Doc Ernie's Blog

Update on micturition dysfunction

Ernie Franz — Sun, 04 Dec 2011 13:58:49 -0800

Well it has been some time since I updated this section. I am doing so to share my experiences and to encourage others that though these changes are quite different from "normal life", they are no longer problematic and in fact are somewhat freeing - less stress and anxiety about planning the next pit stop.

Again, what follows is primarily for those with spinal cord injuries or bladder dysfunction who require intermittent catheterization......

In the summer of 2010, six years post injury I finally saw a Urologist that clarified what I needed to be doing the rest of my days on this earth, well, at least in regard to voiding. In summary, my bladder capacity is 500-550 cc (roughly 16-18 oz). When I try to empty my bladder like 99.99% of the world's population does, I am still left with generally 300 cc AND that 10 oz is under high pressure. Since the pressure in this plumbing system is seeking a place go, it also puts pressure on my kidneys. This over time can lead to hydronephrosis, or distended, bloated and generally very unhappy kidneys. Untreated the final result would almost inevitably be renal damage and the risk for renal failure and dialysis..... No, I don't want to go there! The other problem has been with my altered sensation, I never feel like my bladder is nearing capacity until the volume gets to roughly 475 cc; and then suddenly - wow, I need to find a place to go or run for the bushes.

The solution? Simply catheterize 4-5 times per day to get my bladder volume back to zero and therefore my system pressure back to zero. This is a good thing!!

Yes, fortunately I remain completely continent. The unanticipated huge benefit for me is I no longer spend much of my day figuring out where the next accessible public restroom is - especially while bicycling and when traveling by car. So I am now among the many with spinal cord injuries who self-catheterize 4-5 times per day.

Shortly after figuring this all out, I decided to sample a variety of catheters and options to determine what I should use for the duration. I sampled just about every product out there as most manufacturers would appreciate your business and loyalty for the years ahead. My Urologist preferred I use red rubber caths that could then be washed and re-used over and over, sparing the dump from unnecessary waste. I was not so sure of this. Doing required laundry every day, rinsing, washing, drying catheters. Fortunately my wife is quite understanding, so she does not seem to mind several caths draped over paper towels drying in our bathtub.

One of the hydrophilic single use catheter varieties I considered came with an extra incentive; "try our catheters and we will send you a $10 gift card to use at Amazon.com". Sign me up! Well, let me tell you what happened. This super flexible catheter was so soft, it actually kinked inside my urethra, buckling in such a way as to cause a urethral tear and bleeding. It never did make it into my bladder. So as much as you would think a soft, compliant catheter is a good thing - at least for me, it was too soft and flimsy, which caused the catheter to lose its sense of direction and purpose. With altered sensation (meaning I did not feel any of the urethral tear occurring), before I realized what was happening I had done some major damage which even now, almost 18 months later, is still occasionally a problem. The net result being I have an area just prior to the passage through the prostate that is a bit tight and seems to have a small blind alternate passage. I now must use Coude catheters which have a narrow bent tip I can direct to avoid the trouble spot. Fortunately the Bard red rubber Coude catheters work well, yet I still must say I prefer the single use disposable Lo-Fric Primo Coude catheters. These are especially handy for any travel; doing catheter laundry just does not work when you are on the road. To be honest, I would prefer to use the Astra Lo-Fric caths all the time however I just recently found out (due to a billing mistake by my Medicare supplemental plan; they were paying 100% of my catheter costs, then suddenly realized they should only cover 80%) I still need to pay out of pocket just over $200 per month for catheters. After over 8 months of no catheter charges, I received in one single day bills for 6 months times $200. Argh!! So as of this writing, I am back to doing my daily catheter laundry and reserving my Lo-Fric Primo caths for travel.

My wife suggested perhaps I could become a "sponsored" catheter user! You know, like those who endorse certain product lines - pro athletes or celebrities, who are then supplied with product. Gwen even suggested she could envision me in a pair of Astra Tech Lo-Fric Lycra cycling shorts complete with logos down the thighs! What a strange reality we now survive and attempt to thrive in.

Disability thoughts - Thanksgiving and Confusion

Ernie Franz — Mon, 28 Nov 2011 11:09:44 -0800

Conundrum - co·nun·drum - from Merriam-Webster's Dictionary; first known use in 1645.

1: a riddle whose answer is or involves a pun

2 a : a question or problem having only a conjectural answer
b : an intricate and difficult problem

The word to describe my current thoughts seems to have existed some 200 years prior to the invention of accident or disability insurance, but nonetheless that seems the best single word to sum up the situation not only for me, but for many other disabled friends.

So yes, my title is correct; I approach this subject with great thankfulness and yet much confusion.

Though I would love to obtain a paying job, to do so threatens me with the loss of my medical insurance (Medicare) and my social security disability (SSD) monthly payments which allow us to stay in our home and meet expenses. To be more specific, if I were to earn more than $750 per month, I would then lose my medical insurance and SSD (which alone is significantly more than $750/month). That is what I can legally earn per month, yet compared to others I know with spinal cord injuries or other disabilities, I have found their threshold levels are set even lower than mine! Perhaps this is due to my pre-injury income compared to theirs and/or the number of years I had paid into Social Security, though I am not certain how the calculations are made.

Though extremely grateful for my medical insurance and SSD payments, it seems the ceiling of what I could earn per month ought to be raised, and not just for me, but for many others as well. In doing so we could tap into a huge resource of talent, those disabled who can bring many skills back into the job market.

