Thursday, April 21, 2011

Recovery IV: Three Calamities

Tomorrow will be three weeks since the surgery and three weeks until I can start putting weight on my foot.  Mentally, I am treating tomorrow as the end of the climb and the start of the descent toward recovery, as opposed to mending, which is what my ankle is doing while I can't put weight on it.  I suppose this series of post should have been called "mending," but that's OK.

Nomenclature aside, I wanted to talk about three things that befell me this week.  I went to work for the first time on April 15.  I sat at my desk with my left leg on my desk, my trunk rotated to the right, where my keyboard rested.  I wasn't comfortable, but this position was tolerable.  I went home, where I lounged on the couch for a while, then found that I had trouble getting up because my right lower back was killing me.  Once I was straighter than the specific spot in my back the pain went away.  It has persisted since then, waning very gradually.  I don't twist myself by 90 degrees in order to type anymore, however.  Today's typing technique: leg on the desk, keyboard under knee, each hand typing on its side of the leg.

The second bad thing was removing my boot on Monday.  I took it off to wash my foot and as the boot came off I gasped.  There is no calf.  There's bones and skin with stretch marks.  In three weeks non-use, I went from a strong lower leg with good muscle definition to zero.  The sight was shocking and depressing, more so because I have another three weeks (yes, I know, downhill, but three more weeks!) of atrophy staring at my leg.  This was the first time I had any feelings of depression.  Until then, I was very matter-of-fact "it happened, let's move forward and deal with it."  This was, "holy crap, I have no calf....."

And the third calamity took the cake for a brief moment.  I left work around 3:45 p.m. yesterday, and hobbled toward my car.  I turned the corner and found no cars -- ZERO -- on the block where I'd parked.  My car was included in that very low number.  Towed away.  I threw up my hands in dispair and nearly cried.  It would be very difficult to retrieve the car on crutches.  Retrieval may have to wait until tomorrow, be extremely inconvenient to a number of people, and cost an arm and my second leg.  I looked up at the sign and saw that I'd parked on a block that becomes a tow-away zone at 3:00 p.m.  I stood there on crutches and one foot, deciding what to do.  First, I called the number on the sign.  A recorded message advised where the car had been towed and the means for retrieval.  I would need to know the cars license plate number.  I did not.  I was driving the car I borrowed from my father.  I tried to call my parents, but they weren't home, they were on the way to our house for Seder, night 3.  OK, I'd have to go home, see if they had the number and, if the didn't, get it from them when they got home.

But first I'd have to get home.  It would have to be by BART.  To get a ride home from Rockridge station, I texted and called Jessica at several numbers with no response.  OK, let's schlep to Embarcadero station.  That went pretty well, with me convincing myself that I am getting exercise on what became a five-block (a PR), circumnavigational crutching effort from my office to the station.  I took the elevator down to the station.  My train arrived as soon as I got out of the elevator, a nice passenger ceded her seat and I was on my way.  The train was so crowded by the time I arrived at Rockridge that I needed to play the part of Moses at the Sea of Reeds (crutches being the staff) to get out.  The sea of passengers parted wide enough for me to hop out of the train car holding the crutches in one hand (I am too wide on crutches to get through that opening) and I was free.  An elevator ride down to the ground, a short crutch walk to the taxi stand and I was on my way home.

I got out of the cab, just as my parents arrived and immediately questioned my mode of transportation and, incidentally, why wan't I in their car?  They took the news as well as I could have expected.  Inside, we set about getting retrieval information.  Turns out my parents do not know the license plate number and they keep all their car documents in the car, so they weren't sure they had the number at home.  OK.  I know, let's call your car insurance company, explain what happened and get it from them.  Geico doesn't keep that information -- they only keep VINs.  OK.  Well, let's see if AutoReturn, who had the car, could get it back to us without the license number.  They could.  Hooray!  Just one car was towed from Davis street at the time mine/dad's was towed, so it had to be mine.  Just in case, I asked them for license plate number.  Oh, and the cost of retrieval is $381, and $52 higher than that after 8:12 p.m.

Seder, night 3 proceeded without a hitch and without a reading from the Haggadah with my parents and Anderson-Schulaks in attendance.  Interestingly, of the nine people at the Seder, six were the only children, with only Jessica and my parents boasting siblings.  My parents and I agreed to leave at 7:30 to get to Auto Return by 8:12.  We left as planned, arrived promptly and uneventfully at Auto Return, across the street from SF Hall of Justice, and retrieved the car.  There's a $381 hole in my pocket.  The ticket for parking in the tow-away zone will be another $85.  The good news is that I feared this adventure would cost $700-800, so that's a good thing, I suppose.

Those are my three bads of the last week.  Looking forward to a turn in my fortunes.


Saturday, April 16, 2011

Recovery III

Yesterday, I went back to the office for the first time since breaking my ankle two and a half weeks ago.  The plan was to pick up casual carpoolers and drive into San Francisco, parking on the street free all day with the help of my handicapped parking placard.  It worked.  I waited for riders for less than five minutes and there was minimal traffic into the City.  I found a metered parking space a block and a half from my building and proceeded on crutches toward the office.

As I traveled, I made several observations about myself and others.  I was not inclined to jaywalk.  Normally, I dash across the street as soon as I see the slightest break in the flow of traffic.  Not on crutches.  On crutches I am slow, awkward, uncoordinated, and fear tripping and falling.  So, there I stood at intersections, waiting for the light to change as all around me pedestrians dashed across the street against the light.  But I sighed and waited.  The other thing I discovered about myself was that on crutches I didn't just lose the use of a leg, but also of both hands.  It's counter-intuitive but also obvious -- the hands are gripping the crutches.  I turn around and lean against doors to open them, hopping backwards as they open further.  Pulling them open is even more challenging: Grip a crutch in the armpit, grab the handle with the free hand while pulling and leaning back or hopping backwards.  The door into my office building is quite heavy and opening it this way felt quite unsafe.  I think I'll switch to using the freight elevator to get into the building.

(A side note about crutch use:  for amusement only, I started swinging my bum leg forward, which I noticed resulted in mild exercise, longer strides, and faster pace.)

