Frostbite in San Francisco

After getting home from a surprisingly successful run this morning, I decided I would be pro-active and ice my hip. I am supposed to be doing this regularly to treat some hip pain that has arisen secondary to my bike accident. But, it is tough for me to ice it at work, since our fridge/freezer can't keep things cold enough, and I keep forgetting to do it at home. But today I would do it! I was wearing some tri shorts and thought, "Hey how convenient! I can just stick this ice pack right inside the shorts and it will stay nice & close!" I thought about putting something in between the pack and my skin, but only spotted thick towels. The other gel pack I use generally doesn't get very cold so a thick towel would be too much. I didn't really look too hard. "Hey! Ouch! It's stinging!" I thought, but remembered back many years to prior PT sessions with ice, where it stung until it was numb. I put some oatmeal in the microwave and was getting stuff ready for work and didn't notice that the stinging had stopped.

Getting up to get my oatmeal, I looked down and noticed frost on the outside of my shorts. Uh-oh. I pulled out the gel pack and to my horror, my skin was white, completely numb and completely frozen! I mean, it was stiff. It grosses me out just to think about it. "Oh no! This is bad!!" I grabbed a wash cloth and put some warm water on it and applied it to the skin. The cloth totally cooled and I repeated the process until the skin started to soften. It was still whitish but started to pinken up, pretty painfully I might add.

Frostbite in my mind is forever associated with people who climb Mt. Everest and lose toes, fingers, limbs... (In 9th grade a mountain climber came to talk with us and told us how she had lost some toes to frostbite. I think it was supposed to be an inspirational talk but I pretty much just remember the losing toes part of it.) Will I have to have my whole hip amputated?! Granted I could use a little reduction here and there but not this way. Seriously, I wasn't that worried but I wasn't sure how to treat it. Once it started warming up, the skin became really hot to the touch, and swollen. Fortunately there were no blisters and after some time, the swelling diminished, leaving red welts about the size of the gel pack. After a call to the advice nurse, who admitted to not getting many frostbite cases in San Francisco, I stopped by the injury clinic at my HMO and the awesome nurse practitioner there eased my worries. I should treat it as a bad sunburn, she said. Aloe vera, pain killers if necessary, and expect it to itch and then peel in a few days. Swimming is okay (phew) and I should even apply cool compresses. Oh and, please use a towel around the gel pack in the future. I felt like I was 16 again when I was in a bad car accident the one time in years that I hadn't been wearing a seat belt!

Sometimes I feel like I insist on learning things the hard way.

Vicious (and viscous) flesh-freezing gel pack,
more dangerous than a winter in Minneapolis

A Word of Thanks

Triabetes is lucky to have some fantastic sponsors for 2009; the full list can also be seen at the Triabetes website. Their steadfast support of Triabetes has allowed us to continue to grow upon last year's success with a new group of Ironman athletes(-in-training), and to expand the team to include all triathletes with diabetes. In fact, this year, Triabetes was recognized by USAT, the governing body of triathlon, as an official triathlon team. Membership has been opened to athletes of all levels--from beginners to the very experienced--and distances (i.e., you don't have to do an Ironman to join Triabetes!) Join here! I'm the team captain for Northern California and Tahoe regions and would particularly love to have some local teammates.

Some of the sponsors that I have the most experience with, and can whole-heartedly support, are Diabetes Training Camp, PureFit Nutrition Bars, Polar, RoadID, Vitalyte, Thorlo Socks, TriSports, SweetSpot and Spibelt, and I very much look forward to becoming more familiar with the others--Kestrel bikes, Giro, Fluid, and diaTribe. Another sponsor is the TriFest in Tucson, which I had to miss due to my bike accident. Individuals at these companies have really reached out to Triabetes, often on a personal level. Of course a huge thank-you is extended to LifeScan OneTouch for their title sponsorship in 2008, which made it possible to continue with the documentary.

