Thursday, October 2, 2014

Time Trial

I couldn't resist a time trial at lunchtime today at the Sawcut wash in Monrovia:

4.22 miles, 35 minutes;  8:20 average pace

http://connect.garmin.com/modern/activity/604161292

Saturday, September 27, 2014

Starting to run....and fun with UMT at Kodiak

I just got home from a 5 mile jaunt around the neighborhood, alternating walking and running, completing the loop in 57 minutes.  I am feeling very grateful.  That's AC100 race pace!

I did a similar workout on the Sawcut Wash in Monrovia two days ago at the same pace (58 minutes).  It was fabulously hot and felt indescribable to be out and moving on trail in the sun with a blue sky above....

The limiting element to my running at present is actually my calves rather than the area around my fractured hip socket.  The calves --and the achilles on my injured side-- are weak from lack of use.  The right hamstring & glute attachments on the right are tender at the junction of the upper leg with my butt.  This is distal to the fracture site/stainless steel hardware, I think its soft tissue injury either incurred in the accident or the surgery.  It hurts less to run than it does to walk oddly enough-  I attribute this to a shorter angular extension while running (faster turnover, small steps) than while walking.

I've been progressing the heel drop exercises to strengthen my achilles/calves-  which I started in late July when I got clearance  for weight bearing.  I am now at 3x30 reps, straight leg, bent leg, with 57 pounds on my back.  The right calf has strengthened considerably, just need to work on endurance now.  The hip rehab is focussed now on flexibility, and strength training for he hamstrings and flutes particularly.  PT sessions last about 2 hours, preceded by an hour of warm up and stretching.

Meantime I've had some fun with the Ultra Medical Team.  I had the chance to work with these amazing people at 72mile checkpoint (Nordic Rim) of the Kodiak 100 last weekend up in Big Bear.  We were a small crew, led by Marco Apostal, an amazing guy who worked 36 hours straight from the start through the finish, with only an hour sleep.  I'd driven up Friday night arriving at Nordic Rim around 1am, and worked with the race folk there to set up the aid station and helped there until we shut it down around 2pm Saturday.  Marco came in around 3am after closing down an earlier medical checkpoint; later that morning he showed me how to treat some rather horrid blisters.  He had given me a walk through on how to do it and I had made sketches based on his lesson;  shortly afterwords  a runner came through, kindly  obliging my interest by presenting with layered  heel blisters the size of  silver dollars.    Marco had him up and running and reportedly his feet lasted him through to the finish.  An amazing fun time with a remarkable, committed group of ultra runners.
UMT crew at Nordic Rim, Mile 72 of the Kodiak 100.  


Saturday, September 13, 2014

Fracture rehab, Sept 13

My  physical therapy is progressing. Around a month ago some muscles that I'd had trouble getting to fire -- notably the right glute-- "woke up" and I fairly suddenly became able to do 1-leg glute bridges.  The PT started me on hamstring curls, dynamic lunges, and some other exercises designed to more aggressively work the hip abductors, hamstrings, and glutes-  including "monster walks"-- walking  with a tight rubber strap wrapped around my legs stepping 45 degrees out and forward to the right, then to the left, etc;  and side steps wrapped the same way.  The most effective of the exercises seems to be the dynamic lunges, which leave me sore the next day.

Two weeks ago I had another set of X-rays and the orthopedic surgeon told me he can no longer see the acetabular fracture in the X-rays.  The PT started me on the treadmill with a  0.5 mile slow run;  yesterday I did a 1 mile slow run.  It felt OK.  The injured right side has soreness in the glute primarily.  I remain focussed on improving flexibility with hamstring and quadriceps stretches 2 or 3 times daily, as well as TFL "stretches" using a tennis ball to roll tender spots.  The latter has helped to reduce pain and tightness on the anterior of the hip joint.

Ive been getting out and walking 2 miles per day most days.

I've also been continuing my eccentric heel drop exercises to restore calf strength and deal with soreness in the achilles-  the good leg got beat up from doing all the work while I was on crutches and the bad leg was just weak from lack of use.  These exercises are done typically with 3 sets of 15 on each leg, with both straight leg and bent leg.  The  progression thus far has been:

Week ending July 28:   heel drops, no weight, 1x daily
July 31-> 2x daily
Aug. 9->  2x daily with 25 lbs
Aug. 21-> 2x daily with 33 lbs
Aug. 30, 2x daily with 41 lbs
Sept 11, 2 x daily with 58 lbs
Sept 13, increased reps from 15 to 25

I started working at the office last week.  The folks at my workplace had a little "welcome home" party for me and being there with these people, some of whom have been friends for 25 years, really lifted my spirits.  The only issue I've had working in the office is that sitting is uncomfortable -- meetings are a bit painful unless I stand.  Its good to be recovering a bit of normalcy in my routine.

