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Hard hits - what's really happening?

 
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PostPosted: Sun Nov 05, 2006 8:34 am GMT +0000    Post subject: Hard hits - what's really happening? Reply with quote

Friday night I had my second major bike wreck. Major, to me, = a visit to the hospital. Irritatingly, this wreck occurred at the same place my last major wreck occurred. While neither of these required a hospital visit, I'd rather be safe than sorry. The first time it was just a dislocated shoulder and a leg, back, shoulder, and arm full of cactus (ever had to use pliers to yank them out? yeah, that deep.)

This time I botched the landing on a high-speed (that's about 30mph for me) jump. I landed front tire first, bottomed out the fork and lost my grip on the handlebars. So I slammed chest-first into the handlebars before losing control and wiping out. I was having trouble breathing and I was worried about internal bleeding, so I went ahead and swallowed my pride and went to the hospital. Nothing is broken, they said - just gave me some Darvocet (yay!) and sent me home.

Now then, my questions: I want to know what's really going on after these wrecks. Both times the same thing has happened just after the wreck. I get extremely light-headed, dizzy, and both my hearing and my vision fade in and out. That is, my vision begins to white-out and all the sounds get further and further away. I have never lost consciousness, but it feels like I am going to. After the first wreck this only lasted a couple of minutes and then was gone. I assumed it was some sort of adrenaline flush or something. But this time, it lasted closer to 30 minutes - and it came back two hours later (while I was getting x-rayed actually) for five minutes or so.

So what is really going on? My normal blood pressure is fairly low, if this is relevant. 90/70 I think? Does everyone have this sort of experience after a big hit? One other time in my life I experienced this - I was fairly young, maybe 10 or 11. I was sleeping in the back seat of our family car on a long trip. We stopped for lunch at McD - I jumped up, ran inside, and while standing in line I had this experience - that time I actually completely lost my vision - everything was bright silver. It was very disconcerting. But that leads me to believe that it isn't from a hit to the head or from adrenaline. Blood pressure I'm guessing.... ??

My second question is probably a good one for everyone on this forum: when should I go to the hospital? Hospital's are expensive and it can take a long time to get seen. I *only* had to wait 3 hours this time.... I had a hard time deciding if I should wait to see if the pain went down on its own or if I should just get it checked out. I went with the safer route - but now that I know nothing is broken I regret it - since that visit will probably cost me $500 (my deductible). Specifically, what are warning signs and symptoms for internal bleeding, and is that really a concern with bike wrecks? (I don't know how hard a hit as to be for that to be a concern).

Final question: any reason why I shouldn't get back on my bike as soon as the pain goes away enough? I can breathe without excruciating pain now! But maybe that's just the pain killers speaking...

Thanks for your time! I hope these questions are useful to someone other than me.

Oh yeah - don't worry. My beautiful, brand-new, SC Superlight R XC is fine, apart from some scratches. As always, my bike leaves the scene in better shape than I do.
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The Bike Doc
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PostPosted: Sun Nov 05, 2006 11:07 am GMT +0000    Post subject: Reply with quote

DrewWinters:

To answer the first question, it is likely the light headedness after the wrecks were due to a reaction cause the "Vasovagal" response. Pain can trigger the stimulation of a nerve, the Vagus, which slows the heart rate and lowers the pulse. There is associated nasuea as the vagus nerve goes to the gut and stimulating it can trigger nausea and even vomiting. The lowering of the blood pressure suddenly causes a decrease of blood flow to the head and the subsequent light headed feeling and disturbances to the vision that you accurately describe, textbook description as is often said.

The episode of your getting up from being reclined in the car to go to McD's was likely due to orthostatic hypotension. Going from reclined to verticle in someone with low normal blood pressure can cause a similar reaction as with a vasovagal reaction, except this time the cause of the decrease blood flow to the brain is a sudden drop of the blood pressure form going to reclined to standing rapidly with blood being pooled in the lower legs. End result, vision goes squirly, brain goes funky and in severe cases complete loss of consciousness or feinting occurs. The treatment is to rise slowly, sit full upright for a minute then stand for a minute and do isotonic contractions of your leg muscles (contract the muslces on both the front and the back of the leg at the same time repeatedly) to pump blood back to the heart then brain. Then procede to walk about and get you McD order or such.