Wildflower v.6

Lake San Antonio, CA

Earlier this month marked the 6th year I have made the trek down to Lake San Antonio for the infamous Wildflower Triathlon. The first year, I was a spectator, and swore to myself, as I inched along my chair to stay out of the 100+ degree heat, that I would never do the Long Course (half-ironman distance). That was the first triathlon I had ever seen and I really had no intention of signing up for one myself at that point. I thought that there was no sport I could ever love besides running. And even though I did enjoy getting out on my mountain bike from time to time, the swimming was a deal-breaker. At the age of 7 or 8, when I was taking swimming lessons at the local high school pool, I was doing backstroke when my instructor called out, "That's terrible!" Assuming he was addressing me, I was so afraid that I hid out in the locker room for the next several lessons and never really got back into it.

So it was a huge step for me in many ways to arrive again at Wildflower in 2005 to race in the Olympic-distance event. I had taken swimming lessons, bought a bike, and gotten used to clip-in pedals. The swim was mayhem as usual, the bike felt insanely hilly, and the run up the last hill brought me to tears; but a day or so later, I couldn't wait to sign up for my next event. Four years since then, here is my race report of my 6th Wildflower race event.

***

Last-minute, I found a team that needed a cyclist for the annual Wildflower Long Course Triathlon. The course is a very hilly one, starting out with big rollers for the first 15-18 miles, then long mild grades for another 10-15 miles, then some easy stuff before the really big climbs begin. It is a beautiful place to ride, with little traffic, and lots of wildflowers out this year. Everyone camps, and as we pulled into camp, I saw a 4-foot snake slithering towards someone's tent. I made sure to keep mine zipped up!

The weather was very rainy on Friday, but cleared up by Saturday morning, which was a huge relief. My start was at 10:20 AM, after our relay team swimmer finished. There were a couple of relay cyclists out there on trainers--an unusual scene at a triathlon--getting ready for the big legs of their relays. These guys were out to win. For our team and others that I noticed, there was a jovial mood--we were pretty happy to just worry about one event for a change. Anyway, the course starts out with a couple of easy miles before the first big climb, which is significant. Since the relays start last, there were few people on the course by the time I started. My goal was to see people ahead of me and pick them off one by one. (Although I kept telling myself, "I am not racing!") At one point a gal tried to pass and it got my competitive juices flowing and I took off. (Triathlon does not allow drafting, for good reason, since it is a serious safety hazard unless you are trained. If you are passed completely, you have to drop back 4 bike lengths.) I was careful about drinking and keeping my nutrition going, and making sure my blood sugar was in a good zone. I descended in the drops and am feeling a lot more comfortable doing this. Actually, now I feel much more glued to the road in the drops vs. holding the hoods.

There was a nice tailwind on the flatter section of the ride, and I tried to take advantage of this bonus. (Usually there is a headwind in this section!) I felt strong and was so so so so happy to be out there. The worst hill of the day up Naciamento Lake Rd. ("Nasty Grade") was okay and I just plugged along, happy to have my compact gearing. The descent is a long sweeping curve and I felt solid but was shocked when a truck+trailer blew by me from the left about 2 feet away. But no harm done. It was another moment I was glad I was in my drops.

I was able to feel good through the finish & my stamina has improved somewhat. My collarbone felt good and my lower back held up. The next couple days I was achy in my lower back and arms, but felt more or less recovered after a few days. My time was about 30 minutes slower than last year, which I am trying to not worry about too much, all considered.

On the diabetes front, things went well. I took my full bolus, as well as full symlin dose, about 3 1/2 hours before I started. My BGs were in the upper 100's before the start, when I got hungry and munched on half of a granola bar. I ate it a bit too early and so had to correct with 0.5 U and I upped my basal a little for a half-hour. My BG's were a bit on the high side to begin with, but came down nicely. I had one reading in the 80's but nothing too serious. Basals were as follows
9:00 AM 0.5
10:00 AM 0.65
(10:15 AM race start)
10:30 AM 0.5
12:45 PM 0.35
1:00 PM 0.22
2:15 PM 0.32 (race over).
I didn't bolus during the ride and ate about 150 calories per hour, or one GU + some gatorade about every hour. I didn't have a swim before or a run afterward, so didn't feel the need to eat a ton.