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 with the UMT 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.
Finish line crew.  I'm the guy on crutches.


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.

Friday, June 6, 2014

Training run gone bad: Self rescue with a fractured pelvis & lessons learned

I am writing this post with my right leg propped  and iced, feeling very grateful to be home following a four day stay in Huntington Hospital for surgical repair of a pelvic fracture (the acetabulum, or hip socket).   This accident  occurred last Saturday at Idlehour, on the remotest section of a long training run  on a seldom visited  portion of the Angeles Crest 100 course, an area that has no cell phone reception.  My 2014 training and racing season is now over,  but things might have been far  worse.  The fracture was such that I was able to walk out.  Given the lack of cell coverage and foot traffic through Idlehour, had the fracture been slightly different there is no telling how long I might have lain injured on that trail.   But walking out, I subsequently learned, was perhaps an even more dangerous business:  I was extremely lucky that in hiking out on a fractured pelvis, I didn't fall again or sustain a more serious injury:  Broken bones are sharp, as a friend recently said to me,  and the pelvis and hip are full of blood vessels and nerves.

The previous week,  I'd run 97 miles capped off over the Memorial day weekend with 48 miles of mountain trails (sandwiching a day spent fishin' with my sons).  As I'd gotten into a demanding work-week, with a lot of meetings that prevented my normal lunchtime runs, I was feeling a bit drained, so I decided to moderate my mileage,  emphasizing walking for recovery more than running and not overdoing it ("better under-trained than over-injured").  In concession to my feeling run-down, I decided for my long Saturday run  on a 26 mile route which is a mirror image and much easier version of my normal 28 mile Mt. Wilson training loop.

The Saturday route was to be a lollipop course starting and ending at Eaton Canyon Nature Center, heading up the Mt Wilson Toll Road and encircling the upper portion of Eaton canyon including Mt Wilson's summit.  It has a fair amount of elevation gain and descent (7500 feet), but is far easier than my normal clockwise lollipop route starting on the Sam Merrill trail from Lake Avenue, due to the arrangement of the climbing sections.  My plan on this day was to power walk the first ten miles to Wilson's summit, covering the majority of the climbing, and then take it easy and enjoy the gradual descents.  Here is the route, and  a link to the GPS track: http://connect.garmin.com/activity/513954654



I woke early and left a note for my wife saying where I was running and that I should be back by noon.   Making a predawn start from the Eaton Canyon Nature Center, I hit the ten mile point at Mt Wilson summit feeling good in 2:35, my fastest power walk up the  Wilson Toll Road of the season.  As I ran down the Mt Wilson Road I marveled at the grandeur of the chasm cut to the north by the west fork of the San Gabriel River.  I made good time running down through the Meuller Tunnel and the Mt. Lowe railway fire road and when I reached the intersection with the Idlehour Trail, I stopped and stretched.  Launching into the familiar downhill single-track into Idlehour, I found the trail was in great shape having been worked over the previous weekend by the AC100 trail crews.



After about three miles on this trail I reached Idlehour paralleling the stream bed, which was largely dry due to  low rainfall this year.   As I was descending the twisty single track I caught a toe and landed safely on my hand bottles on a boulder pile, uninjured.  This wasn't the first time hand-strap bottles have served as "air bags" for me,  but the fall woke me up a bit.  I continued on to a particular section where I left the trail and bush-wacked  to reach a part of the stream bed where the surface water was still flowing.  While clambering over,  I stepped on a large boulder and the darned thing shifted and rolled:  I jumped clear and thought, "What the hell?  Am I butterfingers today or what?" I reached the flowing water and  used my filter pump to fill my empty hand bottles.  I thought for a moment about whether I needed to refill the extras in my pack since I only had about 7 or 8 miles to go to compete the run.  Thinking, 'better safe than sorry', and feeling a bit shaken by the two near misses I'd just experienced, I filled all my remaining  bottles.   Packing up,  I very carefully made my way back to the trail, restarted my GPS, and began running.  It was around 10 or 10:30am  and I was well on pace to beat my target 5 miles/hour average for the run, even with the extended sections of power walking baked into my run plan.  'Not bad', I was thinking, and as I was nearing the point where the trail bottoms out and starts climbing up out of Idlehour to the Toll Road, I started stretching it out a bit.

That was when my right food hit  gravel on bedrock.

