(Continued from the
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
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
Photo of the hospital from the CD of my
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
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!
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.
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
- memory loss
- headache (I get a headache just reading about all these possible
- 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
". . . 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."
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
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
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.
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
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
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
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
The numbing shots in my forehead stung, as did the stitching
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
STRAINED MUSCLES: DID YOU GET THE NUMBER ON
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
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
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
- 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.
"Runtrails & Company" - Sue Norwood, Jim O'Neil,
and Cody the Ultra Lab
© 2009 Sue Norwood and Jim O'Neil