The Clavicle Diaries (or how I stopped worrying and learned to wait for the road).

On Saturday 15 August I had my worst crash. I was found unconscious in the road during the Saint Kilda Cycling Club trophy race at Kyneton. Somehow, I had crashed on the final descent with six kilometres left in the 83 Km race. I say ‘somehow’, as my injuries left me with no recollection of the accident at all.

What follows is a little recovery diary. I’ll add to it each week, or more frequently if something major happens, until I’m back on the road (I’m not going to spam followers – if you subscribe you’ll only get this one email, you’ll need to check back if you’re interested in the updates).

Hopefully this will interest folks who find themselves in a similar position; a way of quantifying the time it takes to get back up and running. I know from when I broke my arm, the time goes quickly enough and sometimes a chance to reset can be helpful anyway. But when you’re standing at the start of the tunnel the light can seem a long way off.

Day 0 – The Crash

Before the crash. Photo: (c) Amy Tan. See Amy's great photos from the day on the Northern Combine Facebook page: https://www.facebook.com/NorthernCombineCycling

Before the crash. Photo: (c) Amy Tan. See Amy’s great photos from the day on the Northern Combine Facebook page: https://www.facebook.com/NorthernCombineCycling

One memory: I’m descending in the bunch – the race is on, with only the last climb left to feature. We’ve gone down this hill three times already, there’s nothing dramatic to anticipate.

Then my next memory: I don’t know what’s going on, but when I open my eyes I’m lying on the ground, faces looking down over me. Someone tells me I’ve crashed.

I don’t know if my memory at this stage is scrambled, or if I was lapsing in and out, but the next hour or so moves impressionistically. Bits of conversation, I’m in an ambulance, the sound of the road, the feeling of being moved around, hospital sounds. When they tell me K is here, waiting outside for me, it seems miraculous. Later she tells me I spoke to her on the phone, either from the crash scene or the ambulance: no memory of that.

I’m not in a lot of pain but I’m also unable to move. They’ve taken a brace off my neck, but I can’t lift my head at all. I’m talking and I can answer their cognitive function questions, but I’m pretty scattered.

Their initial examination finds three problems: I’ve broken my collarbone, I’ve bruised my left lung, and the the frontal lobe of my brain. Of course there’s the usual smattering (splattering?) of abrasions and gravel rash, it’s no threat but can be very annoying during recovery.

The whole thing seems a bit unreal, I was racing OK, now this? I just wish I knew exactly what had happened.

Day 1.

At St Vincents

At St Vincents

I’m in St Vincent’s hospital. I woke during the night and felt like I was going to throw up. I got my body off the bed and stood on my feet (for the first time since before the race). I stumbled out into a lit corridor in my underpants sweating and shaking. A surprised nurse guided me to the toilet.

I’m the youngest person in my ward by thirty years. There’s an old woman who sounds like her lungs are filling up with liquid. When the nurses come by and ask how much pain she is in, on a scale of 0 to 10, she always cries, ‘eight!’ She’s been sent here by the universe to remind me to keep a sense of perspective. Then there’s a guy who has had to fast for the past six days. He never complains of pain but he keeps burping these deep long guttural burps.

Various beeping machines are beeping.

I get taken off for more X-rays – they’re concerned about the bruising to my lungs and brain. The clavicle break and abrasions are the source of pain, but apparently not much concern.

K sits with me as I drift in and out. At one point she leaves and reappears with daifuku. I’m a lucky guy.

Day 2

Hospital: The Neuro guy has cleared me. The contusion is so tiny that any brain injury would probably be indistinguishable from the damage of a concussive head injury anyway. I know my name, my date of birth, where I am, the date and day of the week – evidently this orientation is proof my cognitive function is good enough. When I lie down I start spinning though, like when you’re drunk and the ceiling spins in recurring quarter-turns (I haven’t been drunk for four years).

I call work – they’re 100% supportive. It’s nice not to have to stress about that.

I just need to get the ortho team’s clearance and I’m out of here. It’s a long bloody wait. At dusk the ortho guy turns up and says ‘we decided this morning, you’re good to go.’

Abby, my club President, calls while we drive home. She says the picture that is forming is that I hit ‘something that was in the road, or something that was dropped onto the road.’

At home I have a message exchange with folks who wished me well. Steve W, who was doing corner marshalling, just near the descent, was apparently on the scene quickly. He said the chain had come off over the front of the chain rings on to the crank. He said the follow-car driver described seeing me ‘cartwheeling.’ He also said there was a ‘shredded’ Specialized bottle which he assumed was mine. My bottles are fine. My brain is searching to understand what might have happened.

Before bed I send a message to Shane M. I know he’s had a few clavicle breaks and hope he can advise me. He recommends a surgeon. Thanks Shane!

Days 3-8 (Week 1 post-crash)

Please, for me, don't ever listen to the anti-helmet lobby!

Please, for me, don’t ever listen to the anti-helmet lobby!

