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Happy New Year! (UPDATED: repairing teeth)

Tip for Palo Alto area residents: I keep hearing from various parties that the best place to go for trauma is Stanford Hospital, particularly for potential concussion. I don’t quite know how that works out with insurance just yet (out of network), but that’s where they took me.

I feel blessed because my neck is not broken though it took the ER 20 hours to be sure—just back home out of the ER overnight this afternoon. No nerve damage or signs of it.

Everything hurts and 2 hours of sutures on face and mouth (inside too) is no picnic, but I seem to be A-OK, just sore and very tired. I won’t post any pictures—too gruesome. I am not using narcotics, and Tylenol/Advil are doing the job just fine.

I want to forestall answering many emails, so I’m going to tell the story here, once.

Many thanks to the highly skilled plastic surgeon at Stanford who was on call (how lucky is that?!), who related to me his 25 years of sewing up Marines, and 6 crashes of his own—he no longer rides, which is food for thought. I got to listen to all the shop talk while he and another surgeon sewed things up methodically and efficiently—these guys are total pros and every MD with that level of skill has my deep respect and admiration.

Even with XRays, CAT scans and MRI, an old injury had them sure that I had a broken C3 vertebrae, but it turns out that it was/is a “chronic” thing caused by past injury. I’ve had that awkward spot in my neck for years, but that did not occur to me while lying on the gurney in pain. Fentanyl (once) and hydromorphone (3 times 3 hours apart) work, but I asked that it be minimized as I wanted to remain reasonably alert.

The neck brace worn overnight was torture, digging into my back and making it ache as bad as the injuries. Stone-age technology. This is almost funny—the morning doctor asked if I wanted to take the neck brace home with me for “comfort” (strained neck muscles)! I passed.

Fantastic skilled surgical work—not a person could see a stitch when done: so skillfully did he close the wounds that even the the nurses only half-believed me about the 3/4" hole punched through my upper lip all the way through, and the deep cut on my chin, and the large divot inside. Small chunks of tissue were missing (as per the “shop talk”), and nerve, muscle and skin had to be done in sequence. He kept running out of suture material.

It all looks cleanly done, but until it heals and the swelling drops, I don’t know if I’ll look more rascalish or not. Some teeth need repair and that will probably be the worst part. I am eating smoothies for the time being but the front teeth shifted overnight and I cannot chew—might need orthodontia for the two fronts.

Dumb goof

People ask (already), so I might as well relate what to me is a really bad protocol, combined with bad luck:

I was riding my bike, the 2nd day of what was to be intensive 50 mile/day training for 3 weeks. The wind was strong but I was getting warm so (riding no-handed), I pulled off my wool hoodie. That in itself went fine as it always does. The wind was strong so I decided to stop to tie it around my waist. Accordingly, I half-balled the hoodie against the handlebar, in preparation to stop. That proved disastrous—somehow the wind grabbed a sleeve and threw it into the front wheel, which rotating forward, caught the sleeve and instantly balled-up the entire hoodie, stopping the bike in an instant from 15-20 mph. Newton’s Law took over from there at 19.44 mph.

Post-op

I look a lot better all sewn up and cleaned up (front teeth, not so much, that will be a project). Nor do I feel concussed, which is a miracle of sorts. So I feel lucky and blessed and joyful all at once, really happy to come out so well when it could have been so bad (eyes, arms, legs, back, nose, spine all good). Today on New Year’s Day 32 hours later, I don’t even need Tylenol.

The 2 cm hole which punched all the way through my upper lip was a bit messy when the saline was cleaning things. But it’s all nicely sewn back together. The yellow stuff is lymph fluid which oozes out, not infection, or so I think. The doctor advised to not remove it, and I’ll see an MD tomorrow to check for any signs of infection.