***

It was great to be there with Triabetes team captain Sean McKendry, who successfully completed his first triathlon in the Long Course event. Just to add some perspective, many people consider this race to be one of the hardest triathlons out there and say that, in effort, it could be considered a 2/3-ironman distance event. It is tough. Way to go, Sean! And he ended it with a rock-star BG of 130.

Sean's out there swimming somewhere

At last!

first ride

"Hallelujah!" was the thought running through my mind as I rode my bike last Tuesday for the first time in 10 weeks. And, actually, this was my first ride on my new bike, which was an incredibly generous & timely gift from an "anonymous benefactor." The new yet-to-be named bike had rested quietly in my bedroom, reminding me that being patient through my recovery would be worth it. I had my bike fitting early in the morning in Mill Valley, and then took off, a little hesitantly at first, to try out one of the classic area rides--the Paradise Loop. This route loops around the Tiburon Peninsula, and is mostly rolling hills and flat, with one longer climb at the beginning, depending on how you start. I was wondering, "Would I make it up El Camino okay?" "Could I last the whole distance?" "Would my clavicle become too sore?" I am using a new type of Speedplay pedals (Zero) for this bike, which are a bit more stiff to get into. But I was determined to give it a shot. I ate half of a PureFit bar and was on my way. The hill was not too bad, and the descent was okay, although I felt a little rusty on my cornering skills and I was on the brakes more than usual. But with a short stop for photos in Tiburon, I finished the ride feeling pretty good, all things considered. More than anything, I was happy--so happy--to be outside riding again, and riding my new bike in particular. My cousin, a cellist who had a devastating injury to her elbow at a crucial point in her college career, advised me that the best therapy she had was to just play her cello. And for me, after one week of being back "out there," I couldn't agree more.

another weekend ride

10 Weeks Post (Almost)

Today I had some good news from my visit with the orthopedic physician assistant (PA) who has been following my progress over the past two months. The X-ray tech showed me the images of my clavicle and ribs immediately after the exam and my first reaction was, "Oh no! I haven't healed at all!" I walked back over to visit with the PA and wondered what he would say. He pulled up the X-rays and pointed out the areas where bone callus has formed, which is a critical stage in healing. I don't know why, but thinking about all of those bone cells finding each other just makes me laugh. I have this image of cells on one bone calling out, "We're here! We're here!" and cells on the other fragment saying "Catch this rope!" Anyway, I am happy to think of my bone doing its thing to repair the damage I so cruelly inflicted! My PA said that I had passed a critical stage in healing, and that the bones were strong enough now to bear almost normal weight. I asked whether I might accidentally re-fracture the bone but he said this was unlikely unless I did anything really stupid like throw a 50 gallon jug over my head, or take a bad fall. "Can I ride outside?" "Can I run?" "Can I swim?" The answer to these questions was "Yes" with the disclaimer that it would probably be quite painful for some time, so I may not want to. Yeah, I get that. I admit that I've tried running here and there to see how it feels, and I don't think I'm quite ready to go for it yet. Apparently, the bone takes about 3 months to be mostly healed but a full 9 months to become fully remodeled and calcified etc.

After my PA listened carefully to all of my questions, and answered the ones he could, I hustled over to my physical therapy appointment. My PT gave me some new exercises to increase the flexibility in my arm and shoulder. Throughout the healing process, the shoulder joint itself has not stiffened up too much, which is a relief, considering my prior episode of (probable) frozen shoulder on this side. My PT explained that the muscles form a sort of internal brace to protect the fracture and that this may be why stretching my arm much causes nearly searing pain in my upper arm. Also, I need to work on loosening the muscles in my upper back, which is the other area of continued pain. I have a hard time not slumping forward because sitting with an upright posture quickly leads to an achy back.