This week passes as an opiate induced blur. Persistent pain and dizziness form the backdrop as I set about trying to put things in order; understanding what’s happened, pursuing my medical options, getting the bike fixed etc. I’ve got a determination to act quickly, even replacing my destroyed kit at the first opportunity. Watching The USA Pro Challenge, rooting for Phinney and Dennis provides some distraction.

My second paramedic-cut jersey. Not really a collection I want to grow.

My second paramedic-cut jersey. Not really a collection I want to build.

On Thursday I visit an orthopaedic surgeon. He explains my distal clavicle break is unusual and predicts six weeks before hitting the road with surgery. I’ll need a hook plate – I ask how much the plate weighs.
He also thinks damage to my ear might require cosmetic surgery.

It's not humerus

It’s not humerus

Clavicle-classfc

By Saturday a problem that was lurking in the background asserts itself. The injury to my ear, which no one thought much of at the hospital, shows exposed cartilage and is now infected.

We go to the local clinic then rush to the Ear and Eye Hospital. They fast track me, take samples, dig about. They decide it’s a job for the plastic surgeons at St Vincent’s. So, I’m back to hospital first thing Monday morning, probably to go under the scalpel.

They wrap my head up, making me look like a wounded soldier. Then the wound starts to pulsate an angry burning pain. I’m about to lose it for the first time – this is all so bloody trying.

Perhaps most usefully, my ongoing dizziness was diagnosed as Benign Paroxysmal Positional Vertigo which apparently 28% of head trauma victims experience. As soon as I’m able to lie on my left side there is an exercise I can do that will make the sensations go away. Awesome!

It’s hard to believe it’s been a week since the accident. I was meant to be racing at Sam Miranda today. I’m thrilled to see Paul take out B and looking forward to the results of other friends.

After going seven days out of the saddle for the first time in three years, I’m back on the trainer on Sunday. Extremely limited in what I can do, but it’s a start.

Forgive the Zpower, my quarq is still on the crashed bike which is still getting fixed.

Forgive the Zpower, my quarq is on the crashed bike which is still getting fixed.

After a week my gravel rash has healed to a point where I can get about without too much pain, the bruising of my lung is only noticeable when I cough and the broken bone is just a dull ache and a weak annoyance.

The trouble with my ear is more of an issue and reflects a failing of my hospital stay – it should have been properly treated, but the issue just fell through the cracks given the focus on other problems. I can tell you debridement is freaking painful – avoid getting to the point where you need it done!

Vertigo is still a problem and I was fighting nausea on the trainer. But like I said yesterday, this should be corrected once I can lie on my left side.

Day 9 + 10 Hospital, surgery

Monday morning. We had the appointment booked with the plastics team at St Vincent’s to look at my ear. I had a couple of scenarios in mind, with the worst case one involving a general anesthetic and an overnight stay.

We arrived to find I was double booked – with the ortho team, as well as plastics. But this would prove fortuitous.

Plastics got to see me first. When I crashed I tore a piece of my ear off, exposing the cartilage. We suspect this could have just been sutured up the first time around. But with everything else that was going on it got overlooked. After a few days at home it became infected. Now they would have to excise the infected cartilage and use a skin graft to cover the gap, leaving my ear permanently deformed. Hopefully not too noticeably!

Saturday pushed me to the limits of my pain threshold, as I got the ear debrided and cleaned. I was looking forward to getting this plastic surgery done with, and they said it could be done under local anesthetic. I’d go on the emergency wait list and be getting home before nightfall with any luck.

But then the ortho guys got a hold of me. I don’t know what it was – maybe the new X-rays looked bad (we thought the break looked more displaced), maybe hearing about my determination to get back to racing influenced them – but they reversed a previously unanimous decision and decided to operate. Not only that, but they decided to do it right away, using a slot that had had a cancellation, knocking over both procedures (plastic and ortho) in one operation.

While we’re waiting for the new X-ray a prisoner is brought in. He’s a young African guy in shackles. I’ve seen some disturbing things in hospitals …  When he emerges he cheekily shouts to the room, ‘hello everybody!’ I say hello and wave back.

So I was going to be in hospital overnight. But now that I was getting my clavicle plated this was a better scenario.

Soon I was wheeled into the operating theater. I hadn’t had a general anesthetic since I was a kid – I wasn’t looking forward to it. I’d had my fill of unconsciousness lately! They got me breathing in sedatives, and I could feel the general anesthetic begin to buzz. A familiar feeling – even though the last time was 26 years ago! They didn’t ask me to count like when I was a kid, but I did recite a little mantra to myself, with a determination to finish it before I passed out. I got there, then told myself to wake up on the other end.

Ok, conscious now, mostly. Pain. Far out my shoulder hurts. I always try not to express pain in these situations but after everything that’s happened my defences are worn down. Now I’m groaning and calling for pain relief. I’m very groggy and very sore. I keep calling for pain relief. After a while the pain is less excruciating and they wheel me up to a ward. Here I can gaze out th ninth floor window at the city lights.

You're not in Eltham anymore ...