And I learned something about other people.  People care.  At least enough people care to make just a bit easier the life of a one-legged guy.  People are opening doors for me.  They step aside to give me room to walk by.  They smile sympathetically.  They ask how I am doing and how long I'll be on crutches, then shake their heads ruefully and wish me a full and speedy recovery.  Makes this annoyance just a little less annoying.

I sat at the office with my leg up on my desk.  I had to turn my torso a bit to the right to type, but this wasn't too awkward.  I mouse left-handed and my desk leg was in the way, so I solved that by reaching under my leg to mouse.  That worked better than reaching over.  By mid-day, my leg started swelling a bit and I headed home.  On the way to the car I encountered more nice people, including a FedEx driver who gruffly said: "Been there many times," as we passed each other.  I nodded, not sure whether to interpret that as "I feel your pain" or "Buck up, no big deal, you'll get over it."  Possibly, he intended it as both.  When I got to the car, the leg was ready to go home.  Being early afternoon, there was little traffic on City streets and the Bay Bridge and I made it home quickly and uneventfully.  And though I've been working every day since I broke my leg, now I am really back at work.

Oh and today is sunny and gorgeous, 70-something windless degrees -- a perfect day for a bike ride.


Thursday, April 14, 2011

Recovery II: A Touch of Paranoia and a Hint of Hypochondria

Suddenly yesterday, I became convinced that I had a screw loose.  In my ankle.  Maybe I bumped my left food against something as I was passing by.  I stopped and wiggled my foot.  It seemed wiggly-wobbly.  More wobbly than it's been since the surgery.  Oh, oh.  I wiggled it again.  It was definitely wiggle-wobbling.  Shit.

It was late morning and I sat on the couch, contemplating my options.  What were my options?  Do the rational thing -- nothing -- as there was no significant traumatic event that could have loosened a piece of hardware in my ankle?  Or fret and worry and wiggle my foot constantly, paying attention to the smallest jiggle down there and wonder if there real is a problem?  And the more we wonder about these things, the more we convince ourselves that something must be wrong, very wrong.

It didn't take long to convince myself that, indeed, something was wrong.  I followed the self-prescribed plan of periodic foot wiggling.  Obediently, it wiggled side to side.  It didn't help that my boot is strapped loosely (I hate tight wraps) and my foot also wiggled inside the boot.  I decided to tell Jessica that I needed to go to ER.  This could wait an hour, however, and, since Sophie had a short day at school, the three of us went out to lunch.  I sat at the table, picking at Prawns in Black Bean Sauce Luncheon Special with little appetite, turning over in my brain having to go through surgery for screw reattachment, going back on pain meds, dealing with swelling, and resetting my recovery clock by at least two weeks.  These happy thoughts had me pretty depressed.

Lunch finally over, Jessica dropped me off at ER for my sixth (!) visit to Kaiser in three weeks since I broke the ankle.  (I'm proving to be quite a high-maintenance patient.)  I hobbled in.  Security guard (yes, you have to go through a metal detector; I imagine gang members occasionally try to come in to finish the unfinished business) waived me in, as I didn't seem to pose a risk.  I registered and sat in the reception area, awaiting my fate.  In little time, a nurse summoned me in, took my history -- two days' worth -- and hustled me over to the x-ray room.  A very friendly x-ray tech named Hung (I have no funny comments here, insert your own) with a wonderful x-ray table manner took the usual three exposures of the ankle (front, outside, then inside).  He had pulled up x-rays taken the previous day and compared them with the ones he was taking.  "Hmm," he kept saying, "this looks pretty much like the earlier one."  He said that about front and outside exposures immediately after he took them, but there was a significant pause after he took the third, inside exposure.  "Oh, oh," I thought.  But no, again, he said it looked the same.  I was elated.  He said he wanted a doctor to look at the films to confirm what he saw, which was fine with me.

I hobbled to an examination room and sat waiting for a doctor.  She came in a few minutes later and asked what happened and why I was there.  I explained about the initial injury, surgery, casts, the wobble.  She asked whether I had other health problems and I admitted to a touch of paranoia and a bit of hypochondria.  She said, "Nothing wrong with that," and was very understanding and sympathetic, adding that she went through a similar experience with a broken leg.  She looked at my x-rays and said everything looks fine, but she added that she wanted a podiatrist to confirm what she saw.  She called podiatry, where the head of the department looked at the films and agreed with her opinion.  I was set free.  Free from ER and free from my worries...

For the time being...


Tuesday, April 12, 2011

Recovery I

I figure I'm not going to have much to say for the next couple of months except for what's going on with my ankle.  Anticipating multiple entries about how things are going with the ankle, I am numbering entries titled "Recovery _" to keep track better.

Where were we?  Oh yes, boot instead of cast.  That was a week ago.  Now, I'm a week and a half post-surgery, a quarter of time I'll have to spend without putting weight on my foot.  Time is passing and I'm making progress.

Jessica went to a conference in Pasadena, so Sophie and one-legged I were home alone for two days.  With excellent foresight, Jessica arranged a number of play dates for Sophie.  That, plus her performance dance class and religious school, kept her occupied and made things easier for me.  So much so that Brian came over on Saturday and we went out to lunch -- my first ankle-unrelated outing in 12 days.  It was a beautiful day and we sat eating Latin food and drinking Sangrias at Cesar on Piedmont -- a great time.  Walking back to the car on crutches was absolutely exhausting.  Whether it was deconditioning after two weeks of complete inactivity, my lack of coordination on crutches, two Sangrias, or something else entirely but I was out of breath after hobbling for just over a block.  If I'm like this after two weeks, how weak will I be after six?

This was not a pleasant thought.  Worse, I fell climbing three stairs in the house the next day.  Not sure whether I tripped over the top step or the crutch tripped, but suddenly I found myself on my face, having banged my left elbow on the step and on the crutch.  Luckily, left foot was safe in the boot.  Much household commotion ensued.  I fell back into bed.  This was mildly frightening, embarrassing, and emotionally exhausting, so I took a nap.

