Brevet #1 (2011): T minus 1 week.

I can't believe it's finally here. After much anticipation, I'll ride in my first brevet of the 2011 season on Sunday, July 31 and I couldn't have chosen a more fitting ride. The NYC 200K is an oldie but a goody. It's also one of my favorite events since the route is outstanding and marks the first brevet I ever rode in 2007. I was instantly hooked on randonneuring after riding the NYC200K and went on to ride a full SR series that season, but did not attempt PBP. Instead, I put off that goal until 2011. As luck would have it, I'll have wait yet another four years for that glory. In 2015, I'll be 50 years old and I honestly can't think of a better way to celebrate a personal half century.

The NYC200K starts at the George Washington Bridge bus terminal in upper Manhattan and snakes its way through the Palisades and Bear Mountain to Harriman State Park and back. Coincidentally, the route passes right by the main entrance to the Helen Hayes Hospital so I plan to stop in to see who's working on my old floor that might remember my wheelchair-bound self. It sure would be a thrill to find a few familiar faces.

I feel strong on the bike and have a much greater sense of confidence for the distance after last week's successful 104-mile ride. The event should be great fun. Many of the participants will be heading off to Paris in a few weeks so the anticipation and excitement should be palpable. There's still plenty of room for additional riders. Care to join us? Rollout is 7:00 am. Registration can be completed on-line at this link, by mail or in person on Sunday morning.

When DNS = Definitely Not Stupid.

DNS (Did Not Start). These three letters are only marginally better than the dreaded DNF (Did Not Finish). It's an absolutely perfect day for a spring ride and yet, with 32,000 riders feeling like they just won the lottery in NYC, I sit here in my living room. Why? Well, after a steady climb towards greater pain-free shoulder mobility, I began to feel pronounced nerve pain shooting down my left arm this past week. It's not steady or unbearable, but it is concerning and limits my range of motion. I've had to back off my physical therapy exercises a bit and hope it's not something I've caused through overuse. On Monday, I logged my longest ride to date with 24 miles. Old George would have simply thrown the bikes into the car today and said "screw it, I'm sure the pain will work itself out." New George, on the other hand, is more concerned with long-term progress, so while I'm very disappointed to miss this year's Five Boro Bike Tour with my son, I hope this temporary disappointment leads to better healing and recovery. So instead of 42 thrilling miles with sun and wind in my hair, I'm off to the gym for some sweaty stationary miles and a little lifting. I realize now that sometimes, DNS means definitely not stupid. Onward ho!

Tragedy, loss and recovery in "The Long Run"

And I thought I had it bad! There's nothing more humbling than reading a story about someone who's had a far more serious accident and grueling recovery. In The Long Run, NYC firefighter, bar owner and endurance athlete, Matt Long describes how a terrible bike accident in 2005 cut short his plans to run the Boston Marathon, but did not stop him from fighting his way back to run again. I should explain from the start that I'm a sucker for tragic-adventure memoirs. Into Thin Air, Between a Rock and a Hard Place and Off the Wall sit prominently on my book shelf and films like "Grizzly Man" and "Into the Wild" are listed among my Netflix favorites. That said, I did not love this book.

Matt's story is surely an inspirational one. Pinned beneath a 40-ton bus while commuting to work on his bike in mid-town Manhattan, Long was impaled by his seat post and lost a tremendous amount of blood while severely damaging several vital organs and destroying quite a few important bones and muscles. It is nothing short of amazing that he is now able to run again after 40 surgeries and years of rehabilitation. Co-written with a professional writer, it is still far too rambling a tale. His editor should have taken a more aggressive surgical approach. Long's story of recovery includes far too much reflection on his macho life as a firefighter and not enough detail on his incredible rehabilitation for my taste. As a result, readers are not able to fully appreciate and savor all that Matt has gone through in his remarkable journey.