You’re not in Eltham anymore …

I struggle to keep my eyes open. I’m really doped up. I nod off. But soon I’m awake – it’s dark and some one is screaming, I hear an old man crying ‘no!’ and ‘Where is my wife?!’ This goes on for hours. Later I learn he’s 99 years old and the sole carer for his wife. In the bed next to me an old woman is crying in her sleep and talking too – in what sounds to me like an Eastern-European language. It’s all surreal.

So I thought that would be about it. I was scheduled to have a final observation and approval to leave at 2pm Tuesday. But then one of the neuro guys rushed in. They’d reviewed the original CT scans and discovered I’d actually fractured my skull, and somehow they’d overlooked this! Suddenly I’m in a neck brace (I’d done OK without one for a week?) and getting rushed off for more CT Scans. The orderly who wheels me back to my ward is a roadie – we sus each other out in a few seconds and he starts telling me about his trip to Wilsons Promontory and his Strava trophies!

I’m told I’ll be in for another night with an MRI in the morning, before a final review from the neuro team. This hits me pretty hard. I badly want to leave.

An 85 year old woman and her gang of octogenarian supporters take up position in the bed opposite me. She’s in for a hip replacement. At one point I hear her note how they’re all in their 80s and then she says, ‘who isn’t?’ It’s funny how we ghettoise ourselves – who isn’t a cyclist? They’re nice rural oldies, but they talk so loud! A nurse comes in to say I’m being moved to a quieter room! ‘Yeah’, I say, ‘this is the party room.’

Room with a view

Room with a view

Finally: a breakthrough. A plastics guy comes in, telling me about the skull fracture (I guess they’re comparing notes). It’s small, it’s on the back of the base of my skull, it’s from the side impact. They’re satisfied it hasn’t worsened and I can probably go home tonight, so long as I don’t go head-banging any time soon. I ask a nurse – ‘what about the MRI?’ I learn that ED is filling up and they need the bed-space!

My experience of the public health system has been mixed. Ultimately, it’s worked well for me – even getting the clavicle surgery which most folks go private for. But the very front line is terrifying. Seeing the run-down waiting rooms full of struggling people, enduring oppressive wait times. It’s no wonder people fall through the cracks. I made it through, with a bit of intelligence and determination and a supportive partner, and even I had some semi-dodgy things happen (like my ear not getting treated sooner and the skull fracture being missed).

The health sector is Australia’s largest employer and most of these people are superheroes as far as I’m concerned. You could double their pay and that still probably wouldn’t equal the value of their labour.

Now the pieces are in place for my recovery to really begin. I’m going to take it easy for a bit, then build back. Hopefully on the road before the end of September.

Can I get these in titanium?

Can I get these in titanium?

Days 3-8 (Week 2 post-crash, week 1 post-op)

No one told me post-operative pain would hurt more. Anyone who’s broken a bone knows that acute feeling of malfunction in the body, which is unlike other injuries. I felt that in the clavicle before surgery and now that feeling is gone. But in its place is a scalding, frustrating ache. Sometimes it doesn’t register as pain, just discomfort. Then sometimes it asserts itself as pain in powerful waves. Often it feels like a pulling tension.

The nights are hard. I wake up every hour to 90mins. Getting up and lying down is still a strain. I’m staying on top of my medication schedule, making sure to take Endone (Oxy) every three hours. At least this knocks me out for a bit.

Mid week I drop in to Benny’s and he asks if I’m still going to race. That question kinda scares me – I didn’t think these injuries were quite enough to warrant that sort of reflection. That said, if it happens again any time soon, I might be compelled to hobble away from the sport.

Gradually pain management comes under control, but staying on top of things psychologically is much harder. Turns out I’m having an allergic reaction to my antibiotic, with blistering hives and peeling skin:

My right arm after reacting to antibiotic. My back looks like this too.

My right arm after reacting to antibiotic. My back looks like this too.

On Day 16 after the crash I’m back at the hospital.The plastic surgeon is happy with my ear’s progress and I finally got images of the plate:

The $600 man.

The $600 man.

Looking at how all this fits together makes some sense of why I get a pulling or dragging sensation from the shoulder.

Days 17-23 (Week 3 post-crash, week 2 post-op)

I’ve stepped down my intake of painkillers significantly and found I was able to get by OK. At the moment it’s a pretty horrible ache either way, so I may as well be clear headed. I’ve been having persistent dizziness and intermittent shooting pains in my head – but this might be related to stepping off the painkillers.

On Day 17 I went over to Peak Cycles to get the run down on the bike. Basically the frame, derailleurs, power meter and pedals are good and everything else is wrecked. I’m going to need to replace my Fulcrum Zero wheelset. Here’s hoping the insurance I’ve been paying for the last three years comes good …

I finally spoke to the commissaire and follow car driver of the race. It’s the first time I’ve had someone relate a witness account of the crash and it scared me a bit. She said I was at the back of the bunch and the next second my body and bike were flying spectacularly in the air before crashing down and bouncing several times. It’s still a big mystery, but now I have a frightening oral account to deepen it. Maybe I’d angered the cycling gods somehow.

On the plus side, my abrasions are almost completely healed. I’m getting more range of motion back in the shoulder too. But, on another downside I’ve had bad post-intubation throat soreness, which is apparently rare in men (I need a bigger throat).

