2009 ULTRA RUNNING ADVENTURES

 

   
 
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  SUE'S BIKE CRASH, PART 2:
WHAT'S WRONG & HOW DO I FIX IT?

WEDNESDAY, AUGUST 5

 
Duration of Post-Traumatic Amnesia:

"One of the better estimates for severity of a brain injury is post-traumatic amnesia. Any time a person has a significant blow to the head they will have amnesia for the event. They do not remember the event itself and possibly events for some time afterwards . . .

The longer the amnesia, the more severe the brain dysfunction. If the duration of amnesia is up to an hour, it is considered a mild trauma; up to a day of amnesia signifies a moderate injury; up to a week of amnesia after the injury is considered a severe injury. Beyond a week of amnesia, the injury is considered very severe."

  - excerpt from the Center for Neuro Skills website
 

(Continued from the last entry)

If my interpretation of the quote above is correct, the fact that I have post-traumatic amnesia about my bike wreck indicates that I suffered a significant blow to my head (my sore noggin also attests to that!).

The second paragraph isn't as clear to me about the duration of the amnesia -- I hope they mean the length of time I can't remember (about 30 minutes before, during, and after the bike crash) rather than for how long afterwards I don't recall that memory (two days so far). The doctor and my research indicate I may never regain my memory of the incident.

I'd like to think the trauma to my brain was more mild than severe, but hey, I might need that for an excuse some day! (Just joking.)

In this entry I want to focus on the nature of my multiple injuries and what treatment has begun. I hope some of this is useful to others, not just to understand what I'm going through but in case it's ever relevant to your life or the lives of your loved ones.


Photo of the hospital from the CD of my scans

CT scans of both my brain and spine were done almost as soon as I arrived in the ER Monday evening in order to determine what, if any, damage was done to those critical body systems. When we asked for the results, we got not only the printed reports but also one little CD with over 250 pictures of my head and spinal column!

I'll show a couple of them here, with some of the identifying information blacked out. I have no idea what they show. I just think they're very cool, like MRI pictures. I put a brief summary of the results in the last entry.

Here's my official diagnosis again: brain concussion, one or more rib fractures, facial lacerations, multiple abrasions on my face, arms, and legs, plus shoulder and calf strain. I'll start with the most serious ones.

If someone sees a glaring medical mistake, please let me know. My sources of information include one of Jim's EMT training manuals and several internet sites that look legitimate to me, but what do I know? I don't want to be dispensing misinformation. This is written for the average person to understand, not medical professionals. Much of the information I found about concussions, for example, is directed to parents and coaches of kids playing football, since that's apparently the most common cause of concussion in this country.

CONCUSSION: A LOOK INSIDE SUE'S BRAIN

(I used that teaser at the end of the last entry so you'd wonder if I meant actual brain scan pictures or my thought process as I write about the crash and its aftermath. I mean both.)

A concussion is a type of indirect, closed-head (no punctures to the skull) brain injury that is usually the result of a violent blow to the head. The shock of impact on the head is transferred to the soft tissues of the brain, which basically slams against the side of the skull.

Ouch. That's graphic! I'm glad I have no memory of the pain I felt during the crash.

Detecting altered brain function (or "altered states of consciousness") was the reason for all the questions Jim, Dave, and the ER staff asked me. What's fascinating to me is how I was able to answer those questions accurately while I was in shock, yet don't remember the questioning or the people until I was loaded into the ambulance.

Most concussions are caused during collisions with other people (as in football or soccer) or objects  (as in vehicle accidents), or during falls. The most common falls are from bicycles (!) or by toddlers and older people, those most subject to balance problems. Athletes playing most any sport can sustain a concussion. Think skiing, boxing, hockey, baseball, even tennis, if you fall and hit your head on the hard court. I could even sustain a concussion during a fall when running if I hit my head on something hard like a rock or tree.


Somewhere inside Sue's head!

