Tuesday, June 19, 2018

Why have I been absent here for so long?

I destroyed my shoulder after an epic mountain bike crash in November 2014 and had seriously major surgery right before that Christmas.  Details of the extensive slicing and dicing below (click mages to enlarge).

Surgery was followed by 2-1/2 months immobilized in a brace, then physical therapy rehab for most of the rest of 2015.

Unfortunately, the rehab focused only on the shoulder and left the rest of the body to get stiff and weak. That caused a series of injuries that occurred as I was struggling to get back in shape over 2016 and half of 2017

The text, below, is from a note to my physical trainer Kerry Scharf who has helped me work through the process.

You will note that the big lesson in all of this is that recovery from a serious injury requires PT that treats the entire human, not just the specifically injured part.


OK this is to refresh your memory of the chain of events that lead up to today. Please bear with me because the background is relevant.

As you might remember in early November 2014 I had an epic mountain bike crash at Anadel that essentially destroyed my right shoulder.

Then, thinking that the shoulder would be okay if I just shook it out and limbered it up, I went for a run. A car speeding into a service station nearly hit me. I dodged out of the way and tripped headlong at a full sprint into a utility pole. With the damaged shoulder. I got up. Cursed out the driver and jogged home.

But that was the final blow for a shoulder that has had serious injuries, separations, and tears, that started in wrestling in college. While in wresting practice in 1969,  I had a serious separation which included a complete separation of the collarbone at both ends.

Being young and foolish I ignored doctors orders… medical care at the time was not so good because all I was given was a cloth shoulder harness that looked like a bra missing important pieces. I did not go back to wresting, but played soccer as the starting fullback.

My shoulder was subsequently injured in a white water rescue/inspection dive which I was involved with as a volunteer scuba diver with the New York State police. I managed to get twisted in the undercarriage of the car while doing my job in a swollen stream.

Years later, that shoulder was  injured in an offshore sailing accident. What's more, a few months shortly before the mountain bike accident I had also had a previous mountain bike accident which injured the shoulder and the elbow.

All of this may be of interest, because it has cost me to lose a certain amount of range of motion and that may have aggravated the manner and I walk and run.

In late December 2014 I had extensive surgery by Dr. John Goff at Mount Tam sports orthopedics.

There were six procedures involving all elements of the rotator cuff which had been torn either halfway through completely through or ripped from the bone. There was also the need to cut the bicep tendon which had been extensively damaged and needed to be cut and relocated to anchors on my humerus.

While the shoulder is now pocked with anchors and sutures, every attempt was made to encourage the tendons to reattach to the bone. This required extensively abrading the bone and severed tendon ends and strapping both tightly together with the anchors.

The extent of this major surgery meant that I was in a brace strapped to my body for roughly 2-1/2 months and during which I also had limited walking mobility. The extensive scraping of the bone increased the subsequent pain.

In roughly March or April of that year I begin physical therapy at Petaluma orthopedic sports therapy. I was fortunate to have an excellent PT named Jason weeks who has a doctorate in PT from USC.

During the course of the physical therapy, weeks noted that there had probably been other injuries in the mountain bike crash… He noted that there seem to be some sort of mobility issue with the right scapula, and we did work on that issue with a fair amount of success.

It's impossible to know at this point, but the extreme nature of the crash down a steep cliff into a tree may also have caused some kind of hip or other muscle strain which is only now becoming apparent.

I progressed cautiously, painfully as in something invented only by the Spanish Inquisition…but rapidly with Weeks help and by Novober 2015 had reached a plateau primarily in external rotation and we agreed there was a little more to be accomplished in PT.

Not long after that, I searched for a personal trainer and ended up with you.

About this time I had lost muscle mass that even though I was the same weight… 162 pounds my percent body fat had climbed from 18% to 23%.

After I started working with you, percent body fat head decreased by about 2% while I maintained that same weight.  Strength training and some increased mobility were the result of working with you, but sometime about March or April 2016, I noted a mild discomfort in my lower right pelvic area, just inside of the major projection of the hip bone.

When I visited Dr. Sebastian he was convinced that this was muscular and the result perhaps of a complication or recurrence of a hernia repair which I had undergone at least 10 to 12 years prior.