Read onward for more thoughts on this subject; my own recent personal experience, and a solution I have in mind. Believe me, I have already begun to share some of these thoughts with my bicycling buddy from just up the street, Jay Inslee - US Congressman, who is currently running for governor of Washington state.

This past July I was offered a job! A paying, full-time position as medical director of an everyday care + urgent care facility. Though this involved mostly on-site supervision of PA's and NP's, it also included medical care provided by myself on-site, as well as remote supervision through the use of telephone-texting-email consultations. It was an honor and a huge lift to my spirits to be wanted again as a physician - to be sought out for such a position. Those were some of the details of the position, yet there were concerns too.

It would involve commuting to the Seattle Capital Hill area 4 days per week minimum, in addition to several days per month of off-site remote availability. This was to be for 49 weeks/year with a pay scale that would exceed my current disability pay by $800 per month. Still, I must confess, I was interested. Yet before I proceeded any further I thought it best to seek consultation from my attorney and two insurance agents whom could review my SSD and personal disability policy. I had already known that if I were to earn more than $750 per month I would lose my Medicare and SSD payments, but once the legal language of my personal disability policy was deciphered, the conundrum was apparent.

Yes indeed, I would lose my SSD and Medicare, yet the real risk came in the ramifications this would make to my own disability policy. Once a job was taken for 90 days or more, if it later became apparent I could not physically do the work, I would need to wait 6 months before my own policy would resume any monthly payments to me. In the meantime, I would need to reapply for SSD and Medicare. Simply stated, there is no way our family could exist without income for more than perhaps 2 months, if even that long. Beyond these risks, once a job was accepted, if even for a short time my disability policy monthly payments would be calculated no longer upon what my salary was as an Emergency Physician at Virginia Mason; but instead would be based upon the medical director salary of the potential new position (significantly less pay than as an ER physician). So that even after a 6 month wait for payments to resume, once they did, they would be at several thousand dollars less than we currently receive. Such was the intricate and difficult problem. Accept a position which would net me $800 more per month than I currently receive; but at the risk of truly losing our home and many other things we now enjoy if the job proved to be too physically demanding for one with a spinal cord injury.

I was advised to turn down the offer by all those reviewing the options. And that is what I did. Certainly I am deeply grateful for SSD, Medicare and my own disability policy; without them I am uncertain what life would look like. It would be hugely different from what it is today.

So here are my thoughts on the way SSD, Medicare and disability policies in general are set-up. They are not work-friendly. In their current form, they do not encourage one to obtain a job - the risks, as in my case, are too great. Here is my proposal. Most people who have a spinal cord injury cannot physically work a full-time job; perhaps a few, but most cannot work full-time. Even for me as much as I am able to walk and bicycle and maintain physical conditioning, it is very challenging and exhausting to be on my feet more than a few hours a day. Part-time work might be possible, yet that is not enough to obtain job benefits such as medical insurance; but it is enough to cause me to lose SSD and Medicare. And if you are disabled, you must have some medical insurance coverage, or you risk living on the street. So to limit me to $750 per month, or others I know to even $100 per month before each of us loses our SSD and Medicare, is just not right. It makes no sense.

What does make sense to me is cost sharing or means-testing. Simply put, if I make more than $750 per month, don't eliminate my SSD and Medicare entirely, just have me pay a bit more for my Medicare coverage and at the same time lower my monthly SSD payout. I would gladly do this! It is doubtful and risky that I could ever work a full-time job again as I have pointed out, yet a part-time position or intermittent consultant work seems quite possible. Not ever likely enough to qualify me for vital benefits, such as medical insurance, but enough to help our family's budget. In this scenario, as my monthly income goes up, the amount I pay for my Medicare goes up too and the amount of SSD I receive goes down. If at some point I find I can work enough to obtain benefits, then at that time take my Medicare away; and eventually too if my earnings are enough my SSD would go away. Similarly with my own disability policy, rather than an all or nothing approach to monthly payments, it seems appropriate to have a sliding scale. The more I earn per month, the less the disability payout to me. Create some incentive to work, by having the net monthly income (job income + disability income) be beyond what the disability income alone would amount to. As one is hopefully able to adjust to longer work hours and more days of work, your own disability policy begins to support you less and less.

I think that is fair, and I also think such a system would encourage many disabled people to actually find a paying job. A job that would give them a purpose, an identity, a sense of worth and value to society. Yet right now, we are all faced with the hard reality of financial ruin and loss of medical insurance if we work, and for most the upper limit of what you can earn is ridiculously low. As a consequence we have many sharp intelligent people who are paralyzed by the current systems and policies; forced to live a life of simple means. If one cares to otherwise carve out a new identity and purpose there is always volunteer work to be done. Not that there is anything wrong with that, it is just that it would be nice to earn a little money at times!

Thanks for reading.

Sometimes you just have to get... MAD!!

Ernie Franz — Wed, 16 Nov 2011 13:27:03 -0800

This past weekend a tragic accident occurred in Seattle that really upset me. The more I think upon it, the more angry I get. The accident claimed the lives of two innocent young adults, and was entirely caused by the unbelievably reckless driving of an apparently sober individual. Turns out there is even more to the initial story that is confounding...

I doubt this link will last long, but you can read about it here - with my thoughts to follow.

