Ouch, Road Rash                                                                                                 2/25/10

 

You are 45 minutes into your Saturday morning ride.  Your training buddies couldn’t make it.  It is just you, your trusty carbon fiber steed, and the open road.  Your mind has settled into that place where you can escape the pressures of work and stress.  You are averaging 20 miles an hour with a slight tail wind and all is right with the world.  The road surface suddenly changes though.  Loose gravel and a sharp turn ahead.  Your mind switches gears into survival mode.  Too late.  The bend in the road requires more traction that you are afforded, with too little time to brake.  Wham.  Down you go, bouncing and sliding on your left side for what feels like minutes across 15 feet of pavement.  The skin on your left leg, shoulder and forearm is sacrificed, bringing you to a painful stop.  Now what?  Do you call an ambulance?  Do you call a friend to pick you up?  Is it safe to brush yourself off and just finish your ride?

 

Caution:  This article is only meant as a general overview for handling bike mishaps.

If you are unsure as to the extent of your injuries always call 911.  No phone, then stop a passing motorist or ask for help at the closest house.

 

First things first after an accident; stay calm.  Do a system status report.  Assuming you are breathing and have not suffered a head, neck or back injury then move yourself and the bike off to the side of the road.  Next, do you have any major bleeding or signs of broken bones?  Clavicle and wrist fractures are common injuries with cyclist using their hands to break their fall.  Most broken bones will cause sharp pain with movement and increased pain when you attempt to bear weight on that extremity.  Active bleeding from lacerations should be treated with direct pressure.  If you are unsure of the severity of your injuries call an ambulance.  If there are no signs of a head injury, you can take a deep breath, walk, squat, and are able move your neck and arms with out pain; you may be able to safely ride home.  Not sure, then always err on the side of caution and call for help.

 

So you feel good enough to ride home.  Your favorite shorts are trashed and besides some abrasions, you feel lucky.  Before riding home, check your bike over thoroughly.  Look for damage to the frame such as cracks or bends.  Spin your wheels looking at the rims as they pass through your brake pads.  Check for broken spokes or damaged pedals.  Check your brakes and drive train.  Do your handlebars and front wheel still line up?  Check your helmet, looking for cracks or scratches.  Any sign of damage not only requires a new helmet, but you should have yourself checked for head or neck injury.  If you are lucky, you may get away with just a scratched saddle and the need for some new handlebar tape.

 

Now for a review of road rash:  the injury that follows when one uses their skin instead of their brakes to stop their forward momentum.  Once you are safely home, get in the shower.  The most important thing is to remove as much of the debris and dirt in the wound as possible.  This will help prevent infection and speed the healing process.  Thoroughly wash with soap, water and scrub if needed with a wash cloth.  If there are lacerations that may require stitches, or it is too painful to properly wash out the wounds, then go see a doctor.  Soap and water is the best with lots and lots of rinsing.  I do not recommend using betadine, bactine, or hydrogen peroxide.  They kill healthy tissue as well as germs.  Once you are sure that you have removed all visible dirt and gravel, then dry off and dress the wound.  Cover the wound in a layer of antibiotic ointment.  Bacitracin is my favorite.  Neosporin is ok, but 5-10% of the population is allergic to the neomycin found in Neosporin and triple antibiotic ointment. (I have even tried non traditional treatments such as honey, but found it to be overly sticky and difficult to wash off).  Next, apply non-stick gauze 4x4s to the wounds and secure in place with kerlix, cling, an ace wrap or tape.  Your bandage may be too tight if your hands or feet begin to swell.  Most road rash is also associated with soft tissue injuries that will cause localized bruising and swelling.  To prevent this, apply ice for periods up to 15 minutes several times a day.  A bag of frozen veggies works great.  Elevate the injury above the heart.  Take Tylenol/acetaminophen or Motrin/ibuprofen to ease the pain.