My reading of this book is admittedly idiosyncratic. Like Matt, I was hit by a car while cycling and have spent a great deal of time in hospitals and physical therapy unsure that I would ever be able to become the athlete I once was. While my injuries were nowhere near as severe as Matt's, his book leaves me hungry for details about the healing and recovery process. Unfortunately, Matt neglects to devote any time at all to some of the sad realities of what takes up much of a recovering athletes time after a serious injury. Where are the countless hours spent arguing with insurance companies over bills that keep piling up? How does he find the time to exercise again with work, family and therapy demands pressing in? Where does all the money come from to subsidize his recovery? One imagines that Long received a juicy insurance settlement and perhaps a healthy disability package from the FDNY to help smooth things out financially, but we'll never know as he has chosen not to share this aspect of the recovery process with his readers.

Perhaps the most disappointing point in the book for me was Long's decision to sue the Transit Workers Union for holding an illegal strike that caused him to cycle to work on that cold winter's day in 2005. Give me a break, Matt. After all you've been though, you really hold the union responsible for what happened? I would have expected more from the son of the NYS Conservative Party chairman. Luckily, the judge threw the case out before Long could become an embodiment of the need for tort reform as well.

If you're interested in Long's story, you might do yourself a favor and read the great 2009 Runner's World article that also includes six short videos on the magazine's website.

My second day out: getting ready for the road.

After a week away in the Connecticut woods with our entire middle school, I finally got the chance today (after catching up on my sleep) to get out for a spin on the local rail trail. This time I rode a solo end-to-end lap which had me dodging pedestrians on the Walkway (see photo above) and "climbing" a slight grade into a headwind which just about took my breath away. My lung capacity is so diminished at the moment, it's an embarrassment. Note to self: complete at least 3 or 4 cardio workouts each week to push my endurance into a zone that feels a bit more familiar. Since my shoulder felt somewhat achy the day following my last ride, I thought I'd keep it short today. I'm pleased that my shoulder doesn't hurt while riding, but continue to be amazed by how weak my triceps, biceps, forearms and hands are at this point. I'll definitely need to strengthen all types of muscles as I build back to brevet strength by mid-season. With two weeks until Block Island Training Camp begins, I'm praying for nice weather.

I'm Free!

Yesterday was the seven month anniversary of my accident and, to celebrate, I decided to suit up and ride my bike for the first time outdoors. I planned a ride with my wife on a local rail trail in order to focus completely on the ride itself and to eliminate any worry of passing cars. The verdict: despite the long time away, riding a bike was like . . . well . . . riding a bike. Muscle memory is robust; it all came back immediately and my comfort level was just where I wanted it to be. Riding felt far more routine and less dramatic than I might have expected. Pedaling thorough the woods with my wife was both comfortable and comforting.

Physically, there were no nasty surprises. My legs and hips felt fine and my balance is solid and steady. Even my left shoulder behaved well; I can now reach the bars without any hesitation or pain. There is some sensitivity in the left shoulder, but I would expect nothing less. It will take some time to increase my range of motion and my strength. I was surprised by how weak my muscles have become. I noticed that my biceps and triceps, as well as the muscles around my knees, for instance, have not been called into service for a long time and therefore are not quite as powerful as they were in months past. It was also surprisingly challenging to maintain a pace of just 18 mph and I will need to rebuild both speed and endurance in the months ahead.

What a great anniversary present! I couldn't have hoped for anything better at this point. I'm off for the week on a school trip but look forward to logging some more miles when I return. My next goal? Spring break "training camp" on Block Island in mid-April. Before that, I'll log some additional rail trail miles to increase my confidence and strength. Onward!

Green Light: I’m Back, Baby!

