This week’s progress report:
It’s very hard to measure progress with two of my injuries. While I’m faithfully doing oral-motor and swallowing exercises twice a day, I don’t know if I’m improving my ability to swallow without risking aspiration. I swallow mouth-melted ice about 10 times each session, and say “Ah!” afterwards. I feel the cold going down my throat, I burp some after I’m done, and the “Ah!” doesn’t sound like there’s water burbling on my voice box, so those are good signs, I guess. But the problem had been “silent” aspiration, meaning my larynx was not reflexively closing shut to prevent stuff from draining into my lungs, and I was not aware this was happening. So if there’s no way for me to tell if it is happening, how do I know if it has stopped? I’m not gagging or coughing stuff back up, but it’s only water I’m taking down. I remain anxious about the swallowing study I have scheduled on Wednesday, Oct 20th, 3 weeks after my previous, failed study. While it would of course be great to start taking some food on my own, it’s the stomach tube (“G-Tube”) that bothers me more. Getting rid of that is my # 1 priority. It inhibits the positions in which I can sleep; it hurts mightily if my stomach is empty, and if I walk too fast, or downhill, it also causes me to slow down. I want it out! Two criteria for that: getting enough calories on my own through my mouth, and waiting 4 weeks after placement for technical reasons. Since it was placed Sept 30th, my goal for removal is the end of October. Two more weeks.
The other issue is my hands. The fact that I am able to type this fairly well on my computer is of course a good sign. But I still get tired on my forearms with any hand activity. I still have numbness in the tips of for fore- and middle fingers, and in my thumbs, with disruption of temperature sensation in those digits (it’s odd – things always feel either too cold or too hot.) So I function “OK”, but I haven’t tried tying surgical knots yet – my biggest fear is that I won’t be able to return to complete function as an MD. I sense things slowly getting better, but I don’t know if the sensation is actually improving, or if I am just getting used to things, and learning work around. Whatever.
I also have to remember I do still have some broken bone: left wrist, and spinous processes in my cervical (neck) vertebrae at levels 4, 5, and 6, with ligament damage in my neck. Trying to do any serious activity, anything more than a moderate walk, worries me. I must let these heal, and that just takes time.
Speaking of walking, I’m now up to 2.5 miles in an hour. I can measure and see progress here. But I’m still slower than I was 4-5 weeks after foot surgery in 2006, when I walked a 5K (3 miles) in 52 minutes, and 2 weeks later, did my first run after surgery, 5K in 24 minutes. So far to go. Once I get my neck settled, I can get on the trainer with my bike and on the road or treadmill to run; I know how to return to form once I get to that point.
And finally, next week on Thursday I will be seeing the Oral Surgeon to find out about plans to repair my jaw and teeth. Hopefully that will clear up the anxiety I have now timing and recovery issues for that. My biggest fear here is whether I will need a bone graft, and where that will come from. I’ve heard things about taking something from the femur, and wonder how/if that will affect biking and running. But at least it’s a standard type of surgery and recovery, with predictable timelines and outcomes, not this fuzzy recovery I’m experiencing with swallowing and the spinal cord contusion.
Lastly, I thought I’d share a description of damage to my bike from this accident.
It might be hard for those who don’t have a relationship with a high end bike, but the machine one spends hours at a time on, and which may have cost up to $10,000, ends up feeling as much a part of my body at my foot or finger. While I was in the hospital, I could only worry about the damage, and what it might mean to my future needs for replacement. I had all sorts of fears it would need to be replaced, which, given its unique characteristics and inherent sunk costs, was a mind-bender for me.
But looking at it now, there is only one thing which appears damaged. It appears that my poor chin took ALL of the impact, and the damage to the bike is purely secondary, coming as a result of the sudden stop in forward momentum, which was then converted into a downward vector. Often, this causes the front wheel to “taco” or bend, but my front wheel is undamaged, still in true. The front brake is also completely undamaged. The frame is intact, no cracks or bends or marks of any sort. The ONLY thing that is messed up, is the steering tube, the part that extends up from the fork through the head tube of the bike and attaches to the stem/handlebar assembly. This steering tube is bent about 30 degrees. Without going into all sorts of technical bike stuff about how this happened, suffice it to say that the head tube pulled out of the lower headset, the steering tube bent, and the fork is bent back towards the pedals. See the photo above, and the close-up below. The fork, that fat black thing at the bottom, should be in a straight line with the head tube, which is the silver (titanium) thing extending just above it. If you look carefully, you can see the lower portion of the head tube has been pulled out of the lower headset; the bend in the steering tube (which fits inside of the head tube) is probably at this location. Weird.
In a week or two, I will take to bike to the place where I bought it, and discuss the damage and repair issues. But I think all I need is a new fork, steering tube and headset. Saving me massive worries, which I might review after I get the verdict from the bike guys.