Saturday, April 7, 2012

why mountain biking can be dangerous: ER visit #1





So Thursday as I usually do I drove the dogs and the Yeti to Belmont so we could ride for 90 minutes and thus I could consolidate my workout and the dogs'.  It is a tribute to the rigors of raw-feeding that my 10 year old twins can hang with me while I'm riding. Especially Madison, who is two weeks post-op. When I'm riding with the two girls in the woods, Chloe out front scouting out the trail about 40 feet ahead; Madison's whiskers practically brushing my back wheel; I  feel sometimes like I am Diana and we are hunting somewhere on the plains of Europe a thousand years ago.  Then I see a dirty condom wrapper or some other remnant of the urban park that is Belmont Plateau and I'm right back in Philadelphia, Pennsylvania in the year 2012.  It can still be epic though.

So imagine my surprise when I steer around a tree and over a log I have gone over a hundred times before and I somehow manage not to pull up my front wheel at the split second necessary to clear the obstacle.  My wheel stops suddenly, and as these mistakes often end I am rudely catapulted from the bike; land on my head and left side and feel a crushing pain in my spine. Awful. This was no ordinary fall. I lay there in the middle of the trail on my stomach for probably a full minute. Madison came over and sniffed my mouth, whining with concern. I think she tried to give me snout-to-mouth resuscitation. A minute later Chloe bounded back and nudged me. I was moaning and trying to get up.

I finally picked myself up, and realized that I would not be able to ride back to the car, so I dragged my bike up a hill through the underbrush and managed to get back on the gravel access road, at which I did hop on the cursed piece of bubblegum pink metal and ride the few hundred yards back to the car. The ride had lasted 31 minutes...Ss-weet. Madison whined as we neared the car because she was not ready to end the fun but I was trying to figure out how I was going to drive home. The pain was excruciating now.

We did get home and I ushered the dogs into the house and then leaned against the car, wondering how I was going to lift the Yeti up the 10 steps outside my house to get it in the door. My neighbor was there, smoking, leaning against his porch two houses down but I just could not ask a smoker to help me, call me stupid.  So I picked up the bike, brought it up onto the porch, and then ran into the house and threw up into the kitchen sink.

I moped around for awhile, but I could hardly move, and I thought maybe I should take a pain pill, which I only do in extreme circumstances.  I texted Steve Collina, MD and he called me back after his ride and urged me to take the prescription naproxen I had on hand for a few days. So I waited and then took it before bed, which enabled me to sleep through the night, and I was able to actually walk around and even take the dogs to the Wiss on Friday. I worked from home and even stopped at Whole Foods. But I started noticing I was peeing red, and it was not until Saturday am when the hematuria got much worse that I realized that the red color of my urine was not from my usual beet consumption but from a bleeding left kidney. My pain was localized right over the kidney on the left.

So of course I googled "blood in urine female" and managed to convince myself that this was actually no cause for concern, that I had bruised my kidney and it would get better on its own. But since the blood was getting more concentrated, I decided to email Brian Shiple, DO from the Center for Sports Medicine, since he knows my history all too well as he has been treating me since 1996, is currently curing my endocrine disorder, and he was not afraid of lawsuits like some of my other doctor friends so he would not make a mountain out of a molehill.

Subject: hematuria from mountain bike fall--your advice?
From: Andrea
To: Brian Shiple, DO
Date: Mar 31 (7 days ago)


Dr. Shiple, I am so sorry to bother you on a Saturday but before I call my PCP answering service I wanted to run this by you because you understand my medical history etc.  I took a bad spill on the bike Thursday, felt my spine compress and there was severe pain on left side lower back (where I always get back pain after gardening, during my period, etc--where you did most of my prolo back in the day).  I actually had to walk out of the woods, I felt terrible.  Pain was intense but my immune system always has a very exaggerated inflammatory response.  Although I hate pain meds because they interfere with healing, Collina convinced me to take Naproxen 500mg 2x per day since I had them here anyway, which was a good idea because without them I'm not able to do much.  They really keep the edge off so I'm able to walk the dogs etc.

Saw Dr. Mathews last night and he put 2 ribs back into place.  He said my muscle was spasming in lower back.  My lower back on that side is swollen.  I think the thing will heal, I don't think it's slipped disk because I only got numbness in the left leg for a couple hours when I went to Whole Foods.  But the blood in my urine has increased since Thursday, this am (first pee-concentrated) was very red and still now it's pretty red.  Do I need to worry about that?