So the facts are that this 43 year old man, who was driving at a high rate of speed on generally a very busy in-town 4 lane road, with two young girls in his vehicle (ages 10, 11), during daylight hours plowed into a car stopped at an intersection for a red light. The collision carried both vehicles forward some 100 yards from the point of impact, whereupon the smaller car struck by the SUV burst into flames consuming the two innocent young (ages 26, 33) occupants. A witness believed the SUV to be traveling approximately 70-80 mph.

Miraculously the two young girls in the SUV survived, as did the reckless driver. They will be released from the hospital soon enough.

What really distresses me is that the driver who caused the accident was guilty of vehicular homicide in 2009. At that time he took out a woman in her 60's after he again was driving at 80 mph on Seattle city streets and rapidly changing lanes. Again he was apparently sober, but served no jail time, instead paying the victim's funeral expenses and being placed on probation for 2 years. The Seattle Times article seems to indicate he was believed to be psychotic. Even prior to the 2009 accident he apparently had one DUI.

So fast forward to this past weekend, with now 2 more fatalities notched on his (seat)belt. According to authorities, he may now face up to one year in jail. That is again, up to 1 year, unless he is released significantly early for good behavior or perhaps felt to suffer from a mental condition which would make his jail time "inappropriate". Of course he is quite likely to drive again; all it takes is a key and a car. As we know, many are out driving today with no license or a suspended license; yet that does not keep them off the road. We seem to think this is our right, not a privilege.

It seems to me we have failed as a society to take the proper corrective action. Jail time is rarely rehabilitation time, more often it is punitive time - for which we taxpayers fund. Our nature is to give others a second (or third) chance..... but really, is that the right thing here? I wish there was a mechanism for ensuring that he never ever drives again - but that is unlikely. I don't have the answer, nor do I have a solution to propose. I do believe however there should be consequences for our sins, for our actions that harm or kill others.......

My own sins have consequences most certainly. And yes, I can seek/ask forgiveness for my actions or inactions, BUT still there are consequences - a penalty to be paid, or loss of chance, or broken relationship - somehow it is going to cost me. Not always financially, nor involving incarceration (hopefully), but still there is a cost. Separation or disruption of what could have been. Similar in so many ways to my sin that keeps me from a closer relationship to our Lord.

So where I am going with all this? I don't have all the answers. Yet I do hope somehow out of the senseless tragedy of this past weekend in Seattle, lessons and corrective actions can be put into place to prevent such future events. Though at some time in the years ahead forgiveness may be appropriate for the driver, the consequences for his actions should remain in place.

Thanks for reading.

Speaking out - now available for hire!

Ernie Franz — Mon, 24 Jan 2011 11:43:33 -0800

Greetings! As I have mentioned in a few previous entries, I enjoy speaking to a variety of audiences. IF anyone can glean lessons from this story of my life as it unfolds, it gives me great satisfaction and has me believing that what occurred to me can really turn out for the greater good of humanity.

In the past few months I have spoken to our military regarding the behavior choices they face when both on and off duty. Sharing the story of what happened to me hopefully gives us all reason to pause before we get behind the wheel of a car, especially if one has enjoyed a drink with friends. Clearly the choices we make do impact the lives of others. While there is great opportunity for good and bringing joy to others, there is also the potential to bring sadness and brokenness. This of course applies not only to driving, but I am speaking here of how we treat each other - within our own families, and throughout our communities and cities.

After I spoke to several hundred at both the Puget Sound Naval Shipyard and Bangor SubBase, I was asked to speak to about 1000 of our local Bainbridge High School students during a drug and alcohol-free week. In September of 2010, I spoke during all 3 Sunday morning services at NorthSound Church in Edmonds, WA. The last of the 3 messages was recorded and can be found thru this link here. The message is about 20 minutes long; I trust you will find it interesting. You will need to download it and follow the instructions on the website. Out of that opportunity has come yet another, to speak at a CRISTA service in of all places - Palm Springs, CA this spring.

I am available to speak and share my journey. I do not ask for much in the way of compensation, only to cover my travel expenses and to provide a small stipend. I can speak with deep personal experience to the following topics.....

Making the right choices with regard to alcohol and subsequent behaviors

Overcoming loss, injury and disability - getting back on the bike

Faith and how it is challenged by life changing events

Insurance topics such as disability, medical and auto

The injured physician; what is is like to go from being an ER physician to a major trauma patient with a spinal cord injury - all in the blink of an eye

Forgiveness and how to process that, when what you love and do for a living is taken away from you by another.

Resiliency

Physician to patient communication and bedside manner

These are a few examples of topics I have already spoken to. All these are dear to my heart, and if you think that any of these may be of interest to you, your organization or business, please contact me further. I love to travel, meet new people and effectively communicate the personal growth and lessons I have learned from this tragedy.

Thanks for reading!

Financial Update 2010 - adjustments to life

Ernie Franz — Fri, 19 Nov 2010 11:48:40 -0800

Normally this time of year I bring to you a bicycling update, though this year has been different than the last two years which were filled with a lot of great miles and season ending goals being met or exceeded. More on that soon.

A primary focus has been on family sustainability; making good decisions and allowing us to live where we do for at least the near future. Some of the "cutbacks" have been rather minor and possibly a bit humorous; like eliminating home delivery of milk and purchasing it in our local grocery. I made the executive decision to move to a wonderful milk offered in glass bottles produced by grass fed happy cows thriving in Lynden, WA. We have given up home delivery of milk by another good company - a decision my wife laments. Yet I have reminded her, we have to make some sacrifices in order to still enjoy life as we know it; in this case we now save 20 cents per half gallon purchased!