“Sure, you can ride your bike again.” These were the last words my surgeon uttered today as I left her office and they continue to ring in my ears as I type these words. This was only the last piece of good news I received today. It turns out that my diligent adherence to my physical therapy regimen has paid off. Apparently, I even surpassed my doctor’s expectations both in terms of range and strength during today’s evaluation. Whereas in an earlier appointment I heard her say “that’s not what I wanted to see,” today it was “wow, that’s a homerun” and “look at you!” What a perfect way to ring in the first day of spring!

  

The prognosis looks brighter and brighter. My doctor was especially pleased to see both my increased range of assisted motion (65 degrees more than during the evaluation) and my increased muscle control. Most impressive (to both of us!) was my ability to hold my left arm extended above my head after slowly bringing it into position with the help of a cane. Apparently, this indicates the potential range I may have down the road. What a goal! While I thought I was shooting for comfortable handlebar use, it now looks like I may even be able to hang paintings and put dishes away on high shelves before this is all over. As for physical therapy, I now have a modified prescription to focus on extending overhead range and strength. Major strength building is still unnecessary at this point and can wait for years without any ill effects.

So it’s now three months after my most recent surgery and seven months after the accident and I will return to riding on the open roads this week. Since I’m a little nervous about just how weird this might feel, my inaugural spin will be on the “Hudson Valley Rail Trail – Walkway Over the Hudson” so I can get my bearings without worries about traffic. I may also ride my single speed so I can throw on a set of flat pedals for good measure.

Photo: Tom BKK, Creative Commons

Bell Crash Replacement Helmet Arrives, Rider Smiles

Today it was 68 degrees and sunny this morning when I opened a smooth brown UPS box to reveal a beautiful shiny white Bell Sweep helmet. The helmet came to me through Bell's generous "crash replacement" program. After a crash, all a rider needs to do is call Bell with the old helmet's serial number and a credit card and Bell will send any current model for 30% off retail. This strikes me as a great way to build brand loyalty. Since I had about 300 miles on my previous helmet, I was especially pleased to take advantage of this offer. With the discount, I even opted to upgrade and replace my Array with a Sweep.

Next up: I meet with my surgeon on Monday to assess the progress I've made over the past six weeks. I'm looking for the green light to upgrade my physical therapy and get out onto the open roads. Wish me luck.

Stretching as Endurance Activity

At times, it felt like my hospital stay went on forever, but my bones really did heal in a very short period of time. In six weeks, I was basically repaired, actually. Muscles and soft tissue, on the other hand, take a bit longer to get back to normal. In fact, the protracted healing process itself calls into question what will become the "new normal." Recovering from shoulder surgery is one thing (that requires 3-5 sets of stretches each day), but the stiffness in my left hip joint and the tightness in both sets of hip flexor muscles has me feeling a bit too much like a creaky geriatric for my own taste. I've been walking, stretching and lifting every other day at the gym, but I need to redouble my efforts and stretch at least daily, which is tricky because it's so important to warm muscles up before stretching and that in itself can be quite time consuming. Slow as it goes, I am feeling improvement.

Finding time to adequately attend to all of my healing needs is a serious challenge. Ideally, I should be spending over 2 hours every day on exercises and stretching. This IN ADDITION to the thrice weekly visits to the physical therapy office. Needles to say, despite my best intentions, something needs to give. As a result, I've not been able to get any significant aerobic activity in for some time and I feel like I'm really letting my base aerobic fitness slip away.

Luckily, I have the week off from school and will be able to catch up with sleep, physical therapy, stretching, sorting out hospital bills and RIDING. This week, I hope to ride at least 6-8 hours on my trainer. I'll jump on for an hour this afternoon and I've put out a call for a 3-hour session with a few of my local riding buddies later this week. This is the week where my aerobic training will really get serious. My first brevet is not too far off. While I still haven't been given permission to ride a free-standing bike on the open roads, I hope to register soon for the Princeton 200K held this year on April 23. It's a route I love that attracts a group of randonneurs I'm eager to ride with again. Onward!

