6-week check-in: Karel's Broken Hand

The past six weeks have been difficult. Although Karel's broken hand is surgically repaired, the recovery process has been rather painful and slow. Since I failed to blog about the crash back in May, here's a six-week check-in. 

May 18th - The crash

Gearing up for IM 70.3 Chattanooga, we were both in a bit of a taper funk. Karel had been watching mountain bike racing on TV and after participating in the recent Xterra event, he was so excited to get back on his mountain bike. With a happy ride on his training plan for the afternoon, he opted for the mountain bike trails at Pleasant Ridge Park. Around 3:20pm, Karel set out for a ~90 min ride while I opted for the indoor trainer and treadmill. Again, we were both in a funk and an indoor training session seemed like the path of the last resistance for myself. Nearing the end of my run, I received a call from Karel but I ignored it as I figured he was just calling me on his way home. It went to voicemail but I never received the notification that he left a message. After my run, I called Karel as I was warming down and he told me that he was driving home and he would need me to take him to the ER as he was pretty sure he broke his hand. I was a bit taken back as Karel has excellent bike handling skills and I never thought that something like this would happen to Karel - especially on a trail that he has ridden so many times in the past. And he has never broken a bone before despite several bike crashes in his bike racing days. Karel was playing around on some jumps and unfortunately, timed a jump wrong (at high speed) and hit the other jump. This threw him off his bike and upon impact, he hit is arm/hand at a very strong impact. There were only a few scratches on his knee, elbow and chin. Karel knew right away that something was wrong when he looked at his wrist and it was swollen the size of a tennis ball and not situated in the right anatomical position. Thankfully, two mountain bikers rolled up to Karel and helped him (and his bike) return to his car. No bike damage occurred. Karel was still in a bit of shock when he drove himself home but the pain was really strong. 

I quickly changed, made us both a smoothie (I was worried about Karel's blood sugar dropping and then him fainting alongside the pain) and we drove to the ER. I brought my computer as I figured it would be a wait and boy, was I right. Certainly this wasn't how I envisioned our evening going but that's life. 
Unfortunately, I was not able to sit in the emergency room waiting room with Karel due to COVID rules so I had to sit outside and Karel waited inside. We waited over 2 hours until Karel was seen in the ER and then another two hours in the ER. Once Karel was admitted to an ER room, I was allowed inside to be with him. We didn't leave until almost 10pm (after arriving a bit before 6pm). I felt so bad for Karel just sitting there in so much pain. And then things got worse as the resident doctor had to put Karel's wrist back in place (it took two attempts) and that pain was unbearable for Karel - he was shaking and holding back tears. 

The x-ray findings: Osseous structures: Comminuted, impacted distal radial fracture. There is slight apex volar angulation of the fracture. Query nondisplaced ulnar styloid fracture. Soft tissues: Mild soft tissue swelling noted about the wrist.

We were hoping that the temporary full arm cast along with the pain medication would help Karel after his ER visit but the pain only got worse. And it wasn't just the wrist but the nerve pain that was causing tremendous pain. The hand was swollen and his fingers were all numb and "dead" and he had no movement in his hand. Karel wasn't able to sleep for the next few days as the pain was just so intense. He was able to nap a little during the day but it was a very difficult few days for him. 

May 20th - Visit with Surgeon 

After several phone calls and urgency, Karel was able to have an appointment with the surgeon at the Prisma Hand Center on the 20th. Still on a lot of pain medication, Karel reported his pain as 10/10 (although it was likely 20/10 if that was a thing). Thankfully, the surgeon had an opening on Friday so Karel was able to get his hand repaired the next day. The evening was pretty bad for Karel as his pain was so extreme that he didn't even think he would make it until the next day. We decided to cut off the cast to see if that would provide some relief and sadly, it didn't. Karel couldn't wait until the surgery - most of all, he just wanted to be knocked out so he didn't have to feel the pain any longer. We emailed the surgeon to let him know our concerns about the ulnar nerve which may have been causing the issues that he was experiencing in his last two fingers as well as in his elbow.

May 21st - Surgery

As I was driving to Chattanooga for the 70.3, Karel was in surgery (with my mom there to help him out). The surgery took around 2 hours because alongside putting in a radius plate and 11 screws, the surgeon also opened up Karel's wrist and elbow to dissect the ulnar nerve to see if he could find the reason why Karel was experiencing such intense nerve pain. Sadly, he couldn't find anything. 