While not being able to swim, run or bike, I have been able to enjoy hiking during the beautiful spring weather we've been enjoying. The hillsides are green and the wildflowers are in full bloom. Here's a shot from the top of a hill in the Marin Headlands.

6 Weeks Post

6 weeks post accident
Originally uploaded by annetics

Here's a snapshot of the Xray I had done today on my clavicle. It has actually been hurting more in the past week, but the orthopedic PA says that it is still in a good position, and that it is beginning to heal. I'm very grateful that I did not require surgery and will try to be patient. I have a lot of pain in my arm and shoulder area and I guess that may subside once the fracture heals? The physical therapist was pleased with the range of motion of my shoulder joint and got me started on some simple exercises to build my core strength up again. The pain in my back doesn't seem to be improving much these days but I guess that is not too surprising. In my mind, 6 weeks was the magic point when I thought I would feel better, and 8 weeks the absolute latest that I would still be healing. In the meantime, I am glad that I'm able to ride my bike trainer, as mind-numbing as it is, and was very excited to get up to a full hour on Saturday. I'll continue with the mini-updates on the right-hand side of my blog using Twitter. These are mostly so I can keep track of my progress and for my family members who enjoy these details. But, follow along if you're interested.

In Memory of a Bike

This weekend, I'll be getting back my bike that I was riding in the crash. I haven't seen it yet but have been told that it is pretty much toast. At least, the handlebars, wheels, and fork are demolished. I don't know about the frame--I'm hoping I can salvage the saddle and am really hoping that the bike computer survived. If saying good-bye to my trusty Geo Prizm (after I was hit in a hit-and-run in San Francisco in 2006) is any example, it will be sad to say good-bye to my faithful red Cannondale. The bike has seen me through thousands of miles of training and racing, including 2 of the Ironman races and numerous other triathlons. I've taken the bike into the shop far more often than my car, and have been careful to keep it running well. Most of the parts have been replaced, and often upgraded. I was hoping to use it for awhile to race with while I get more experience, and then pass it off to someone who would appreciate the gift.

In 2006, on my red bike, next to my red car.
Don't worry, I always wear my helmet while riding. See, it's on the car.

Morning Thoughts

Morning Rainbow
Originally uploaded by annetics

We've had some pretty intense rain and hail in the past day or two, so I was happy to be greeted by this sight this morning and am reminded how fortunate I am to live in such a beautiful place.

This week is Diabetes Training Camp for the Triabetes captains down in Tucson, and I am not able to be there because of my bike accident on Feb 1. It has been heartbreaking for me to miss it but it just wasn't an option. The healing is going well, and I have been able to get on my trainer for 15 minutes at a time for several days now; but I won't be able to swim, bike (outside) or run at all until the end of the month, at the earliest. I'm really glad I can use the trainer, though, and conveniently, I already had an old tire on my rear wheel, so won't care if it is completely worn down by the trainer flywheel.

I had a visit with the physical therapist on Monday, and she felt that my shoulder joint is in good shape and gave me a few exercises for loosening up the muscles in my arm and shoulder. We couldn't do much with the core muscles because the ribs are not healed yet, so that will have to wait. I have been concerned about some loss of muscle mass in the left calf, which I noticed 5 days after the crash. None of the doctors I have seen felt like it was a neurological issue; the PT felt like it was most likely related to some deep bruising in the area. I still have an area of bruising on the outside of my calf which is quite painful to the touch. Perhaps the bruises in the lower leg just take longer to heal. I am breathing easier since the rib pain is much reduced and I do not get out of breath as easily. I never did get the Xray of my hand because, even if it were broken, nothing would be done about it, and I think I'm getting enough radiation as it is. I still wonder if I broke some ribs on the right side. The last time I saw the orthopedic PA, he said that I had likely broken at least half of the ribs going down the back on the left. He was pointing out the fractures in each rib in the Xray going down the left side. "Here it is, here it is, here it is...."