"Just Say No Thank-You"

This week I finally listened to Nancy Reagan and just said NO to drugs. I haven't written much about pain management since my accident, but I've been on one form of medicinal pain relief or another over the past five months. With 25 broken bones, the hospital staff even brought in the palliative care team to design a "cocktail" that would make movement and merely staying in one place bearable. After they got things squared away, I was not in much pain, although I did nod off in the middle of a few conversations. Once I entered intensive physical therapy at Helen Hayes, the importance of pain medication took on another dimension. One can't work through the intense demands of physical therapy without some degree of pain reduction to pave the way. Since returning home, I have been in the process of steady reduction. I was nearly off the medication all together in December when I had my shoulder operated on and that sent me right back up in my dosage for a spell.

Last week, though, I hit another milestone. On Friday morning, I took my final pain pill and I'm pleased to report that three days later, (while I may feel a bit more stiff) I did not suffer any negative side effects. Of course, I will probably end up like these guys now that I no longer dope, but maybe Nancy Reagan was right. Maybe some times we need to stand up and just say no, or as my friend Jamie used to say, "just say no thank-you."

On Rehabilitation, Potential and Mindset

One week after getting the bad news that my latest surgery wasn't as successful as we originally thought, I'm settling into my new rehabilitation schedule nicely and getting my mind around what lies ahead. My new rehab regimen includes physical therapy sessions three times each week and home exercises five times a day. All of this is limited to "passive range" work designed to increase the shoulder's mobility without any weight-bearing or strengthening that could jeopardize the healing and attachment of sensitive muscles. After only a week, I feel a difference from my pre-surgery self. My arm really does feel better this time around. This upper body work is in addition to the ongoing work I'm doing to increase the strength and flexibility of my hips and legs which includes walking, riding, strengthening and stretching.

I was at an conference this week in which several of the sessions addressed the intersection of cognitive science and learning. One speaker, in particular, discussed how new developments in brain science influence our thoughts on potential. Unfortunately, most of us still see the world through what social psychologist Carol Dweck has termed a "fixed" rather than a "growth" mindset. As such, we perceive human potential as fixed from birth. Some people are smart, others are dumb. Some are fast, others slow. While individuals all have certain temperaments and physical characteristics that influence success, each of us also has tremendous potential to expand these boundaries through commitment and hard work. Scientists now believe this is true in both the cognitive and physical worlds.

So while my eventual mobility is now a mystery, it's a mystery I intend to solve.There are certain limitations I'll face. No amount of physical therapy and hard work can strengthen muscles that are no longer connected, but exactly what power connected muscles will have and what adaptations and compensatory strategies I may be able to develop are unknown at this time. I'm in it for for the long haul, though and hope to surpass whatever obstacles come my way. Several things I know for sure. I will race again. I will complete pain-free 1200K grand randonees. It's simply a matter of how long it takes and what work is needed. Enough writing, already,  I'm off to do a few exercises.

Recovery update: A little more good news than bad news.

“That’s not what I had hoped to see,” are not the words you want your orthopedic surgeon to utter as she scans the x-ray taken moments earlier. Apparently, she recalls reattaching a piece of my humerus which is now unattached. So that’s the bad news. The good news is that despite serious stiffness, I seem to have more muscle strength in the area of external rotation in my left arm than I did before the surgery. She explained that this likely means that 2 if not 3 of the rotator cuff muscles remain attached. This is hopeful because this musculature is tied to the ability to raise the arm in a forward direction which was severely limited before the operation and which is critical to a variety of things, including riding an upright bike.

So my rehabilitation protocol is to undertake passive range exercises with a physical therapist three times a week along with daily home exercises until the middle of March when I go back in for a follow-up exam. I've also been granted a reprieve from sling-wearing and have returned to the ranks of suburban automobile drivers. If there's one thing I've learned this year, it's patience. All told, I wore a sling for over 100 days this year and was restricted from driving for over 14 weeks. I have to wait on my bicycle riding privileges, though. No road riding until after mid-March when we’ll see how the recovery is going. So there's no more surgery for me at this point; it's onward and upward as the next stage of recovery begins. 

