Archive | Injuries RSS feed for this section

Accident reconstruction

8 Jul

Since my return to the site of the accident the other day, I’ve spent a good deal of time thinking about how the locations of my various injuries might reveal some information about how I hit the ground. Unfortunately, the only conclusion I’ve come to (so far) is that something very complicated must have happened because there was evidence of contact with the ground in so many places.

Here is what I think is the complete list of body parts which showed evidence of hitting the ground:

  • Right cheek (abrasions to the right of eye and mouth, black eye)
  • Right earlobe (minor abrasion)
  • Right side of upper lip (two chipped teeth and a cut which was sutured)
  • Right side of chin (laceration was sutured)
  • Neck (very minor scratches)
  • Top of right shoulder (abrasion)
  • Left elbow (small abrasion)
  • Right elbow (large abrasion, some soreness for a few weeks after accident)
  • Back of left hand (minor abrasions just below bottom knuckles)
  • Palm of left hand (skin stripped from an area near the wrist)
  • Back of right hand (small abrasions on lowest knuckle of index finger)
  • Legs (various scratches and scrapes, none bad enough to bandage)

There were probably a number of minor scratches on my torso, but none seemed particularly significant at the time. Note that there’s no reason to believe that the left side of my face (where the mandibular fracture was) made contact with the ground. The fracture was most likely caused by the force to the right side of my face.

The one thing that seems pretty clear from the injuries is that I fell on the right side of my body. This is something I had assumed since the day of the accident, and something that seems consistent with the accident having happened while turning right. Beyond that, it’s hard to say much. It hardly seems  geometrically possible that I could have fallen in such a way that all of these body parts could have come in contact with the ground. Here are a few of the more puzzling questions:

  • How did I manage to scrape both the front and back of my left hand? I’m just baffled. I really don’t have a clue.
  • How could I have scraped the top of my shoulder against the ground? Uneven pavement might have helped. Other than that, I don’t know.
  • How did I scrape both of my elbows when falling on the right side?
  • How did I scrape my elbows and my hands, but nothing on the arms in between?

While I typed these questions, I actually thought of an explanation for how I might have gone down. Here’s my best guess. After losing control of the bike, I fell to the right, with my right shoulder and face hitting the ground but my hands remaining on the handlebars. As my body slowed down but the bike continued skidding, my hands let go of the handlebars, and with the left side of my body moving faster than the right, I sort of rolled over so that both my left and right arms hit the ground. This course of events would seem to explain the second and third of my questions, but not the first or fourth.

It’s really all quite a mystery, and I’ll probably never know what really happened.

Carrots

7 Jul

This evening (by which I mean Monday, July 6), I acquired three large carrots, weighing a full pound among them and ate them. My jaw handled them just fine, but I was concerned about my repaired front teeth, so tried to bite with my side teeth. This was somewhat challenging because it was hard to open my mouth wide enough to fit the thicker parts of the carrots into the side of my mouth. However, I did eventually succeed in eating all three carrots, allowing me to answer in the affirmative the question of whether it is possible for me to eat so many carrots as to make me feel sick. Fortunately, I’m feeling better already, though.

One of the three carrots I ate, in my hand (which I did not eat).

One of the three carrots I ate, in my hand (which I did not eat).

The accident revisited

4 Jul

I have to begin with a confession. When I wrote about my accident, I wasn’t entirely sure that everything I was saying was true. I didn’t say anything that I knew to be false, but I didn’t remember all of the details of how I had fallen. When I had no information about something, I didn’t say anything, but there were a couple of statements I made that were guesses based on what I did remember and what seemed to be the best information at the time.

For example, I wrote that I had been taking the downhill stretches faster than I was accustomed, and claimed that this was the cause of my accident. It’s true that I had taken some downhill stretches faster than I would have when riding alone, but I never had any specific recollection of going fast down the particular hill where the accident took place. When I stated that I had been going faster at the time of the accident, I was extrapolating based on what I did remember in a way that seemed to explain why I had fallen. Similarly, when I said that my bike crossed over the center line in the road, I didn’t have any specific recollection of that having happened at that particular turn. I had some recollection of it having happened somewhere, and it seemed reasonable to conclude that it was the place where I had crashed.

Anyway, I needed to make that confession because I revisited the scene of the accident this morning, and what I saw there led me to question both of the claims discussed in the preceding paragraph.

As I approached the turn where the accident took place, I could see that there were plenty of signs warning of a difficult turn. First was  something painted on the street by a well-meaning amateur.

SLOW!

Then there were the road signs as I approached the turns.