After sleeping off that experience, next day I had an appointment with Dr. Jake and a resident, John Lynde.  Lynde saw me first. He took off my boot and unwrapped the ankle.  It looked a lot better than a week earlier.  The swelling I had on the shin was completely gone and the swelling on the ankle was greatly reduced.  It was almost back to normal size.  His second task was staple removal.  He asked whether I ever had staples removed.  No.  He said it's kind of an odd sensation.  I don't know whether I'd call it odd.  It's odd if you're looking at it, watching someone stick pliers into the side of your ankle, grab a staple and yank it out.  Otherwise, it stung and ached and bled a little, while he did it.  I didn't enjoy watching it, so turned away.  Removal couldn't end soon enough.  There were lots and lots of staples.  Twenty-one altogether; I overestimated the number in the earlier post.  Sophie came with us and she couldn't watch ANYTHING, she didn't even look at the unwrapped ankle.

Dr. Jake came in and looked at the x-rays taken 20 minutes earlier.  He was very pleased with the way the ankle was healing and the way the hardware (2 long screws on inside of ankle; 7 shorter screws and a plate on the outside) held everything together.  He was very positive and optimistic.  From his lips to God's ears.   By the end of the week, I can start flexing and gently rotating the foot for range of motion.  It'll be nice to be doing something with it.  I'm excited and a bit anxious about it.

At this point, I said to him, "You know, when I saw you a week ago to get my boot, I forgot to ask how you thought things went in surgery."  And he said, "You know, it's funny, patients never remember when I talk to them in the recovery room."  Huh? Apparently, he visited me in the recovery room and told me everything went very well.  I have absolutely no recollection of that.  So, yesterday he told me again.

During this visit, I had to go on crutches almost as much as on Saturday and this time I didn't tire nearly as much.  Jessica reminded me that being under general anesthesia is like being dead and takes a long time to recover.  Perhaps my exhaustion on Saturday was a symptom of a long and slow recovery from anesthesia?  I hope so.

Meanwhile, I'm feeling no pain in the ankle -- just two pain pills in the last three days -- and am optimistic about a full recovery.  Tentatively planning to return to riding doubles at Knoxville in October.


Wednesday, April 6, 2011

Another Crash

Wouldn't you know it?  No sooner have I exorcised my crashing demons by blogging about crashing than I suffer my worst crash yet.  And the indignity of it -- it was not a cycling crash!

Solvang was on Saturday, March 26.  On the following Tuesday, I went to a 90-minute class at Velo, which ended with a 30-minute standing interval.  My post-Solvang legs weren't so fresh to begin with and the 30 minutes of standing left me pretty darn tired.  But when presented with an opportunity to go ice skating that evening, I couldn't say no.  I love the effortlessness of motion on ice.  A few thrusts and strides and I can glide seemingly forever.  And I love messing around on the ice, doing figure 8s, swoops and turns of all sorts, but I don't jump.

Crash, Rip and Flop
So, there we were, Sophie and I, she practicing her cross-overs and spins and me goofing off, trying stuff on the outside edge, then inside, going forward and backwards, drawing loops on the ice.  Boom, I lost my balance and fell on my  butt.  No big deal, though surprising.  My legs kind of weren't there.  I got up quickly and thought that the legs must be pretty tired from all the riding.  But I thought nothing of it, continuing with my swirls and doodles.  I was skating backwards into a turn, when I lost my balance again and began falling backward.  My left foot got caught behind the right and under me and, as I fell, it had nowhere to go.  You know how a hand flexes in both directions, but the foot doesn't?  Mine did.  I fell, letting out a scream, as I felt something tearing and tearing and tearing awfully painfully in my left ankle.  "AAAAAAAARGH!!!" I said involuntarily and very loudly.  There would be no getting up quickly from this fall.

I sat on the ice and realized that I had no control over my left ankle -- it just flopped to the outside and I couldn't get it back into normal position.  Luckily, I was in a skate, which held my foot tightly.  Unlucky, I was on the ice and would have to get off the ice and then remove the skate before I could leave the rink.

Sophie asked whether I was OK and I told her, that I wasn't and that I was hurt badly.  I told her I hoped I tore ankle ligaments, but privately I feared a fracture or fractures.  I got on my hands and knees and got on my right foot, but there was no getting on my left foot.  I could not control it and it could not bear any weight.  Another skater asked whether I need help getting off the ice and I accepted gratefully.

He helped me off and I plopped down on a bench.  I went into shock, sweating profusely and feeling nauseous.  Sophie was near me the whole time, looking very worried and asking whether it hurt and if it was feeling better.  A rink employee came by to ask me about the accident and to fill out forms.  No, I was not going to blame the rink for my injury.  She offered to call an ambulance, but I declined.  I couldn't imagine going to ER with a 9-year old and keeping her in a hospital with me possibly until midnight.  Jessica couldn't pick us up because she taught until 10:00 p.m. that night and her phone was off during class.

Meanwhile, two huge problems loomed: (1) removing the skate, and (2) getting home.

Even if my car had automatic transmission, I don't think I would have attempted to drive, but since my car has standard transmission, driving was out of the question.  I could call a cab and get a ride home, but how to get the car back from the rink?  We solved the second problem thanks to a young brain.  Sophie suggested calling our neighbors.  After hemming and hawing for a while, I did.  I called and they said they'd come and get us.  They were on the way.  I still had my left skate on.  Hockey skates are puck-proof, so are difficult to cut off.  I had to try to take off the left one in the usual manner.  I unlaced it as much as I could.  As slowly and gingerly as possible, I began to tug the back of the skate off.  It complied.  Centimeter by centimeter, very slowly but, surprisingly, not painfully, the skate came off.  As soon as it came off, the foot just flopped over to the left and I felt it swell and swell.  "Oh no."  I tried to keep the foot stable, but it started shaking from the effort.  The rink employee brought an Ace bandage and we managed to stabilize the foot a bit.  I put the skates in the bag and, with Sophie carrying the bag, hopped to the front area of the rink, where it was warmer.