Other changes have been more difficult, but in reflection, only more troublesome because they required a deviation from what had become our "standard of living" for the past 22 years. So merely because I now drive a VW instead of an Audi (which I had really enjoyed the past 12 years), I can be quite thankful it still moves me from point A to B reliably and safely, with better gas mileage and is still a kick to drive!

What follows is then a brief update on life and finances. I will blog about job opportunities and some medical health updates very soon (promise) ....

Since I last wrote in July 2010 about the uncertain financial terrain we have made some changes beyond just the milk we now drink!

1. We did sell both our cars, an Audi and a Volvo, and purchased two smaller fuel efficient used cars that still meet our needs - a Honda and the aforementioned VW. Though the plan was to put some money back into the bank, that did not quite happen - - yet we should be good with transportation for some time to come. Much to be thankful for in the realm of moving about safely and yet with some thrills behind the wheel. I can still dream one day of possibly owning a Porsche, and yet if it is a dream unfulfilled I am okay with that too.

2. Our home has been re-financed to a 30 year fixed rate loan at a nice low interest rate. Should our finances improve one day, we can make additional payments on the principal; yet for now this has significantly lowered our monthly expenditures.

3. We did restructure our medical/dental insurance coverage which both has lowered our monthly bills, and improved our coverage. When I last blogged, my Medicare coverage did not start July 1st as it should have. Yikes! Turns out - all my paperwork and application to Medicare was lost! Fortunately I had saved enough snippets of paper to prove successfully that I had indeed applied in a timely manner and my appeal was upheld! So by October 1st all was finally in place - Medicare coverage and a Regence MedAdvantage plan that provides me infinitely better coverage (including prescriptions and basic dental care - yeah!) - all at a lower monthly cost.

4. As for family insurance - first I would strongly urge you to seek out a clever creative knowledgeable insurance agent, which we happen to have. The market is confusing and constantly changing - quite obviously. While I completely agree healthcare reform is vital for many reasons, for now the insurers and those covered are sorting our what this all means and how it impacts rates, benefits and the future. The other four members of our family have moved to another health savings plan, but with a significantly lower monthly cost and which had the option of dental coverage! That coverage will pay 1/2 the cost of each child having their wisdom teeth removed; a huge benefit!! I have again begun to feel as though we can provide responsibly for these children Gwen and I have brought into this world.

5. I have hinted already that much of this has been difficult only because we have grown accustomed to a certain level of income and the freedoms that afforded. We have now had one year of reduced income via the ending of one of my disability policies; and though we travel less, purchase less clothing and non-durable goods, and seldom go out for dinner - life is still very good and enjoyable. Challenging - YES; a growing experience - yes, but I have much to be grateful for.

Thanks for reading! More soon.....

Rough financial terrain - the current landscape

Ernie Franz — Thu, 08 Jul 2010 12:39:13 -0800

First, an apology - I am not the best of bloggers, which is perhaps obvious! I am not inclined to feel like you, all of my readers, need to know every detail of our existence. Yet during my recent bicycling rides I have been pondering just what honest truth I can share with each of you about this life as one with a spinal cord injury.

What follows then is, more or less, where we are at as a family in terms of finances following my injury. You may have noticed I have until this point avoided this topic; yet lately a bit of financial angst has set in - so that, if nothing else, this writing gives me a chance to vent some of those frustrations. This also will give me the chance to relate what I am trying to do about our ongoing financial shortfall, and (as writing can do) perhaps organize my thoughts around this topic.

Thanks for reading and for even possibly for considering my employment .... some ideas on that topic as you read the following.

When I was injured at the hands of the intoxicated teen in August 2004 he was driving an uninsured vehicle. He and his family had no resources to compensate us, and though a lawsuit was filed initially it was dropped as there was nothing to be had. Our hope had been that some 3rd party, like a store or business, could be found at fault for selling alcohol to a minor - but that was not to be. In 2005 the state of Washington ordered the driver to provide restitution payments to me for damages caused, and determined that he should pay me $8,000 for uncovered medical expenses from the initial trauma. Since that time I have been occasionally receiving typically $40 checks; of which interestingly enough - if I fail to cash, I will owe the state a $50 fine!

We did receive a payment from our own auto insurance company. Basically if you are in any accident in which a car is involved, whether that be in an auto, or as a pedestrian or as a cyclist - your own auto insurance policy may cover you with PIP - personal injury protection, or if applicable UIM, or under insured motorist coverage. In my case we received a payment (minus attorney's fees, especially since this all became complicated) as I was truly hit by an under insured "motorist". In my case, I believe it was primarily the PIP coverage for which we received compensation. Those funds went to the following areas: our 3 children's college funds, to provide a vehicle we needed to purchase that I could get in and out of, pay uncovered medical and rehabilitation expenses, and finally to provide a better viola to my full-time professional musician wife (who struggles as almost all musicians to meet expenses; yet who provides music, joy and thereby brings meaning to much of life).

We have managed to stay afloat as a family due to two disability policies I had, and with the help of Social Security disability. Unfortunately one of those policies ended five years post-injury, or last fall 2009. Since that time we have faced then a very significant loss in monthly income compared to what we have been accustomed to since 1988. Don't get me wrong – we have so very much to be thankful for !!! An amazing recovery, relationships, community, and the deep satisfaction that comes from volunteer work. Yet something needs to change beyond just our ability to pare down to basics. I find myself torn between wanting to be the provider for our family, and yet face the reality of the lack of physical ability that will keep me from accomplishing that goal.