Right Turn, 15MPH
I’ve always been a careful cyclist, so this signage came as a surprise to me. I just couldn’t believe that I’d ignored it. The fact that I didn’t remember it being there  might suggest that I wasn’t paying close enough attention, but I also could easily have forgotten in my post-accident shock. (It also occurred to me that when the EMT asked how fast I had been going and eventually got me to agree that I had been going 20 to 30 miles per hour, I had admitted to breaking the speed limit.)

When I got to the actual turn, there were even more warnings.

Yellow Light, Right Arrow

I stopped at the corner to reflect on things and examine the scene for a while. Obviously, with the accident having happened 90 days earlier, there were no visible traces of my accident. However, one patch of pavement did catch my attention.

Cracked pavement

With the shade and an unfavorable angle, the photo doesn’t adequately display the magnitude of the hazard that this presents to bicyclists. In particular, it’s hard to see in the picture how deep some of the ridges were. Here’s another shot, which still doesn’t really do it justice, but it provides a little bit more information.

Another view of the cracked pavement

Also, the hill that preceded this turn actually did seem pretty steep, contrary to what I had thought when I looked at it on Google Street View.

Somewhat steep hill

In the hours since my return to the site, I’ve become increasingly convinced that the condition of the pavement played some role in my accident. The evidence is far from conclusive, but my biggest objection to that theory was easily resolved. This objection was that the cracked pavement was only found on the side where I was supposed to be riding, and I remembered crossing over the center line. As I mentioned previously, though, that memory of crossing the line may not be from this particular spot. Moreover, even if it is from that spot, it’s possible that I lost control on the broken pavement and then crossed over the line and fell.

I’ve spent a good amount of time examining my injuries and the scratches that the bike acquired in the accident, trying to figure out exactly how I fell and whether that might convey any information about the quality of the pavement I was on. The main way that such information might arise is if the bike were scratched in places that wouldn’t touch smooth pavement when I fell on it, but might have been able to touch pavement that was sufficiently uneven. Indeed, there are some scratches in places that seem like they shouldn’t have made contact with the road, but it’s not clear to me that the scratches could have come from falling on the ridged pavement either. The only other possibility seems to be that these scratches predated the accident (but I didn’t notice them until afterwards) or that they were acquired while the bike was at the fire station.

Since the morning, I’ve also had flashbacks of falling from my bike towards badly cracked pavement. I suspect that this isn’t an actual memory but something that my mind has fabricated to support my new theory of the cause of the accident.

Of course, all of this speculation on what happened that day has only minimal practical value. Determining the cause of the accident isn’t going to change the fact that it happened. Nor would it change the fact that the worst effects of the accident have, by all indications, passed. The only possible benefit from knowing why I fell would seem to be liability purposes, and not only does it seem unlikely that I’d be able to build a strong enough case, but I have no interest in pursuing litigation against a city that is broke when my insurance companies seem to have picked up most of the tab for my bills. I’d much rather see money go to fixing road hazards, which is why I reported this spot on the East Bay Bicycle Coalition’s hazard reporting site. Much to their credit, Oakland’s Public Works Agency apparently does a good job of fixing hazards quickly after they are reported, according to an article in the East Bay Express.

Eleven week billing update

22 Jun

I decided to consolidate billing-related posts into a weekly digest from now on. I’d like to be able to say that it’s because I’m too busy to write a new post every time a bill comes, but that would be a lie. The only reason I can offer is that I was tired of thinking of titles for posts about billing.

With that said, here’s what’s happened in the last week.

  • I received a statement from my oral surgeon. It was dated June 10, which was the day I had the arch bars removed. It was addressed to my father, but at my address, apparently a result of confusion over the fact that one of my insurance policies is through my father. The statement said that I had a balance of $1,963.18 which was “Due Now.” This number is apparently the $1,888.18 for the surgery left unpaid by the UC Berkeley insurance plus a $75 fee for the office consultation the day after the accident. I had expected my second insurance plan to pay something, so I was a little bit surprised to see the whole amount due now. The statement also stated that interest of 18% per year would be charged after 60 days and that my entire balance was 61-90 days old. This latter measurement apparently began from the date of service rather than the date of billing.I called the office of the oral surgeon to see if they had billed the second insurance company. I was told that they had, that I would receive another statement after the insurance had paid, and that no interest would be charged until then. The statement I received was apparently “just an updated statement,” which apparently means I can ignore the part about the balance being due now.
  • I also received a letter from Meridian Resource Company, LLC, on behalf of Anthem Blue Cross seeking to determine whether somebody else may be liable for some of the charges from the oral surgeon’s office. The only way I can imagine that this would be the case is if the road condition were such that the City of Oakland were liable, but I doubt that this is the case.
  • I still have a bill from Bay Imaging Consultants for $53.79. They seem to have not billed my father’s insurance, so I should get them to do so. I’ve been lazy about it, though, because the bill doesn’t have a due date.

