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.

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.