As for work, if I were to earn more than $750 per month, I would lose all social security disability income and the ability to have Medicare and supplemental insurance coverage. Basically I need to earn either less than $750 per month, or earn a lot (over $135k) for it to make any sense to go back to some type of full time work. I am hopeful that perhaps I may find a job that could pay me less than $750 per month, yet provide some other compensation such as health/dental insurance and/or deferred compensation of some variety. I am in the process of investigating possible opportunities with some local non-profit organizations focused on global medical care; in addition to seeking out ways to work as a medical examiner for insurance companies and pursuing speaking opportunities that may pay me an income.

Here is a summary of our family's current financial challenges:
1. All three teens need their wisdom teeth extracted at roughly $2250/teen with no insurance to cover this expense.
2. In an attempt to save money I have discontinued two of my medications (at $4-5/pill) which were otherwise deemed important; and have stopped receiving injections in my left arm and hand which allow me some additional movement/flexibility in that hand. These treatments each cost $1300 and have been given 4 times per year; yet my last treatment was in October 2009. I have decreased physical therapy and massage to once per month in an attempt to save money as well, yet honestly these have both been very helpful to me in the past.
3. I have some upcoming consultations which are likely to be expensive, yet important to complete. I have not have a urologic evaluation since January 2005 and am scheduled to see a specialist in the next few weeks to help determine if I need to catheterize myself more frequently, or perhaps not at all (that would be great!!).
4. I have been keeping up with my continuous re-certification requirements for Emergency Medicine and have passed all necessary exams to date to qualify for the board exam offered this September. Once passed, my board certification will be effective until 2020. Yet the exam fee is $1750, and having not been able to practice in the ER since 2004, it is even more vital that I take a review course to prepare for the exam. That alone is $1000, and does not include air travel and lodging.
5. Our family's ongoing medical/dental expenditures typically average $2000 to $2500 per month. That includes money spent on medical insurance with the remainder being uncovered medical and/or dental expenditures. Close to 90% of those dollars are attributable to me.
6. This fall we will now have 2 kids in college, both with monthly living expenses not covered by their 529 college funds. It was a sad day when I realized over a year ago those college funds were only for tuition, books and school supplies – not for room/board/living expenses. Given the economy it has been so far impossible for both boys to find part-time work.
7. On July 1, 2010 my Medicare insurance coverage was to begin, but did not….yikes! Investigation in process.

So while I have come to appreciate what many people face day in and day out, in terms of financial uncertainty, it is hard still for the first time in 22 years to not be able to afford some basic medical and dental care, and to have no reserve for emergencies, or to experience much of the life we once knew. In order to raise some funds we are looking into selling both our vehicles to obtain cheaper/older autos; we are also in the midst of a home re-fi with increasing consideration of accepting a 30 year mortgage just to keep monthly expenditures lower.
Overall I do not want to sound ungrateful. We have been provided for and cared for and loved by our community in amazing ways. Our church body of friends and many here on Bainbridge Island have done so very much to encourage us and have played a vital role in my recovery. I am deeply indebted to so many for their prayers, encouragement and talents in aiding my rehabilitation.

You could help by praying for me. I do want to work, and though I love the volunteer work I have been able to throw myself into, the time has come for me to find something to supplement our family income. Whatever that will be, I desire it to be work that is exciting and that will thrill me to get out of bed each morning! Though I had hoped to remain a long term faculty volunteer at the University of Washington school of medicine, serve as a spinal cord mentor to others so injured, and maintain active involvement in church ministry to others who have experienced loss, illness and hardship – it may be time that some of that energy needs to be re-directed and those volunteer activities curtailed. Time and events will tell….

I will do my best to keep you posted. IF you know of any opportunities in the medical field; speaking, teaching or potentially as an insurance examiner – I would appreciate the referral.
Thanks again for reading!
Be well,
Ernie

Cycling 2009 ends with an epic adventure

Ernie Franz — Tue, 05 Jan 2010 14:10:12 -0800

Well, now that we are officially into the 2010 cycling season (sort of anyway - waiting for the roads to dry, a bit of sun and temps above 45F), thought it was finally time to give a brief recap on the adventures of 2009. Overall it was a great season with roughly 2500 miles logged on the road.

As for what has now become my standard season ending ride, the goal was once again to complete 100 miles at the Dam2Dam Mike Utley Foundation bike ride the last weekend in September. A fund raiser for spinal cord research and for other such beneficial projects to help those with SCI find life and hope once again.

My amazing wife Gwen, and faithful physical therapist Keith Heinzelman, were in attendance. Our plans changed however the night before the ride when Gwen, carrying all my bags of gear with her vision blocked, sprained her foot on the curb at the Wenatchee Holiday Inn. This shortened her ride for the next day due to swelling and pain with weight bearing....she was to miss out then on the adventure Keith and I were to have!

In 2008, and recorded in this blog as well, I was able to complete 100 miles. This year the course was altered by a tragic accident which closed the Beebe bridge, a normal part of the 100 mile route. The bridge was structurally damaged by an apple semi-truck about a month before the bicycle ride. Sadly two people lost their lives as the cab tore through the railing and plunged into the river below.

With the bridge sagging and in need of vital repairs, the route had to be changed. This resulted in our facing a significant climb which began just 30 miles into the route. Though only 5.3 miles in length, the average gradient was over 8% with several sections over 12% - gaining 2200 feet in those few miles.