A concussion is often one of the less serious types of head injuries. Some folks don't even know they have sustained a concussion because the symptoms are so mild. I experienced a bit more trauma than this, which resulted in amnesia after the event. I may or may not regain the memory of the 25-30 minutes I "lost" while I was in an altered state of consciousness.

There are many degrees of concussion and several methods of assessing those degrees. I read about enough of them to get confused! One website said post-traumatic amnesia (PTA) is the best indicator of the severity of traumatic brain injury (TBI). The longer is lasts, the more severe the concussion.

Although posttraumatic amnesia is a common result of a traumatic brain injury like concussion, not every concussion victim gets amnesia or loses consciousness. You can also have amnesia from a concussion and not loose consciousness. I obviously lost full consciousness for a while but my subconscious (or some level) was apparently functioning pretty well without me "knowing" it. This is something I'll be researching further to satisfy my own curiosity.

I figure forewarned is forearmed. The more information we have, the better Jim and I will know what to expect and what to look for. Even though I know the potential symptoms, he's the one who's more likely to detect them -- because of the concussion!

The ability to process all types of information may be reduced after a concussion. It can affect memory, judgment, reflexes, speech, balance, and muscle coordination and may cause any of these symptoms -- or none:

  • impaired balance
  • dizziness
  • memory loss
  • headache (I get a headache just reading about all these possible symptoms!)
  • confusion
  • difficulty thinking, or what I'd call "fuzz brain"
  • vision disturbances
  • sensitivity to light
  • nausea, vomiting
  • ringing in the ears
  • loss of smell or taste

Except for about ten miserable minutes when several of those symptoms manifested themselves all at once about twelve hours after the crash, I haven't experienced any of them since. The doctor says that's a good sign, even though I still have the same amount of amnesia as before.


Somewhere along Sue's spine. Although there were no signs of injury from the
wreck, I discovered that I have some serious age-related degeneration going on.

My research indicates that complete recovery from a concussion is usually expected, although patients may experience various degrees of amnesia, disorientation, dizziness, nausea, pain, etc.

More serious or long-term symptoms may include lethargy, fatigue, sleep disturbances, or even personality changes. These are all things Jim and I need to be alert for. Here's another related quote from the Center for Neuro Skills website:

". . . People who suffer a head injury may suffer from side effects that persist for weeks or months. This is known as postconcussive syndrome. Symptoms include memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, insomnia, or excessive drowsiness. Patients with postconcussive syndrome should avoid activities that put them at risk for a repeated concussion."

A good website for the average person to read about incidence, effects, and prevention of concussions is managed by Neurosurgery Today.org. The following quote about the seriousness of subsequent concussions is probably the most important thing I've read so far about my future health:

"Even mild concussions should not be taken lightly. Neurosurgeons and other brain injury experts emphasize that although some concussions are less serious than others, there is no such thing as a "minor concussion." In most cases a single concussion should not cause permanent damage. A second concussion soon after the first one, however, does not have to be very strong for its effects to be deadly or permanently disabling . . ."

What does that tell you about how soon I should get back on a mountain bike??

Apparently I don't have a contusion, which is bruising caused when the force of the blow to the head is great enough to rupture blood vessels on or within the brain. At least the CT scan of my brain didn't show this. However, not everything that happens in a traumatic head injury shows up on a CT scan.

The best treatment for a concussion is REST. So far I don't have any problem with resting, mainly because my ribs hurt sufficiently to kill any desire I have to get out and exercise.

And guess what the best treatment for rib fractures is??  Several weeks of rest -- and no strenuous activity. That may become a problem for me. Even now, my head wants to be outside enjoying the beautiful weather and scenery. I don't do well cooped up for long. Thank goodness I'm not lying in a hospital bed in traction!

RIB FRACTURES: I HOPE I DON'T HAVE TO SNEEZE ANY TIME SOON!