Our neighbors Matt and Kristen came together in one car.  Kristen drove away their car, Matt drove Sophie and me home.  The drive went OK.  I hopped up the stairs to the house and in.  I grabbed another Ace bandage and gulped down a handful of Advil.  Sophie put me to bed and wrapped me up just right -- not too tight and not too loose -- and the foot felt better.  Honestly, the pain was quite manageable as long as the foot remained sort of lined up.  Turning to one side or the other hurt and made it feel like parts of my foot and ankle were wobbling on their own and I had no control over what they did.  I lay in bed with the foot wrapped and elevated.

Jessica got home.  I relived the event all over again.

What's Up Doc?
One thing I like about Kaiser is you can call urgent care and get an appointment to see a doctor in a few hours.  Thus, I managed to get an appointed in Orthopedics for 10:10 on Wednesday, the next morning.  The ortho unwrapped my ankle and my eyes got big.  But not as big as the ankle, which was the size of a medium-large grapefruit.  The leg looked wrong.  The shin bone was going one way and the ankle bone was going the other.  They were roughly parallel, but looked disconnected, not like it says in the song (the shin bone is connected to the ankle bone...).  The doc explained that ankle fractures are very rare and that it's quite easy to sprain an ankle and do so severely, but breaking it really took some effort.

He sent me to radiology for an x-ray, which took five minutes and I was back in his office.  He began the discussion with "It's difficult to break an ankle..." and I wondered why he was telling me this again, when he put up my x-rays and continued, "but you broke yours in two places."  I said, "Fuck!"  He demonstrated, making a ring with his fingers and thumbs: "An ankle joint is like a horizontal ring.  Yours is fractured in two places and is what we call 'an unstable ankle.'" "Why would they call it that?" I wondered cynically, trying to keep my wobbly ankle from flopping about.  Imagine a horizontal ring -- hold out your right thumb and pointer fingers and form a ring by touching them to their respective digital partners on the left hand.  While the fingers are connected, the ring is firm and stable.  Break the connection between two of the digits -- the ring becomes a flexible circle with an opening.  Now break the connection between the other two fingers.  The result is two semi-circles that can move independently of one another and cannot support the foot.  That's what I had -- fractures on both sides of the ankle.

He explained that were I sedentary pencil pusher, he'd recommend a cast, but I'd develop arthritis within a year.  Since I am active, he recommended surgery and referred me to podiatrist surgeon.  A podiatrist and not an orthopedic surgeon?  Yes, they operate only on feet.  Feet is all they do.  Orthos work on shoulders, knees, elbows, hips, feet, etc.  Podiatrists do feet and only feet.  They know their feet.  They know your feet too.

So, I hobbled to podiatry.  A resident, Dr. Dickinson, saw me first.  He went over much of what the ortho had said and showed us the x-ray, which showed three fractures, NOT TWO -- confirming instantly that it's better to have a podiatrist rather than an ortho work on me.  The third fracture is on the back of the ankle.  It is relatively minor and is obscured by the Achilles tendon.  He recommended not messing with the Achilles and leaving this fracture to heal naturally, but on the other two, yes, we will operate.  Oh, and they have an opening Friday afternoon.  Wow, this is moving very quickly.  Jessica had knee surgery 15 years ago and they let her almost heal for over a month after her initial injury before operating, but this is not how it would be with me.  Under the knife I go in just two days.

OK, it's broken, we can't undo it, so let's work on getting better.   3:00 Friday it is.  Jake Lee, my surgeon came in.  More talk about anatomy, recommended course of treatment, and recovery (long and slow and inactive -- more later).  All of a sudden a cast technician comes in.  I guess I'm going to be in a cast for the first time in 48 years.  The tech pushes my foot up to nearly 90-degree angle, because it has to be in just-right position.  The pushing doesn't feel so good.  He wrapped some cotton tape around my foot, then put on a few layers of wet plaster cloth, which he wrapped with more cotton tape and an Ace bandage.

Dr. Jake and Dickinson the resident returned and took x-rays of my ankle.  Oops, the ankle is out of whack, the bone fragments are misaligned and we have to cut off the cast and reset the ankle.  They cut off the cast.  What's resetting a fracture?  It's pushing the bones back into place.  Dr. Jake started pushing on the side of my foot to get the bones to align correctly.  That feels worse.  He is pushing pretty hard.  What do we do when someone pushes? We push back.  This resetting business isn't going so well.  I ask him to ease up a moment, take a few deep breaths, relax and signal to him to push again.  It's going much easier and Presto! he got it lined up.  It looks good on the x-ray.  Dr. Jake is holding my foot and Dickinson is wrapping, as the two of them are starting to apply the second cast.  Dickinson is wrapping pretty tightly and I understand that it's important to hold the foot in the right place, but the foot feels awkward curled under, but that's how they're going to cast it.  They continue wrapping and casting and that's how it is.  Weird.  It'll have stay that way for two days.  They do a fist bump and do a fist bump with me.  OK, we're young and hip and happy with the work we did.  Sounds good.

I hobbled to the entrance.  Jessica pulled up in the car.  The cast weighs a ton.  It's hard enough to walk on crutches, harder with the cast throwing off the balance.  I got in.  We went home.

The next two days went by mostly uneventfully and quickly.  A couple of times, my arch cramped inside the cast.  There was nothing I could do about it.  I couldn't flex the foot or pull on my toes.  The best I could do was grab and pinch my lower lip in hope that activating this acupressure point would help relieve the cramp.  Not sure if it was that or simply time passing, but the cramps went away.  Ankle pain was not an issue.  I guess Dr. Jake reset it well.  The cast bugged my foot.  I am sure it had something to do with the injury, but also with the position in which it held my foot.  I asked Jessica to cut out some of the cotton tape the docs used to wrap the foot under the cast.  That relieved the pressure a bit, but it still felt awkward and uncomfortable.

Friday morning came.  On Wednesday they had told us that on Friday morning we'd receive a call with instructions, but to plan to arrive two hours before surgery would begin.  On Thursday night we received a call during which a nurse told me not to eat or drink or take blood thinning pain killers, where and when to arrive for surgery and we were all set.  Except on Friday at 9:30, we received another call from Kaiser advising us of a cancellation and would we be able to come an hour earlier at 11:00?  You bet, I'd go immediately to get it started as soon as possible.  But getting out of the house took longer than we thought and we arrived at 10:45.

