Saturday, November 13, 2010

4 Months Post-op

Tomorrow will mark 4 months from my pectus excavatum surgical correction. Tonight was the first time I’ve pedaled a bicycle since the operation.


Bike: Surly Long Haul Trucker

Duration: 40 minutes

Approx. Caloric Burn: 500

Mileage: 0

Scenery: Living Room of My Apartment

I don’t think I’ve ever appreciated a lame indoor mag-trainer ride as much as tonight. As of this past week, my doctor cleared me for light exercise beyond the walking I’ve been doing. I’m ten pounds heavier after four months of being pretty much sedentary (compared to my traditional outdoor recreation lifestyle), and this is despite a whole lot of muscle atrophy. This means I am fatter than I’ve ever been, and I can’t wait to turn that around. It was necessary to take it easy for quite a while after this big surgery, but now it’s going to be necessary to ease back into getting in shape. It will take time- how much, I really don’t know. My chest still has a long way to go before I can really work out hard- my doc says bone takes a good full year before you can trust it like before it was broken (with a big break like what was done to my sternum). Plus, I’m still experiencing a lot of the “clicking” in my chest that I blogged about a few posts ago, and it’s thought now that I may have a section of cartilage that has not yet bonded to my sternum from the respective rib. So basically, it’s a bit loose, and rubbing/knocking as I move. Yes, it feels as disgusting as it sounds. I was told that it may require a third surgical procedure (at the same time as my second (bar removal)) to tie it to its place at my sternum and encourage the bond to finally happen. I don’t claim to have a great understanding of how this works; I just know I’ll really appreciate when it’s done and I don’t feel like I have parts loose in my chest cavity.

Also during my appointment, I finally got to take a look at the chest scans I had done pre-op that my surgeon used to determine both my need for correction and which procedure would be used to do it. They are pretty nuts.

This is a cross section of my chest with the orientation of looking from my waist up, at one of the deeper sections of the deformity. It really shows how badly my sternum was recessed, and thus squashing the anterior of my heart. This is why my heart could not expand normally during exercise, and I experienced high heart rates, labored breathing, and early fatigue.

This is an X-ray showing how deep my chest wall was recessed. If you know what to look for, you can see how little distance there was for my heart in between my anterior chest wall, and my spinal column. That’s my heart again, squished into the only space it could find.

And this is another cross section, now a vertical slice of my chest at a depth where it can be seen just how twisted my sternum was, in addition to being recessed. This is one of the many reasons I had to go with the Ravitch procedure as opposed to the minimally invasive Nuss procedure. My sternum needed to be broken, with a large wedge of it removed to get it into the same plane and off of my heart.

Here is a more pleasing scene- my Trucker in my living room. I was so happy to be able to handle a ride. My chest is still hurting, but it’s now pain that is tolerable and safe to exercise through according to my doctor. I was told that I may continue to experience pain from the surgical bar supporting my chest, as it can put slight pressure on nerves from time to time (as I’m sure you realize, we’re not really originally designed to have stuff lodged in us, but it works).

The Trucker felt just like I remembered, and I felt at home again pedaling after thinking about it for too long. I’m not sure the full fenders, racks, and frame pump were needed while touring my living room, but they come with the ride. Nor do I suspect there’s even that many Long Haul Truckers even getting slaved to mag-trainers; generally they’re just not the “training” folks pick of bikes. Bike Snob NYC would have something to say. But it was the upright geometry I was looking for in a true recovery ride. I look forward to more non-eventful, safe, and lame trainer work through the winter. Then I’ll be ready for something real when the spring comes. I’m coming back from the couch.

Sunday, October 17, 2010

Playing with GPS data...

I've owned my GPS, a Garmin eTrex Vista HCx for a couple years now, and I'm still learning how I can benefit from it. It's taken me a long time to learn the Basecamp software that came with it, mainly out of laziness. I work with frustrating computer programs and work, and that leaves me with little motivation to learn new programs at home, but I've been interested in publishing routes from my GPS to this blog, so I've done a little investigating. I've found a few ways to do it, but the only one I've understood to the point of getting it to work is through the site. I can upload .gpx files from my Garmin, save them as routes, and then it creates programing code that I can copy and paste into a blog entry, and the route shows up here on the blog. Easy enough for me. It seems to default to regular Googlemaps "street" mode, and I'd prefer the "satellite" or "topo maps" modes, but you can view these by clicking the "View Full Screen" link on the map, and it will take you to and expanded page to see those views (once on the full screen page, there's a selector in the upper right of the map).
The whole point of trying to do this is to share rides, runs, and hikes on this blog. Seeing as I don't have recent trips of any sort to show off, I posted a trail run from Yosemite done last February to at least try out the process. In the future, I should be able to share notable adventures and interesting routes via my actual GPS tracks just like this:

Recovery walks...