For the entire climb my HR was between 170-185 for 1hr 20min. If I was not an incomplete quad, it would have been a challenge - but this was in a real sense hors categorie for me. With prayers for strength and thinking of all the people supporting us, Keith and I did eventually make it over the climb to get to the flatter 60 mile long section - - we briefly thought much of the day's work was done......

But found at the top of the climb we had now winds reported steady at 30-35 mph with gusts to 40! An all too brief 5 mile tailwind section was completely enjoyed (no pedaling required to coast along at 30+ mph), followed by somewhat manageable crosswinds (that meant leaning hard into the wind to somehow just stay on the road) for 15 miles, but then turning a corner we faced 40+ miles of full-on increasing headwinds!!

Keith and I rode into this unrelenting wind with our best effort at 4-5 mph for perhaps 90 minutes, HR around 160 for the effort, and it was all we could do to stay upright! There was simply no way to even take a hand off the bars to grab a sip of water, as it would have resulted in a fall. We were using every available muscle group just to respond to the winds and not be blown off the bike. In a sympathetic act of kindness one of the support vehicles began motor-pacing us and attempted to block some of the wind for over 5 miles, which helped Keith and I to get another 1 mph of speed. The wind was so strong that on downhill sections we could hit almost 6-7 mph! When we finally realized it was 3:30pm (stopping to look at a watch) and that we had 38 more miles to ride, most of it still into the wind (at that pace possibly 7+ more hours on the bike as Keith reminded me) - we came to our senses and abandoned Plan A.

A purely "guy thing" had happened up to that point. As it turned out in our eventual debriefing of the ride, Keith was so ready to get off the bike and into the support vehicle - but he did not want to suggest that because after all, he was by far the stronger of the two of us, and how could he admit that to a quad who seemingly was determined to finish the ride? As for me, I had badly wanted to get a ride in the support vehicle, but assumed there was no way Keith would let me give up after we had made is this far! A communication gap, finally closed by the reality of the pace and number of miles left to ride into the gale.

So the last two riders on the course got a support vehicle ride to where Keith and I could meet up with Gwen. Now off the windswept plains of eastern Washington, along the Columbia river, the 3 of us rode back the last 10 miles to the finish in much calmer conditions - as we chased Gwen who paced us home.

At the end of the day Keith and I had cycled 70 miles altogether. Gwen cycling and excelling at being a patient, prayerful and understanding wife. Some final statistics for this 51 year old incomplete quad from the day: Riding time 6hrs 7 min, 70 miles, average speed 11.4mph, maximum speed 39.7 mph; average heart rate for the ride 151 beats/minute, maximum HR 186. So my HR was over 160 bpm for 39% of the ride, or for 2hrs 21 min. That's a few calories burned and certainly an epic adventure!

Two weeks later, with Gwen's encouragement, I made up for some of my "missed miles" by riding 44 miles roundtrip to a scheduled doctor's appointment. He and his office staff seemed to get a kick out of that. So for now I am once again indoors with group fitness spinning classes, until the drier slightly warmer weather appears. This changed life is not easy, but it still is very rewarding, challenging and exciting. I'll try to write more soon.....Thanks for reading.

Blog Orientation Essentials

Ernie Franz — Thu, 30 Jul 2009 15:20:23 -0800

This entry serves to give a quick orientation to recommended reading and audio/video links to those who might be visiting here for the first time. I have listed things below in a chronological order so that you may understand where I have come from, up until this point in time. You can get to those sections/links by clicking on the highlighted words. The first two entries are articles I have written from within the blog itself. Following that are a series of video and audio links.

As for reading within this site I would recommend starting with The Trauma section, which will give you the details of my injury August 23, 2004 - including x-rays, the car, and initial recovery.

You may then read more about my recovery and rehabilitation via two articles in this section entitled Recovery, which also includes the statement I made to the fellow that hit me, prior to his sentencing.

At the one year anniversary of getting swatted I was fortunate to be able to finish the ride home by cycling past the spot of injury and making it safely back to homebase. That story is nicely told in a 2 part video Bicycle Blues in the Key of E (be sure to watch it in HQ): Part I & Part II.

Last fall I was asked to be the lead-off speaker at the Spine Symposium Conference - Improving Outcomes in Spinal Injury, held at the University of Washington/Harborview. My 8 minute talk follows brief introductory comments by Dr. Jens Chapman, host of the symposium. I think you will find the segment interesting. Follow this link, then you will need to click on your choice of media player and speed connection to view the lecture. My talk starts at about 2min 35sec into the program.

Late Spring 2009 I particpated in a local Ride of Silence, an event now held across the US, which is ridden in memory of those cyclists killed or injured by automobiles. Our local newpaper presented this nicely done video segment of the ride.

In July 2009, Dave Beck of local NPR station, KUOW at 94.9 FM, contacted me for an interview about recovery from trauma, and to discuss life changes that occur after illness or trauma. Though I certainly wish that what occured to me, now almost 5 years ago, never had happened - I can say for certain that my life has changed, and in many ways for the better since the injury. Certainly not in a financial sense, but in my relationships, my faith, in the way I now approach life, the opportunities I have teaching medical students, and in working with those who have experienced trauma and loss. You may listen to that 20 minute interview here, which is also available as a podcast.

Thank you for following along on this journey! I pray you will find some material of encouragment to yourself or others. Be well....