As with any injury, rib fractures also run the gamut from not-so-serious to very serious. Dr. Mapes did not order chest X-rays because he could tell on palpitation and through other testing that none of my ribs is completely broken nor my lungs punctured. I showed enough reaction to his poking that he could tell one or more of them is at least cracked (he put "fractured" on the diagnosis). My left rib cage and shoulder are still noticeably sore but I can take occasional big breaths without severe pain.

Most rib fractures are self-healing as long as the patient is patient enough to rest adequately and avoid strenuous exercise until healing is complete. Various sources indicate the healing process can take three to nine weeks, but there are lots of variables here. My injury doesn't appear to be too severe and most of me is in excellent physical shape right now (certainly my respiratory and circulatory systems are).

Dr. Mapes told me (and I've read this several times) to periodically breathe as deeply as I can to prevent pneumonia or other complications as the rib(s) heal. I'm not too worried about infection of either my lungs or wounds since I'm staying inside the camper most of the time. It's very dusty here and I'm not in any mood to be around other people yet because of my appearance.

The first night I tried sleeping in bed but I was so limited in the range of comfortable positions that I wiggled all night. Lying on my back (the best position for my injures) put too much pressure on my rib cage and made it very painful to sit up, then stand, when I had to go to the bathroom. After my dizzy session in the bathroom, I sat/slouched on the couch another couple hours and felt much more comfortable. I'll continue to sleep there until my ribs heal some more.

ROAD RASH: THE BANE OF CYCLISTS EVERYWHERE

Lac-er-ate: v. 1) Torn; mangled. 2) Wounded. 3) Having jagged, deeply cut edges. Laceration n. (American Heritage Dictionary definition)

ab-ra-sion: n. 1) The process of wearing down or rubbing away by means of friction. 2) A scraped or worn area. (American Heritage Dictionary)

I've mentioned before in this journal about what I klutz I am when I'm running, even hiking, on trails.

I've sustained numerous abrasions, lacerations, and hematomas from falls the past thirty years and I've got the scars on my arms and legs to prove it. Many of those are from my AT Adventure Run, when it seems like I took a tumble at least once a day. I've also gotten some road rash from running and cycling falls on pavement but I've never, ever gotten so many or such deep wounds as I received in this bike crash, and never any serious ones on my face.

More "firsts."

I admit to having some self-pride, even vanity, in my looks. I don't particularly care about the scars I have on my arms and legs. A perpetual Tom Boy, I consider them a kind of a badge of honor from all my athletic adventures. I earned those! I assume I'll have a few more scars on my limbs from this accident, but I'm hoping I don't end up with any on my face. I don't wear make-up and don't want to resume (I did when I worked, but not in the last ten years since retirement). I also don't want to have plastic surgery unless my face heals in a really unsightly manner.

I have no idea how I fell with the bike; some of my injuries seem inconsistent but it's obvious that my left side took the brunt of the impact since the worst wounds are over there. Let's just say that it'll be a while before I can sleep on that side.

Let's assess the damage:

HEAD AND FACE: My most potentially serious visible wounds are to my left forehead, my left eyelid, and my left cheek directly below my eye. I am eternally grateful that I didn't sustain any more apparent damage to that eye than a scratch and some grit inside. I also have a more minor abrasion on my left chin and left of my nose. A small cut on the right side of my nose is probably from my glasses.

This is one of the less disturbing photos that Jim took of my face before the ER staff began cleaning up my wounds:

The deepest gash I received was to my left forehead, the one that's still bleeding a little bit above. My eyelid was also torn but I never have felt any pain in either area except when the forehead cut was stitched up. I have felt the most pain in my left cheek, probably because it moves when I blink, talk, or eat. That area also swelled up in the last two days; it should subside soon.

My left eye felt like it had either some grit in it or scratches inside. In the ER a device similar to a contact lens was placed in that eye for several minutes to irrigate it with 500 ml of a cleansing saline solution:

My eye felt better afterwards but still hurt some; Dr. Mapes said there are probably some tiny scratches from the grit, although he couldn't see any. I was given some antibiotic ointment to use in my eye as long as it hurts. It no longer bothers me so I stopped using the ointment today.