Getting to Ambulatory Surgery Unit would prove a challenge.  We had to go all the way around the ground floor of the hospital, then up the elevator, then all the way around again.  This was a very screwily designed building.  And I'm not sure who decided that Ambulatory  Surgery was the right place for my ankle surgery since I couldn't walk.  I'm not so good on crutches, I learned.  Even worse on a completely empty stomach.  Being asked to walk around the block twice on crutches on an empty stomach was a bit much.  Half-way around the first floor, we came to an information desk, where I sat on the desk and requested a wheelchair.  The woman at the desk was surprised and immobilized by my request.  She seemed completely incapable of helping, but fortunately a nurse from another department happened by and said, "come on, I'll get you a wheelchair."  OK, so I had to walk the rest of the way around the first floor, but I was encouraged by the offer of help from a person who seemed to know what she was doing and gave a shit.  I hobbled enthusiastically after her.

She wheeled me to Ambulatory Surgery office, where we left my Kaiser card and began to wait.  The desk person finally registered me and by 11:45 we were in a tiny pre-op room that had a tiny bathroom, a recliner and a tiny TV.  The nurse left for me a goofy gauzy blue cap and two gowns (one opening in front and the other in back) and told us what and whom to expect: A nurse to fill out forms and take vital signs, then anesthesiologist to talk about anesthesia options, then surgical team to tell what would happen, then surgery.  I changed into my hospital finery and sat down in the recliner.  The nurse hooked me up to an IV bag of what she called intravenous Gatorade -- my first calories since the previous night.

We had a tiny room with bright lights.  It was a warm day.  Air conditioning was off.  Slowly, the room was warming up.  I was worrying a blemish -- my hands needed something to do to deal with the nerves, so I was picking at a zit, and picking, and picking.  Jessica ran out of patience watching me do this -- she was under plenty of stress herself and my activity bugged her -- and she gave me a worry stone, a heart-shaped red rock that I rubbed and rubbed.  It gave my hands something to do and I left the zit alone.

The nurse came in.  He checked my blood pressure and pulse.  He asked me a bunch of questions about my medical history and social habits, as well as perfunctory ones about my address, birth date and other stuff.  Then we waited for a long time again.  We'd been in that room for almost two hours and I was getting sleepy.

Finally, the anesthesiologist came in.  First thing he said was that he wouldn't be my anesthesiologist because he was going off duty, but he wanted to go over my options.  OK.  He started telling me about my options and none appealed.  I didn't want a spinal tap or an epidural, just because I didn't like the idea of a spinal injection.  Local seemed too much for me -- I didn't want to be awake during this.  With general, I worried about nausea and having a breathing tube shoved down my throat and resulting tracheal bruising.  Then another anesthesiologist came in.  It turned out that she would be attending during my surgery.  As the two of them talked about the same thing together, I expressed my reservations about each type of anesthesia, but then she said she was going to go with general and that was that.  Well OK, but ........  But then she said two things: (1) given the time of day, general made sense because they wanted to send me home after surgery and with spinal and local anesthesia they require a patient to use a bathroom before going home and that can take a really long time, especially in a dehydrated individual (me); and (2) now they don't shove a tube all the way down your throat, but put a sort of a tracheal opening piece of plastic there, so bruising wouldn't be a problem.  And I didn't care about nausea so much, so general seemed like an acceptable option.

Both anesthesiologists were still in pre-op with me at 3:15, when all of a sudden, everything became rush-rush.  A nurse came and wheeled me to OR.  Jessica gave me big hugs and kisses at the entrance and there I was in a big white room.  The anesthesiologist was there, as was my surgeon, Jake, and three or four other people whom I did not recognize behind their masks.  I lay down on the operating table, they swung out supports for my arms.  The anesthesiologist plugged a drug drip into my IV port.  Dr. Jake called a team meeting directly over me.  He announced my name and Kaiser number, the nature of my injury and described my surgery.

The Surgery
The anesthesiologist put an oxygen mask over my face and told me to breathe deeply.  I started counting my breaths and after the fourth or fifth breath woke up with a new cast on my leg in the recovery room.

Sorry, that's all I remember.  An hour and a half of my life gone and I have no idea what happened.  The cast was straight rather than crooked, so that was new and improved.  Post-op nurse called Jessica who rushed up.  Dr. Jake called her immediately after the surgery and told her everything went fine.  I felt OK.  A little nauseous, but not bad.  They gave me a pill for that and nausea was gone.  The ankle felt fine.  They gave me a pain pill for the road and told me to take my pain meds.  A nurse wheeled me to discharge area.  I half crutched, half hobbled, half hopped into the car and we went home.

I have to keep my weight off the foot completely for two weeks.  After two weeks, I am to come in for docs to make sure my incisions are healing well.  If they are, I get a stiff boot, which I am to wear for four weeks.  During these for weeks I am also to keep my weight off the foot completely, although I am allowed to flex my foot lightly to work on range of motion only.  Then I get to see my surgeon.  Assuming the fractures are healing right, I can start physical therapy.

The evening after the surgery was fine.  I took my pain meds like a good patient.  Two of those pills made me really drowsy and seemed to slow my breathing.  Several times during the night I woke up as I snorted in air the way someone suffering from sleep apnea would; as if my breathing stopped and the act of sudden inhalation woke me up.  That was freaky.  During the night I also got mildly itchy all over -- anesthesia wearing off.  That was bizarre.  I was lying there, scratching everywhere.  The ankle was OK.  This cast was better than the last, but still rather tight.  Every couple of hours, my foot swelled and first my little toe, then its two closest neighbors would get pins-and-needly, then numb, then hot, then the sensation would spread to other parts of the foot.  The only way I could deal with that was by taking my leg off the pillows, on which I'd propped it, and let blood flow to the foot better, while wiggling my toes vigorously.  If that didn't work, I sat up and let my lame foot dangle, again to encourage blood flow.  That hurt worse briefly, but the pain went away within 10-20 seconds and I could lie down again.  As the foot swelled, the cast felt tighter and tighter, impeding vigorous wiggling.