Once Karel woke up from surgery, he was in no pain! But this was just because of the nerve block and his right arm was completely numb. He laughed that it felt like this foreign object was attached to him that he had no control over but he didn't care as he was in no pain and it was such a relief after a brutal past few days. 

May 25th - PT

Karel's first PT visit was a bit discouraging. He was given a custom cast but there was little that he could do with his hand. The nerve pain continued and his little finger and ring finger felt like they were on fire. He wasn't able to even lightly touch the ulnar side of his hand without pain. He had no strength in his hand and it was very swollen. All to be expected after all that his hand went through, but the PT (and surgeon) were still concerned about the ulnar nerve. Karel must have yanked and hit his ulnar nerve upon impact which caused the nerve issue. 

June 1st - Surgeon follow-up and PT

Although the fracture was healing very nicely and the swelling was going down, Karel continued to struggle with the burning pain in the small finger and under the ring finger. The burning was traveling all the way down the ulnar side of the hand. Karel got off the pain meds but after trying to get off the Gabapentin for the nerve pain, there was a drastic increase in pain and anxiety. So he had to restart the Gaba but was able to get off the Oxy (which he only took for a few days). It was quite the trial and error to figure out the medication schedule as even with Tylenol, Ibuprofen, Aspirin and Gaba, nothing was giving Karel relief. Most of all, Karel just wanted to sleep and he was unable to do to the pain. And Karel is one with a high pain threshold and does not like to take any medications. The surgeon suggested for Karel to get a nerve study if things did not improve in the next two weeks. The PT session was ok. The swelling went down so Karel was able to get a slightly smaller cast and was able to do a few more exercises. 

Although it was nice to have Karel in Roanoke with me and our athletes for the IM 70.3 Blue Ridge race, he was in tremendous pain. Throughout this entire journey up until about three weeks ago, Karel has slept in a separate bed than me as he is unable to make it more than 2 hours at a time without needing to get up and ice or heat his hand due to the pain. 

June 15th - Surgeon follow-up and PT
Four weeks after surgery, things are starting to improve. While better, the nerve pain is still bothersome. At this point, the fire in the fingers has changed to a feeling of ants crawling around in the fingers. Still some burning. The range of motion is slowly improving and the swelling is finally going down. He still has a big lump around his wrist and has little strength in his fingers. The only finger that has normal strength is his middle finger. It's been very frustrating for Karel as he can't use his dominant hand and even the most easy tasks like picking something up, eating or pushing a key on the computer or phone is very difficult. He is making progress at PT and he is very committed to his exercises. 

June 17th - off medications, starting supplements

Karel really wanted to get off the Gaba as he wasn't comfortable taking this medication - especially now that he didn't feel like it was helping. It took about a week to taper off the Gaba. The hand is slowly improving and he is able to use it a bit more and the pain is much less. The pain comes and goes so it is much more tolerable. And he is finally able to (mostly) sleep through the night. The biggest improvement is being able to get back to some type of exercise routine- which provides structure to the day and helps with the discomfort of the hand as it takes his mind off his hand. Because his hand may take up to 6 months to regain full strength, Karel hasn't been able to do any of his scheduled races and the return to biking and swimming has been slow. But he is very grateful that he is able to exercise. We are also extremely thankful to our dear friend Stephen who is a hand surgeon (and triathlete) who has been so helpful as a sounding board for Karel. Because Karel has never been through this before, we don't know what's normal vs. not normal so Stephen has helped with so many of Karel's concerns. Currently Karel is taking Carnityl, NAC - N-Acetylcysteine, and Alpha-Lipoic Acid (all from Thorne) to hopefully help with the nerve pain (advised from a friend of ours who had success with these supplements). 

Training update

Pain is no fun as it's a major disrupter to quality of life. But Karel wanted more than anything to get back to exercise - even if it wasn't comfortable. And I sure do miss my training partner. We do almost all of our outdoor riding together so it's been tough to have to do so many of my rides alone. The surgeon and PT gave Karel the OK that he was allowed to exercise so long as he wore his removable cast for the first few sessions after his surgery to protect the hand. After a few weeks, Karel no longer needed the cast but continued to tape his hand to brace it. He is also using gel pads for extra padding on the bike as the vibrations on the road cause him a lot of discomfort. 