Back in the Saddle Again (Literally)

Back on my Bianchi Imola's Brooks B-17 to be exact. While I set up my bike and trainer in my wife's dance studio several weeks ago, one thing or another has stood in my way until now. Last week I came down with a stomach bug that (like a boomerang) hit me twice before leaving, I've been working full-time again, and the gym down the street has both weight machines and stationary bikes which makes for easy one-stop rehab shopping. While I've been to the gym many times, today was the first time since the accident that I clipped in for a spin on a real bicycle.

The feeling was better than I could have anticipated. At first, I had to remove a little grass that was still embedded in my left shoe clasp along with a crushed Endurolyte tablet that somehow found it's way into my right shoe. It was also my first time in cycling shorts and these, too, felt comfortably familiar. Throwing my leg over the top tube and pedaling while looking out the window at the driveway and the road beyond connected me more directly to the sport I love and will enjoy again before long. After clipping in, I cranked an Amadou and Miriam CD and got down to business cycling through one of Dirk Friel's great 60-minute base-building workouts in Workouts in a Binder.

I meet with my surgeon one week from today and anticipate that she'll release me from my sling internment and allow me to again begin rehab on my shoulder in earnest. I have (so far) spent 91 days with my left arm in a sling this year and I am officially sick of it! Once I get the green light, I'll be back to driving, stretching, lifting and all other forms of PT. As I mentioned in an earlier post, the surgery was mostly successful but the actual range of motion I'm able to regain will be discovered through the physical therapy process. I'm eager to get started so I can get back on the road in March.

New Year, New Goals: 2011

2010 was something! The season began well, but the ending I could have lived without. On the positive side, I achieved personal best times on each of my SR series rides this year. Unfortunately, I was unable to attain the Cyclos Montagnards R60 award I was chasing when I fell and broke my humerus at mile 310 on the NJ 600K. I had successfully logged R60 times on the 200K, 300K, and 400K, but the late start after a full day's work in June's 600K was my undoing. I finished the event in 25 hours and 50 minutes, which was pretty close to my 24 hour goal, but not close enough. As a result, I achieved a CM R70 designation this year and felt that I would avenge that 600K finish during the 2011 season. The accident kept me out of the Lap of the Lake 1000K in early July but did not ruin our family vacation to Europe nor my ability to ride in the Endless Mountains 1000K in August.

Needles to say, the EM1000K did not turn out as I had hoped. 1 hour and 45 minutes into the ride, I was hit from behind by a distracted driver and suffered 24 broken bones. A six week hospital stay and four surgeries later, I am riding again (on a stationary bike) and looking forward to a full recovery and getting out onto the roads again this spring. Speed is not part of the equation for me in the coming year. I simply hope to rebuild my endurance and strength on the bike, ride with friends and complete my first PBP which I been eying for the past four years. Thanks to everyone who supported me either directly or in your thoughts this past year. Safe travels and be sure to keep the rubber side down.

Goals for 2011

Personal:

1. Treat everyone in my life as well as I have been treated by others this past year.
2. Pay back my wife for all of the sacrifices she's made and support she's provided.

Cycling:

1. Complete a full SR series.
2. Participate in PBP 2011!

Another Amazing Care Package

There's generous, and then there's GENEROUS! Over the past four months, I've been reminded time and again just how many of my friends and family members fall into the second category. The most recent reminder came today when I went to the mail to find, not one, but two boxes from my friends Matt and Mo. The last time I saw these two was back in September when they stopped by the hospital on their return to Boston from a race in Pennsylvania. This has been a busy fall for the two of them, to say the least. Mo's been racing a full schedule of  'cross races with other Elite riders and is currently in Belgium racing in the World Cup, while Matt has been riding quite a bit himself as well as supporting Mo and holding down a full-time job as a doctoral research assistant at Harvard. 