Day 23 was a big day at the hospital. I’m now discharged from plastics and neuro, but I’ll keep seeing ortho.

Everyone is happy with the way I’m healing, but there were words of caution, indeed warning, about what progress to expect. This isn’t just because of the collar bone, but because of the sum total of the injuries I received. In fact the skull fracture and associated brain injury is now the biggest worry.

I’m frightened by the situation. I’m still aiming for a return to racing in three months but now accepting that might not happen. I spoke to doctors today who didn’t want me riding outside in that time-frame, let alone racing. There was also some acknowledgement that a racing cyclist would be expected to ignore such advice. But I’m feeling so banged about at the moment that I might start approaching recovery more conservatively.

Days 24-29 (Week 4 post-crash, week 3 post-op)

Back to work and BPPV returned with a vengeance.

After a night of little sleep with clavicle pain, I got up after five, watched the Vuelta, then got to the station early enough for the free train. Though the neurosurgeon yesterday recommended a return to work at reduced hours I was quietly believing I’d be good to work as normal. But this whole experience keeps forcing humility and patience.

Within about 15 minutes of talking to my co-workers I knew I wasn’t going to make it through the day. Working in an open-plan office, a glance from my monitor would force a shift in depth perception to thirty metres; I’d nearly fall off my chair every time. The same thing would happen if I turned from one person to another, speaking either side of me. I went home after five hours, and may have to work these hours for a little while.

I thought I had my vertigo condition, caused by the head trauma, beaten. An exercise called the Epley maneuver had seemed to put a stop to the dizziness but in the last couple of days I’d been less steady getting out of bed, and today seemed to be underscoring the reversal.

A depressing finding is that whilst 50% of people who experience BPPV have it return within three years, it is more likely to recur when originating from a concussion. I could be managing this for the rest of my life.

I have to recognise that head trauma is the overriding concern coming out of this crash. I should probably change the post title!

So, feeling pretty bleak right now. But there are good stories in the background: Seeing my very supportive co-workers was really nice; it looks like the insurance is working out, and I’ll write more about that when it’s stitched up. And if Dumoulin can can actually win the Vuelta I’ll do a little dance. I’ll probably fall over then, but you know, it’s a dangerous sport.

Through the week I contested ongoing dizziness and some difficult pain, but I’m continuing to have steady improvement in range of motion. My employers have been amazingly supportive and are working out a graduated return to full-time hours.

I still struggle to understand what happened in the crash. Having no memory of the incident is as troubling now as it was the following day. But I’ve got a couple of possible analogues which show just how easily impacting an object at speed can cause an unavoidable high-side:

I remember this one from last year’s Tour of Utah:

That was caused by a snow pole at the side of the road. This one is probably more like what happened to me:

These guys say they were riding at 50kph – so add 13kph and put them on a descent, then you’ll have some idea of how I could have got airborne.

Days 30-35 (Week 5 post-crash, week 4 post-op)

Five weeks on from the crash today. Monday will mark four weeks since the operation. Back at work for two weeks now. Time is flying. I wish my recovery was.

This last week was the first where pain in my clavicle area really began to subside. No longer causing constant pain, it would be better described as persistently uncomfortable. I can bear a little bit of weight on it. I’ve started back on the trainer, very gradually. No matter what you hear, too much time off the bike is a bad thing; if you keep going past freshness you get to weakness pretty quickly.

Staples out. Scar at four weeks post-op.

Staples out. Scar at four weeks post-op.

If the clavicle was my only problem, I’d be on the verge of some gentle road riding. But at this point that injury is of secondary concern. It turns out my head injury has effected some lingering problems. I’m fighting multiple vertigo and disequilibrium issues. My BPPV is being controlled well with the Epley maneuver but there is an additional source of dizziness and imbalance I haven’t identified. Walking down Little Lonsdale Street in the city one morning I felt I was going to have to steady myself against a wall, just to stay on my feet. I’m waiting for an appointment at the balance disorders clinic connected to the Eye and Ear hospital. Fingers crossed they can diagnose and cure, because this is not a safe condition to take into a peloton. Hey, maybe it will just go away!

I’ve learned more about my skull fracture. The part I broke is called the Occipital Condyle

Occipital Condyle in pink.

Occipital Condyle in pink.

It’s a protuberance of the occipital bone which is the big bit of skull at the base and back of your head.

I broke my right one – a displace fractured so I really managed to bang it about. These fractures have a mortality rate of 11%, mainly because the high energy impacts required for the fracture are often associated with other potentially lethal injuries.

The neurosurgeon told me I was lucky to be alive, but I knew that before the crash! It’s one of the reasons I ride and race bikes – not much else can get you so close to the essence of life, viscerally and cerebrally. I’m still aiming to come back strong.

Days 36-43 (Week 6 post-crash, week 5 post-op)

A rollercoaster week: ups, downs and positive breakthroughs.