Despite all of this, the PT and others feel optimistic that I will have a full recovery and I am feeling much, much better than a month ago! It is going to take a lot of work and I think my biggest challenge will be in having the patience to build up slowly instead of thinking I can just jump in where I left off before the accident. In a way, I feel like I have been building a house over the past few years (of training) which was just burned to the ground in a fire. But if I think about it, I probably still have a good foundation and framework, and just need to put the walls back up (and probably not even all the walls).

2009 DiabetesMine Design Challenge!

It's time to get your creative juices flowing for the 2009 DiabetesMine Design Challenge, which was announced by Amy Tenderich of DiabetesMine this morning. A while back, Amy asked me if I would be willing to participate in the video announcement for this contest; of course I readily agreed! I strongly believe that huge strides in diabetes management could be made by improving the design of current medical devices, without necessarily requiring huge improvements in the medical technology itself. (Although, I would love to see some diabetes products that don't require expensive and high maintenance disposable parts. And of course a super-accurate, noninvasive blood glucose meter is the holy grail!)

View the video below, and check out the rules at the official contest page. There are top-notch judges and cash prizes of up to $10,000!

Early Bird Crit...I Should Have Slept Late

My goal for the first 6 or 7 months of 2009 was to spend a lot of time on the bike. Things were going along as planned until February 1, the day of the Early Bird Criterium Bike Race in Fremont, CA. There was a lot of aggressive riding and the field was large at 62, so I was relieved to finally hear the bell signaling the final lap. I took the 3rd of 4 corners wide and had a clear path ahead of me--I had decided to stay away from the pack for the final corner and sprint to the finish. Out of nowhere someone was down in front of me and with horror, I ran into the woman and flipped over the handlebars, landing flat on my back according to a witness. From what I have been told, the other rider had some mishap in the pack and darted out to the left and crashed right in front of me. Laying curled up on my right side in agony, I was screaming bloody murder. The first words out of my mouth were, "Why do I do these things?!" and "I think the tip of my finger is missing! Ahhhhh!" I am not impressed by my bravery at this moment. At least I didn't curse. After receiving very caring help from friends, race organizers and a nurse named Katherine, I was quickly taken with the other rider to a hospital by ambulance.

thumbs-up from the spine board

readmitted the day after for more testing and happy drugs!

Since then I have been diagnosed with 4 broken ribs and other fractured ribs on the left posterior side, a broken left clavicle and fractured L2 vertebra (transverse process). Additionally I have a small region of collapsed lung on the left side which I am hoping is not too serious. There is something wrong with my left hand and left calf although I am told that the hand is somehow related to my clavicle injury (??) and I haven't really had the calf checked out yet. I had some pretty nasty contusions and the expected road rash and weird pains that make me wonder if the bike hit me as I went around. (Why wouldn't it?) There is a big patch of numb skin and something is still funky with my gluteal muscles. My helmet was cracked and I had a very sore spot on the back of my head for days due to being strapped down to the spine board for 4 hours. Fortunately, I escaped with no traumatic brain injury. I won't lie--this has been by far the most painful experience of my life, easily beating out my tonsillectomy in my late twenties.

trying to cushion the broken bones

On a more positive note, I have been overwhelmed by the kindness of teammates, family and friends. I appreciate every call and email that I have received. Once again in my life, I have been reminded that one of my greatest blessings is an abundance of wonderful friends and family members. Also, I have made steady albeit slow progress and the most severe pain seems to be making its way to the past. I finally have some medical appointments lined up that are giving me more confidence that I will be thoroughly examined, which is a huge relief.

When my left arm regains a bit more functionality, I will write up the story of how my Animas pump survived its own test, coming away a bit scathed but still doing its job to keep the ketones at bay.