Well, I'm at Day 95 of recovery. Things have been getting slowly better, slowly being the key word...but also better. :)
I still haven't ridden a bike, other than sitting atop the Karate Monkey in my living room and rolling ahead a few feet to see how it feels. It started out feeling terrible- my pectorals weren't excited about me leaning over that far and putting pressure on a handlebar, but as of this weekend it's feeling tolerable. I may try to go for a very short ride sometime soon, as my doctor told me it should be ok, as long as I'm not feeling pain. We'll see.
Fall hikes/walks have continued to be my form of exercise to get away from all the sitting in front of the TV. MN has been enjoying a stellar fall this year- I'd say the best one since we moved back this direction in 2007. The sky has been largely sunny for a long time now, temps anywhere from 50s to 80s (yeah- 80's; a bit too hot some days), and the colors stayed out for quite a while. Definitely better than last year, when Oct. was just a big cold raining mess (although I did enjoy the raining mess rides as per usual for me.) Just wasn't much for fall colors in '09.
Since it's been so nice out, the Fivefingers season has been longer than normal. It's been great getting out in the North Woods to hike in them so often. It makes me miss running, which I'll have to wait until at least mid-Jan. to try again, but I like the hiking for now.
I also tried something new while outside this fall and in need of a "take-it-easy" pass-time while recovering- geocaching. I think my verdict on that is that it would be fun with kids, getting them out to treasure-hunt, but I don't see myself getting much into it when there is so much cycling and climbing around. I just own a GPS and thought I'd kill some time one day up on the North Shore, and found a couple caches. It's kind of funny to know there are all these silly coffee cans filled with junk buried around the places I've spent so much time recreating in.
Fall will hopefully continue for a while longer, but I can say that I'm actually ready for the winter. I'm enjoying the colder temps and jackets, and progressing through the winter season will mean I'm getting closer to full recovery days. I'm really looking forward to next Spring!

Shovel Point in Fall:
Relaxing at along the Caribou River:
I seem to have some "tree-antlers" in this shot, but I still seem happy to be off the couch...
More scenery along the Caribou River, Northern MN:

Alison at Jensen Lake, Lebanon Hills Regional Park:
Fivefingers in the woods:
Bridge Pond, Lebanon Hills Regional Park:
Trail around Jensen Lake:
Esbit heating up dinner near Stoney Point, Lake Superior, north of Two Harbors:

Saturday, September 18, 2010

Finally treating the bikes right...

There's been many ways I've transported my bicycles over the years.
It started out with the back of a '74 Ford Pinto I bought for $200 (hatchback didn't even lock, but who would look in that kind of car for an expensive mountain bike, right?). High school was the time period then, and riding was just entering my life in great ways- mountain biking the ND badlands.
Then I graduated to a '84 Bronco II, still shoving my bikes in the back, often with other bikes packed in contorted ways around it, all of them robbing each other of paint with each long drive to whatever trip destination was the current adventure. Like the Pinto, it was nice to have a bike with for when the vehicle decided not to run.
After the Bronco came what is still the vehicle that's logged the most outdoor trip memories, my old Grand Caravan (many of you remember). Now transporting bicycles in (on) the van had many methods. My Surly 1x1 often just stayed in it instead of the garage, so when I was driving and not cycle-commuting, I'd have it on hand for any impromptu rides that may have come up. During trips, my friends and I packed into the van up to 7 people, their bikes (which often included a mtb as well as a road machine), climbing, and camping gear (plus tools, water, food, and maybe piles of homework if we were feeling responsible.) This meant that sometimes the bikes would get lashed onto the roof (no roof rack- we were aviation students with serious bills and no notable income), or to whatever sketchy old strap-to-the-hatch bike rack someone had borrowed from someone kind and older who "had a good bike rack in their garage that they really didn't use anymore." Sometimes this mass of rack/straps/bikes/locks would be covered in a ratty old tarp held together with duct tape and bungy cords (which had to get re-configured at about every 5th truckstop or so), since we would no doubt be driving out of ND in the butt of a winter blizzard to reach sunny UT in March. Many excellent trips with excellent people in that van. Some of the best.
The van was eventually laid to rest at 208,000 miles, which was actually a bit early for it's kind, but it had seen a lot of outdoor trip drama. With the van gone, my Nissan Frontier that I am still driving entered the scene. While I'm certainly of average earnings, I've finally reached a point in my life where I don't have to treat my valued bikes like garbage to move them around anymore, and that's a good thing. My pickup has a lockable topper, and with the help of my father-in-law, within that topper is a custom 4 bike rack welded from angle iron he had laying around (he's a project junkie), and fork mounts I'd purchased for previous homemade racks (usually made of wood, that would dry up and fall apart, but I still had the fork mounts). In addition to our pickup, my wife's new vehicle just received our first fully lockable roof rack setup. So there should be no reason to be shoving bicycles into whatever spaces are left after packing in other trip gear and people anymore.
With the new capability comes goals too. Even though there was a lack of great ways to take care of bicycles in past ventures, it's clear that the poor early years of needing to get creative to pull off the bigs trips were many of the greatest outdoor years thus far. These vehicles/racks were purchased to get out there. Time to get planning, heal from surgery, and haul some bikes to see some country.

