There is Light!

This tunnel of mine started five and a half months ago on April 6th as a result of my first bike crash in 30 years of triathlon cycling. Please know that I am not complaining, my lot in life is relatively easy and I recognize that I am blessed beyond belief (some might say, this a first world problem), I get that.

I am now nine days post surgery #3 that occurred up at the Mayo Clinic in MN.  To say I am giddy about the result is a huge understatement!  I have been constantly moving my left elbow 24 hours a day for these past nine days.  That, after five+ months of it being stuck in one place at a 70 degree angle (okay, I did have a whopping 5 to 10 degrees of motion).  The medical term is ankylosis (a completely contractured joint), which resulted from the heterotropic ossification (or HO, an unwelcomed chunk of unattached bone) that grew directly in the joint of my left elbow.

Luckily my research took me to the right place as I found Dr. Shawn O'Driscoll at the Mayo Clinic. He is the stuck elbow guru that I needed.  He is aggressive, active, methodical with his surgery technique and experienced beyond belief.  My demeanor and athletic background made me the perfect candidate for his work.  I was confident...and rightfully so.  I was told that I had a 45% chance of this elbow ever being "normal" again, but an 85% chance of being functional.  With this doctor I had only a 1% chance of having permanent nerve damage in my hand vs. 11% according to the current literature.  I was happy to take those odds.

After 2+ hours of delicate elbow surgery and I ended up here (above picture) for the next three nights.  Motion and pain management was the name of the game.  My medical team was intelligent, friendly, large, professional and extremely involved & interested in my progression toward full recovery.  Not only was the HO removed (Dr. O stated that it was "significant" in size), but also removed was the screw that had been placed there to stabilize the fracture acutely.  There was also plenty of joint clean up and debridement around the ulnar nerve as well as a capsular release to help get my joint back into a world of movement again.  Here's a picture of the screw that was removed...happy to have that out of my ulna bone now (though I still have two even larger ones permanently in my left hip).

So for three days I mostly sat in the hospital bed with multiple tubes connecting me to modern medicine:).  I had the normal saline drip IV, a nerve block (another IV specific to the brachial plexus group of nerves to totally numb my arm/hand), a drainage tube and bottle that collected my surgical blood/edema, a pulsox unit for general HR/saturation data, cyclical leg compression sleeves, and of course, my trusty CPM machine. All of this, 24/7 for my time in the hospital.  

Now I am home and here's what my current world is looking like.  What a hoot...I'm still giddy about the potential!  

Check out my passive range of motion today after I've loosened things up!  Pretty awesome to have this back!  Yes, it's still a bit sore and I've got a long way to go in gaining strength and full active motion...but I am certainly a giddy dude right now!  

The key now is to continue getting this motion in a more natural manner and that requires near continuous motion of the joint.  Thankfully I've got the incredible support of my dear wife Nancy. I'll continue to "sleep" with the CMP machine until I can go 6 continuous hours without losing joint mobility.  So, about another month of this, weaning off the CPM machine and getting back to more normal life and activity.  I have plenty of work to do PT wise and this next 10 days is extremely important in keeping the range of motion I currently have.  I've got to keep moving, keep moving...hey, just like that Ironman I was supposed to be doing this weekend in Chattanooga...just keep moving!  

And I will!

Update on Jim's Health Status - Heading for Surgery #3 Soon!

For those that have followed my story, thanks for your patience.  The time has finally come for the next step in this chapter of my world.  I will soon be having surgery to "release" my left elbow. Surgery is scheduled for Tuesday, Sept. 16th, up in Rochester, Minnesota at the Mayo Clinic under the experienced hands of Shawn O'Driscoll one of the world's best elbow gurus.  I enter this step without reservation and while every surgery has it's risk, I feel no anxiety, only excitement about the potential for moving toward "normal" again.  I'm a long way from here:

but I do not quite stack up with the rest of my family when it comes to muscle don't you think?

My doctor will be removing the new (and un-welcomed) bone growth that naturally occurred as a result of significant trauma to my ulnar nerve.  This trauma occurred as a result of the serious bike wreck I had on April 6th of this year and was compounded by surgery/immobilization that may have triggered more significant trauma to the area.  In addition to having this heterotropic ossification removed, the surgeon will also remove the 3.5 inch screw (less titanium in my body...leaving only two screws in my left hip).  In addition he will clip, clean, debris, smooth and possibly transpose structures/nerves within my elbow as needed.  He will also come out with good insight into any arthritic changes my joint has suffered and thus we will have a better idea of how to move forward.  Below is a review for those interested in the anatomy of my injury.

I will wake up from surgery with a CPM (Continuous Passive Motion) machine attached to my arm in an attempt to limit swelling/edema and maintain range of motion.  This device will be moving my arm 24 hours a day for those first 3 days in the hospital at the Mayo.  Doc says I get a 5 min. break an hour to move around a bit and go to the bathroom, but otherwise, it's 100% elbow moving!  They will teach me to "milk" my elbow by working the extremes of the motion in particular and yes, I'll learn to sleep with this gadget somehow.  I will have a nerve block at my brachial plexus so that should do the trick on controlling pain.  Once I am discharged from the hospital I will be flying home (Nancy will be a great Sherpa of course) and bringing my trusty CPM machine with me for 4 to 6 weeks of more elbow moving fun!  Over time I will be weaning from it based on how the swelling and motion are improving along the way.  Here's a picture of one of these units:

As you can tell from my muscle picture above, once I've re-established good range of motion, I'll still have much work to do on regaining strength in my left upper body.  My biceps and triceps in particular, but also my shoulder complex/rotator cuff muscles which have all atrophied (and frozen) considerably over the past 5 months.  Anyway, I look excitedly toward all of the PT work ahead and will accept the challenges just like I was working toward that elusive Ironman race.

Thanks in advance for your thoughts, prayers and well wishes...and particularly for your patience with me, if you are one of my current athletes.  My wife and kids and entire family have been extremely patient through this and I am extremely grateful for their support.  Even with all the "hassle" I still believe you MUST go after your dreams!  Only a life chasing your true passion will be "enough" when the finish line is in sight.  Let us keep rolling and let us make the most of this and every day!