 

Change the dressing daily.  If you find the dressings stuck to the wounds, try wetting it first in the shower.  Wash your wounds every day, again using soap and water.  Use a wash cloth with gentle scrubbing to remove the old ointment, scabs and dead tissue.  Try to avoid allowing thick scabs to form which may slow the healing process.  Some bleeding or oozing is expected with each washing the first few days.  Partial thickness wounds may heal in a week as new skin grows from underneath.  Full thickness wounds may take a month or more as you grow new skin in from the sides of the wound.  Keep the wounds covered while they are still oozing.  Periods of air drying may help some wounds that remain moist after the first week.  Watch for signs of infection seen usually in the first 24-72 hours with increased redness, yellow discharge, or fevers.   If it has been more than 5 years since your last tetanus shot, consider seeing your doctor for a booster.  Any questions, always seek medical care.  Infected wounds will take longer to heal and increase the chance of scarring.  There are some people that recommend products such as nu-skin which is a super glue like liquid applied to the surface of the wound, or op-site dressings that provide a thin plastic like dressing that remains in place for several days.  I have never had much luck with either of these occlusive dressings.  Most road rash will have significant oozing, which then becomes trapped under these protective coatings.

 

Once the wound has healed over with fresh skin, help prevent scarring by keeping it soft using an ointment such as A and D.  Some people recommend using vitamin E capsules, breaking them open and applying to the new skin.  Other people recommend using a product called Merderma or an equivalent store brand, though I have never seen a significant difference.  Avoid exposing this fresh skin to the sun for several months.  People often ask me about how soon they may return to their training.  The old adage of “if it hurts, don’t do it” usually applies.  For the most part, I feel the sooner, the better.  Exercise can help preserve your flexibility and may improve your circulation.  I also believe it speeds the mental recovery from an accident.  Cycling may be easier to resume than running.  An attempt at stationary training may be a useful step before returning to the open road.  If you are unfamiliar with working on your bike, be sure to have a mechanic do a thorough post crash inspection.  Swimming in public pools should be delayed until the wounds no longer require dressings.  A healthy diet balanced with sensible choices of protein, fresh fruits and vegetables would be beneficial.  Supplements such as Vitamin D3 at 5000 units a day, Zinc at 50 mg a day, and Vitamin C at 500 mg a day may also aide in the healing process.  Consider keeping a fully stocked road rash kit at home.  This helps avoid the embarrassing walk through Walgreen’s in your clunky cycling shoes looking like you just lost a fight with a cheese grater.

 

Bike crashes are a part of cycling.  It is one of those risks we take as opposed to living life on the couch.  Here are three of my favorite tips to avoid crashing: 1) respect all squirrelly riders by giving them what you think to be a healthy perimeter and then add another two feet, 2) improve you handling skills by getting in some off road riding with your mountain bike, and most important 3) if it is just your second ride of the spring after a long winter, never try riding downhill sections of Route 213 through Olivebridge on your tri bike while in the forward tuck position.

 

Finally, here are a few extra tips to be better prepared for your next mishap, especially if you are riding alone.

 

1)      Always ride with your cell phone tucked away in a waterproof zip lock bag.

2)      Know the names and intersections of the roads you are traveling on.  There is nothing like calling Mom to come pick you up when you have no idea where you are.

3)      Have an idea of who you could call for help before you leave for your ride.

4)      Ride with a bracelet such as ones made by “Road ID”.  These include important contact and medical information should you hit your head and forget who you are.

5)      Keep your ICE list updated in your cell phone.

6)      Consider letting someone know your training plans for the day and what time you should be home.

 

Have fun, be safe.

 

Scott Costley, D.O.

 

Previous posts below: 

     
The best way of predicting your future health does not come from looking at your past health. It comes from asking “what are you doing right now to become healthy and stay healthy?”