My right foot shot forward  downslope, and I had a nanosecond of realization of my right leg bending up too far as I hit the ground.  The next thing I remember, I was on the ground sitting up in an impossible split with my right leg forward extended down the trail, my left leg extended behind me knee down.

I rolled to my left side and somehow pulled myself up with my arms and left leg as I fought nausea.  I made a quick self-assessment and didn't feel anything obviously broken or see any visual bruising, but I couldn't bend at the waist or move my right leg more than a few degrees forward or backward without a sickening pain that made me gasp.   It occurred to me that perhaps I'd dislocated my hip and that it had popped back in place, or that I'd sprained it.   Feeling nauseous, I remember thinking that I had better get moving while I still could to get out of Idlehour and up to the Toll Road.  The first few steps caused me to cry out.  I kept moving  because I hadn't seen anyone all morning.  I drank a slug of water and started hiking, doing all  the work with my left leg and using the right leg just as a pivot.   I reached the uphill and found a rhythm. Slowly working the uphill switchbacks I finally reached the ridge where the trail tops out and starts descending to the Toll Road.

Hitting the Toll Road I found that it was more comfortable to run, slowly with short tippy toe steps, than to try to walk on the 10% grade.   Thus I made my way down to Henninger's and was passed by a couple of mountain bikers coming up, who looked at me with an odd expression and rode on.  I was completely focussed on moving forward and it didn't occur to me to ask for help.  Looking back on it, it was like I was moving in a separate universe.  I was thinking I would get to Henninger Flats and ask for a ride down to the bottom of the Toll Road and have my wife pick me up there.  Earlier that morning I'd been passed by a yellow LA County Fire truck  heading up the Toll Road and  I expected to see that truck at Henninger.  No Joy! When I got to Henninger Flats there were a few people camping but no trucks.

For a moment I considering stopping and banging on doors.  But I had visions of gimping up steps and finding nobody home or worse, finding someone and triggering a helicopter evacuation.   I decided to press on to the bottom of the Toll Road:  After all, I'd made it this far and so how bad could it be? It was only another 2.5 miles.   At the time this made sense to me, and after all, the extent of my injury only became clear later after a CT scan.    Friends and family have since described my thinking as inexplicable except that I must have been in shock and not thinking clearly.  Perhaps so, but as I reflect on it, its in fact perfectly consistent with a lifetime of self-reliance and a preference for keeping my own company, including while running long in remote wilderness areas.   But this difficulty in asking for help, a life long habit, certainly didn't serve me well on this day. 

I overtook and passed a few hikers heading down from Henninger and stuck grimly to my pace determined to get this thing over with.  About a mile and a half from the bottom I called my wife  Steph and explained that I'd taken a fall and asked her to meet me at the Toll Road trailhead.  However, I couldn't recall the street name so we left it that she would figure it out.  About a half mile further I stopped running just as I passed an Asian lady hiking down with her son who appeared to be developmentally disabled.  Of all the people I passed on the Toll Road that day,  it was this lady, with her hands full, who asked if I was ok.  I told her I was NOT ok.  We arranged that she would go ahead and get her car to the Pinecrest trailhead and drive me back to my car at Eaton Canyon.

Calling Steph to alert her to the new plan (she was still some distance out) I finally reached the bottom and slogged my way up the short asphalt path up through the gate to Pinecrest Drive.  My Good Samaritan pulled up in short order, thankfully was driving a Mazda minivan making it relatively easy for me to get in the back seat.  I had a bit of trouble getting into my Honda Accord but managed it with my Good Samaritan's help and was just starting the car when my wife pulled up.  Hooking my right foot with my left foot I was able to place it by the gas pedal and thus was able to drive, with just enough reach in my foot to brake.  Steph followed me home and helped me out of the car.  Once inside my son took my pack and belt and steph helped me take off my clothes -- standing-  and  shower.  Feeling better having drunk another bottle of water (I drank most of what I'd pumped at Idlehour),  Steph helped me dress;  I drank a smoothie and a cup of coffee, and she drove me to Huntington hospital ER.

Reaching the ER Steph dropped me off while she parked the car.  The ER attendants asked if I needed help, but I waived them off.  Walking in, the triage staff  had me sit in a wheel chair and took my vitals.  In short order they wheeled me in for an X-ray.  While waiting there outside the radiology lab with Steph I suddenly started sweating profusely and felt the room start to go gray.  The attendant summoned help and I vaguely remember being rocked backwards to get my head low and rushed into an ER room where I found myself swiftly disrobed, put on oxygen, with an IV and EKG probes with a full court press going on.  Later, a CT scan revealed "an extensive pelvic fracture" and the rest is history --  I was admitted and underwent surgery the next day to screw my hip socket back together:

Left panel: Fx of right acetabulum, CT section. Rt. hip shows on left side of image. Right: Screwed back together.