Saturday morning I felt pretty good.  Ankle pain was 1-2 out of 10, so I didn't take many pain meds.  A physician friend said a cast shouldn't feel tight, so I went to ER during the NCAA Final Four.  That was perfect timing: I was one of two patients in ER.  It turned out my cast wasn't too tight.  It was a partial cast that was wrapped too tightly with cotton wrap and Ace bandages.  ER doc cut off my wraps and wrapped the cast very, very loosely and it felt tons better.  I was in and out of there in 20 minutes; how often can you get out of ER in 20 minutes?  A funny thing about my ER experience:  my co-pay for the surgery was $15; my co-pay for the ER visit, during which my cast was unwrapped and re-wrapped, was $50.

As I said, I wasn't taking many pain meds on Saturday, so on Saturday night I paid.  My swelling-numbness-burning episodes became much more frequent, going from once every couple of hours to once every 10-15 minutes, with pain shooting to level 8, taking up greater portions of my foot, and lasting longer than on Saturday morning.  Doctors say, "stay on top of the pain," meaning take your pain meds before you really need them because if you wait until you really need them, you'll have to take higher doses at higher frequencies and it'll take time to get pain under control.  They told me this, but, naively, I thought I was out of the woods a day after surgery.  I learned about getting on top of the pain after it got on top of me first.  I get it now.  I am being proactive, honest.

Off With You!
With my poor drug-taking and swelling episodes increasing in frequency, the cast was feeling mighty uncomfortable even after re-wrapping.  Lucky me, Dr. Jake called on Monday afternoon to check on me and I told him about my problems with the cast.  Tightness was not the only problem.  When swelling was down and I stood up, the cast slid down on my leg and it felt as if it was resting on my ankle bones near incision sites where the bones were bruised or screwed together and that didn't feel good.  He told me to come in and he'd replace it with a boot, which is what I did on Tuesday morning.

The same cast tech cut off the cast and removed some of the dressing.  That was my third cast in four days.  Then Dr. Jake came in and removed the rest of the dressing.  And there it was -- my bare ankle.  Somewhat swollen with a 5-inch incision on the outside and a 3.5-inch incision on the inside.  Both stapled often.  The outside incision has 12-15 staples.  The inside has about 10. 

The boot is much lighter, which is great.  It's also bulkier (I found it's harder to get shorts on over it) and much warmer than the cast.  I am reluctant to take it off, then put on a pair of pants and wear the boot over the pants because I'm concerned about the fit and because I want to keep it on as much as possible. But it severely limits my wardrobe choices.

Mental Health Check
I have to say, I am in a good mood.  Of course, I would rather not have a broken and surgically repaired ankle.  But since I can't undo what's been done, only try to repair it, I am very enthusiastic about moving forward with the repairs.  I am working from home -- working less than I would have if I'd been in the office -- and am keeping of top of the things I want to stay on top of.  I have my computer, I have my music, I have food and drink in bed, and I'm blogging.  After not shaving for five days, I am experimenting with facial hair and am sporting an early Lenin-style beard.  Early returns on its aesthetics are positive.  The only thing lacking is live social contact.  I've told my friends that I want them to visit and two have visited me already.  I think I may be able to return to work by April 15 or so.  We'll see.


Solvang 300

Yes, Solvang 300 -- more and less.

To Ride Or Not To Ride?
Double riding season is here and I'd been sick for nearly three weeks.  Fell ill three weeks before Solvang, feverish for a couple of days and coughing up Technicolor sputum for two of those weeks.  After two weeks of inactivity, went to Velo, but lasted only 45 minutes before the legs failed.  Tried again two days later and, riding much more moderately, managed to last through the class.  So there I was, three days to a double century, still coughing and just not feeling right.  Decided I'd travel to Solvang and if I felt up to it, would start the ride.  How long I'd ride would depend on my health and condition.  Besides, I'd talked David Newman into joining me and I didn't feel right abandoning him.

Hey, Mr. Weatherman...
Weather was lousy during while I was sick.  Of the three weeks, it rained about 17 days.  But Weather Channel said, "20% chance of rain" on ride day, so I was optimistic even though National Weather Service predicted 60%.  I insisted on disregarding NWS and looking at WC's forecast as 80% chance of no rain.  Optimism aside, clothes and equipment for the ride deserved serious consideration.  Should I bring the bike with fenders? booties? rain jacket? etc.  David insisted that bringing a fendered bike guaranteed rain.  Since he doesn't have a fendered bike, I went without.  Having completely bought into WC's drivel, left the rain jacket and booties at home too.  Brought a long sleeve, medium weight wool base layer, a long sleeve jersey, a vest and toe warmers -- predicted low of 39 required them if predicted precipitation did not.  Speaking of predicted precipitation, I myopically checked the forecast for Solvang, but not for places we'd visit: San Luis Obispo, Santa Maria, Morro Bay, etc.

Our drive to Solvang was uneventful except for periods of rain and more rain.  When we arrived in Solvang, though, it was beautiful.  Clear sky, pleasant temperatures, and light breeze completely banished thoughts of rain during the ride.  We went wine tasting, then ate a very ordinary meal at the restaurant locals recommended as the best place in town, checked in for the ride, picked our numbers and returned to our room.  Meanwhile, the wind was picking up and the temperature was dropping.  It was cold enough that I started regretting not bringing glove liners to go with my long-fingered gloves, which I did bring.

We got up at 5:00.  It was dry, with clouds overhead.  In a Solvang promo brochure, David had read that Solvang has 300 sunny days a year.  We discussed whether that means that Solvang has 65 days of rain or whether some of the 65 sun-free days include overcast days on which it did not rain.  The morning of the ride, I was convinced that we would have a sun-free and rain-free day.