Spine Symposium talk on UW-TV

Ernie Franz — Wed, 06 May 2009 23:05:01 -0800

In October of 2008 I was honored to serve as the lead-off speaker at the Improving Outcomes in Spinal Injury conference, which was organized by Jens Chapman, MD of Harborview Medical Center. Dr. Chapman is both a friend and my physician. He is following me for spinal stenosis in my lumbar spine, a condition inherited, yet also accelerated in its advancement due to my injuries in 2004.

After Jens gives a brief overview of the day, I provide a brief 8 minute presentation of my injuries and my perspective on how outcomes can be improved in spinal injury care. That talk may be found on UWTV via this link. You will then need to select your media player of choice and connection speed. At that point a video stream of the presentation should open up for you.

Thanks for watching!

Ernie

Inspiration from various sources

Ernie Franz — Sat, 17 Jan 2009 18:45:27 -0800

What follows are a variety of quotations and comments from various sources which have inspired me and helped me in the recovery process. My intent is to keep adding verses and quotes to this section as I come across new material that in turn my inspire you in your own personal journey.

"Faith does not operate in the realm of the possible. There is no glory for God in that which is humanly possible. Faith begins where man's power ends." - George Muller

"Faith is not an instinct. It certainly is not a feeling - feelings don't help much when you're in the lion's den or hanging on a wooden cross. Faith is not inferred from the happy way things work. It is an act of will, a choice, based on the unbreakable Word of God who cannot lie, and who showed us what love and obedience and sacrifice mean, in the person of Jesus Christ." - Elisabeth Elliot

I command you, be strong and courageous! Do not be afraid or discouraged. For the Lord your God is with you wherever you go. Joshua 1:9

"God's people have no assurances that the dark experiences of life will be held at bay, much less that God will provide some sort of running commentary on the meaning of each day's allotment of confusion, boredom, pain, or achievement. It is no great matter where we are, provided we see that the Lord has placed us there, and that He is with us." - John Newton

I love the Lord, for he heard my voice; he heard my cry for mercy. Because he turned his ear to me, I will call on him as long as I live. The cords of death entangled me, the anguish of the grave came upon me; I was overcome by trouble and sorrow. Then I called on the name of the Lord: "O Lord, save me!" The Lord is gracious and righteous; our God is full of compassion. The Lord protects the simplehearted; when I was in great need, he saved me. Be at rest once more, O my soul, for the Lord has been good to you. For you, O Lord, have delivered my soul from death, my eyes from tears, my feet from stumbling, that I may walk before the Lord in the land of the living. from Psalm 116

"Faith is to believe what we do not see, and the reward of this faith is to see what we believe." - St. Augustine

YouTube Video Links

Ernie Franz — Sat, 17 Jan 2009 17:12:19 -0800

Three videos have recently been uploaded to YouTube which tell various parts of this ongoing story. The first two are due to the wonderful work of Kevin Lynch, who in 2005 put together a movie for our local Bainbridge Film Festival featuring my recovery and my "finishing the ride home" on the one year anniversary of being struck. Bicycling past the spot of injury, this time with a police escort, 20 or so close friends, 3 other ER docs, and a US Congressman - among others. The movie is entitled Bicycle Blues in the key of E. Part I via this link, and Part II here. Be sure to enable the "watch in high quality" or HD setting below the screen to your right. Kevin Lynch is a master spin class instructor on Bainbridge Island when he is not flying about the globe competing in and/or filming professional triathlons.

The other video was done for the Kitsap Sun newspaper group with support from MADD; it chronicles the effects of alcohol and driving and the lives of those impacted in our community. There are three parts to this video, with my interview taking place here in Part II.

I believe these videos will give you a deeper sense of what I have gone through, and also will help you understand a bit more of my character and the key supportive roles so many have played in my recovery process. Enjoy, and thanks for watching....

100 Miles! Cycling update fall 2008

Ernie Franz — Sat, 22 Nov 2008 15:28:37 -0800

First, an apology…..
I am sorry that it has been so long since my last update. I am obviously not a blogger who is into bringing you each tidbit of news or accomplishment achieved in my life.
Yet there are a few very important physical goals that have been able to achieve since my last update in June.

During the dry season here I was able to average 100 to 120 miles per week bicycling on the road. Total miles on my Moots titanium hybrid are now 2500 in the past 15 months. Now that the rainy season is upon us, I am back indoors in group spinning classes 3 to 4 days per week. Dry roads and temps above 43 degrees F keep me outdoors and on the road.

Now to the reporting of two fantastic goals accomplished this cycling season....

I can now ride the entire Chilly Hilly bicycle route, 33 miles and 2500 feet of elevation gain – and do not have to get off to walk any sections. Long hills are okay, yet the steeper the gradient the more difficult it becomes. Riding the ~ 18 percent gradient up to Battle Point Park is the most difficult, fortunately it is only a short section of steep road before leveling off. My heart rate is typically 185 on that climb, not too bad for a 50 year old pump.

On September 27th 2008 I was able to complete my major training goal for the season.
I bicycled 100 miles in the Wenatchee, WA area on the Dam2Dam ride for the Mike Utley Foundation to raise funds for spinal cord injury research. The actual stats were 102 miles in 7 hours 10 minutes on the bike, average speed 14.1 mph, total elevation gain ~ 3250 feet, average heart rate 144 bpm.
I was supported by my wife Gwen, who rode 60 miles (only her third time on the bike all summer), Keith Heinzelman (my amazing physical therapist) and good friend Tom Crane who both rode the whole route with me.
Honestly, it is still hard to comprehend and believe that a C5 incomplete quad can complete a 100 mile bicycle ride in one day, riding on a two-wheeled bike. The more people I meet with spinal cord injuries, the more fortunate and blessed I realize I truly am.