Saturday, September 11, 2010

Congratulations Kelly!

My close friend of many years, Kelly Paasch, ran and finished the Wasatch 100 today (and yesterday). 33 hours and 8 minutes of mountain trail running. Very impressive! It is truly a huge accomplishment and I am proud of him. Great job man! If I can heal from this summer's chest trauma we'll have to go explore some trail sometime (perhaps you can go easy on me.) :)

Monday, September 06, 2010

Day 53

Day 53 from surgery provided a little sense of normalcy for me, in the respect that I got out for a hike that wasn't super short, and to a place out of the city, albeit not far. After spending a quick but valuable Saturday with Alison while she got to come home from Memphis, I dropped her off at the airport again, and needed to find a way to keep myself busy. I sat around the apartment, tried to read, got some chores out of the way, and did some cooking, but I didn't feel much satisfaction with the day. I really felt like I needed to get out and spend some time outside. As stated in previous blogs since surgery my outdoor abilities are pretty much restricted to walking around in places I'm not likely to fall over (not that a have a falling over problem or anything- I just can't put much force into my upper body and slipping and catching myself would result in unpleasantries). I suppose luckily in this sort of case, I'm not likely to find myself clinging to any knife-edge ridgelines in Southern MN. I headed out to Afton State Park and took a summer hike along the snowshoe loop system in it's southern portion. I'd never hiked it in the winter (or at all actually), and I imagine it's a very different looking place then. It felt odd to be following posts with snowshoe graphics marking a trail that was currently overgrown with prarie tallgrass, flowers, bushes, and lots of leaves (quite a few bugs too, but we won't talk negative for now.) I managed to get in exactly 4 miles of hiking, with an ultra-light daypack weighing in under 3lbs (although I can technically carry up to 25lbs via doctor instruction, I don't know what I could possibly need for this kind of walk that would neccesitate my dealing with what would be an allowable but uncomfortable pack at this point). I went light on the footware side too, hiking in FiveFingers. I was a good way to get out and return to something outside, and go on my longest walk since the pectus operation. I'll probably try to get out again soon and walk more of Afton's trails since it's close to town and doesn't take much effort. I'm not quite ready to sport the Dana and Sundowners on the Superior Hiking Trail yet. :) Little steps back to normal...

Thursday, September 02, 2010

Some things are cooling down.