The next question harbors close to asking me what the winning lottery numbers will be or who will win the next election. (Sooth saying is not in my medical training.) When should you go to the ER? Basically if it hurts bad, you crashed major with lots of speed or have numbness, tingling or weakness get an evaluation. Better to be out $500 deductable and be told your okay, than to hold off on going and later develope permanent injury due to not getting checked out.

When can you get back on your bike? When it doesn't hurt. If getting on the bike still causes significant discomfort, hold back and allow you body more time to heal.


I am glad your Superlight managed to roll away with only a few minor scratches. I am even more glad that you were able to walk away with nothing more serious. The type of crash you had has takenout many a good rider.

Thanks,
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PostPosted: Sun Nov 05, 2006 3:37 pm GMT +0000    Post subject: Reply with quote

Thank you for the quick response! It's good to know.

I can see how my second question could be a bit difficult to predict. And your right, I'd rather know I'm OK than wonder whether I will be. I imagine one of these days I'll be glad I decided to play it safe. Now if I could only convince myself to play it safe BEFORE I get injured...

Thanks again!
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PostPosted: Tue Nov 14, 2006 3:48 pm GMT +0000    Post subject: Reply with quote

Well, things went from bad to worse for me.

When they X-rayed me at the hospital after the wreck, they weren't able to see that my spleen was bleeding internally. Not long after I wrote the last message here, things started going badly. What tipped me off that something else could be wrong was an increasing pain in my left shoulder that didn't seem to actually come from my shoulder. That is, it didn't change with movement or use of my shoulder - it stayed more or less constant regardless of what I did to it....turns out I guessed right: referred pain! Anyway, within a few days I was under a CT scan - and in surgery soon after. My spleen was damaged beyond hope of recovery in the wreck and it was bleeding out into my abdomen by the time they figured it out. Surgeon said he removed a liter of blood from my abdomen and that my spleen was three times the normal size (it had been bleeding inside itself, apparently. So they cut me open, sternum to navel, and took it out on Thursday!

I'm still at the hospital, but doc said I could probably go home tomorrow.

I guess the moral of this story for bikers is, beware of internal injuries after hard crashes. Just because your skin is OK, doesn't mean you are. <shrug> Doesn't look like I'm going to be racing anytime soon. Sad
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The Bike Doc
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PostPosted: Wed Nov 15, 2006 10:10 am GMT +0000    Post subject: Reply with quote

Drew:

Thank you for the follow-up. I hope for your speedy recovery. If you have not yet received it, get the influenza vaccine and the 23 valent pneumococcal vaccine. Without your spleen, you will be more prone to serious infections.
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PostPosted: Fri Nov 17, 2006 9:51 am GMT +0000    Post subject: Reply with quote

The hospital vaccinated me for flu, meningitis, and pneumonia. One of the three left my hip feeling like they used rebar to inject it...

But I'm home now and doing much better. However, I have another question. I'm on Hydrocodone (Lortab) for pain - but it seems to do much, much more than that. If I don't take it, I have trouble standing up for very long without getting lightheaded and even feeling faint. I feel like a have a fever - that is, my head feels hot and I can feel my pulse throughout my head. I feel really strange all over. It only does a moderate job of taking away the pain! But without it, I feel terrible.

What is going on? I've only been on it a couple of days now, surely I'm not already so addicted than I'm feeling withdrawal?
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The Bike Doc
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Joined: 08 May 2003
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Location: Corpus Christi and Warda, Texas

PostPosted: Sat Nov 18, 2006 2:13 pm GMT +0000    Post subject: Reply with quote

Drew:

It may be possible that you are experiencing some withdrawl symptoms. You likely recieved narcotic medications intravenously during your first few days after your opperation, then you were switched to an oral narcotic such as the Lortab you are on. Most people do not have problems developing tolerance during a short course, however some individuals may. Visit with your doctor and surgeon regarding your symptoms. It could be withdrawl symptoms or it could be something related to the original injury and subsequent operation.

Thanks,
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