My vertigo was persisting horribly – I could get it settled with the Epley maneuver but it kept coming back. Even with the BPPV settled there was something else at play. Twice I almost fell over in the road as I walked over to the train station. I rang the balance clinic and they said it could take weeks to be seen. I booked an appointment with a private vestibular therapist for Thursday – it couldn’t arrive soon enough!

On Tuesday I was so sick with vertigo I could barely function at work. They put me in the sickbay where I passed out with exhaustion. After an hour they decided to send me home – I had to insist I go home and not to the ED! Once home I collapsed and slept all day.

So I felt a certain desperation when I arrived to see the private therapist. The experience was fantastic and gave me a lot of confidence that things will get better. I spent the best part of two hours doing vestibular exercises and by the end I felt much sharper. Turns out the vestibular system really likes getting a work out. Ironically, the therapist couldn’t trigger my BPPV. She even suggested it might have passed, though it has since returned again. She did agree I had some general non-BPPV vestibular wobbliness from the head injury, but this would be expected to respond well to exercise.

This was a breakthrough day for me. At least now I have a time-frame. I’m not going to be imbalanced forever and it’s all in my vestibular system, not some kind of brain damage (though I’ve had a few odd cognitive moments – getting words and places uncharacteristically mixed up – but this should pass too).

So I’ve learned to stop worrying! The vestibular therapist was extremely encouraging about getting back on the bike ASAP as any issues are best resolved by testing them.

I’ve stopped taking pain killers in the day now, and things are getting better. Today I drove for the first time since the crash six weeks ago. Six weeks!

So after that time (and five weeks since the operation) here’s the balance sheet:

  • Clavicle fracture: Pain eased during week four (post crash) – now requiring painkillers only to sleep. Still sore and weak, but making steady progress.
  • Skull fracture: I can only assume it’s healing well. I have no pain at the location and shooting pains have stopped.
  • Ear wound: The skin graft has taken well. I look like a Star Trek alien with a subtle deformity. I can live with that!
  • Disequilibrium / BPPV: Still persisting, but getting better, and now I know how to attack it and have help.
  • Lung bruising: Pain was only ever present when I coughed and went after two weeks.
  • Abrasions and lacerations: Completely healed, took about 25 days. I had a big vein appear on my temple I’ve never seen before – which I believe was related to the deep cut beside my left eye (sometimes this causes blood to go straight from artery to vein, bypassing the capillaries, and making the engorged vein appear) but that seems to have settled.
  • Post-Intubation throat soreness: Annoyingly this lasted for about 4.5 weeks. Ok now.
  • Allergic reaction to antibiotic: All healed, some discolouration on my back remains.
  • General soft-tissue damage: All healed with some lingering neck soreness and back pain – but this might be related to the hook plate.

I’m spending a lot of time reading medical journals – like the prisoner who becomes a legal expert!

On the up.

Days 44-50 (Week 7 post-crash, week 6 post-op)

Without wanting to tempt fate, it feels like things are coming together now.

This has been such a difficult journey. When I first spoke to people from the hospital I was talking about aiming to race the Combine Champs. The Champs were a week ago and I’m not yet back on the bike. So I’ve been forced to adjust to wholly unexpected healing time scale.

But as I expressed last week, learning things were going to get better, especially the balance and vertigo problems from my head injury, was a tremendous boost.

I spent the week rebuilding my bike, having secured all the necessary replacement parts through insurance. It’s silly, but I felt a certain pride in doing it all myself – cleaning up the mess and installing new shifters, new gear and brake cables and new bar tape (and getting a great deal on replacement wheels).

Gradually my strength is coming back on the trainer. Of course I didn’t damage my legs, but you’d be amazed how much you need your arms to produce any real power. I’m doing hour rides at about 75% with a few intervals thrown in. Getting there …

Ok now .. touch wood … but I’ve been largely BPPV free for 72 hours. I’ve had a few wobbly moments which I call, ‘incipient dizziness’ (yes, I learned the term from aviation and in this case I may as well just say ‘incipient spin’!). These moments evoke the feeling I might be about to have a BPPV episode but then the feeling passes before the dizziness takes hold.

I was seriously considering getting back on the bike this weekend. Ultimately I erred on the side of caution – actually wanting to give the clavicle a little more time, rather than the vestibular recovery.

I’m targeting this coming weekend October 10-11 for the first ride. It will have been eight weeks since the crash.

 

Days 50-55 (Week 8 post-crash, week 7 post-op)

On the verge of returning to the road. Still the fracture hurts, and still my BPPV keeps recurring. My last post was tempting fate after all – the longest I’ve gone without vertigo remains 72 hours.

Really it’s been an awful week. Seeing news that a rider I know was run down in a terrible hit-and-run has given me perspective. I have very little to complain about. But despite eight weeks having passed since the crash my body still feels broken. The clavicle fracture feels like it has the strength my broken arm achieved after about ten days.

Do I challenge my fears and test how these problems play out on the road? My vestibular physio thinks it’s a good idea, and you get better at something by doing it, right? But the fear of doing further harm is real.

Days 56-57

Eight weeks to the day since the crash, I’d had enough. Even with light rain falling I was still determined to ride.

