hamstring stretches, lying prone, using a length of webbing with a loop tied in the end to capture my foot (as opposed to doing bent-over toe touches, which irritate my right hip).  3 x 20 sec
  2. Calf stretches on ramp or leaning against wall, 3 x 20 sec
  3. Quad lifts, quad locked, lying on my back, 3 x 10 rep
  4. Hamstring/glut bridges starting on my back with knees bent, 3 x 10.  These I find to be REALLY difficult much to my surprise.
  5. Standing hip clamshells with elastic loop around legs 3 x 10
  6. Standing hip flex, w/ elastic loop around legs, 3 x 10
All of the above, twice daily followed by icing.

Also, last week I started eccentric heel drops, no weight;  3 x 15 straight leg, 3 x 15 bent leg, every other day.  This week I am increasing the frequency to daily.  On the right side I cannot do 15 reps with straight leg so I cut the reps to 10.  I will increase to twice daily as soon as the right leg can do  compete sets in control.




Monday, July 21, 2014

No more crutches!


Today I got my 6 week check up:  X-rays look good says the doc.  He gave me the OK to put full weight on the fractured leg-  No more crutches!

It felt extremely strange walking on the bad  leg;  the calf and quad are very weak and my arch  and heel are sore and tender after 7 weeks without weight since the surgery.  But I walked around the block with my wife and daughter!

Friday, July 18, 2014

Richard Peck, Rest in Peace




 My friend Richard was buried yesterday.  He had been diagnosed with an aggressive cancer back at the end of February.  He passed on July 1st.  


I met Richard back in 2011 when he took his son Nick and his other Webelos to check out Troop 4.  Richard struck me as no-nonsense, and a little gruff as he sized me up; we hit it off and he jumped right in and was right there working knots with the boys.  A few months later Nick and Richard joined our troop. 

Richard was absolutely devoted to Nick.   He and Nick went camping at the beach and he taught the boys first aid;  we went camping in the local mountains, and he helped the boys make the most shocking pagan war flag, it was awesome.   Richard often told me how excited he was about Nicks growing confidence and independence and sense of self empowerment.   Richard  helped out everywhere and the boys and the adults loved him.  He was salt of the earth.   He taught cooking  and pulled my introverted son into it;  they shared a love for Penzey’s spices.    Richard gave us his chile verde recipe. 

At Bandido a couple years ago Richard helped me out with a climbing program.  He was off belaying other boys while I taught  Nick how to rappel.  Richard was so proud of Nick for taking that on.  He wrote me later that  he “could see a sense of pride.... No false bravado from him....Bravery is accepting that you are afraid, and pushing forward in spite of that. One of the best emotions in life is laughing through tears...:. Or grinning while physically shaking .... Good stuff !!”  We went out on our own and climbed and rappelled at Horseflats; Richard belayed me while I tackled the crack at Romeo Void over and over until I got it.   I was pretty scared on the crux of that little climb but Richard had me on belay until I got it.  Richard loved all this so much he got his climbing instructor card.  He took Nick out on  his final instructor’s exam -  where Nick got to show off some ‘special’ techniques on a 70 foot rappel!  Richard was beyond proud of  Nick for how he handled this;  he told me that most of the adults had bowed out (it was very high “pucker factor”).   The last time we climbed was after the Angeles Crest 100 last year (where Richard crewed me, along with my wife, brother, and a couple of other close  friends)  when Nick and Richard and I went up to practice anchors and rappel rescue at Horseflats.   We looked forward to climbing and exploring more up there.  We wanted to scope out the scary 80- foot Toprope wall, but we never got the chance.   



I trusted Richard  and that trust extended  from the rock into some hairy stuff in the real world.   He was real.    We tried to be on our  best behavior around the scouts and I for one had to work hard to keep my language clean.   But I loved the fact that when we were together  without the boys his language could sometimes blister paint -- I felt like I could breath around him.  Richard became my close friend and confidant.  When I got  upset at people places or things, he would just listen, wouldn’t judge, but would tell me that he wasn’t going to put any bullets in my chamber.


About these adventures, Richard once wrote to me, “We all have a ‘golden window’ in life sometimes, to do things we haven't done before, and may not be able to do again in the future. This is one of those opportunities for me…”  I read those words now and they seem prophetic and leave me speechless.   His time was too short and I miss him.

Monday, June 16, 2014

updates


Monday, June 16, 2014


Supplements and diet

A note on diet and supplements.

I have cut the carbs relative to my usual diet since I need less energy being largely chair bound.  To my usual morning smoothie (see http://fredippides.blogspot.com/p/other-stuff-diet-and-injury-prevention.html) I am using more chia.


I am taking certain supplements to help with healing:

HMB:  900mg, 3 times daily.  HMB has supposedly been shown to slow muscle wasting, and is supposed to help middle aged athletes put on and maintain muscle mass.  I decided to take this to do what I can to prevent loss of muscle in my injured leg, which cannot bear weight for the next 2-3 months.