In a couple of ways- I'm getting back to living, to some extent, after my surgery. Summer is creeping toward fall. I'm happy to see both of these thing.
The past three weeks I've been back at work after the long month home starting to recovery from my chest operation. I can't say things at work have been wonderful- our airline is going through an awful lot of changes, and all of it's employees futures have yet to be finalized. I'm not as worried that my job will be moving soon as I was initially, but the possibility is still there. It's been irritating to say the least. But it has been nice to not be confined to the apartment, and to be feeling better than I was. Going from constant pain and discomfort to feeling little pain and simply being weak is a welcome improvement. October will mark the point where my lifting restrictions aren't a big factor anymore, and they'll be totally lifted in January. I'm told I'll feel more and more "normal" as those dates go by. So I'm happy to see the summer coming to an end. I don't enjoy heat and humidity (another reason I don't intend to move where my job may go), and fall is my favorite season in MN. I'm ready for long sleeves and changing colors. Ready to stare out at at even colder Lake Superior and burn some firewood. Ready to camp again after all this being holed up at home in the city.
One thing I'll be missing this fall is cycling (and climbing, and backpacking, and running, but mostly cycling). I think fall is my favorite riding season too. It's normal to be at peak yearly fitness around now, and I expect the weather and scenery will great as per normal for fall, so it's perfect for long rides. You might cite that the sun won't be up as long, but hey, the make helmet lights for that. Getting caught out after dark and riding home with the moon and crisp fresh air isn't exactly a negative in my opinion. I see it as part of the fall outdoor experience. But I'll have to wait until fall of 2011 for those types of rides. But instead of fussing over missed riding, I'm going to try my best to enjoy the things I can do- day hikes (snow-shoeing as winter sets in), and the aforementioned camping. There's a lot even a post-surgery outdoor fanatic can do with a good pair of feet and some time. There are a lot of parks in MN I haven't been too, and way more of the Shore to explore, and I hope to get out even despite the fact that I'll be in the worst form of my outdoor life for awhile yet.
I've been keeping my mind occupied indoors more than normal, out of necessity with all this sitting still. I've read some good books- about food, nature, bikes, faith, all good stuff. I'm also working on learning Spanish. It's a good time to do the things I normally am too distracted to do while running around outside.
So some things are looking up. But since there is always a yin to the yang, or whatever contrasting symbolism you prefer, I do have something that has pretty much only been a bother. Alison has had to essentially live out of state recently. Her new flying job involves a standard 8 or so weeks of training, and this time we're not lucky enough to see it happen right here in the Cities. She's down in TN for now, and we don't know where she'll be based when she's on the line. We're back to the lifestyle of living apart quite a bit, and that's a part of flying I've never liked. It does help us value the time we have together though. I suppose there's something good of it.
In time out of state training will end, I'll heal even more, and we will all get back to living like we were. For now we'll try to keep our mood positive and enjoy the things we can.

Monday, August 16, 2010


Recovery is starting to get easier, and that's a wonderful thing. I have returned to work, on "easy duty" status- office type stuff, not getting back into the classroom for a bit still. I'm having less chest pain, but it's definitely not gone. My muscles are still pretty sore/inflexible, and not able to take much stress, but once again, healing. One irritation that has actually gotten a bit more frequent is something my surgeon told me to be ready for, and it's a little weird. Since I have a foreign object lodged in my chest cavity- the strut attached to my ribs that is supporting my sternum until new cartilage can do so, and that cartilage is growing, and in general things are changing inside- my chest will occasionally "click" from the inside. This is apparently from things doing a bit of rubbing or grinding against one another- for example, the bar on my ribs or the new cartilage I guess. I don't totally understand it, but what I do know is that it feels disgusting. It feels like something is broken and loose and moving around inside my chest. Sick. I guess it is supposed to pass with time. I felt it once and a while at the beginning of recovery, but it's happening quite a bit now- many many times per day and night. Sometime it will happen with every breath for a little while. It's a bit distracting. All part of getting better though.
On another topic- I hate that I can't commute via bicycle right now. Alison and I currently own and pay insurance on three vehicles (we're trying to sell one), and they are sucking too much money. Automobiles tend to do nothing but take money from your pocket quickly, and my pickup has been exceptional at that recently. I just dumped a ton of money into diagnosing a IPDM (electronic relay box basically) that was causing the engine to randomly shut down (and wouldn't store any sort of diagnostic trouble code). Now that that's done, I've driven less than one hundred miles, and I've got a code coming through for a large EVAP system leak. It could be something as simple as a bad gas cap, but maybe something costly too. Not sure yet, and I can't really do much auto work for obvious reasons. Bugger. I guess I have two other cars.
If you are not recovering from surgery you should ride your bike to work instead of paying too much money on your silly car or truck. That's my view. You'll get hooked on it and wonder how you never did it before- trust me.
I'll keep you all posted on the surgery recovery, and I'm sure the truck issues will get solved. Later.

Tuesday, August 10, 2010

Honesty... :)

I read this on part of the Jill Outside blog this morning...

"I love climbing fire roads!.....The other kids sometimes complain and think fire roads are super lame, so I pretend to hate them too."

I like fire roads too.