What Shall I Wear?
We ate bananas with Nutella, got dressed.  This was a critical moment.  I put on every piece of cycling clothing I brought.  David, a warm-blooded and impervious to cold guy that he is, limited himself to short-sleeve base layer, short sleeve jersey, arm warmers, vest, and shorts, booties, a beanie, knee warmers.  He left a wind jacket and a long-sleeve base layer in the room.  I am a wimp.  I overdress and take off clothes if I get too hot.  If I don't bring 'em or wear 'em I'm out of luck and I don't like that because not being prepared for the weather is my fault.

We started riding at 6:00.  It was dark and still overcast.  From doing this ride three years in a row, I knew the route well enough that the darkness didn't matter.  There were very few riders on the road.  It seemed that slow people started at 5:30 (supposedly earliest start time, but we learned later that some started as early as 5:00) and fast people wouldn't get going until later.  So, we were in no-rider's-land.  Just us, glimmers of dawn through the clouds, bare outlines of rolling hills.  We passed an occasional rider here and there.

Sex is a Religious Experience
After a while, a group of five caught up to us and we sped up and began riding with them.  They were from Southern California.  David was pulling and talking to Manny (not his real name for reasons that are about to  become obvious).  Manny is deeply religious and he was glad to share all aspects of his faith.  That included the fact that he and his wife have a weekly sex-based podcast based on keeping a Christian marriage physically mutually satisfying.  Manny also told David that he and his wife had done something like a 40-day pledge (can't remember what it was called, David, help me out here), which involved having sex 40 days in a row.  Manny admitted that it wasn't easy and said that periodically they needed appliances and other sexual aides to keep their streak going.  The original goal had been 60 in a row, but Manny and the Mrs. conceded that they couldn't live up to that kind of pressure.  My conversation partner and I discussed more conventional topics -- wars, real estate, the stock market, children, etc.

A couple of the Southern Californians were slower than the rest of group and they fell behind on a climb.  While their faster friends stopped at the top of the hill on Foxen Canyon Road, David and I descended into the canyon, snickering and having fun at Manny's expense.

Cruising Before The Bruising
On we rode through valleys between ridges of hills and past vineyards.  After some rollers, we came to the eight-mile, largely downhill stretch of road I like so much.  Combined with the tail wind, we made good time into the first rest stop.  The rest stop was crowded.  We filled bottles and gel containers and took off just five minutes after arriving, intending to use nature's facilities for comfort breaks.  More flat roads with mild tailwinds.  Landscape shifted from vineyards and rolling hills to flat agricultural land east of Santa Maria, leafy green produce and still-green strawberries peeking through plastic sheets, people doing stoop labor across the street from cookie-cutter subdivisions.

Though we were in full daylight now, due to heavy cloud cover, we didn't have much actual daylight, but rain had not come and we were still optimistic.  Finally, about 12 miles southeast of San Luis Obispo, it came. At first light rain, then heavier.  Two faster riders came by just as the rain started in earnest.   Now we had to choose draft and deal with a face-full of road spray and sand or work harder, but remain cleaner without having spit out dirt every couple of minutes.  Most cyclists are fundamentally lazy, so we chose to suck dirty wheels over hard pedaling. Soon enough, we reached the second rest stop, where the rain fell harder.

It was still early in the rain storm, so we hadn't yet become saturated.  Spending time at the rest stop, getting soaked without making progress made no sense, especially with this stop's long bathroom lines.  So, quickly, we set off after refilling again.

A few turns and we found ourselves in San Luis, where the rain started in earnest.  It became clear that it would not be clear and that we'd have rain for the rest of the day.  We rode through San Luis with seven or eight guys.  Once we passed the Cal Poly campus, the group fell apart and we were down to a tri-guy on an aero bike, who'd attended Cal Poly and a 60-something Australian from Pasadena, who was the strongest of the four of us.  At this point, however, we didn't know that the Aussie was the strongest.  First the tri-guy rode away, while the rest of us, greatly aided by the tail wind, continued at a steady 20-something pace.  As we rode on, the tri-guy came back to us and I got on his wheel.  After spitting out his dirt and gravel, I took over pulling duties, as he pulled off to the side and gestured for me come through.  I continued at the same pace for a while, occasionally looking back to make sure the group was intact, but the tri-guy disappeared.  He fell away rather quickly and far.  By this point, the wind was helping tremendously.  We were on Highway 1.  The road is largely flat and straight, with rare one and two percent rises and falls.  We were going uphill at nearly 25 mph and downhill at over 30.  On flats, we averaged 27-28.  At that speed, we didn't mind eating dirt.  In fact, as we ate road dirt, David and I wore shit-eating grins.

Twelve miles of northbound Highway 1 have never passed so quickly.  We passed a cyclist just outside Morro Bay and he latched on.  As we were about to blow past the first Morro Bay exit, he yelled at us to take the exit because Planet Ultra changed this year's course.  That was good to know.  I planned on continuing for another mile or two on one, then going to the harbor to get my number marked at a check point.  A check point that wasn't there this year, as we found out from a group that had taken last year's course.  We ended up skirting Morro Bay rather than riding through it -- a pleasant improvement over the town's tourist traffic-filled narrow streets.

Rain, Rain, Go Away
It was time for payback for all that tailwind and it came in the form of... yes, headwind.  Had it only been headwind, we would have coped fine, but now we were riding into rain.  Riding at 15-20 miles an hour into rain blown at us at 15-20 miles an hour felt like we were riding into 30-40-mile an hour rain.  Lucky, rain was relatively mild.  And lucky -- I was wearing my long-sleeve wool base layer.  Unlucky -- David was just in arm warmers and he started getting cold.  You know how you're only as warm as the coldest part of your body?  David's wet arm warmers were plastered tightly against his arms and provided no protection.  He was shivery cold.  I was OK.  Not comfortable, but just warm enough that it wasn't an issue.  The vest protected me from the wind and the wool kept me warm.  Glad sheep were able to figure out insulation business and people were smart enough to adopt ovine technology.  When it rained harder, my shorts felt squishy full of water, as did my right shoe (not the left for some reason).  Standing up to pedal was unpleasant -- the saddle got wetter and colder and I didn't enjoy sitting back down into a puddle.

