Daily Blog

Broken Ankle, Game Plan, Angst

I broke my ankle coming into Moscow.  It was an error on my part riding in some mud off a dirt road while still basically configured for road riding (slick tires, and adventure versus dirt boots).  The area did not look that muddy, it looked mostly like a bit of hard packed grass, but under the grass there was a lot of mud.  My bad and a lack of experience which I knew I was missing going into the trip.

I lucked out and found a great orthopedic surgeon at European Medical Center in Moscow, Dr. Frolov head of orthopedic surgery assisted by Dr. Gerasimov.  They have a Sports Orthopedic center and pioneered several ORIF (Open Reduction Internal Fixation), modifications now used as SOP in leg surgery worldwide.  In my case they were able to place some screws and one metal plate to lock the fibula that had broken into place so it can heal.  Unbelievably I was walking 2 days after the surgery.  A week later I was walking with no crutches part of the time.  I’m now at about 16 days post surgery and have dropped the crutches entirely and for the most part my gait is normal.  {quick side note.. Frolov had worked at ‘Moscow General’ the analog of LA County USC there on Soto in Los Angeles, and from what I can derive both facilities were similar… large public health care institutions with great researchers but poor budget for actual patient care.  Necessity is in fact, the mother of invention.)

The problem with all of this is answering the question “do you pull out and stop traveling on your around the world motorcycle trip or keep going”

No doctor on the planet is going to tell you to keep going.  The formal post op instructions are no sports for 6 months.  However, walking, swimming, driving a car, etc. (not really ‘sports’) are all a matter of your own specific progress, so there is some wiggle room.  But bear in mind, its your risk.  The doctors instructions are the safe route.  You may end up with a much worse injury should you decide to continue.

My options are 1) go through a lengthy motorcycle registration process and stay in Moscow and sell the bike then just fly home, 2) carefully drive back across the border and get the bike to say Italy and ship it from there and fly home, or 3) carefully continue the journey and just stay on-road the entire time,or 4) store the bike here in Moscow with one of the many friends I have made and come back and complete the task next year.  With option 3 I don’t get the road of bones (or at least the summer road part), but I do get Mongolia or at least parts of it and I do get the around the world goal.

I decided to keep going.

The way I evaluated this was as follows.  I document it here for any who face a similar set of questions and to hopefully provide an answer to the 80% or more people who now think I am completely crazy.

First, do what your doctor tells you to do, that is the safe course every time.  I of course rationalized that and decided to continue, bu I think I’m not entirely without support for doing so.

In my case the post surgery progress has been remarkable.  The ankle feels good.  7 days after the surgery I rode the motorcycle sans luggage out of necessity to a new airbnb and had no problems.  I’ll admit I was nervous but once I got going I felt good.  It was a 10-15 mile trip in traffic.  I spent a lot of time testing the ankle just holding the bike up.  When I broke the ankle and was trying to get into town the bike fell over twice when I let it lean to far to the left onto the broken ankle and had insufficient leg strength to keep it up.  I bunny hopped away and let the bike fall twice, that was the day I broke it though.  I tested that scenario today and had no problem holding the bike up at all (not fully weighted however).  So barring a big weight to the left I should be ok, and I can bunny hop like nobody!

Its clear to me that the big factor is weight.  I am so glad I focused on that in my initial research or it would be game over right now with a bigger bike.  The DRZ weighs in at just over 300 and I can control it well right now 13 days post surgery.  The luggage weighs about 110 pounds and I just sent back 30 pounds including my beloved Lone Rider tent, some tools, some spare parts, and even some documentation and clothing.  the luggage is now down into the 80 pound range meaning ‘all in’ I’m at about 400 pounds.  I’ll have to camp less but I need to pull out all the stops here if I hope to make it around the world.

I’ve thought a lot about the rotation aspect that the mud put on my ankle and its not a factor in road riding nearly as much.  I have looked at dirt bike boots but I think there is more risk there from badly fitting boots that are harder on the wound than it is worth.  I am going to affix a metal CE rated knee guard to the side of the affected leg.  This should at least protect the ankle from a direct hit from a broadside from a car, a worst case scenario.