Sunday, August 08, 2010

The Salsa Mukluk

So I've spent quite a bit of my time on the internet lately while healing. While doing this, I noticed Salsa Cycles has come out with yet another bike I like the look of. It's not exactly a brand new design, but I think they've done a great job entering the market of this still-infant branch of riding- snow-biking. It's the Salsa Mukluk. You've heard me speak of the Surly Pugsley in the past. If I was a man of much money I'd have owned one of them as soon as they came out, as I live in the part of the country where one can come in extremely useful- we have one of the biggest winter-riding cultures in the US here. When you hear of winter biking, there's a good chance MN and AK are the states that come up. This is because of the Arrowhead 135 and the Iditarod Sport Invitational.
The most obvious feature of a snow-bike is the tire footprint. Huge is the description. 3.7" wide tires are the norm, and generally the frame will accommodate up to 4". This takes a dedicated rim, 100mm (long) bottom bracket, and off-set of the drivetrain. What the bike is designed to due is ride at very low tire pressures with the huge tire footprint providing much more floatation over snow, ice, sand, debris, and other forms of crud, all of which we have a lot of here in MN (and AK is certainly known for as well).
I've had the chance to ride a Pug in a parking lot, but that's it. I'd love to ride one where it matters and see the difference. Those who own them swear by them, and they're a pretty bike-centric group who know what they're talking about. You'd be hard pressed to find a snow bike owner who doesn't ride seriously.
It's nice to see the snow-biking culture expand to include another machine available (and one that is aluminum- the bike will be subject to the worst riding elements you can imagine, afterall). There are certainly more snow-bikes out there, but they usually involve a whole lot more money. The sport is becoming more accessible to the the common cyclist. It will not be this winter due to my current physical challenges, but if I live in MN long term, there is a good chance I'll figure out how to own a snow bike. After all, we have a lot of winter.

The Salsa Mukluk:

Thursday, August 05, 2010


So it’s taken me just over three weeks to work up the motivation to update the blog. Pretty much everything has been going slowly, as this has been the biggest stretch of concentrated physical pain and discomfort I’ve every gone through, but my condition is crawling towards the better. I’ve had surgery before, but never with a recovery like this one.

My surgery went as scheduled on the 14th of last month, but lasted longer than most. My sternum posed a particular challenge to my surgeon, despite his being one of the most experienced in the country in this procedure. Due to it’s being twisted as described in my last post, it was necessary for him to break it in a couple places, as well as lift my upper abdominal muscles in addition to my pectorals to get it positioned where it should be. The good news is that it was successfully moved, but you can guess the bad news. The extra invasiveness of breaking the sternum and moving my abdominal muscles equal a harder, more painful recovery. I was told by my surgeon that my repair was one of the most difficult he's ever performed.

I was anticipating being back to work and feeling a lot better than this as of now, but I’m still at home until somewhere around the end of next week, if not the following Monday. Recovering has been a huge challenge and a new life experience.

When I came out of surgery, the first thing I remembered was being in the “recovery room”. I was no longer intibated. I remember trying to lift my head to look down at my chest and a nurse kept me from doing so, saying I’d be much better off to not be moving. She got me a mirror, and I remember seeing my chest through very fuzzy consciousness and it no longer had a severe excavatum case. Apparently I then smiled and fell back asleep due to the drugs.

I woke up later as they were moving me into my hospital room. A team of people got me off my surgical bed and into my recovery bed. I remember an incredible stiffness and a lot of pain in my chest, which they then got me on morphine to control. Alison and my mother in law Faye were there, and I don’t remember a lot else. The next few hours aren’t very clear to me, other than watching a machine that told me how often I could self-administer morphine doses to ease my pain.

Eventually, I had to pee very badly, as I was being injected with a saline type solution through my I.V. in addition to the morphine. I tried to go into a portable urinal, but I couldn’t. I asked my nurse to help me up, and that turned out terribly. She had “floated” up to this floor from where she normally worked as the hospital was busy, and I don’t think she understood just how unable I was to get out of bed due to having my abs and pecs both lifted and reattached. She pulled me up a bit abruptly, and once I was sitting up, I had so much pain in my chest that I had trouble breathing, started sweating profusely, and then I must have passed out, because I don’t remember her getting me to lay back down and that’s the next place I found myself, with a fan blowing on me and everyone looking very concerned. I didn’t try to get up for a while after that, and managed to pee in the bottle.

I was in the hospital for two and a half days, going home on Friday night. During my time there, I managed to learn how to get in and out of bed, and starting walking a bit before they’d let me go home. The physical therapy folks they had me work with told me I had to avoid using my pecs and abs altogether, and to get up and down I had to use my legs to first roll myself onto my side, then I’d hook them under my bed and use them, plus the muscles in my side to sit up. I’d do the opposite to get back into bed. If I did it all right the pain was bad, and if I did it wrong the pain was incredible. I spent quite a bit of time awake, not able to sleep due to pain, and the fact that every roommate they gave me seemed to be very loud. I don’t quite understand how it’s standard to order you to get some sleep and then put you next to the loud old guy with terrible sleep-apnea.