Because of this, he ordered me to stop strength training

You may have a record in your files of when I stop seeing you once or twice a week

I got a second opinion from Dr. Perryman who was convinced that there was no muscular or hernia involvement.

Dr. Sebastian was still convinced that the discomfort… Which for me was less than a one on a scale of 1 to 10… More a discomfort or a "presence" than anything else… I only went to see Sebastian because it was new and it hasn't gone away.

Because of this conviction by Dr. Sebastian, I underwent an ultrasound after which the radiologist concluded there was no evidence of hernia or any muscle damage.

Despite all of the evidence to the contrary Dr. Sebastian prescribed a CAT scan of the area, still firmly believing there was some sort of muscular involved. I agreed to the CAT scan and, at his direction, made an appointment to meet with Dr. Brown to review the results of the CAT scan.

Belatedly, with % body fat approaching 25, I resumed strength training in October and made some nice gains, knocking it back to 22.5 at same weight by Dec

During this time, I continued my cardio and by the end of 2016 was regularly running 5 to 6 miles and had worked my time down to below a 9-minute per mile average. I continued to work on decreasing the time until mid December when we took a two week trip to Amsterdam to reward our daughter for getting an academic full ride at St. Mary's College.

Mid January this year 2017, I took my first run since returning from Amsterdam. Third of the way through that run I noticed a significant pain in my right hip maybe tight glute I thought… Perhaps a 3 or 4 on a pain scale of 1 to 10 and I put that down to the stiffness from the visit to Amsterdam.

That Amsterdam visit involved two airplane rides of about 13 hours, plus we were staying on a rented boat which left very little space for stretching. In addition, all of those vacation activities were very off schedule, but did involve extensive walking… 25 to 30,000 paces per day… But in between, there was a lot of sitting.

All of that was what initially convinces me on my first that I was simply stiff, and had a muscle that needed the exercise. However the pain increased as I continued the run and was probably a 5 on a scale of 1 to 10.

The next day I went in for the CAT scan. Afterwards, while I was waiting for them to burn a DVD of the scan for me I took a walk around the block, thinking that I would further listen what I was convinced was a tight glute.

In the process of that I was crossing the street, and there was a car safely away, but I decided to sprint across. As soon as I launched into the first stride I fell down. It was as if my leg didn't work.

But then I realized it was probably my reaction to a pain which was like a hot ice pick jammed into my left buttock.… on the pain scale, it rivaled my shoulder surgery when I stopped taking the pain pills… Which was about four or five days after the surgery.

I got up, actually relieved that my shoulder felt fine, no new or unusual pain, and cross the street and kept walking. I decided to see if that falling down thing was going to continue, and found that I didn't fall when I started the  first stride, But found that my knee was weak from the onset of that 10-point pain

So, I walked back to the hospital got my DVD, and made the appointment with Dr. Brown, now that I actually had something that was clearly identifiable. Not the same pain in the same place, but a much stronger pain in a different place.

The radiologist report found nothing muscular wrong in the CAT scan. It did note something that "might" be an indication of inflammation in the hip area that I had originally gone to see Dr. Sebastian about in 2016.

When reviewing the CAT scan with me, Dr. Brown said he found nothing to indicate a hernia or muscular issues. Furthermore he could not find that possible inflammation noted by the radiologist.

That was when I decided not to waste what I thought was a perfectly good appointment, so I brought up the pain in my hip, which after an amazingly cursory examination he said was either piriformis, or upper hamstring.

Brown gave me had appointment with the physical therapy here in town, which I finally went to after repeated rest absences from running and subsequent pain during interim runs convinced me that self-treatment was not going to work

Before I went to PT, I asked Dr. Sebastian to have the radiologist take one more look at the CAT scan because of Dr. Brown's failure.

 I received a phone call from Dr. Sebastian's office saying that the radiologist did not see any sign of inflammation which had initially been reported.

I went back PT after a diagnosis buy a great sports medicine physician, Ty Affleck, M.D. who figured out what had baffled all the other doctors and tests: I was too tight and not flexible enough (from all of the periods of inactivity)

I received a stretching regime along with strength training that has pretty much eliminated the pain that had plagued be in the years after the injury and surgery.

The BIG lesson is that PT needs to treat the entire human, not just the specifically injured part.

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