In addition I have spent the last 3 days gradually adding weight and riding farther around the area I am in.  The goal is to exit Moscow on Sunday morning when traffic is low and head east.

Another thing in my favor is that I’m at least 2 weeks away from Mongolia, that would put me at about 4 weeks of healing time enough for the bone to have begun to stitch back together and at least well on the road to healing completely.

There are some good articles on fibula fractures and recovery.  Mostly fibula fractures and the time they take to heal are unremarkable.  In athletes there is a tendency to not want to wait for the injury to fully heal.  But I think I have learned with this injury that means the jarring you would get from running or jumping, or the lateral stresses from say basketball or tennis, but not what you would typically encounter during a road motorcycle ride.  Further the healing time for a fibula fracture is about 6 weeks but that varies with the person.  I am 61 but a week before the crash had knocked out a 600 pound set of leg presses, which ain’t bad for a guy with toothpick legs!  I think that people that actively microscopically re-injure their tissue via intense workouts probably heal faster because their bodies are doing it on a regular basis anyway. So I’m feeling like the constant bicycling, hiking, swimming, running, and gym work is paying off here big time.  I’ll cash in on all those hours staring at that white line or that pavement or those plates right here.  I’m walking pretty much normally the night before resuming the trip and have gone 2 days with no crutches and also added a weighted backpack in there for good measure.  The leg feels great.

Anyway capturing my thought process for other riders who may find themselves in this situation.  The safe thing to do is store the bike and fly home.  But it is after all an adventure.

 

Broken Ankle Root Causes – Boots/Planning/Experience

So I had my ankle surgery a week ago and am here in Moscow recovering.  Its not 100% I can continue my ride but looks like I might be able to.  I did want to document on my blog the mistakes I made that lead to the broken ankle.  The actual injury was a broken fibula technically  a lateral malleolus fracture caused by a fall in heavy wet grass/mud wherein my left leg rotated backwards and the weight of the motorcycle (325 lbs or so) and the luggage (110 or so) landed on the lower ankle and foot which was pointing backward after the crash.  Fortunately I did not injure the knee which based on the twisted direction of the leg I would have bet on.  The actual fracture would have been much worse with a bigger bike not to mention the problem a solo rider would have lifting that bike off in mud with a really bad fracture from the weight of the bike.  I barely got the 400 pounds up enough to slide the leg out and the pain level on the leg under the bike was a 7 or maybe 8 on a scale of 10.

Causes

First, I did not take the time to be a good dirt bike rider before doing the trip but that was a conscience choice I would make again.  So raw inexperience was a factor.  However, read on.  I think its a bit more involved than that if you are contemplating a long adventure ride.

A couple of things that I did right:  1) I evaluated boot choices carefully before I left, 2) I chose the much lighter less powerful DRZ 400 rather than a 650 pound or more BMW or KLM common to adventure riders, 3) I went with soft luggage panniers.  Items 2 and 3 probably were the difference between a broken fibula which bears only about 15% of our leg weight, and a multi fracture, possibly compound fracture and in a worst case being stuck under the bike for a long period of time.

So the real root cause followed the ‘3 strikes law’ which seems to hold in sports, plane flying, diving, surfing, hang gliding, you name it… 3 things go wrong and watch out because your risk goes up exponentially.  In my case I was carrying a strike from the second I left my driveway, I did not have the experience I would have liked to have had.  But that was my choice, mentally I needed to do the trip ‘as-is’.  The second strike was not switching to dirt bike tires early in the trip.  I hit my first off road areas in Morocco and the bike did well enough but the super moto road tires are smooth and had little traction.  Not so bad on dirt or gravel, but dangerous on mud and rain.  I did quite a bit of mud and rain coming into and out of Sarajevo but did not fall.  I got a new back tire in Sarajevo and should have gone to a 50%dirt/50% road tire or better right there, but was waiting for Novosibirsk as part of the original game plan.  The plan was to switch to dirt tires in Novosibirsk.  What I did not know at the time was that Google Maps will send you to unpaved areas depending on how you use it so if you go anywhere but paved highways you will want at least A 50/50 tire on the bike before you start those areas.

Finally there is the matter of boots, the third and maybe most important strike.  I went with the TCX drifters initially and then switched to Forma Adventure boots.  They are about the same and offer decent protection but not what you need in real off road situations.  One weakness they both have is a lack of real hard ankle protection standard on dirt bike boots.  The trade off for me is that the Forma boots actually can be worn for walking a long way.  I wore them all day in a couple of towns when I was being a tourist and walking because they look good and are very comfortable.  What you lose though is that protection.   In retrospect the easy answer for me would have been to go with the SIDI Adventure II boots which I had tried on and have much better ankle protection than either the TCX or Forma’s.  I looked at the Adventure II’s and decided they were overkill and would be unusable for walking around in the many towns I would be visiting.  This was true. The Forma’s and TCX were great for stopping, jumping off the bike, ambling down a trail and snapping a few photos.  When you stop in a restaurant or market these look good and are comfortable.  But if you know you are going off road you are risking your health and trip by having these on in heavy off road conditions.

Summary:  You have to identify the point at which you may go off road precisely and NOT go off road if you are still configured for road.  You have to have at least 50/50 tires on the bike and boots with serious ankle protection when you hit real off road conditions the first time on your trip.  Otherwise you would be advised to travel around the off road area.  When I looked at the Adventure II’s and passed I thought I heard a whooshing sound, and in fact that was the third and final strike which sealed my fate and led to the fracture 3 months later.

 

Treating a Broken Ankle in Russia part 3

I got to the hospital at 8 am Friday July 6, did some paperwork including a “we don’t guarantee anything promise you will not sue us” doc.

The rest was this easy:

They took me to my room, I changed into a surgical gown.  They shaved and sterilized the ankle.  I got a “twilight sleep” shot.  I stayed awake for a bit but because I had gotten up early to pack was tired.  I went to sleep around 9:15.  I remember some jostling and moving but basically woke back up at 11 am in recovery and felt fine.  I had no feeling or motion in legs at all as per the spinal block used.  I went back to sleep and they moved me into my room at 12.  I went back to sleep and woke up at 1:30 and wrote these posts.  Legs are coming back and I feel fine.  The room itself is not decorated as nice as our newer  hospitals (but as good as say Tri city in Vista) but perfectly functional, clean, and with newer equipment.

Appears  to have been a slam dunk and at a price 40-50% lower than I would  have paid for in the states.

What is bothersome is why a struggling country and all of Europe can do this at this price and we cannot even as an outpatient procedure let alone with 2 added hospital days.

Treating a Broken Ankle in Russia part 3

I got to the hospital at 8 am Friday July 6, did some paperwork including a “we don’t guarantee anything promise you will not sue us” doc.

The rest was this easy:

They took me to my room, I changed into a surgical gown.  They shaved and sterilized the ankle.  I got a “twilight sleep” shot.  I stayed awake for a bit but because I had gotten up early to pack was tired.  I went to sleep around 9:15.  I remember some jostling and moving but basically woke back up at 11 am in recovery and felt fine.  I had no feeling or motion in legs at all as per the spinal block used.  I went back to sleep and they moved me into my room at 12.  I went back to sleep and woke up at 1:30 and wrote these posts.  Legs are coming back and I feel fine.  The room itself is not decorated as nice as our newer  hospitals (but as good as say Tri city in Vista) but perfectly functional, clean, and with newer equipment.

Appears  to have been a slam dunk and at a price 40-50% lower than I would  have paid for in the states.

What is bothersome is why a struggling country and all of Europe can do this at this price and we cannot even as an outpatient procedure let alone with 2 added hospital days.

Treating a Broken Ankle in Russian part 2

Once back at the hotel after the exam I googled ankle injuries and surgery and in fact the ankle surgery they were proposing was standard procedure for that break (ORIF).  I could find no negative reviews on the doc and the hospital had a good rep with expats.

Setting the break and then putting it in a cast for 6-8 weeks was not an option as it would have me completely sideline for almost 2 months.  Also using the screws/plates perfectly positions the bones and give the ankle a lot of strength immediately post surgery and leads to better long term outcomes.  No brainer there.

The only niggling issue was that they were projecting a 10 day recovery which was way faster then what I was seeing online.  I took a deeper dive on various research papers and meta’s and decided they were right.  I called and setup the surgery.  The following day I had a series of of pre op tests including blood work, ekg, chest x Ray, dopler study of blood flow in legs.  Total cost of all that was about 600 US.

During all of my tests and consult with the aenesthesilogisr and doctors everything was fast, and efficient.  The various medical devices looked new and it most of it was western (GE, etc)  all of the techs seemed very competent and most spoke at east a bit of English.  The hospital was super clean, organized and modern.  For comparison they are on par with Scripps Encinitas but quite a bit faster .

Finally I did some cost  checking on the same surgery in San Diego and it was in the 15-25 k range.  No surprise there   But probably those did not include a 2 day hospital stay and the initial physical therapy which they do heee.

So with the pre op testing done I was ready for surgery then next morning.

Meantime a wonderful young man working at the hotel who was also an avid motorcyclist offered to help me with the bike.  So him And I started it and then covered it with a tarp.  He is going to find a truck to transport it to the Airbnb I got for the recovery.  The hospital agreed to let me store the other gear there so I was good to go.

Surgery…. next post

 

Treating a Broken Ankle in Russia

So I crashed the bike off road and broke my ankle.  It’s a fibula fracture which is the smaller of the two main support bones in the ankle.  I wanted to document what it’s like to go through to the Russian medical system in Moscow.

First off I did a lot of googling on options and in Russia there are public and private clinics.   The public clinics  appear to have decent doctors and staff but are horribly understaffed and plenty of bad stories coming out of them.

On the private side I ended up going with European Medical Center which has several hospitals in the greater Moscow area.  They advertise as English speakers.

I went in for the exam the morning after the accident.  The ankle swelled badly when I took off the motorcycle boot.

There was an initial discussion about insurance, but they do not work directly with my insurance company and instead use third parties to do that.  So ar a private hospital  it’s pay as you go if they do not take your insurance…a likely case for tourist.  So I elected to pay and then collect docs and submit on my own.  I had done this a lot for relatives and know that system pretty well.

The exam by the orthopaedic surgeon himself was 180 and X-rays were 130.  The diagnosis was trivial as the X-rays showed a good size fracture of the fibula.  They said I had two options: a 4-6 week cast where I would not be able to fly, drive, or take the moto possibly extending to 8 weeks.  Or an ORIF which is a plate and screw technique that strongly puts the bone in place.  You can begin walking in the first week and no cast.  Possibly this would let me get back on the bike in as little as a week or two.  These leg injuries and cast increase the risk of DVT while flying.

They wanted to do surgery the next morning but I needed to do my due diligence on the diagnosis and treatment.  So they splinted the leg (180) and I headed back to the hotel. On the way out I noted many thank you letters from pro hock players, soccer players, gymnasts, etc. even a few cosmonauts on the walls.  The proposed cost for the surgery and 2 day hospital stay was 9500 US “all in”.

to be continued…..

Through Russian border

I made it through the border no problems.  It took about 3 1/2 hours and was not bad at all.  I got most of the way through in 15 minutes but the customs piece took a while.  On the way in I noted a sign that said “Moscow x kilometers”. About 300 miles away.  Volgograd is 500 and Moscow saves me a me least a day maybe two.  In addition I can finally get my clutch plates but only in Moscow.  So Moscow here I come!  When I did my trip planning I wanted to avoid Moscow because I was unsure of the traffic and my ability to handle city driving there on a motorcycle.  My skills have improved considerably and Moscow sounds like fun.  I’ll miss the war memorial in Volgograd but I got a good taste of that in Kiev.  Trip plan? What trip plan?  Loving it though!

Kiev Day 1

I was lucky to find a guy in a ‘caver’ (a kind of rock climbing but in caves which is popular here because of no big peaks)/camping supply store who really knew his stuff and is going to fix my dog torn nemo 2p tent.  Even better he had worked further north and east of the Road of Bones and had great input on what lies ahead.  So I finally have that part of the trip laid out, and worked most of the day lining up tires and rims for Novosibirsk and Yakutsk.  Not done yet but well under way.