But we coped.  We caught up with the fixie group, which included Jason Pierce, riding Solvang by Furnace Creek 508 rules -- no drafting.  508 rules also forbid socializing with fellow riders, but we broke that one and talked for a while, riding into the lunch rest stop.  Rain seemed to have let up a bit.  But we were still cold sitting around -- riding felt much better.  For David it was a difference between being cold and butt cold.  For me -- between a little less than comfortable and cold.  David shivered on and off the bike.  I shivered after 5-10 minutes at rest stops and the only way to stop shivering was to get back on the bike.  So, we didn't linger at the lunch stop -- half a sandwich and a coke (somehow I defaulted into my double century diet of gel and electrolyte supplements) and left behind a group that followed a slow tandem.

Too Much Junk On The Road
Slow was a matter of degree, as we were riding into a fairly stiff wind that blew rain in our faces.  I tried to ride somewhat to the side of the tandem to keep the spray off my face, but soon decided to pass the tandem and ride faster to keep warmer.  David and several other guys came along.  We played leapfrog with Jason and other fixie riders.  Around mile 125, rain intensified and flat tire epidemic began.  Every half a mile there was a cyclist repairing a flat or a group of riders standing around and watching a cyclist repairing a flat.  I counted my blessings and thanked my 25 MM MICHELIN PRO RACE 3 tires for failing to fail so far.  We rode through coastal cities south of San Luis and entered Oceano, where David flatted.  We messed up his CO2 cartridge and he had to pump, as many cyclists rode past.  Pumping warmed him, though minimally.  We started riding, and felt acute needs to go number one.  Pulled into a gas station, whose proprietress lied to us through her last two remaining teeth that there was no bathrooms on the premises.  We availed ourselves of a side wall at an abandoned Main Street business and started riding for another two miles, when David flatted again.  More flat repair amid shivery curses, more cyclists riding by.  Oceano -- San Luis Obispo's arm pit.

Slogged into Guadalupe rest stop, where it wasn't raining.  We were still cold and shivering.  Back on the bikes and within five minutes it started raining again.  Between Morro Bay and 50 miles later someone explained to me that sections of the ride around Morro Bay and Guadalupe were excised from the route and Planet Ultra added 15 miles to the stretch between the last rest stop and the finish, making it 29 miles.  I was feeling OK.  Legs were pretty good.  Stomach and brain were pretty good and I kept spinning rather than plodding as is my habit when I tire.  These were good signs, but I'd had enough rain.  Six hours of riding in the wet, most of it into headwind, was plenty.  So, I decided that after three years of completing this ride, finishing Solvang Spring Double this year -- rain or no rain -- was no great accomplishment and that I'd return the old way, over Box Canyon, or whatever they call that road.  I'd had enough of spitting out road grit and wiping my glasses, only to have to spit and wipe again two minutes later.  The plan was to get back, take a quick shower, grab David's jacket, long sleeve base layer, and wool socks and drive the course looking for him.

My Slow Leak
Before I got there, I had to ride southbound to the last rest stop.  This stretch always gets and why should this year be different?  I started out of Guadalupe fairly sprightly, but found myself riding away from David, then slowing down to wait.  Once he caught up, I'd resume riding only to find myself waiting again.  After a few episodes of this, David waived at me to keep riding, so I did.  I rode smoothly and not too quickly.  Three sides of a square outside Guadalupe removed from the route, I hit Highway 1 in about 30 minutes, then found myself feeling like a slowly leaking tire.  I was slowing down gradually and inexorably until I found myself riding toward Lompoc at 12 miles an hour.  Scary, I was gaining on people.  It was an amazing low speed chase.  Where Highway I'd1 tilted slightly uphill, I went 10 and was still gaining.  After about 20 minutes of this, I caught up with the SLO tandem (it passed us during flat repairs), grinding its way up a 1.5% hill and towing a rider.  I decided to rest by riding with them.  Again, I tried riding to the side to avoid terrestrial rain, the one falling from the sky was plenty.

Recovered by riding back there for 20 minutes, I rode away at blazing 16 mph, but, hey, it was into a rainy headwind after 165 miles.  I pleasantly surprised myself by spinning smoothly toward the final rest stop, picking up a polite wheelsucker, who asked permission as he latched on and thanked me as we approached the rest stop.  He pulled over, I kept going.

The Home Stretch
I don't know which way the new route goes.  The old route is a single lane road that climbs almost four miles up a 4-5% hill, which has a few short steeper pitches.  I loved my 30-tooth chainring all the way up the hill.  Where I bogged down a bit, I stood up to pick up the cadence, then sate and resumed spinning.  A good-for-my-head climb that was about as long as I expected it would be.

As I began to descend this narrow road, around a hairpin roared a recent model remake of a 1960s or '70s American car, some Mustangy-GTO-ish hideousness that was on my side of this narrow road, traveling at 35 mph on a road suitable for 20 mph speed.  "Oh shit!" My options were to ditch it to the right into the canyon or to ditch it to the right into the canyon.  Going into the left side of the road was dangerous because the driver might swerve there and I'd become a hood ornament.  As I processed all this very slowly, he saw me, pitched the car to his right with tires screeching, and we managed to miss each other.  And I really, really had to go to the bathroom.  Immediately!  The rest of the descent and ride back to Buellton was rainy, windy, and uneventful.

I showered, got dressed, and collected David's clothes.  Just then, my phone pinged with a text message from David, informing me that he'd just finished.  How?  I estimated arriving at the last rest stop 15-20 minutes before him and took a shortcut back.  I texted him I'd be right there, surprising him too.  I drove to the squash court, where David told me that he and other riders took Highway 101 back -- a 10-mile downhill shortcut.  He was still shivering.  On 101, he flatted for the third time.  That shortcut was popular that day and he secured a tube from another double rider who CHARGED $10 FOR THE TUBE!  Yes, that asshole profited from a fellow cyclist's misfortune.  I was appalled to learn this.

After coming to our senses, we still failed to learn our lesson and had another unremarkable dinner (ordering different food) at the same best restaurant in Solvang.  Slept badly, both having body temperature regulation problems.  Not surprising given the weather we'd endured for last seven hours of the ride.

And that's how our Solvang Double became Solvang 300 -- 300 kilometers.