One good thing I can say is that the hospital food was actually decent, and so was my appetite. It felt great to get some sustenance and not just be filled with narcotics. I did have to get put on two different very potent laxatives with my drugs and food as I ended up looking pretty pregnant after it all, getting a heavy case of abdominal bloating. This went on for the first week and a half of recovery, and felt terrible, but I got over it.

Coming home was a good change of scenery, but a hard process. Before leaving, I had to have a drainage tube removed from my chest that was running from my chest cavity, right around the area the bar is located, to a little plastic container which looked like a grenade full of blood, attached to my hospital gown. I felt the entire length of tube pull from my insides, much like long piece of spaghetti snaking through my chest cavity. The doctor who pulled it asked me how I was feeling, and I replied, “that was one of the most disgusting feelings I’ve ever had”, but it was great to have it out, and at least that process didn’t hurt.

I was wheeled down to the hospital entrance with Alison, and my mom, who flew down to be with us in the hospital and at home for the first weekend, and had a very nervous car ride home. I’m still a bit uncomfortable riding in automobiles, as I feel every bump, corner, acceleration, and stop, and I’m constantly thinking how much pain my seatbelt and the airbag would cause me if we were to be in a fender bender.

While at home, I’ve spent most of my time watching movies, going through the LOST series all over again, reading, watching the Tour de France finish, Facebook’ing and trying to sleep. My other pastime has been pain management. For the most part, I’ve been able to stay ahead of the pain enough to tolerate it, but it’s gotten away from me a couple times. One particular night, I woke up with pain the right side of my back, around from my right pec. Upon getting up, it quickly spread around my side to my chest, and got very very intense. Alison helped me take pain medication, put me back in bed, and it got worse. Worse to the point I thought I was going to need an ambulance. I could barely move at all due to the pain, and had her call the hospital. They instructed us to get to the E.R., but I couldn’t get up. Alison massaged my muscles while the pain medication kicked in, and after an hour or so of this, I was able to get up and to our couch. Continued massage and deep breathing eventually worked out the pain. The doctors ended up thinking it was muscle cramping due to all the recovery pain I was having. I was too tense for too long, and this was how it played out. They prescribed me muscle relaxers, and since then I’ve been able to control the issue.

For rehabilitation I’ve also gone out, as instructed, for walks around my neighborhood, which have gone from one block to many now. I’m always exhausted when returning, and have to rest quite a while afterword. It’s been an awful change for me to have gone from my previous state of fitness to this, but it’s all part of a greater gain in the end. I have not felt any great improvement in lung capacity or cardiac output yet, because I have obviously not been in any condition to push myself. Plus, my chest has been somewhat fluid filled during healing, and very sore. My surgeon is very happy to have lifted my sternum off my heart though, and the expectation is that I will see a gain in those functions after I heal and return to strength. I recently spoke with someone I know who had a similar severe pectus case that was repaired, and he reported a 40% gain in heart expansion. It will take a while to see it yet for me, but I think I’ll see a great change. Now is the time for trust, hope, and healing. Later will be exercise.

As far as cosmetics go, I’m still quite lumpy, but greatly improved. I don’t know what I’ll look like after full recovery and muscle return. For now I still have a noticeable indentation in my upper right chest. I’m a bit confused as to the reason, as I’ve had two different answers when asking about it after surgery. I seem to remember being told right after the procedure that not all of my deformed cartilages were removed, as this would leave too little structure even with the surgical bar to support the chest during recovery. So that left me thinking it was remaining defect- that not all of it was correctable. However, I had my first follow up appointment this week, and my surgeon now described the indentation mostly as a result of muscle issues. Both right after my surgery, and at the follow up, he cited that my right pectoral muscle is currently around half the size of my left, due to it never having room to gain mass as a result of the severe excavatum deformity we just corrected. So even with the structure of my chest fixed, I will still look a bit off unless my right pec fills in with time and weight training therapy. It is right now unclear whether it will reverse to normal, or if it’s atrophy will be long term. I was told that during recovery my muscles will atrophy more, and I will look like I’m getting a repeat case of the “funnel chest” I’ve had, but that is muscle related, not skeletal. Glad they warned me of that or I’m sure I will have worried myself silly as it happens. So long term, I do not know what exactly my chest will look like. The main goal was heart improvement, and we seem to have achieved that, and cosmetically it’s been a great improvement that may get better with time. I’m looking forward to being able to exercise in the future and see what my body is capable of now that it’s been repaired.