I did it. I got back on.

I drove to Arthurs Creek and rode short laps. If something went wrong I’d never be too far from the car. The feeling of uncoordination at first was ridiculous. The slick roads added an extra stress, but after a few laps I was finding a rhythm.

A breakthrough day!

Then Sunday came, and with it more vertigo. This time I had left-side BPPV for the first time. But I had to know if I could ride following such a messy start. So I drove out to Hurstbridge and rode the Coburg champs course from last year. I was OK.

So now I know I can ride safely despite ongoing vertigo. Who knows how long the condition will last? My vestibular physio says I’m unlucky that it’s still persisting at all – I really hit my head pretty hard. I’m going to have to train around the condition.

As for the clavicle, both rides hurt – it’s hard to know if the pain is emanating from the fracture or from the hook plate end in my shoulder. Ninety minutes was pushing it, but now the bone is into the callus-forming phase it’s becoming rapidly more resilient.

From the start, I’ve been blogging this diary with the thought of someone in a similar predicament, who might be searching for information. There is very little on the internet about cyclists experiences with distal clavicle fractures and hook plates. I hope some of this account has been useful. Essentially, you can expect a longer recovery than the typical medial fractures we often see in racing. If the clavicle fracture was my only issue I’d be pretty much good to go. Getting my head together will take a while longer yet.

I said I’d end this blog with a return to the road, and so I will. In eight weeks, however, I’ll get the hook plate surgically removed so I figure an update here with that experience may be useful.

This has been a tough journey. Yet with so much personal support, and with secure and flexible employment, ironically, this episode couldn’t have happened at a better time. But I wouldn’t wish it on anyone. Stay rubber side down. :)

Day 56 - Back on the road.

Day 56 – Back on the road.

 

Postscript


128 Days later

This is the start of a difficult week. On Wednesday, two days before Christmas Day, I’ll be under general anesthetic once again. This time I’ll be getting the hook plate out and it can’t happen soon enough. It has really been a challenge to train through the discomfort of the plate. I was never quite able to regain the form I had prior to the crash, especially as I’ve struggled with back pain which I think is referred from the ligament strain of the plate (I’ve never had back pain before). I’m looking forward so much to being able to lift my left arm over my head for the first time in four months!

I had a scare in early December when the hospital said I couldn’t be operated on until February – the thought of having the plate in all summer made me despair! But the worst of it was the stress that surrounded that news became the immediate catalyst for the break-up of my long relationship with K. I was always so grateful for her attentiveness through the crash and early stages of healing. For her, the stress of having me injured wasn’t the reason to go, of course, but I’m sure it didn’t help.

Luckily, the hospital found an opening for me and soon I’ll be back under the knife. It will be a tough week and I’m looking forward to getting through to the other side.

Last week I ramped up a bit, hoping to create a buffer against the inevitable loss of fitness that will come after surgery. It will be interesting to see just how quickly I can be back up and running. Without major bone healing issues (aside from the screw-holes filling in) I’ll really just be waiting for the incision trauma to sort itself out.

Watch this space! Actually, that would be boring, just revisit in a few days :)

Day 130: Surgery – Hook plate removal

Well that was kind of amazing. If you want your surgical team to get their skates on, finding a booking right before Christmas might be the way.

General anaesthetic and surgery at 9am – home by 2pm!

On the way home from work yesterday the hospital rang and asked me to come in at 7am. I asked them if this meant I could get home on the same day. They seemed skeptical, but said so long as I had someone to drive me home there was an outside chance. I made a call to Alex, and he generously agreed to play chauffeur, should the need arise. But I thought this would be in the night, if at all.

I prepared for a potentially longer stay, putting music on my ipod, choosing books etc. Before I knew it, it was midnight, and I only got five hours’ sleep.

So as I lay in the prep area this morning, chatting to the nurses and inhaling sedatives, I promptly fell asleep!

I missed the whole general anaesthetic countdown / nervous anticipation thing. One moment I was telling the nurses about my work, and the next a voice said to me, ‘your heart rate was impressively low.’ (turns out it sat on 42 through the procedure which is pretty good I guess, if not Indurain-esque).

‘Was?,’ I asked.

‘You’re out of surgery’, he said, ‘it’s done’. I looked up and saw a clock – it was 11am. I felt a little sore, in my shoulder, but it was nothing compared to how I felt when the plate went in. Really, I felt fantastic. So relieved!

It wasn’t long until they had me off to a ward where they let me eat and dress. I spoke to the pharmacist on the phone and said, ‘hello Mr pharmacist’. While this was a reference to the 60s song it’s also an example of how people try to be funny in a post anaesthetic state, almost always without success (I’ve seen this a few times, now I’m guilty of it).

The next thing Alex was there and they were letting me go. I couldn’t believe it. It wasn’t even 2pm.

So now I’ve got to take it easy for a bit. But this recovery will clearly be faster than the first one. The incision to get the plate out was a fraction of the size of the one to get it in, they didn’t even use staples. All this bodes well for getting back on the bike without losing too much form. The screw holes in bone will take a while to fill in, but so long as I don’t fall …

This was a good day.