When Matt and I first met on the Boston 400K last spring, we discussed a terrible crash that left him with a broken femoral neck and facilitated his switch from USACycling events to ultra-distance racing and randonneuring. It was a conversation I remember vividly, especially after I suffered a similar fracture in my own crash this August. As I mentioned in an earlier post, the danger with fractures of this type is the possibility of vascular necrosis where the femoral head dies from lack of blood. The window for this outcome is two years and Matt is luckily out of the danger zone. He's also one hell of a tough, fast cyclist who holds both the North-South and West-East Maine cross-state records.

So the care package I received today included countless goodies to speed my recovery (like hardcore calcium supplements), to brighten my days (Mo's Special Dark Roast coffee) and make me feel like a member of the ProTour (a signed Giro d'Italia leader's jersey signed by Ivan Basso). Matt also loaned me his custom-made titanium cane which was designed for him by a friend of his who builds frames for Seven Cycles. Needless to say, it's a work of art. More than anything else, I hope that I am as generous with others as others have been with me.

Today also marked an important milestone in my shoulder recovery. I got up early to head down to the City for a follow-up appointment to remove my stitches and review a fresh set of x-rays to ensure that everything is healing properly. I'm pleased to report that everything is heading in the right direction! I was also given a modest daily "pendulum" exercise to open up the shoulder capsule a bit. There will be nothing more ambitious in the rehab department for my shoulder for at least another four weeks to protect against an accidental dislocation of the reattached bone and muscle. In the meantime, I'm required to continue wearing the sling which means no driving for me. Physical therapy will be added in after my next appointment and it still looks like I may be riding on the road again by April.

When Exercise Becomes Training.

OK, so after lazing around the house in a post-op haze for the past week, I went out and had a killer workout at the local gym today. I'd let me membership lapse a few years ago, but re-upped this fall so that I could be assured of a dry place to do my walking and then stationary riding. The weights are also helpful. Today's numbers in the rehab triathlon? Treadmill = 1 mile, weights/stretches = 1 hour and bike = 20 miles. 

I feel like I've hit another milestone. It's definitely time to re-brand my "exercising" as "training." The craziest thing about this dreadful accident recovery is that I am actually not that far off of my normal training schedule. Volume is reduced significantly, yes, but Oct. and Nov. are typically months in which I reduce my riding and catch up on other interests and give my body (and family) a chance to recover from a tough season. So it looks like this year, too, despite an arm in a sling, I'm able to kick it up a notch around Christmas in anticipation of the year ahead. With Paris-Brest-Paris on the horizon in August, now is a perfect time to begin logging base training miles.

I graduated a few weeks ago at the gym to an upright stationary bike from a recumbent and I much prefer the angle at which this places my legs in relationship to the pedals. This weekend I will be setting up my Bianchi on the Cylops trainer next door in Jessie's studio (thanks to winter break at the dance school!)  This morning I was unable to remove the Time pedals from my totaled Indy Fab with one arm so Jessie brought the frame over to my buddies at the Bicycle Depot. They were gracious and helpful as always, but I think a they were little shaken by the look of my bike. With the Bianchi set up next door, I'll be able to log longer base workouts starting tomorrow.

My shoulder feels much better this week and I shoot into NYC on Tuesday for a follow-up visit to my surgeon who will remove the stitches and discuss rehab plans with me. My hunch is that I will remain in this sling without any PT for six weeks until my humerus has fully healed. I'll remind her of my plan to be cycling on the roads in March. I'll let you know what she says.

By the way, I just got an email announcing a 30% off sale on Rapha gear with free shipping. Don't wait, sale ends on Jan 3.

Shoulder surgery a success!