I promised some before and after pictures so I’ve included some of the ones we’ve taken over the past month. As you can see, there has been quite an improvement. I have a long way to go yet to getting back to my regular life, but I still trust that this will be worth it in the end. You can see that in my appearance alone.

I’ll end with a big thank you to everyone who has helped me along this process- family, friends, coworkers, and particularly my wife. You have all been critical to keeping me physically, mentally, and spiritually together during such a painful time, and I thank you. Very much.

I trust you'll be able to decipher the before's and the after's. :)

Tuesday, July 13, 2010


So in my last post I stated there was a reason I was doing a replacement ride for this year’s Headwaters 100, and that I’d explain later was it was. Well, here it is; many of you already know of the situation, but I’m finally putting it on the blog:

I’ve dealt with a chest wall birth defect my entire life known in the medical community as “pectus excavatum”. It is basically a dent in the chest. In my case, it is a severe dent. What causes this is rapid, non-normal growth of the cartilages supporting the sternum. This progressed while I grew up, and eventually my sternum has ended up in a position where it has rotated near 90 degrees, with the right side of it now pointing to my spine. Not quite right, huh? Plus, it is very recessed, and as you can imagine, this places unwanted pressure on my heart and lungs, particularly the right ventricle of my heart. As far as symptoms go, this has shown itself the most in the form of exercise fatigue, and a reduced ability to be competitive at the outdoor activities that you all know I spend most of my time off doing. Bad mixture. This is because cardiac output, as explained by my surgeon, is essentially determined by three things: blood available x heart beats per minute x expansion of the heart (right ventricle). You can see the problem right there. My heart can’t expand, and this puts me at an obvious disadvantage. Correcting the deformity would solve this. Not correcting it would mean continuing impairment, as well as the possibility of heart arrhythmias as my heart beats against the hard surface of my chest wall while it is meant to have more expansion volume. I have been in no immediate life threatening condition over the years of dealing with my pectus excavatum, but it has been determined medically necessary to correct with surgery at this point. The way surgery is determined to be necessary is by a pectus or “Haller” index, which is measured via chest x-ray and c-t scan. It’s essentially the ratio of a persons chest depth and width. A normal persons index is 2-2.5, they recommend surgical repair at values of 3.2 or more, and I exceeded 4. It needs to happen.

I am ready to have a “normal” chest to say the least. I have become very sick of having the impairment, and am excited to breath and circulate without restriction. I can’t wait to feel the difference over time. And I would be lying to say that the appearance of the deformity has not been a point of bother through my life. You haven’t seen me at the beach much, have you? I have through the years made an awkward peace with the way my chest has looked, but it has always been tedious explaining to everyone what my condition is, and I’ve always wished it wasn’t there. I didn’t choose to have a giant hole in my chest, and I know that nobody I care about judges me for looking considerably different, but people are people; I’m no exception, and we all suffer the mental capacity for embarrassment when we are “different”. It will be nice to “feel normal”. But by far, the improvement of heart and lung function is the main reason for going through the surgical repair. If it was an issue of cosmetics, there is no way I would put myself through the surgery I am facing. Additionally, I feel it worth pointing out that many people have considerably worse deformities/injuries/sicknesses, and I feel very fortunate that this is the worst of my health and appearance concerns. This should pass.

As for what the surgical process involves, you may read this paragraph if details of medical procedures do not bother you, or you may skip to the next if they make you uncomfortable, but I felt I would explain what I’m going to experience as many would like to know. I will be undergoing the Ravitch procedure for pectus excavatum repair. It involves an incision over the center of my deformity (the examples I’ve seen look like an upside down smiley-face), where the deformed cartilages are then removed. My sternum will then be positioned where it should have been all along, and a stainless steel bar (I’d prefer titanium so as to not set off every airport alarm, but no luck) will be placed behind my sternum to support it in it’s correct setting. Then they zip me back up.

I’ll be in the hospital for 2-3 days for observation/pain management, and then I’ll get to go home. I’m scheduled off work until somewhere around the first week of August to recover, and then I’ll go back to the office. A “full recovery” is estimated for somewhere around six weeks. This is referring to normal day to day activities for a regular American, not a cyclist/backpacker/rock climber/generally dissatisfied with sedentary pastimes type of person, or in other words me. I’ve been told it will be 3 or so months before returning to light cycling, and around a full year until I can start to ease back into climbing or backpacking. Ugh. Plus second surgery will have to happen (outpatient), to remove the bar will follow anywhere from 3 to 12 months after the initial surgery, when new cartilage has developed in the right places to support my sternum, and I’ll have to recover from that one too. My cams are going to get dusty hanging in the closet, but they’ll be waiting for me when I get strong again.