48 hours after his hand surgery, Karel got on the trainer for an hour spin. He said it wasn't comfortable but he was happy that he did something after being so sedentary for the past 5 days. 

The next week (May 24th) Karel was able to do a few indoor trainer rides and two runs on the treadmill. On Sun 30th, Karel ran outside with me. He was a bit winded and exhausted during the run outside. Total exercise this week: 6.5 hours.

The following week (May 31st- June 6th) was a bit of a setback due to pain. But Karel brought his bike and trainer to Roanoke and he was able to do a few trainer sessions and runs outside. Total exercise this week: 6 hours.

On the week of the 7th-12th, Karel attempted his first swim at our friend Kristen's neighborhood pool. It was more of a splash (not structured) s Karel couldn't really use his hand but just move it through the water. He mostly used fins but he was able to get in 3000 yards. He went for another swim on the 11th. It wasn't comfortable but it did help to take his mind away from the nerve pain. On the 10th, Karel attempted to ride outside on his road bike (I rode with him) and it was really uncomfortable as he couldn't put any weight/pressure on the hand. He didn't enjoy the ride outside but was craving that feeling of being outside on his bike. I don't think he's ever gone more than two weeks in his life without riding his bike outside. Total exercise this week: 10 hours. 

On the week of the 14-20th, Karel found himself in a bit more of an exercise routine. He tried the tri bike vs. the road bike and while it was a little better to just rest the arm on the bars outside, the vibrations on our bumpy roads made it hard for Karel to enjoy the ride outside. He has been using the tri bike indoors (he really dislikes the trainer ;) He really loves riding outside so he was trying everything he could think of to find a way to ride outside. Running seems to be the most tolerable as nothing touches the hand when he runs, so that has been the one constant over the past few weeks. Total exercise this week: 15.5 hours. 

On the week of the 21st-27th, riding outside is still very uncomfortable and while the hand strength is improving, he still doesn't have full usage of his hand. It's also very hard for him to drink while riding. Karel is finding creative ways to tape/brace his hand while exercising and he has also made some adjustments to his tri bike with extra padding to help where his hand rests. He is able to swim a few times a week, but he still needs to brace his hand with tape to give it support. He's also using a lot of pool toys to help with swimming. Total exercise this week: 16.5 hours. 

And here we are today. This week has been a somewhat good one for Karel. I see the improvements that he is making everyday but Karel can't see the small improvements. He is still frustrated that he can't do simple things around the house, while eating or when exercising as he lacks mobility in his wrist and strength in his fingers. He feels more comfortable on his gravel bike on the road as it is a bit of a better feel on the handlebars. This past Saturday we rode together and it was his longest ride at 4 hours. He just wanted to complete the ride more than anything. He mostly stayed in the aerobars (which he doesn't enjoy as he likes to change up his position, especially while climbing) and he had a few low moments but overall, he was just happy that he is able to ride outside - even though it wasn't comfortable. He feels like his fitness is low as everything feels hard but again, he is just happy that he is able to train and get back into a routine. Total exercise this week: 18 hours. 

Although this has been a really tough experience for Karel, he really wants to get back on his mountain bike. And I also want him to get back out on his mountain bike. But right now, he still lacks the strength to be able to ride on the trails and to use his mountain bike gears. While the first few days of his injury really tested him, each day he wakes up and focuses on what he can do on that day. He isn't waiting until everything is perfect but instead, just taking each day as it comes and doing whatever he can on that day. The first few weeks he didn't try to follow any type of training plan but now he is able to train with more purpose. Right now the hope is that he can compete in the IM 70.3 World Championships and follow it up a week later at Xterra Utah and then in December, at the Xterra World Championship. I hate seeing him in pain and I am hopeful that he can continue to improve the strength in his hand and that the nerve pain continues to lessen and will eventually go away. We never expected this injury to be so debilitating but we try to keep this all in perspective that it could have been much worse. Because his job of bike fitting, working on bikes and working on the computer requires the use of his hand, it has been tough for Karel to not be able to do certain things that were once so simple and routine. It has taught us to never take anything for granted....and that we are more capable than we think (and sometimes we just need a bit of creativity!)

And thank you for those who sent Karel edible gifts. Chocolate makes everything better :)