Yesterday I spent the morning in surgery almost four months after my accident with a wonderful doctor who was seeking to reattach an overlooked bone fragment and the associated rotator cuff muscles to my left humerus. Without these, there's no way for me to lift my left arm. I'm pleased to report that the difficult procedure seems to have been successful. The surgeon was able to save and reattach part of the bone, some of the muscle and a few of the tendons. There's no way to know how much mobility will return until I go through physical therapy which will not begin for another six weeks to give the bone enough time to heal. In the meantime, I need to keep my left arm immobilized in a sling. When therapy begins it will be a bit like Goldilocks; if I push it too hard, the muscles may detach and if I don't push it hard enough, my shoulder may stay frozen. I might also need an arthroscopic procedure once the bone is healed to increase the range. And so it goes.

Pain management has been a challenge this time around. Since I've been taking a low dose of medication for some time, I seem to have built up a degree of tolerance and so the dosage the doctor prescribed did virtually nothing. We finally dialed in the correct dosage by 10:30 last night, so there were a few rough hours in there. Let's just say that I have a much better appreciation of Jessie's forays into natural childbirth as a result.

Looks like my plan to get back on the bike again in March is still on track.

Back on the (a) bike!

After 9 weeks, I’m finally back on the bike! OK, it may be bolted to the floor at the gym, but it’s a bike nonetheless. That’s right - I’m back, baby! Yesterday I renewed my lapsed membership at the local gym and began the next stage of my recovery that involves additional weight machines, the treadmill and, of course, a stationary bike. After a 15 minute warm-up on the treadmill, I rode 7 miles on the bike topping out at 20 mph. It felt so good to sweat as a result of hard work rather than a restless night’s sleep, heavy medication or the unseasonably warm temperature of a hospital room. I also noticed that the tightness of my left hip flexor muscle which leads to a limp, if I don’t stretch it out adequately, is not an issue on the bike at all. I found that I’m able to pedal smoothly and quickly which feels like pure freedom even when bolted to the floor. I now know for sure that I will ride again.

This is a big week coming up. I will have both an MRI and CT scan done tomorrow night at Beth Israel and then follow up with my shoulder specialist on Wednesday. I was pleased to find out last week that I’ve not suffered any significant nerve damage from the accident. The EMG test was a thrill – electrodes, shocks and needles – yet the results were outstanding. The doctor was able to ascertain some lingering trauma from two herniated discs I suffered several years ago, but I was glad to learn that my current shoulder weakness is not tied to a nasty nerve problem. The growing consensus seems to be a rotator cuff tear of some magnitude, so we’ll see. Hopefully, the MRI results will not be invalidated by all of the metal in my shoulder. I should have a much better sense of what lies ahead on Wednesday. I’m also excited to be returning to work on a part-time basis this week. Onward and upward!

Getting to bottom of things.

Today was an excellent day. I drove (that's right drove) to NYC to meet with a highly regarded shoulder specialist to get to the bottom of why my range of motion is still so limited and the pain continues in my left shoulder. I was very impressed with my new doctor who spent a delightfully un-rushed period of time with me listening to my story, examining my shoulder, reviewing a set of recent x-rays and explaining a few of the possibilities with me. The next step will be to get more information through additional tests. I need an MRI (to investigate soft tissue/muscle damage), a CT scan (to get a better sense of bone healing from various angles) and an EMG (nerve test). It will be some week next week but I expect to have a much better sense of the prognosis and treatment the next time the doctor and I meet.

The second reason my day was so enjoyable is that I made a pit stop on the way home at Helen Hayes to visit Bob, my former roommate, and a few other friends, therapists, nurses and aids. Things change fast in a rehab hospital. I knew that many of the patients I had been living with were discharged around the same time I was, but I was also able to see the dramatic progress the few who stayed had made in the past three weeks. It was also fun to see the nurses and aids who had known me only really from a sitting or lying posture.