SAM-e 400mg, 2x daily.  SAM-e is metabolized into glutathione, an important compound required in the liver to sweep toxic metabolites of many types out of the body.  In particular, glutathione stores become depleted by using acetaminophen.  Once glutathione is depleted, the toxic metabolites of acetaminophen do liver damage which can run away and ultimately cause liver failure.  Since I am taking vicodin, which contains a lot of acetaminophen, this seemed like a good idea.  Treatments for acetaminophen toxicity all involve ingestion of glutothione precursors after all.

In addition SAM-e is supposed to promote cartilage growth;  in any event its been shown effective in treating osteo-arthritis.  A big concern about my fractured acetabulum is that the cartilage  must have been damaged  when the socket cracked and separated.  If this cartilage doesn't heal I will have  a short running career (if I have one at all) once the fracture heals.

I am also taking a lot of glucosamine, again, out of concern for cartilage damage sustained during the acetabulum fracture.

3000-4000 i.u. of vitamin D daily to promote bone healing.

100% of the RDA for calcium  in the form of calcium citrate, for bone healing.

500 mg vitamin C on top of 2-3 oranges per day.  This is promote formation of the collagen matrix that evidently first forms in a fracture, before the fracture begins to calcify and heal.

Second week & a nice Father's day on crutches

I had a great Father's Day yesterday.  My wife and kids took on the task of cleaning out the garage, which had become piled up with e-waste, miscellaneous junk, making it difficult / impossible  to safely access and use the chin up /leg up station given my crutches;  the plus floor mat that I'd set up  a few years ago had become covered with junk.  So I found myself crutching around trying to help, while my wife &  the kids were putting tools away, sweeping up and hauling out.
After lunch I zonked out, had to take a nap.  Then back out for more garage fun in the afternoon.
It was fabulous. Once it was cleared I got on the chin up bar and did a couple sets -  could only do 15 versus my normal 20;  and did a couple sets of leg-ups.  I tired easily.  I spent a lot of the day outside  which did wonders for my mood relative to sitting lazy-boy-chair bound, indoors.

 Come 9:00, after a dinner out, I was completely whipped and went to sleep.

I had a hard time staying asleep however as my leg just ached all night, particularly along the IT band and the front of the hip.  I think I'd better take it easy today.

Last week I progressively got better sleep, but sleep has still been an issue.  When I got home from the hospital I was typically up every 1-2 hours to pee and was extremely uncomfortable;  by the end of the second week I could sleep 5-6 hours which did wonders for my sanity.

The goal now is to get into an upper body/core strength regimen that doesn't stress the hip;  and to continue and extend the isometric exercises I've been doing to maintain muscle tone on the injured leg.  As the pain settles and hope I can sleep more and make it through the day without napping-  ultimately  I hope to dump the vicodin and then get back to work.

Wednesday, June 11, 2014


First week

I had the staples holding my right buttock together removed on Monday.  I had visions of the doctor wielding a large magnet to suck the staples out,  after the fashion of Grinchy Claus  taking down the Who's stockings down in Whoville. Somehow that seemed more plausible in my mind than the use of  office staple removers like the ones I use at work on stacks of paper.  Nor, use of a wire cutter to cut the things in half and needle nose pliers to pull each half out of the skin.   Neither vision was correct, and in the end it was a medtech, not the doc, nor even a nurse that removed them and it was entirely painless.  Another example that  worrying is like paying a debt that you don't owe.

I am up at 6am today because Tina called around 5am from Dale's crew vehicle somewhere near Parker, AZ to check whether there was gasoline at Salome or Congress.  Dale is riding the RAAM course faster than he did RAW last year.  I think she called me by mistake.  But I heard the call because I was awake, the vicodin having worn off from the night before, the right hip  aching something fierce.  It was good to have something useful to do.  Regretably I cannot accept epic games of Shoots and Ladders as constituting useful work, although of all the activities available to me at the present, playing games with my kids should be the top priority and is ultimately most useful.

Its Wednesday and I have been home from the hospital one week now.  I can move my leg much better than 1 week ago.  When I arrived at home, I could not slide my heel towards my butt while laying flat on bed at all. Now its no problem.  I couldn't previously lift my right leg up in that position-  again, now its no problem.    It still hurts a great deal if my right leg rotates inwards  as for example it would if I slept on my left side.   There is a pretty constant dull ache.

I am using less vicodin than before.  This is good since it seems to screw up my mood and memory.  Under the influence of the prescribed vicodin,  I entered my SSAN incorrectly on a state on-line form last week.  Incomprehensible.  Also, extremely difficult to correct.  It cannot be done on-line.  However there is a help-desk number.  Great!  And so I have spend several hours on the phone navigating voice menu systems to get to the desired operator help line only to get the message "the maximum number of callers has been reached.  Please hang up and try calling at a different time".  This sort of experience should be required for anyone in favor of universal, government run health care system.  Sit while in pain and navigate a government computerized phone menu system, only to be timed out again and again.  Then go out and preach government health care.  I should think that news of 12 month waits at the VA would clue people in, but hey?  I am just  a neanderthal.

OK enough of the sour attitude.  I resolve to do something fun with kids today.
Chocolate covered bacon

A few days ago I made such a resolution and the outcome was:  Chocolate covered bacon.  Fabulous. Today I will continue soap carving with my young son, which we began yesterday.