My vision is probably the sense that is the most important to me. I'm so thankful that my eye wasn't permanently damaged.

ARMS & LEGS: I have nasty abrasions on my left shoulder (my shirt, which now has holes in the shoulder, helped to protect it some), the front of my left elbow,  the front of my left forearm about 2" from my watch, an area around my left knee that stretches for about 8", and smaller ones on my RIGHT forearm and knee.

I have no abrasions or bruises on my left hip, to my surprise. It is a only a little bit sore if I touch it. My pricey and rather thick Terry-brand bike shorts emerged unscathed, which is also a nice surprise. They weren't even dirty. Considering what that side of the bike seat looks like, it's a wonder the shorts weren't shredded. This is part of the mystery -- why not? Where was my body in relation to the bike when I fell?

On the other hand, my thin synthetic MS50 race shirt was a mess, with obvious signs of abrasion, some holes, and lots of dirt on the left shoulder. It was too warm to consider wearing more protective clothing, but you can bet I will the next time I ride a bike!

I showed a picture of my knee abrasions in the last entry. Here is one of my left arm before it was cleaned up:

Are you starting to wonder how I escaped without any other broken bones or teeth?? Me, too.

WOUND TREATMENT: ER staff began cleaning and debriding (cutting out dead skin) my wounds when it was clear I didn't have any serious head or spinal injuries. They also applied triple antibiotic ointment and told me to do the same at home when I changed the bandages twice a day.

A nurse bandaged up the two worst abrasions, the ones on my forearms, to stop the bleeding but the others remained open until right before I was released. It was best to let them air out before covering them.

It wasn't until I'd been in the ER for a couple hours that Dr. Mapes returned with an assistant to put one dissolvable stitch in my left eyelid and a bunch of stitches in the laceration on my forehead -- ten on the outside that need to come out in a few days and more dissolvable ones on the inside. Jim took these two photos of the doc and the drape over my face. In order to reduce the glare of the bright lights in my face, Dr. Mapes worked through a small hole in the drape:


Dr. Mapes stitches up my forehead gash through a small hole in the drape.

 


He's done some stitching in the hole in the drape. I was unable to "fix"
the light spots in these photos as Jim requested.

The numbing shots in my forehead stung, as did the stitching process, but I stayed quiet and didn't move a muscle. Apparently there aren't as many nerves in the eyelid, because I didn't feel the needles in that location at all.

My droopy eyelid still looks funny today but should heal OK and look better when the swelling goes down. I don't have a picture of the eyelid stitch itself but you can see the droop in this photo taken today of the forehead stitches and ugly cheek abrasion and swelling below my eye:

I told you not to read this while eating your lunch! That's about as gross as a Hollywood make-up job for a gruesome Halloween movie. Hope the "after" shot comes out better.

Shortly before I was released from the hospital a nurse came back in to put antibiotic cream on my open wounds and cover them with bandages. She also gave us instructions re: wound care, including the importance of using sunscreen to protect the new skin that grows in.

We understood the nurse to say to clean the lacerations and abrasions twice a day, keep putting antibiotic cream on all of them, and keep the ones on my arms and legs bandaged until we came back in four days to get the stitches removed.

We later learned that treatment was for only the first two days. Oops. I should have kept them uncovered more so they'd heal as fast as the facial wounds, which were never bandaged. Jim kept telling me they needed airing out and I didn't listen to him soon enough.

STRAINED MUSCLES: DID YOU GET THE NUMBER ON THAT TRUCK?

That's one of Jim's and my favorite lines the morning after an ultra: sometimes we feel like a truck ran over us. I have no evidence that any vehicle stuck me, but I obviously hit the road hard enough (on or off the bike I was riding) on Monday afternoon to do plenty of bodily damage.

