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.

Ride through Marin

Stinson Beach from Panoramic Highway
Originally uploaded by annetics

After puttering around this morning, I finally made it out the door for my ride through Marin County today. My plan was to start in Mill Valley, and do a loop through Nicasio, Point Reyes Station, and then head south on Highway 1 to Stinson Beach. From there, I would climb up Panoramic Highway and head back down to Mill Valley.

After my recent tune-up to my bike, I was surprised that the shifting was still acting up and by the time I reached Ross, I couldn't get the bike to shift to the big chain ring. The guys at Paradigm Cycles in San Anselmo quickly diagnosed the problem as a frayed cable, ready to snap completely. Yikes! They were able to make the repair in less than 30 minutes while I had a nice chicken salad at a cafe across the street. I was very happy that they were able to do this repair on the spot, and I was back on the road in about 40 minutes, with much snappier shifting. Thanks!

I continued my ride as planned and enjoyed the warm day. I stopped here and there to take pictures. My goal was to go for an easy ride but if I'd really been serious about it, I wouldn't have chosen to ride through Stinson. I just couldn't resist with the clear weather! More pictures can be seen at my flickr site here.

The blood sugars behaved. I ate about 1 gel per hour and left my basal rate at 100%. My blood sugars were all between 89 and 115; I checked about once an hour. I had taken 0.5 units for a bar I ate right before riding, and another unit for the chicken salad (which had some carbs in it); I was worried that the 1 U might do me in but it seemed to work out pretty well. I don't usually exercise in the afternoon, so it was a bit of a guess.

Grateful for Family

Since receiving the news that my Grandma Findlay passed away on Saturday, I have been reflecting on her life and our relationship. I am grateful that I was able to visit with her and my grandfather over the holidays, when she seemed as strong as ever. With my grandfather currently recuperating from surgery in a care center, she was dissatisfied that there wasn't a better place to go for a walk. "I wish I could do some digging in my garden!" was her sentiment. At 89 years of age, she was still going strong. I have many, many good memories of times together over the years, and will deeply miss her chuckle as I share with her my latest adventures. Recently, we enjoyed trading stories about swimming, since she had done that regularly for many years. Always, I knew she cared for me and wished for my continued happiness and well-being. She had an unbending sense of integrity that I hope I can emulate, and a tough and hard-working spirit that was also a great example to me. She had her share of struggles in life yet continued onward with hope and determination. I will miss her greatly.

Race Report: Disney World Marathon

Although the temp's were actually warmer in San Francisco over the weekend, I had the pleasure of traveling to Florida to meet up with friends from Children With Diabetes for the Disney World running weekend. Races included a 5k, half marathon and full marathon. Brian Foster gets the award for running both the half marathon and the full marathon, one day apart. Way to go!

Diabetes-wise, things went well. I managed the taper by boosting my basal by 20% in the couple days leading up to the race. I was having some big oscillations 2 days before, likely related to traveling across 3 time zones, not eating normal meals and getting too little sleep. Things settled down and the day before, my BG's were good. I continued with my regular Symlin dose of 6 U before meals up until race morning. Because the marathon started at 5:50 AM and we needed to be on the shuttle at 3:45 AM (!), I had to get up around 3:15 (that's 12:15 AM Pacific time, mind you). In order to help with breakfast and pre-race adrenalin, I had pre-programmed my basal rate at 0.75 U/hr beginning at 3 AM until one hour before race start. My normal rate at that time is 0.5 U/hr but with the 3-hour time change, who knows what "normal" really was.

There weren't a whole lot of options for breakfast at the Coronado so mine consisted of a container of soy milk for some protein and a banana. Typically I don't eat a whole lot before a marathon anyway. I took 2.5 U (which was unintentionally a little more than I would have normally bolused for my 32-g breakfast) at 3:25 AM for the food and watched as my BG remained close to 90. Sometime around 4, it started to climb. I watched it on the Dexcom, looking to see it plateau, but it was climbing steadily. When I tested at 200 at 4:30, I decided to take 0.5 U to nudge it down a bit. By the race start I was at 132 and felt comfortable starting there, since my basal had been reduced back to 0.65 for an hour. (Normal for that time is 0.7 so it was not a big reduction.)

The blood sugar was holding steady around 160 and I was eating 1 gel every 45 to 50 minutes, as well as sipping some of the sports drink here and there. About 90 minutes into the run, I saw the BG come down to 128 so decided to lower my basal to 0.50. This worked great and I relied mostly on the sports drink, along with 1 or 2 more gels, for the duration of the race. I finished with a BG of 143 (narrowly losing out to Peter's 139!) but promptly started to rise into the 300s. I'm not sure if this post-race spike is because I'm not paying attention to what I'm eating (and bolusing for), or if there are some calories hanging out in my stomach that suddenly get digested, or some other reason. Anyway, I need to remember to increase my basal right after the race.

I increased my basal rates by 30% until I got the BGs down. Interestingly to me, the stiffness in my legs started to feel a lot better once I got the BGs under control.

Thanks to Peter, who ran with me the whole way, even when I was not feeling so speedy. At times, I was probably even not very friendly! (Sorry!) The pacing on the race was a little less than ideal for me. Three weeks ago, I ran 22 miles with no problem, and was able to kick it in the last few miles. But during the race, I was feeling sore by mile 18 and feeling like I would be happy to finish after the 20 mile mark. Against my better judgement, I allowed myself to run at a faster pace the first half of the race. My heart rate was creeping up to the mid-170s by the 3rd mile or so, and it never really dropped below 170 for the rest of the race. My original plan was to keep it closer to 155 or 160 but my average HR ended up being 174 and I actually hit my max at some point. Silly Anne! I think, had I stuck to my plan, my finish time would have been about the same, if not faster, and I would have experienced a lot less pain. The race surface was asphalt but also a lot of concrete, which is also pretty tough on the body. Also, I don't think I tapered too well, unless doing 3 rides of about 50 miles each less than 2 weeks out counts as a taper.

I am satisfied with my time of 4:11. It's 21 minutes slower than my most recent non-IM marathon (Boston in 2006) and 32 minutes slower than my PR, but I knew that I would not be running at that pace for this marathon. It was great meeting up with some old friends and making some new connections with people in the diabetes community. Thanks to those who organized this event!

With the marathon done, I am anxiously recovering, if that is possible, and looking forward to doing a lot of cycling in the next 6 months! I can't wait!

Dave Shack, Ironman Extraordinaire!

Triabetes team member Dave Shack was featured in an article in the New York Times today. Check it out here and be sure to listen to the audio on the left side. It has been great getting to know Dave and his family over the past year. It took me many years of running and a couple years of triathlon to get the courage to sign up for my first Ironman; Dave tackled it all in one year of training. Congrat's, Dave!

Note: I thought I would add a note for those who may be interested in supporting Triabetes. You can currently do so through the Triabetes website here. If you are associated with a business that may be interested in sponsoring Triabetes, you can send a note.

Thanks, IronKidz!

A new video has been released from Andiamo Productions, featuring the "IronKidz"--our young training partners leading up to Ironman Wisconsin. Thanks to Marissa, my IronKid, for her support before, during and after the race. Not only did it spur me on to the finish on race day, but her support also kept me going in the weeks and months leading up to the race. Thank you Marissa and all the other IronKidz!


The Triabetes IronKiDz Project from Andiamo Productions on Vimeo.