Later, back at home with time to kill between doses of vicodin, I downloaded my GPS track for the run, left on after the accident.  I was quite surprised to see how relatively fast the pace was hiking and running out on that broken pelvis.  The slow uphill pace starting around mile 18.5 is my gimping pace and I managed 12-13 minute miles down the Toll Road:


The serious nature of the fracture I sustained is quite succinctly summarized  in an interview with Dr. David Helfet,  posted at www. hss.edu,
http://www.hss.edu/conditions_pelvic-fractures-acetabular-fractures.asp#.U492FdyaJL8:

Pelvic fractures and acetabular fractures are among the most serious injuries treated by orthopedic surgeons. Often the result of a traumatic incident such as a motor vehicle accident or a bad fall, these fractures require rapid and precise treatment ....The acetabulum refers to the part of the pelvis that meets the upper end of the thigh bone (the femoral head) to form the hip joint. In a healthy hip, these two bones fit together like a ball and cup, in which the ball rotates freely in the cup.The term broken hip usually refers to a fracture of the ball portion of this joint, that is, the upper femur, femoral neck or the femoral head. In this section, we are speaking specifically of a fracture of the cup or acetabulum. Fractures of the acetabulum are harder to treat because access to this bone is more difficult, and because of the acetabulum's proximity to the major blood vessels to the legs, the sciatic nerve (the major nerve that arises from the lower spine and provides sensation and movement to the leg and foot), the intestines, the ureter and the bladder. Unlike a hip fracture, which can be treated relatively easily, to repair an acetabular fracture, the orthopaedic surgeon, must, in essence, fix the broken bones from the inside out.
The take-away from this passage is that I was incredibly lucky last Saturday as these acetabular fractures frequently are accompanied with a hip dislocation, severe internal bleeding and acute nerve damage.  I evidently experienced none of these and was therefore able to walk out to safety, and by God's grace didn't fall again or otherwise more seriously exacerbate this injury.  The alternative outcome could have been to be stranded, unable to move on a sun-baked trail, with internal bleeding and shock and no cell phone reception to call for help.  The ortho believes that the 5 mile hike out probably exacerbated the fracture but it is clear I got off lucky.  I am looking at 2-3 months of no weight bearing, and certainly the next couple of weeks unable to work due to pain and vicodin (almost as bad as the pain).

 My horizons have very suddenly shrunk from 100 miles to about 100 feet and I find real challenge for the time being in just getting around and in and out of bed without hurting myself.  I've spent the last day grieving over this and for the bomb that I have dropped on those that had relied on me that now must carry me:  First, my wife and kids, then my work tribe, and finally my buddy Dale who in just a few days will be starting his 3000 mile bike race across America (RAAM) without the crew support that I had committed to him.

I am still processing all of this.

Tentatively here are a few conclusions I've made.

  1. First, despite all the above, my trail running experience over the last 35 years, and the last 2 years in particular,  has damn well been worth it.  Its re-awoken me to the 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, with "power and authority" as AC100 Racebook editor Larry Gassan likes to put it.  That aspect of life is so easy to miss amidst the inevitable  pain that life also brings, and amidst the ongoing and often dull routine of shouldering life's day to day responsibilities.    I have a friend who crewed me at AC100 last year who I went climbing with only a few months ago  who is now struggling with terminal cancer, absolutely ravaged by the disease.   I am mindful that one day one can wake up and find the opportunity for such ecstasy severely circumscribed or  taken away completely:  The lesson for me is, "Grab onto it while you can!"-- and hopefully, share it with the ones you love.
  2. This ecstasy has risk and I have a responsibility to do what I can to mitigate that risk out of love for the people that I care about and who depend on me, in addition to the duty to myself.  In all honesty, if I recover to the extent that I am able to do these wilderness trail runs again the reality is that I will likely still do most of these runs solo, its just too hardwired into my fabric to trade the spiritual experience of long solo runs to become a social runner.  That being the case:
    • I better find a solution to be able to call on help when its needed-  such as a satellite phone or attachment, or a satellite tracker/messenger.  I've since learned that these satellite messengers in particular are available for the price of a good pair of trail running shoes, its a no-brainer to carry one in remote areas.
    • While I left a note for my wife with my general route plan, in the future, I should leave more detailed route plans with a map to facilitate obtaining help in case of accident.  
    • I was feeling run-down going into this demanding run.  I toned the run down from my original training plan; and in fact covered the route with some of my fastest splits this training season....well, there is a fine line here, but it bears careful consideration whether it was wise to tackle  what was still a demanding route in a remote area, solo, while not feeling at top strength.
    • I now know that if a serious injury to critical highly vascular area of the body such as the pelvis or hip occurs, it is unwise to move and risk more serious injury.  I could have tried dialing 9-1-1. But this brings me to the last point:
Finally and most significant I think, is that my failure to avail myself of help when it did become available -- at Henninger Flats, at the trailhead, at the ER entrance, etc., was a mistake that unnecessarily added to my injury and could have had far more serious consequences. This bears serious reflection.  The decision to move out of Idlehour to a point where communication and help was possible can be understood, even if it was misguided;   but to have pressed on past the point where help was available unnecessarily put my life at risk.  Broken bones are sharp as a friend with medical/ SAR training recently pointed out, and the pelvis is loaded with blood vessels and nerves.    Had I fallen a again... 