Here are my top 10 recommendations for 2010:

• Come in for a yearly physical. Stay informed about health topics in the news. Ask questions.
• Keep your resting blood pressure less than 130/85.
• Eat foods with lots of fiber. Avoid cheese. Eat nuts, brightly colored veggies and whole grains.
• Monitor your Vitamin D blood levels. Take supplements to keep it between 50-80
• Check your cholesterol. You want the LDL less than 100, the triglycerides less than 125, and the HDL more than 50.
• Exercise 3-5 days a week.
• Don’t smoke.
• Watch your waistline. You want a tummy less than 35 inches for a woman or 40 inches for a man (measured at the belly button).
• Take time to recharge your batteries. Do something every day that makes YOU happy.
• Be a role model of good health habits for those around you.

Our bodies are like a hand made canoe that we have borrowed to travel down the river of life. No single canoe is like another, and no one gave us a chance to pick ours out. Make the best of what you were given. Take care of your vessel and enjoy your trip.

Scott Costley, D.O. Rosendale Medical Center

OLDER POSTS:

What is your Vitamin D level?

Listen up multi sport athletes; you need to ask your doctor for a blood test. This may be the most important blood test you have never had, yet could impact not only your athletic potential, but also your over all health. I am talking about a blood test for Vitamin D. Never heard about the importance of this test? I’m not surprised because I only stumbled into this important topic a year ago. Ever wonder why you feel more fatigued and grumpy in the winter, why it is so hard to avoid gaining that off season 10, why you are more likely to catch a cold or the flu, and why then you see your mood and athletic performance improve in the spring and continue through the summer. Think D.

Some key facts. We all have low D levels unless you take adequate supplements or obtain it through UVB exposure. In the last year of testing hundreds of patients, I have found nearly no one with normal levels of D, especially during the months of September through April. Vitamin D is not found in any appreciable amount in our multivitamins or our food supply.

What is D? Vitamin D is actually not a vitamin; it is classified as a steroid. We were all taught in school that we need D to properly absorb calcium, but did you also know that vitamin D plays a critical role in nearly every basic bodily function? From a healthy muscle contraction, to proper immune health, to preventing cancer, heart disease, diabetes, obesity, maybe even autism. Why haven’t you heard about it before now? It all comes down to money, vitamin D is cheap, over the counter and the government has been slow to come out with a change in a USDA recommendation that would turn health care on its head. Why are we seeing such a problem with this now, because the medical profession has told us for the last 20 years to avoid the sun, to slather on the sun screen, and we have become much more of an indoor society.

What do I recommend? For starters, become informed. Go to wikipedia and type vitamin D. Or go to the Vitamin D council web site at http://www.vitamindcouncil.org/ and spend 30 minutes looking at Dr Cannell’s monthly column and the previous monthly archived columns. Ask you doctor for the vitamin D blood test. Be sure they order the vitamin D 25 OH total; ask for your test result. Most labs consider deficiency at less than 20, insufficiency at 20-30; I consider normal between 50 and 100. If your levels are low, and they will be, consider any over the counter supplement. Most people need 1000 units a day to boost their levels by 10 points. For example, if your level is comes back at the typical average in my practice of 20, then you should consider taking 5000 units daily of over the counter D3. Any brand is fine. Yes I know this is twelve times the USDA recommended amount, and it sounds huge, but this also converts to only 0.125mg. After three months, ask for another blood test to recheck your levels and adjust your dosage as needed. I have some individuals that are poor absorbers and have only reached a normal blood levels when I gradually increased them to 15,000 units a day.

What about natural sources for D. Well yes, you can get D from some foods, but it is very limited. Milk has D added to it, at the amount of 100 units per cup, but who wants to drink 50 cups of milk a day. The skin is a great producer of D, at a rate of 10,000 to 30,000 units with just 10-15 minutes of sun exposure. The only catch…… at our northern latitude you can only get an adequate amount of UVB rays to produce this amount from May to September and you ideally need to have both your arms and back exposed to the mid day sun between 11 AM and 2 PM. I do not recommending that you burn, after 15 minutes, put the sun screen on.

If you can’t get your D levels checked I would suggest you take at minimum 2000 units daily, though research indicates that levels up to 5000 units per day may be more appropriate for adults over 125 lbs. Research this yourself, talk with your doctor, and take your D.

Scott Costley, D.O. Family Physician Rosendale Medical Center