Do you think I should make an appt for some kind of MRI or CT or just wait and see what happens?  I guess I could call the doc on charge at my PCP but they are clueless about athletes.  I have never had blood in my urine before though, with all of the spills I have had.  It's not a UTI, I don't get them. 
I know, I'm an idiot but I do want my kidney to remain functional for the next half a century. A

Subject: hematuria from mountain bike fall--your advice?
From: Brian Shiple, DO
To: Andrea
Date: Mar 31 (7 days ago)


Yea having working kidneys is a good thing Andrea. You need an ER eval with xray and most likely a CT scan for persistent hematuria d/t trauma. You can follow up with Collina or if we can fit you in with me, but either way is fine.
prepared with full medical history/non-phila drinking H20/Ipad/Droid

Brian J. Shiple, D.O.
Board Certified Sports Medicine
The Center for Sports Medicine,
905 West Sproul Rd, Suite 106
Springfield, PA 19064
Office-484-472-8812
Fax-484-472-8878
www.drshiple.com



Subject: hematuria from mountain bike fall--your advice?
From: Andrea
To: Brian Shiple, DO
Date: Mar 31 (7 days ago)


what is ER?


Subject: hematuria from mountain bike fall--your advice?

From: Brian Shiple, DO
To: Andrea
Date: Mar 31 (7 days ago)


Emergency room. Go to the ER today so you can get your helical CT of your kidneys.

Brian J. Shiple, D.O.
Board Certified Sports Medicine
The Center for Sports Medicine,
905 West Sproul Rd, Suite 106
Springfield, PA 19064
Office-484-472-8812
Fax-484-472-8878
www.drshiple.com





Subject: hematuria from mountain bike fall--your advice?
From: Andrea
To: Brian Shiple, DO
Date: Mar 31 (2 days ago)


Really?  Crap. Ok. Thank you and have a good weekend.




So I got asked Chris to drive me to the Hospital of the University of Pennsylvania because they have a better trauma team there than at Penn Presbyterian Hospital.  I was prepared to languish forever in the waiting room, but after they checked me in they asked me to pee in a cup and as you can see it was quite crimson by now, so they brought me right in to Bed #10.  After the requisite questions and documentation they wheeled me down to have a CT scan.


the CT Scan at HUP

They stuck an IV in my arm for the dye because the CATSCAN ordered needed contrast, and I also received a chest x-ray.  When all was said and done it was determined that I had a laceration of my left kidney, the side I had fallen on, and the laceration was probably accomplished by my own rib, which is best illustrated by the following pictures:




Here is a view from my Real Bodyworks anatomy app on my Ipad.  You can see the left kidney in relation to the last floating rib.  The lower ribs tend to break less often than the ones anchored to the breastbone because of their flexibility, but in my case the rib did not fracture, so we theorized that the kidney was jostled by the fall and actually bounced off the rib.  This is probably better illustrated by the second picture which is rotated towards the left side of the body.  At any rate, without an actual piece of rib left sticking out of the kidney this is all a theory but apparently it is not an uncommon injury.

So since my pain was controlled with the naproxen, they suggested I switch to Tylenol because naproxen has blood thinning properties, and sent me home Saturday night.  As I tucked myself gingerly into bed I found that I did not have any Tylenol, and besides you have to take Tylenol every 4 hours and naproxen would get me through the night.  So I popped one in my mouth and went to bed, thinking about how miserable I was going to be not exercising for 2 weeks.

3 comments:

Anonymous said...

That sucks. I just had a bad fall at Pennypack going down a big slider. Foot popped out of pedal half way down and crashed hard into a big rock. Thought I broke my hip but when I got up to walk I felt me knee "flopping". I knew what it was since I work in the PT field (torn MCL), so I rode back o the car before the pain got too severe. Supposed to be off bike for at least a month, but I rode yesterday after 16 days. Still really sore but can't stay off the bike. Maybe you could just ride easy and spin on the road bike? People alway ask me why I continue to ride when I get injured. They just don't "get it". Maybe I should sit at home in my bubble and learn to knit? Yea right!! Hope you heel quickly and get back out on the trails.

The Bikinator said...

So sorry you got hurt. I hope you can get through the day with no pain meds soon, and that you can feel like your life is back to normal soon as well. It's so hard for an athlete to have to stop training and heal from an injury.

andrea walheim said...

thanks both of you for your comments. Actually the story gets worse...stay tuned. I'm healing fast I keep telling myself...