Its significant that the only help I took was that offered by my Good Samaritan, and by my wife; that I couldn't bring myself to ask any strangers for help.  It was stupid, but more precisely, it was reflective of a lack of humility to not ask for the help I  needed.  I will get to think on this a lot  for the next several weeks as I will need to ask for help to do the most basic tasks starting with dressing myself.  A fit penance for this hubris.

I will post my progress.


Monday, May 26, 2014

Memorial Day weekend: Capping 97 miles

I completed a 97 mile week today with my usual Mt Wilson Toll Road 20 mile workout:  Powerwalk up 10 miles to the summit (2:44), run down (20 miles total, 4:05).  I ran in my Trail Gloves and carried a lot of water;  however,  I found that the spigot at the summit was back on.  Thats good, lugging water for a 20 mile jaunt is a bit uncomfortable.

Yesterday I'd run 28.3 miles in the Verdugos, as I needed a break from the Mt. Wilson loop course I've been doing.  That's a great course but I've done it now 3 weeks in a row.  I started the Verdugos course before sunrise, power walking  up from La Tuna Canyon to the ridge top (3.3 miles) with a ton of water.  I made a water cache there, then ran out  east to Burbank (9.5 miles at the Burbank trailhead) and back to the water cache (15.7 miles).  Then ran west to a La Canada trailhead (20.2 miles at the turnaround) then back to the water cache and down for 28.2 miles in 5:23.  I did a lot of walking-- wherever the grade was ~10%, and because both achilles/hamstrings were tight and I had some pain.  I love this course since, running the ridge top, one gets a real sense of distance;  plus the fire road is largely a white decomposed granite so that the route is just sun soaked and one is bathed in light.  The views of the San Gabriels north is also just spectacular -  a real sense of grandeur on this route.  The only downside is that there is no water.  Here is the track for the route/the run:  http://connect.garmin.com/activity/518177476

The weekday running last week comprised 49 miles.  I did double workouts from Wednesday on, after I'd recovered from last weekend's training.  When I get into the double workout mode-  waking early to run, then running again at lunchtime, I feel cleared out.  Hard to describe but worth experiencing.

So far so good in this base building phase of my training; I'll keep this 90-100 mile week training load up for a couple more weeks, then take a down week to crew my pal Dale for the back half of  his solo RAAM bike race across America.  After RAAM, I'll resume 100 mile weeks and hopefully begin to work on speed if all goes well.

Sunday, May 18, 2014

Mt Wilson with extra water...

I topped off my training week this morning with my  old standard Mt Wilson route from Eaton Canyon (6am start), walk up the Mt Wilson Toll Road to the summit, and then run down, for 20 miles.  Given what I learned yesterday about the water spigots being taped  off as non-potable, and not having streams along the route,  I carried a lot of extra water this morning, not being sure how hot it might get.  It was a warm and humid inversion layer up to about 2500 feet and then clear and cool above that, so I didn't need the extra half gallon of water I had lugged up.  I hit the summit in 2:48-  a bit slow.    I  spent some time talking to a couple of ultra runners that came up while I was shaking out my socks.  Neither had heard about the Forest Service closing the spigots.  I topped both of these guys off with my extra water and then headed down for a 4:10 total run time. One of the guys had 1 steel water bottle; the other had 2 hand bottles and indicated he was heading down through Idlehour to Lake-  a 15 or 16 mile route depending on the path taken from the Idlehour trail junction with the Mt Lowe Railway bed.  Thats a long tough run for 2 water bottles.

Today I was carrying 2 hand bottles, 2 spares in a belt and a light pack with that extra half gallon.   I don't enjoy pain (much).  Something about pissing blood just doesn't appeal to me:   Here is a report I made last year of an experience I had  of what can happen   Not drinking enough-hematuria on a Mt Wilson run July 2013