Below, it might look like abrasions, but a 2cm through-hole had existed in my upper lip as well as deep internal gouges and a deep cut in my chin. Repairing nerve, muscle, and skin required at least 90 minutes of stitching by this very skilled plastic surgeon, and a 2nd doctor assisted. I’m guessing at least 100 stitches or so and the surgeon ran out of sutures at least 3 times. The job was so well done with invisible self-dissolving stitches of very fine diameter that even the nursing staff were skeptical that a 2cm through-hole had existed in my upper lip prior. Lots of stitches are inside in lower and upper lips areas too—a big job, expertly done.

f2.2 @ 1/30 sec, ISO 160; 2019-01-01 11:15:06 [altitude 511 ft / 156 m]
iPhone 7 Plus + iPhone 7 Plus 2.9 mm f/2.2

[low-res image for bot]

Update: I picked up my bike from the fire station. I had not seen it since before the crash, but my theory looks to have been spot-on: the sleeve got sucked up and wedged into the front brake. The bike computer showed that I was going 19.44 mph.

f1.8 @ 1/120 sec, ISO 40; 2019-01-01 15:53:04
[altitude 316 ft / 96 m, "bike after crash as picked up at Fire Station"]
iPhone 7 Plus + iPhone 7 Plus 4.0 mm f/1.8

[low-res image for bot]

Repairing the teeth

Periodontist Dan Nelson writes:

I’m a subscriber and I follow your blog and read about your recent bike accident. I’m also a periodontist in Mountain View. As a dental specialist and an owner of a referral based practice, I know a lot of really great dentists and specialists who can help you in your area (if you don’t already have a great dentist). Trauma to your front teeth can involve a lot of different issues and you’re likely to need at least an evaluation by a specialist or two (and endodontist and periodontist come to mind). Please feel free to reach out to me if you need help of any kind. I’m happy to recommend some high quality dentists who can help.

I am grateful to periodontist Dan Nelson DDS in Mountain View for recommending an excellent endodontist and securing a 9 AM appointment for me. In this sort of crash, prompt action can save teeth that might die from the damage, so if you have trauma to teeth, get them looked at without delay. I wasn’t aware of two key risks: (1) death of the nerve into the tooth, and (2) bone growth into the tooth, was if not prevented can cause the tooth to die.

I visited Dr. Keivan Zoufan DDS MDS in Los Altos this morning on a day he had scheduled no patients or staff. We had a short examination and chat and then used his state of the art CT scanner to create a 3D scan of my teeth, as shown below—all in a few minutes. This is incredible stuff—turns out that the broken-off tooth shows no internal damage but the intact tooth can be seen to be wedged out of place along with a broken piece of bone in the surrounding jaw, as seen below. Seems that this particular tooth was “too strong” and instead of breaking itself, disrupted the tissue around it.

Dr. Zoufan’s wife, orthodontist Dr. Mozafari DDS was also in, also with no scheduled patients and thus no staff present. To my utter surprise, Dr. Mozafari along with Dr. Zoufan as assistant (!) installed orthodontia to ease the intact tooth back into its proper place, thus raising the odds of both saving the nerve and avoiding losing the tooth by having bone grow into the tooth, not to mention restoring proper alignment for a proper bite (this takes time of course).

Talk about exceeding expectations! I don't think I've ever had such attention from a doctor for a regular visit, let alone two and the work was quickly and expertly done. I felt very special, and I thank them both profusely for their expert on-the-spot analysis and repair. Highly recommended!

Dr. Zoufan also ground the out-of-place tooth a little to allow chewing with some care, versus a hard stop-click prior which has made any solid food challenging so far. Given a little time the orthodontia should move the tooth back into place.

Tooth pushed out of place with broken bone chip in jaw
Tooth pushed out of place with broken bone chip in jaw

Update Jan 13, 2019

I’m healing up very fast. Biking the past 3 days seems to have accelerated the pace. I also think that the Bemer pulsed electromagnetic therapy has contributed.

14 days of healing
f4 @ 1/30 sec, ISO 80; 2019-01-12 16:35:11
DSC-RX100 + 28-100mm F1.8-4.9 @ 39mm equiv (14.6mm)

[low-res image for bot]

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