I wasn't feeling much or any pain in the first four hours after my crash. I could feel Dr. Mapes poking my sore ribs, however, and I knew my left shoulder and left calf were sore. He noted those in my diagnosis.

Motrin and generic Percocet may have killed the pain late Monday night, but by Tuesday morning they had worn off and I was definitely "feeling the pain" and in more areas than already noted. My whole left side was sore, including my hip (which still shows no bruising). I should have taken more Ibuprofen during the night. Two or three pills every four to five hours have kept the aches and pains to a minimum for two days now.

My calf and hip no longer hurt. My ribs hurt a little bit if I poke them, breathe heavily, or lie on my left side. Laughing is fine. I haven't sneezed yet; that might hurt. Only two parts still hurt (besides the sting of the abrasions): my left shoulder and the left part of my skull.

I'm concerned about my shoulder because of the rotator cuff tears I've been dealing with for almost a year. When I found out through an MRI what was wrong in April, I began physical therapy to strengthen both shoulders. I've made a lot of progress with home treatment since we left Roanoke, and I hope I haven't set myself back significantly. It may be a while before I can safely resume my maintenance program with free weights and stretchy-bands so I don't do more harm to either the rotator cuff or fractured ribs.

I didn't notice my sore head until Tuesday. I have an area about six inches in diameter above my left ear and over to my forehead gash that is sore to the touch. Most of it is under my hair. Jim doesn't see any abrasion, bleeding, or bruising under my hair but it's obvious that this part of my skull took a beating when I crashed -- even with my helmet on.

Imagine what damage would have been done if I hadn't had a helmet on!

FOCUS ON HEALING: IT'S ALL ABOUT ME

When Jim starts feeling neglected or he thinks I'm taking something too personally, he'll tease me and say, "It's all about Sue, isn't it?"

I haven't totally neglected Jim and Cody or household duties since the accident two days ago but yes,  my main concern is ME right now. I need to focus on healing so I can resume normal life and good health as soon as possible. I already miss views like this at 12,000 feet in the San Juan Mountains:


Rico-Silverton Trail near Rolling Mountain Pass

I'm trying to accomplish my goal in several ways:

  • sleeping as long as my body tells me to, which is 9-10 hours a day (we've pretty much been doing that all summer!)
  • staying inside most of the time, away from the dust that permeates our campground
  • resting and avoiding exercise until my ribs heal
  • drinking more water than usual
  • eating even more nutritiously than I usually do (and less; since I'm not exercising, I don't have as much appetite)
  • continuing to take the supplements I normally do, with an increase in Vitamin C
  • cleaning and dressing my wounds regularly
  • researching concussions, amnesia, levels of consciousness, rib fractures, wound care, and anything else I can think of that's related to my injuries
  • visualizing being healed and "whole" again (AKA "that New Age stuff," per Jim)
  • re-reading parts of the excellent book, Deep Survival, by Laurence Gonzales to remind myself of the characteristics displayed by survivors of all types of disasters and stresses, from plane crashes in remote jungles to financial ruin; I have displayed some of these characteristics under harrowing circumstances before, and I'm trying to use them now (explaining this could be an entire separate entry -- just read Gonzales' book!)

I consider it an interesting personal challenge to see how quickly and successfully I can recover from this setback. I don't give up easily and I fully expect to succeed.

~~~~~~~~~~~~~~~~~~~~~~~~~~~

That's pretty much it for the bodily damage assessment and treatment so far. I'll update with more information after my follow-up visit to the hospital on Friday.

In the next entries I'll talk about revisiting the accident scene on Tuesday, what my last conscious thoughts were about before the wreck, trying to make sense of the anomalies we see, collateral damage, things that I did right and wrong before and during that ride, some thoughts about my proclivity to take risks, and other insights into my brain.

Happy trails,

Sue
"Runtrails & Company" - Sue Norwood, Jim O'Neil, and Cody the Ultra Lab

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