One of the best things about the visit is that I was able to walk into the hospital without crutch or cane. I've had a real breakthrough over the past week. Through a combination of Feldenchrist work, massage, physical therapy and strengthening exercises, I am now able to walk without my crutch for sustained periods of time. While I still feel some sensitivity and weakness in the left hip, I have even been able to counteract the slight limp which had developed. This continues to be my focus as I build strength and balance.

The visit to Helen Hayes was wonderful for a variety of reasons. 1) I was able to reconnect with some amazing people, 2) the dramatic progress I saw in my friends reminds me of what is possible, 3) It was great to show my therapists how far I have come and 4) I was reminded that even the worst prognosis can be counterbalanced by love, determination and hard work.

Week Two at Home: Progress in several flavors.

Fully into week two after being discharged from the hospital, I am feeling more settled and independent each day. After getting some confusing and disappointing news from my insurance carrier last week, I seem to have navigated my way into a) an appropriate level of care from my therapists and b) an appointment next week with an outstanding shoulder specialist at Beth Israel hospital in New York. I also met with my GP yesterday to prove that I was still alive and he had no trouble granting me driving privileges. It's such a relief to both Jessie and me that I can drive!

I met with my new occupational therapist today who works out of the same office in New Paltz as my new physical therapist. I enjoyed the session (I really am becoming a masochist) and felt like it represented a very productive start. For example, after working with him for about 30 minutes, I was able to lift my arm farther than I have since the operation. Hopefully this is a good omen.

Finally, after therapy today, I took my iPod and crutch and hit the Walkway Over the Hudson. This time, I was able to make the full round trip to Poughkeepsie which amounts to about three miles. While the pace was slow and measured, it sure felt great.

The Road to Recovery: Phase four has begun

It's been over a week since I was discharged from Helen Hayes and the thrill hasn't worn off yet. There is nothing like sleeping through the night in your own bed to make you feel like things are heading in the right direction. Of all of the things that hospitals facilitate, sleeping through the night is not one of them. For the first two weeks of my confinement, I was awakened by the nursing staff every four hours to receive medications and have my vitals checked and for the last four weeks I was awakened by pain, a suffering roommate and careless night nurses in about equal measure. But that's all behind me now! I'm free!

While sleeping is much easier, maintaining discipline with rehab is a bit more challenging. Unlike in the hospital where my rehab followed a rigorous schedule, I am in charge of most of my own rehabilitation now by working my way through an exercise plan outlined by my therapists at Helen Hayes. I also began the week with visits by occupational and physical therapists from a home health care agency. Each of these folks determined that I was safe and sound navigating the obstacles and challenges in the house and so I was promoted to outpatient care in short order. On Thursday, I met with a wonderful physical therapist that Jessie has worked with for an initial assessment and look forward to working with her at her office in New Paltz several days each week. I will have a similar meeting with an occupational therapist at the same office on Tuesday.

I also spent a considerable amount of time this week navigating the complex and logically-challenged world of US health insurance. This week, I found out that a) the orthopedist I saw as an inpatient at Helen Hayes is not covered for me to see as an outpatient, b) I cannot have physical therapy and occupational therapy in the same day despite the fact that I cannot drive and need others to bring me to receive care, and c) none of the expert shoulder specialists who were recommended to me are covered by my insurance carrier. Yikes! It's a good thing that I'm not currently working so I can spend the necessary time trying to get the care I need so as not to slip behind in my progress. Luckily, I've also tapped into excellent advice from friends and family and expect that I will eventually get the care that I need just so long as I can maintain persistence and focus. It's also a good thing that I'm an endurance athlete.

On a physical level, I am walking with a crutch without much pain as I rebuild the strength in both of my legs and hips. My left shoulder remains a serious concern as I am not able to move my left arm very much at all. Still no weight bearing there and a considerable amount of pain without intervention.

It's another beautiful fall day today - after some in-house shoulder exercises and a little lunch, I think I'l hobble across the Walkway to get in my daily walking practice. Hasta luego!