A much smaller incision this time. Importantly, the arrow shows the surgeon where the clavicle is located. :)

A much smaller incision this time. Importantly, the arrow shows the surgeon where the clavicle is located. :)

 

Days 130 – 138 Back on the bike – end of this story!

Following surgery to remove the hook plate, the big question remained: How long would it take to get back to riding?

Before I was discharged from hospital the nurses told me I would have to stay in a sling for two weeks. They emphasised the importance of keeping the shoulder supported, and preventing the arm from dangling. ‘But what if I’m doing something where my hands and arms take the weight of my body off the shoulder?’ I asked. My intent was obvious – the nurse was non-committal.

After getting home for a late lunch, I rattled about the house then figured – there’s nothing wrong with my legs! I got on the trainer and did a single lap of the island on Zwift. The following day I rode for 45mins on Zwift. When Christmas day came I couldn’t resist the desire to ride out to Christmas Hills, despite a blustering northerly wind. Four days later I’d finished the Festive 500 and by New Years Eve I’d ridden 615km with only two days off the road after surgery:

Xmas day - back on th ebike 48 hours after surgery.

Xmas day – back on the bike 48 hours after surgery.

Riding, week 1 after surgery:

  • December 23: Hook plate removal surgery under general anaesthetic – 20mins on Zwift
  • December 24: 45mins on Zwift
  • December 25: 40km
  • December 26: 110km
  • December 27: 69km
  • December 28: 109km
  • December 29: 204km
  • December 30: 19km
  • December 31: 65km
Flowerdale - During a 200km ride to complete the Festive 500.

Flowerdale – During a 200km ride to complete the Festive 500.

So there it is. Hook plate removal is absolutely nowhere near as disruptive as the original fixation. For four months I’ve felt like I’ve been balancing a brick on my left shoulder, now it feels like a little pinch and that feeling is attenuating daily. My back pain has almost disappeared, and importantly I can aero-tuck again! It’s such a huge relief. Incidentally, I haven’t had a major vertigo episode for six weeks.

Now the time has come to put this long episode behind me. I’m grateful for my good fortune; that I can rebuild now and set some motivating goals for 2016, from a position of relative strength.

Thanks for reading, and if you’re reading because you’ve found yourself facing a similar challenge, don’t hesitate to comment – I’ll offer any help and advice I can.

Stay safe,
Alain

 

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25 thoughts on “The Clavicle Diaries (or how I stopped worrying and learned to wait for the road).

  1. Sorry to hear about your crash Alain. Hope the surgeon turning you into RoboCop doesnt ruin your climbing ability & that you have a speedy recovery.

  2. Sorry to hear this news the other day Alain. I know you’ll take it easy and get back on the road in good time. Best wishes for a solid recovery. I know you have the mental and physical toughness to heal well. Fantastic that K is there helping you along and I you are both able to get some excellent daifuku. Alex

  3. Hey Alain. I found your journal while looking for NC info, and it brought back a few memories that I thought I’d share. I suffered similar injuries to you in a bike crash last August – badly broken collarbone requiring a plate and other issues. Due to my collarbone and knock to the head, the hospital (also St Vincent’s) didn’t pay much attention to my gravel rash. A wound on my hip wasn’t cleaned properly and continually became infected and I still had an open wound six months later. As for the plate, I was also rushed into an surgery opening and perhaps was’t fully prepared for what was to follow. I remember that intense, burning pain post-op really well. It was bad for a couple of weeks, but then it would ease day by day. After about 6 weeks I could sleep on my right shoulder, which was a big relief.

    I started riding the trainer about 2 weeks after the surgery, and doing gentle laps around the block after 3. But I’d say I was too keen to get back at it, took the sling off too soon and in hindsight I wish I’d waited a full month to get back to sport. However impatient and restless you get, take your time with recovery. An extra week or two of rest will help you in the years to come.

    5 weeks after surgery I was back on the road, and by the start of summer I was doing 4+ hour rides in the hills. Having supportive mates who are happy to go at your pace helps a lot – don’t feel pressured to start climbing out of the saddle too soon (I did a couple of times with painful results). Also keep in mind that with shoulder injuries the bone gets better a lot more quickly than the surrounding tissue, and my rotator cuff still gave me issues 6 months post-op.

    I was racing crits in January and bombing down the Alps in March. A year on from the crash and I’ve got no pain whatsoever (except some tenderness if I get bumped right on the plate). In October I’m heading back to St Vincent’s to ask about having the plate removed.

    Just wanted to let you know that it’ll be cool. In the meantime, be patient and thorough with your recovery – the forced time off will if anything strengthen your desire to ride, and you’ll have a good, long summer on the bike.

    All the best!

    • Thanks for your comment Chris!

      Recovery is a hard balancing act – you want to get back on as fast as you can, but doing so prematurely could drag out the healing.

      The events of the last week have cooled my jets a bit, I’m more open to a slow and steady recovery now.

      Great to hear you got back up to speed quickly enough!