Loose ends, Part I

16 Jun

With my recovery nearly complete, my posts here will be less frequent than they once were. I’ll still be posting about billing and insurance when there’s news on that front. I’ll also post updates on any new developments with my injuries if and when things arise. Eventually, I’ll get around to posting about some of the things I’ve learned from my accident and its aftermath (including a guide for those who are recovering from similar injuries) and how my experiences have influenced my worldview.

In the mean time, there are a few things that I probably should have mentioned a while ago. I’ll post three here. I may include more in subsequent posts.

  • Some time after I returned from my oral surgery, I found an x-ray of my mouth among the things that I had carried home from the surgeon’s office. I have never had any recollection of the taking of the x-ray, but it was apparently done after I had my mouth wired, as the wires are visible. Here it is. Note that the left side of my mouth (with the fracture) appears on the right side of the image.
    x-ray
  • It seems that I’ve neglected to explain that the part of my jaw that I broke, the condyle (or maybe it was the neck of the condyloid process, just below the condyle) is located near the joint with the upper jaw, rather than near the teeth. I suspect that this made the recovery easier than it otherwise might have been because the pictures of jaws broken between the teeth look far more gruesome than anything I saw on my own face.
  • A few days after the oral surgeon wired my mouth shut, my mother mentioned to me that she had read that people who have their jaws wired shut often have to carry wire cutters for emergency use. I had no recollection of the oral surgeon saying anything to me about wire cutters, but I could not rule out the possibility that he had said something but I could not remember because I was still feeling the anesthesia. Furthermore, some research showed that my mother’s claim was correct. Moreover, I discovered a few days before my wireless upgrade that the instructions I received from the hospital said,

    If your jaw was wired shut, it is important that you be able to open the wires in any emergency that makes it difficult to breathe, such as vomiting, extreme coughing or choking. Therefore, you must carry a pair of small wire-cutters with you at all times. Be sure you know which wires to cut in case this is necessary. If not, ask your doctor.

    To be clear, this came from the hospital, and I had my jaw wired a few days later by an oral surgeon at a different practice. But I never carried a wire cutter. I’m still alive today. Go figure.

Ten weeks

14 Jun

My accident was ten weeks ago today. With the teeth having been repaired and arch bars off, there are no obvious visual signs of serious injury remaining. I do still have scars from the road rash on my elbows and hands. My facial wounds healed long ago, but I’m finding that the bump on my chin where I had stitches is very prone to getting cut when I shave.

I sometimes get a tingly numbness on the left side of my face, but this seems to have grown more slight over the past few days. Occasionally, I feel a little discomfort (which I would not describe as pain) on the left side of my jaw. I do get a little bit of pain on the right side of my jaw when I open my mouth very wide, but I think it’s just a pulled muscle. Sometimes I also get a soft sound coming from the left side of my jaw when I open or close my mouth. The best word I can think of to describe it is a creaking sound, but I don’t think that captures it perfectly.

The benefits of a metal-free mouth

13 Jun

I’ve quickly come to believe that the best thing about not having arch bars on my teeth is that it’s much easier to keep my teeth clean. Food was always getting stuck in the arch bars and the wires that secured them to my teeth, and it would often take fifteen minutes or so to clean them with the toothbrush and the WaterPik and then dental floss. Without the wires, it’s much easier: I just brush and then floss.

Another great thing about having the arch bars out is that my gums don’t hurt all the time. I can’t remember whether I mentioned this in a previous post, but when I had the arch bars on my gums would always hurt a little bit where the wires touched them. Sometimes the arch bars and wires would move slightly, and then my gums would hurt a bit more. It wasn’t that bad, because I eventually got used to it and stop noticing it, but now that the pain is gone, I notice that my gums feel much better.

Good enough

12 Jun

I went in to the oral surgeon’s office today expecting to learn some new jaw exercises. In view of my recent reading, I was somewhat skeptical of the idea that my opening was actually going to get better, so I showed up prepared to ask whether it was reasonable to

When the oral surgeon came into the examination room, he asked me how my opening was. I started to answer before he clarified that he wanted to see it. I opened my mouth, and to my surprise, he told me that it was better than he expected. He added that most people can put three fingers in their mouth, and then demonstrated by trying to put three of his fingers in his mouth. The third one didn’t really fit, though. He had me try to do the same, and I was able to put two fingers in easily, but my opening wasn’t wide enough for a third finger.  The oral surgeon said it was close enough,  demonstrated with his fingers that it was only a millimeter or two from normal, and then watched as I opened and closed my mouth a couple of times to make sure that it was opening straight. He said that I “totally qualify” to have my braces taken off and asked if I wanted them removed right then. I wanted little more, so I answered in the affirmative.