On another note for those of you in the aviation community- I am relieved to have been told by several AMEs and AOPA that this will have no grounds to affect my airman medical certification, barring any complications. It’s treated no different from breaking a bone and healing up again. Good news.

I’ll try to post some “pre” and “post” pictures at some point in the future, and myself or Alison will keep everyone updated on my progress as things move along, but for now I’ll leave you with an example shot of what my chest currently looks like. I have many, but I picked out a picture that also happens to have a nice background- Parriot Mesa in Castle Valley, UT. Beats looking at me in some boring documentation-type picture taken in my apartment.

I appreciate all your thoughts and prayers, and I’ll blog more on the recovery side of this…

Sunday, June 13, 2010

Superior Times...

The past few weekends have been spent in Northern MN, which is the part of MN that keeps me from going nuts after leaving UT three years ago. I really do enjoy the Lake Superior Region. The first weekend marked Alison’s first loaded touring ride. We started in Willow River, MN, and road to Jay Cooke State Park on the Willard Munger state trail. I tried to pick an overnighter that wouldn’t be too difficult, and this trip worked out very well. The route was almost entirely on non-motorized trail, the weather was nice aside from a steady headwind the second day (but that’s touring; can’t pick your routes on wind each day), we had a great place to spend the night (with showers), and were able to relax quite a bit in between hours in the saddle. The mileage was a laid back 80 mile total over the two days. It was a good way to get a taste of touring without needing a lot of time. But as always it made me want to pitch all my responsibilities and take six months off for a mega-tour. Someday. Not sure when. I seem to have landed in a teaching position that does not have summers off. Hmm.

The second weekend (Memorial Day Weekend) was spent day hiking, lounging, and eating (a bit much) up on the North Shore of Lake Superior. We made Cascade River State Park our home base. That allowed us to get out and hike the river loop there that I’ve been meaning to see for a couple summers now, and it was well worth the walk. There’s not as many people up there on the trail, because the people here in the Metro, true to have-it-now urban fashion, will usually not venture much past the first couple state parks on the Shore, leaving the more distant parks emptier. Good. Bit of a selfish catch 22 actually. I think it would do most people more good than they realize to take a walk in the North Woods, but it is what it is precisely because there are very few people around and I appreciate their not being there.

After leaving the woods where the people aren’t, we headed to Grand Marais, where the people are. Namely where the people make food. The Angry Trout is one of our favorite places to eat in all of MN (and we live in a foodie neighborhood.) I really do recommend stopping in for a meal if you’re in the area.

The third weekend to discuss was a personal Headwaters 100 replacement ride. I will explain in a later post the reason it was replaced. I spent this weekend in the same general area of the North Shore, but this time camping at Temperance River State Park. The trip simply had the goal of riding one hundred miles in a beautiful area, and the goal was achieved. The conditions were much less than perfect, but it didn’t matter. I had a wedding reception to attend in downtown MPLS the night before, so I ended up on the Shore after sleeping on 4 hours, and driving 4 and a half. The weather was challenging, with highs in the upper 40’s/lower 50’s, and thick fog/mist to enjoy the entire route (good ol’ Lake Superior induced conditions- gotta respect a Lake so big it drastically affects the weather.) As many of you know, bad weather seems to energize the cyclist in me, and I actually found myself enjoying the ride more than fair weather long hauls.

The route lead from Temperance north, passing countless rivers, wooded valleys, and state parks, all while following the shore of the big lake (which could be seen much of the time, but not always due to said fog.) I also passed through Grand Marais twice- once northbound at mile 30, and southbound at mile 70. The turnaround point was a little over 20 miles shy of the Canadian border. Had I not started late in the day, I really felt the pull to make it a very big ride and see another country. Even so, the ride covered a descent chunk of the US portion of the North Shore. And if I’d gone further, I definitely would have ended up riding in the dark on sketchy shoulder-less stretches of HWY 61 to finish the ride- not ideal. I did have my NiteRider lamp with in case, but was content not to use it this time.

All in all a fantastic ride. With the weather being so crummy (or excellent depending on your point of view), north of Grand Marais it was pretty much just me, my old Lemond, and the Lake. A good trio.

This weekend has been a “catch-up” weekend around St. Paul. Broken down pickup, apartment chores, etc… The upcoming weekends/weeks should hold some fun- most likely some more big waterside fun- the North Shore again, and if we’re lucky with flight loads- Hawaii. Gonna try again.