      Cheers,
      Alain

  4. Hang in there and keep patient. When you look back on this in 5 years time you will perceive the time very differently. Hopefully the worst is behind you.

  5. Hey Alain, hope you’re getting better. Reading the other guy’s comments, I would also say to take your recovery easily, and remember that long after your cycling career is over, you will still have your career as a male stripper, so don’t jeopardise that!
    Seriously, man, you’ve been through a lot so use the enforced layoff to enjoy some other aspects of life. It’s not all about wattage.
    Cheers,
    Chris

    • Ha – thanks Chris! Hope you had a good race yesterday; I had thought of going just to take some photos and stay in touch, but it would have been too much to ask K to drive given how much she’s waited on me. You’re right, I know. K and I even went for a leisurely stroll on local trails today for what must be the first time in three or four years. It actually seems like it would be dangerously easy to drift away now the momentum’s broken. But something to aim for: let’s ride out your way when I’m back on! :)

  6. Jesus! I’m terribly sorry to hear about this Alain… I’ve been so absorbed with a full course load at school this semester and still working 30 hours a week that I just haven’t been following much else online. I read through this entire post and just can’t believe the hell you’ve been through. Kristine and I both send you our best wishes for a full recovery and return to some normalcy as quickly as possible. You’ve come so far in this sport and you’re a really great guy, I just hate to see this happen to someone like you. Take care of yourself, rest and recover, and may the wind be at your back from here on out.

  7. Thanks for the blog Alain; glad you are recovering well after a nasty crash. Sitting here with similar Hook plate in my shoulder after MTB fall Sept and plate In place Oct. I may not be in my prime, but still love biking (road & MTB) in my 50s. I was interested in the your recovery post-plate removal as mine is due in 3 weeks. Have to agree with your comments on Hook plate insertion discomfort; even now, you just feel it niggling away in there, but cerainly better than the bones/ligaments all moving in different directions under load.
    Cheers,
    Vic

    • Thanks for your comment Vic, and wishing you a speedy recovery. :)

      For me, the feeling of relief after plate removal was immediate. I’ve had some ongoing problems with the healing of the incision – mostly because I’ve ridden hard since surgery to rebuild my fitness. I can feel ongoing bone-healing too; it can still be hard to find a comfortable sleeping position. But compared to the period of fixation it’s all so much better, and no impediment to riding!

      • Hook plate removal yesterday…as you note, immediate relief. Just the feeling of not having metal against bone is great. Looks like the Op has been a sucess as the ligaments are holding it everything together nicely and no further Op required. No sling and great range of movement already (Day 2) with minimal sleeping discomfort.
        Hope that helps anyone else in similar state with a Hook plate installed.
        Wishing you well for your ongoing recovery.
        Vic :-)

  8. Oh Alain, I hope you’re well recovered and back on the bike stronger than ever now. I was volunteering at the race too and taking lots of random photos and cheering. We heard there was a terrible crash and saw the St John’s van go past…

    I didn’t realise your accident was so serious. Head and brain injuries are never anything to take lightly and I’d always err on the side of caution. It’s amazing what can be missed in ER, I’m very sorry yours were so crucial and extendedly painful!

    I had a small fall from my bike late 2014 and hit my head, was unconscious for a few seconds so had a regulation ambulance trip to The Alfred. They checked me out but didn’t do any scans – I remember the doctor asked me if I wanted an X-ray, warning me that it would expose me to radiation. I don’t really remember what I answered, I think I joked and asked if I needed it. He didn’t seem to think so, so I was given some panadol and discharged not long afterwards. I still had a headache after a few days so went to my GP, who ordered an X ray and referral for a CT scan. The radiologist came out personally and explained the scan revealed a subdural haematoma next to my brain, which was causing the headaches and I should go back to the ER to see a neurologist.

    Anyway, long story short, I stayed overnight in the ER and missed the Cup Day Kermesse, which I was devastated about. Two weeks off work, no riding or driving until the headache went away and a total of 3 CT scans. It was really tiring having a brain injury and it was a scary time. I just had a small fall, I couldn’t have been going very fast commuting on the bike path, but ended up with a bleed next to my brain. The bike was fine and the body and kit were fine. I went to the state’s best trauma hospital and was discharged without fuss. I couldn’t understand it. Lesson learnt: listen to your body and listen to the doctors. Ride safe. Always wear a helmet.

    Your motivation to ride and race and your eventual return is impressive! I hope you’re fully recovered now and it hasn’t dulled your desire to ride and train hard.

    Ride safe!

    • Thanks for the great comment Amy – good advice. I have no doubt my helmet saved my life. It’s a risky sport, but so worth the risk! PS. I think that’s your photo I’ve got at the top here, with credit to you. Hope that’s OK. :)

  9. Hello There, Just saw you had a hook and plate for you clavicle. Did you suffer any acromion erosion?
    Do you know how long will it take for the acromion to regenerate?

    Thanks.

    • I’m not qualified to give you an answer to your last question. But I was very lucky that I was able to have my hook plate removed at the first opportunity. So I didn’t have any erosion which sounds like it is more likely to result from prolonged fixation. Cheers :)

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