The oral surgeon told me that the wires around my teeth would poke my gums as he pulled them out, so he gave me three options for counteracting the pain: nitrous oxide and a numbing gel; nitrous oxide, the numbing gel, and  novacaine; or general anesthesia. I chose the first of these options, and the oral surgeon told me that most people can handle it, adding that it was “like having a really mean hygienist.”

The oral surgeon moved me to another room, where an assistant put gauze in my mouth, spread the numbing gel on my gums, and hooked me up with nitrous oxide through my nose. The oral surgeon came into the room and started to say, “The adventure that began in April…”. He said it in this overly dramatic tone that sounded like it might have come from one of Barack Obama’s speeches (video; see 9:44), but the second half of the oral surgeon’s sentence, “…comes to a close,” was decidedly less dramatic. He then took the gauze out of my mouth, told me to open my mouth, and cut each of the wires on the top of my mouth before pulling them out. It hurt a little bit, but the pain went away when the wire was out, so it wasn’t bad. At this point, I realized that I had actually started breathing through my mouth again, and I wasn’t feeling the nitrous oxide as much. The oral surgeon then removed the bottom wires. Somewhere in the middle of removing the bottom wires, I noticed that I was sweating a lot, but I don’t know if this was nervousness, an effect of the numbing agents, or a result of the room actually being hot.

The oral surgeon turned off the nitrous oxide and turned on a supply of oxygen, and told me that I didn’t need to return to his office, but I could call if I had concerns. He added that I’d be ready to chew the hardest foods (which he identified as crisp apples, hard French bread, and very hard vegetables) around July 4. The assistant gave me a toothpaste and toothbrush and had me brush my teeth. I had brushed before going, so there wasn’t anything but blood on them, but I complied anyway. The assistant told me that my gums would bleed easily for the next two or three weeks, but that I shouldn’t let this keep me from flossing.

Finally, I have some pictures. First up is a picture of my mouth, sans arch bars.

open mouth

It isn’t perfectly straight, but the appearance of crookedness is exaggerated by the fact that my front teeth are not the same length. The second picture is of me trying to stuff my fingers in my mouth.

I tried to stick my fingers in my mouth before I got caught by the vegan police.

I tried to stick my fingers in my mouth. I suppose this endeavor was made slightly easier by the fact of my having slender fingers.

My natural teeth

7 Jun

For the first few weeks after my accident, and then again in the first several days after my chipped teeth were repaired, I’d often wonder what my teeth had looked like before the accident and lament that I’d never know. On this point, however, I was wrong.

When I got my braces off just short of eight years ago, my orthodontist made models of my teeth. These were to be used to shape the clear plastic retainers that I would have to wear regularly from then on. For most of the past eight years, the models have sat collecting dust in my old room in my parents’ house.

My old teeth

For me, the most striking thing about the models (which unfortunately my photograph doesn’t adequately show) is that they show that my right front tooth was actually slightly bigger than the left front tooth before the former was chipped in the accident. In the repaired version, the edge of my right front tooth (number 8 for the dental notation enthusiasts out there) slants so that the tooth approximately matches both of its neighbors in length where it meets them. In particular, the right front tooth is considerably smaller than its neighbor to the left, and it also looks weird.

The models also confirm that my bottom front teeth have moved a little bit. The two in the center now stick out slightly further than the ones to the left and right. This is something that I’ve suspected since my jaw was wired shut, when I detected a change in the way things felt to my tongue. I’m hoping that the movement is due to pressure applied by the wires in my mouth and that the movement is slight enough that my retainers will be able to nudge them back into place after I get the arch bars out.

Some pessimism

6 Jun

Several weeks ago, I saved a copy of a review on the treatment of condylar fractures to my hard drive. More specifically, the paper attempts to address the question of whether open treatment (surgery involving an incision) or closed treatment (such as the treatment used in my case) of these injuries is better. I wasn’t looking for an answer to this specific question in the article; my oral surgeon mentioned open treatment only as something that would be used if the closed treatment failed.

It was only today that I actually got around to reading the review. I was glad that I wasn’t reading it to find out whether open or closed treatments are better because the findings were inconclusive. Nonetheless, I did learn some interesting things from it. I was particularly interested in one of the findings of a study of Ellis and Throckmorton:

The patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of the injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods.

I’m unfamiliar with many of the words in there, but to the extent that I understand the sentence, I think that it might confirm what I have suspected: that the asymmetretry in my mouth’s opening may be related to the way in which my bones have healed, and not just a result of stiffness in the muscles. In particular, the ramus is a part of the mandible, and apparently it is sometimes shorter after a condylar fracture has occured. This isn’t actually something that is of particular concern to me, but I do wish that my oral surgeon had acknowledged it to me.

Other studies found that patients with closed treatment experienced chronic pain and malocclusion (misalignment of the teeth), neither of which I’ve experienced since treatment.

%d bloggers like this: