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  1. #1
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    A Lost Spleen and Lessons Learned

    Sometimes a wreck doesn't have to be that hard to end up badly...I hope you'll read this story: not because it's interesting but because my experience seems a bit unusual and the little lessons I learned may be useful for you someday.

    Friday, Day 1. I botched a little jump off a ramp. I landed front-tire first (yeah, yeah - I'm not so good at the jumps. I know this... the rebound on the shock was set too fast and I didn't lean back far enough - the back end kicked up on me; I'm new to full-sus.) and my chest hit the handlebars when my hands went off the sides... then, obviously, I wiped out. Not a particularly thrilling story (though I should mention I was going 25mph, give or take 5), and I've walked away with relatively minor injuries from wrecks similar to this before - at least, relatively speaking to what came next. When I got home and became a little more lucid I realized it would be prudent to have some xrays done so I went to the ER. My left shoulder starting hurting very, very badly. That isn't unusual (esp. since I dislocated my right shoulder after a wipe out on this same jump a year earlier!) but what was unusual is that the pain did not seem to be associated in any way with what I did with my arm. I could poke my shoulder, swing my arm around, pick things up - nothing I did with my arm seemed to affect the pain! The ER Doc didn't think anything of it (this was a big mistake) and sent me home with some Darvocet. That night I discovered I couldn't lie down without unbelievable pain - in my shoulder! I slept sitting up... a difficult feat!

    The next day, however, I was feeling fine and flying high... mmmm... Darvocet.... by Sunday evening though, my shoulder was starting to ache again. Otherwise I was dandy. By Monday evening, I was on twice as much Darvocet as Sat. and Sun. and my shoulder was killing me...

    Tues. Day 5: I went in to my regular Doc. and told him what was going on. I could barely concentrate through the pain - it was running all the way down my arm into my fingers - in a straight line. Doc looked me over and figured I had a pinched nerve in my neck (good guess, but wrong). He gave me a prescription for several new pain drugs: Toradol and Ultram. Beware: may cause nausea! I spent the entire evening on the bathroom floor. Wrong diagnosis = wrong drugs.

    Wed. Day 6: Taking only Toradol, no Ultram = feeling fine all day, but I can't eat almost anything....

    Thurs. Day 7: I get up and try to eat a little breakfast to take my Toradol with, when I am struck by several very sharp pains (in my left shoulder, of course). I felt an on-coming wave of that 'nearly-passed-out' feeling (you know the one: vision and hearing fade out, you get really dizzy and light-headed: it's a response to either pain or low-blood pressure... or sometimes both) so I laid down on the floor. When the feeling did not quickly subside, and my shoulder continued to hurt badly, I called for my roommate to come call the Doc.... who did so, and then dutifully took me to the Doc, who took a quick look at me and realized he'd made a mistake. My belly was noticeably distended (easy to notice on a 5'8", 130lb man) and I was getting rather pale. He quickly got an CAT scan order passed to the hospital and had my roommate take me. I never really came completely out of that 'nearly-passed-out' mode - but eventually I got my CAT scan and was in surgery within a hour of the surgeon seeing the scan. I had destroyed my spleen and it had been bleeding for a week. After removing my spleen (and a liter of blood from my abdomen, and getting a transfusion to keep me alive) I spent a week in the hospital recovering....

    So what lessons are there to learn from this?
    First: don't be a macho man, get yourself checked out! At least your mother won't yell at you for not taking care of yourself...

    Second: if your condition worsens, don't hesitate to call the doctor. It's better than bleeding to death on the floor in your pajamas...

    Third: This is the important one, the one you may not have already known about: referred pain. You may have heard about left-shoulder pain associated with heart-attacks. You actually have many organs that you only feel as referred pain - pain, that is, that you feel in a place other than where the damage is. The pain I was feeling was my spleen - but I only felt it in my shoulder. Referred pain is a tale-tell sign of internal injury. Mine ranged from searing, agonizing pain-of-doom to dull ache, just because the pain isn't serious doesn't mean the injury isn't.

    I hope these lessons don't HAVE to come in handy, but if they do become salient, I hope they are useful to you. Maybe it'll save you an organ or two even!

    Happy trails everyone! I should be back on them this week! It's been a long two months without them for me...

  2. #2
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    Glad to hear you are recovering well. Sorry to hear abou the 7 days of pain and frustration you had to endure to get the correct diagnosis and corrective surgery.

    Thanks for the post.

  3. #3
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    Great post. Thank you. Get well.
    All problems in mountain biking can be solved by going faster, except the ones that are caused by going too fast.

  4. #4
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    Thanks for the great post!

    ... and in case y'all don't know, there's smart doctors and there's dumb as sheot doctors. Same as there are all types of mtb'ers. You need to be involved and ask a lot of questions like: what other things could be causing this and under what circumstances do I come back immediately? A lot of docs are falsely confident in their abilities. Hmmm, not unlike us, eh?

  5. #5
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    Sorry to hear about the extended process of getting you properly taken care of. Thanks for the great reminder to look out for us first and not be afraid to question the docs.

    Hope you heal up soon!
    As if four times wasn't enough-> Psycho Mike's 2013 Ride to Conquer Cancer Page

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  6. #6
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    Thanks for the replies! I'm doing much better now, thank you - just antsy to get back on the trails. Everything is frozen solid down here in Texas... go figure.

  7. #7
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    Quote Originally Posted by DrewWinters
    Second: if your condition worsens, don't hesitate to call the doctor. It's better than bleeding to death on the floor in your pajamas...
    First- Sorry about the crash.

    Second- Even sorrier about the injury, and doctors who couldn't find it.

    Third- Sorriest that you still wear pajamas (Next time this happens [hope there isn't a next time, but...], remember the words, "Wouldn't be caught dead in...")

    Seriously, hope you're feeling better and on your bike soon. Also, reffered pain can show up in the jaw, back, and chest. All aches that don't go away and don't respond to pain killers are suspect, especially if there's no mechanical injury there.

  8. #8
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    My mistake, let me rephrase... "...it's better than bleeding to death on the floor in your extremely manly (and comfortable) velvet pants"

    Is that better?

    btw - I didn't mean this to be a rant against doctors. I'm not angry at either doctor for missing it. Doctors are mechanics for the most complicating machine on the planet - mistakes happen. At least now I have an extra stash of fun pain-killers....

  9. #9
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    Quote Originally Posted by DrewWinters
    My mistake, let me rephrase... "...it's better than bleeding to death on the floor in your extremely manly (and comfortable) velvet pants"

    Is that better?

    btw - I didn't mean this to be a rant against doctors. I'm not angry at either doctor for missing it. Doctors are mechanics for the most complicating machine on the planet - mistakes happen. At least now I have an extra stash of fun pain-killers....
    I would prefer it to read fleece, but I'll accept velvet. The Hugh Hefner look works for some people, just not Hef- or most cyclists.

    Rant at the doctors all you want. According to very conservative estimates medical errors kill more people than guns and cars combined. I've seen good doctors, and also had a friend who nearly died when his doctor missed symtoms a good number of lay people could find- a patient tells you he's-

    -irritable
    -tired, but sleepless
    -constantly urinating
    -unusally thirsty
    -loosing weight

    -what simple (in office) test do you perform? My friend's doctor performed no tests. He was in his office 3 times in a month with worsening symptoms. The doctor kept giving him stronger sleeping pills. When he finally ordered a complete blood workup (not needed for those symptoms) he got a call from the blood lab telling him to get someone to drive him to the ER the instant he put down the phone, and if nobody could drive him call an ambulance. He was on the verge of a diabetic coma with a blood sugar reading of over 500. Any human can make a mistake, but when a patient comes back with the same symptoms it's time to clear your mind and begin the dianosis over because you might have missed something. I'm willing to accept that the doctor in this case may have had a really bad day and missed an obvious diagnosis, but to then hold onto that mis-diagnosis not once, but twice (just a little stress, stronger sleeping pills will help), should cost one doctor his medical license. Now look who's ranting?

  10. #10
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    Actually, the ER doctor in my case may have lost his medical license over this. I heard third-hand (so take it for what it's worth at that point - a rumor) that the surgeon demanded that the ER doc go before a review board over it, and that this wasn't the first time he'd made this sort of mistake, and was therefore at high risk of losing his medical license. I don't know how it turned out, or just how accurate the story was by the time it got back to me, but the hospital did not take the mistake lightly...

    I agree with you though, I certainly don't think we need to ignore or allay the guilt of careless doctors. On the other hand, our indignation should always be tempered with an understanding of just how difficult the job is. I don't mean to imply that the doctor in your friend's case wasn't at fault though. I'm glad he didn't end up in a diabetic coma!

  11. #11
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    You would be able to find out if he did in fact lost his license quite easily. It's actually your right. Usually, if they have no prior violations, then he's most likely going to be fined and/or sanctioned.

  12. #12
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    Maybe ten years ago, an aquaintence from school was skiing and took a nasty tumble. He was a hard core mofo, shook it off and wanted to ski down but the ski patrol had seen it and insisted they take him down and call an ambulance. At the ER, they CAT scanned his belly and found a ruptured spleen.... they neglected to scan his chest and find the hole in his heart from a broken rib. When they put him to sleep to operate on his belly his heart stopped. He was talking to his family on the way into the OR and they buried him a couple days later.
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  13. #13
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    Quote Originally Posted by DrewWinters
    Actually, the ER doctor in my case may have lost his medical license over this. I heard third-hand (so take it for what it's worth at that point - a rumor) that the surgeon demanded that the ER doc go before a review board over it, and that this wasn't the first time he'd made this sort of mistake, and was therefore at high risk of losing his medical license. I don't know how it turned out, or just how accurate the story was by the time it got back to me, but the hospital did not take the mistake lightly...

    I agree with you though, I certainly don't think we need to ignore or allay the guilt of careless doctors. On the other hand, our indignation should always be tempered with an understanding of just how difficult the job is. I don't mean to imply that the doctor in your friend's case wasn't at fault though. I'm glad he didn't end up in a diabetic coma!
    In the ER I used to work if you had come in with those symptoms, especially with that mechanism of injury, you would have had (at a minimum) x-rays on your chest, abdomen and C-spine as well as a CT of the head. I would sometimes wonder about the exams that got ordered on some patients, but as you know, missing something can be a bad thing. These exams may not have found anything, but the Doc would have been covered.

    One question; Did you have insurance? Sadly, that sometimes makes a difference in what gets ordered.
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  14. #14
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    Quote Originally Posted by xray_ed
    In the ER I used to work if you had come in with those symptoms, especially with that mechanism of injury, you would have had (at a minimum) x-rays on your chest, abdomen and C-spine as well as a CT of the head. I would sometimes wonder about the exams that got ordered on some patients, but as you know, missing something can be a bad thing. These exams may not have found anything, but the Doc would have been covered.

    One question; Did you have insurance? Sadly, that sometimes makes a difference in what gets ordered.

    I do have insurance. I had a bunch of x-rays done - but I don't remember which ones. The problem was, this was only a few hours after the wreck - it was bleeding inside the spleen itself and apparently did not show up. No CT scans for me until the next week. Incidentally, the whole "take a deep breath and hold it" part of the CT scan becomes remarkably painful with a ruptured spleen...

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