Bottom line there is that if I get to the key split in the road at Kyubeme after about August 10th I’ll miss the part I wanted to do, but the risk of snow even in August is too great to proceed.  If I can get there in the first week of August its optimal if the weather holds for about 5-7 days.  The rivers will be at their lowest and Ill have a good shot at it.  The engineer/climber I talked with was the right guy to run into at this point of the trip. Just invaluable.

Its been nice to be here even for this short time.  There is still a lot of Soviet looking stuff and people around.  I’ve had great conversations with people about the state of things with Russia.  Its a terrible situation, these people really are brothers but the big money and politics is just really messing up what would normally be two very close peoples.  Probably closer by a long way than Americans are with British or Canadians but the governments and special interest just cannot leave well enough alone.

Its been interesting grocery shopping here.  Prices are low and the food selection is great.  Tons of fruits and vegetables and fish but not a lot of fresh meats at least in the store near my airbnb place.

Sucks for them, but I’m hoping they can work through it.

A lot of the Balkan Peninsula has a bit of a cloud hanging over it.  Its a just below the surface distress that shows on peoples faces.  Its not overwhelming but they have been through a lot.  The older people in particular have a hard time of it in certain cases.   Still the human spirit comes through and most people are fairly positive most of the time as near as I can tell.

Providence and an Engineer

My two primary ‘keep an eye out’ items are 1) the time frame in which I can safely get through the northeast of Siberia, and 2) the rips in my tent from the dogs in France (they were sufficiently repentant of their fell deed).  Because its a series of holidays in Ukraine I have been unable to find anyone to repair the ultra light tent.

I got an airbnb here and when I started looking lo and behold there was a ‘outdoor’ place only 3 miles away.  I headed over this morning in the hopes of getting a person who might attempt the tent repair.  I got to the shop and it was closed.  I was sitting their noodling things and a guy walked up, clearly an outdoor type and opened the shop.  Antono was an experienced climber and ‘caver’ (a special type of rock climbing which his store had a lot of gear for and which is popular here given the lack of mountains).  He had a woman who could completely repair both of the items I needed repaired, but since its a holiday she was not available.  So he is going to do a temporary repair which I think will hold.

I then found out that he had spent considerable time working in an area further north and east in Siberia from the area I am going.  He had excellent knowledge of the area.  When he worked there, they only worked in June and July, then they would leave in August.  His estimated temperature lows in early August were 50F or so but definitely said the temperatures start dropping in early August as the very short summer winds down.  But he also said its not unusual to get first light snows in late August.

Two groups of riders tried the worst part of it last year in mid August and got turned back by rain which had swollen the rivers.  So a lot depends on the immediate weather forecast when I get to the crux point at Kyubeme.  If the weather is not favorable I’ll take the easier route north, if it looks good, I’ll try and race the weather through the Old Summer Road.

This puts some good parameters around the rest of my trip.  I know now that I need to hit Yakutsk by Aug 1 or risk goes up.  Aug 15th is a cut off, if I’m not there by then I’ll have to go directly to Vladivostok and head to South Korea.  I feel like the optimal time to hit Yakutsk is between July

The good news is the rivers should be at their lows, which bodes well for me if I can get there on time.  If i just drove directly to that area from here it would take me about 10 days, so I have time but I have to be careful about where I spend it.  I may need to take a shorter route through Mongolia, and if I even get the backpacking permit for the Altai, which I won’t know until I get to Barnaul, I might have to cut that out.

All and all a great day and I met probably the exact guy I needed to meet at exactly the right time.

Romanian Riders

I wanted to mention that at the Ukrainian border I met two really nice Romanian riders, one guy on an 850 class Bmw and the other guy on a Yamaha tenere which is 600-800 cc’s.  I should have got their pics.   At any rate they had just started from Romania but I loved their route:  it was through ukraine then the ‘stans’ if I heard them right Turkmenistan, Uzbekistan, khazikstam then Mongolia then Russia via Moscow and St. Petersburg’s then onto Finland, etc and back to Romania.  Awesome trip.  No circumnavigation involved but what a great trip plan on bikes.  I hope I run into them in Barnaul or there abouts.  Smart dudes with a great game plan.