Here are a few photos from the ride. First with my wife, then with Keith and Tom at the finish, and finally with Mike Utley.
Thanks for reading!

Cycling update May 2008

Ernie Franz — Tue, 03 Jun 2008 17:04:03 -0800

Time to bring you up to speed with my latest cycling adventures since riding Chilly Hilly in late February 2008. Basically it has been a very very wet end to winter and splash into spring. No signs yet of global warming here in the Pacific NW. Thank goodness too for spinning classes, which I have been able to attend 2-3 times/week. Basically, if it is dry and above 45 degrees F, I hope to be out on my bike; especially now that I am finished at the University of Washington medical school until next January.

I have been able now to log a total of over 1100 miles on my Moots since I received it around August 2007, not too bad considering the weather, and that I hardly rode outside from October till late February. I am most often out on my own, cell phone in pocket, flashing tail light, helmet mirror - praying for no flat tires. Given the hilly nature of Bainbridge Island I am slowly adding post-SCI previously unconquered hills to my list of those I have now scaled. Not checking them off with quite the significance of Bainbridge resident Ed Viesturs, the first American to climb the 14 mountains in the world higher than 8,000 meters, but nonetheless rewarding, and too involving risk - not knowing if I may stall and topple in the midst of a climb. While I am gradually increasing the degree of difficulty, I think Toe Jam Hill with its 22 - 24 percent gradient is forever safe from my aspirations.

Most of my rides are 18-25 miles, but I have recently been increasing my mileage as I have found my endurance is improving. This past month I traveled to Moab, Utah to ride my Moots on the roads - while my friends and son, Daniel, rode classic Moab mountain bike routes such as Porcupine Rim and Flat Pass. I managed to put in 110 miles in 3 days, one day 45 miles, which was easier than expected and not as exhausting as it would have been even 6 months ago. This has caused me to dream of attempting 100 miles in one day for the Mike Utley Dam2Dam fundraiser on September 27th this year.

My cycling goals for this year will be to:

Increase mileage
Improve strength and hill climbing
Complete 100 miles in an effort to raise funds for SCI research thru the Mike Utley Foundation on September 27, 2008. This link will allow you to donate funds in my name directly to the Mike Utley Foundation - I would be deeply honored to ride for you, and raise money for this cause that will benefit the 11 - 13,000 new spinal cord injuries per year in this country, and which will help others living with SCI, such as myself and all those less fortunate than I.

I have found that my stability is improving on the bike, also that the left leg clonus (non-painful repetitive spasms & twitching) I had gotten while pedaling (especially when fatigued) is now almost gone! It seems the more pedal revolutions I do with my legs, the more they are acting "normal". Still I do not feel them well, and have never experienced a sense of muscle burning or fatigue in my legs themselves - only getting overall body fatigue when I am spent.

Nonetheless, much to be thankful for! Still waiting to find if there are other quads or paras who are able to ride an upright two wheeled bicycle. With my stability slowly improving I have decided it is time to shed my "training wheels". I have been using TUFO tubular tires - the Diamond D28, which are 700 x 28 mm, with a max psi of 90. Yet, I am set to make the switch to the TUFO Elite Ride 700 x 25 mm tires with a 145 psi rating and smooth center tread. This should decrease my rolling resistance and increase my speed. I will keep you posted....in the meantime, think seriously of investigating the Utley Foundation website and donating. Thanks!!

The way it is....

Ernie Franz — Fri, 18 Apr 2008 10:47:14 -0800

This section is really intended for those with spinal cord injuries. "Constitutional truths" in this case has absolutely nothing to do with what our forefathers generated over 200 years ago, nor anything pertaining to our countries politically misguided adventures or upcoming election.

Instead it speaks to catheters, suppositories, and how to best avoid UTI's. These are a part of routine life those of us with SCI deal with, and others perhaps are inquisitive about. The content that follows is really meant for those who have some dysfunction in elimination processes in hopes you may find a helpful hint or two.

As I have written previously, every person with an incomplete spinal cord injury is going to experience different abilities or functional changes in elimination processes, both in bowel and bladder function. What follows is information about what has worked for this physician/patient.

I underwent urodynamic studies in January 2005. While I can still say I don't feel much below my clavicles, I still had a sense that testing was being done somehow as I managed to have a significant vagal (aka fainting, or falling out) episode while 3 catheters were indwelling in 2 orifices below my umbilicus. Fortunately as I fell from standing the alert nurse ran across the room and caught me just as I had fallen backwards onto the exam table. I'll spare you any more details of the testing. Basically the study showed I maintain high bladder pressures, even after voiding. That I can only void about half of what is in my bladder. Net conclusion = self-catheterization was necessary once per day to get my collecting system some time at zero pressure and spare my kidneys long term damage. Being the non-compliant doctor, it only took me 9 months to begin this daily routine. I think I still just wanted to be/thought I might be "normal" again someday (whatever "normal" is).

So since late fall 2005 I do self catheterize once per day, usually right before bedtime so that I get a bit more uninterrupted sleep before my small capacity bladder begs for a urinal. I can say with certainty, that this is not a big deal at all. I used to think it was, or that I'd never get used to it, but it is not a problem and would encourage anyone who has to do this not to hesitate, nor to fear it. Yes, the first few times take some getting used to, and for me resulted in a couple of lightheaded episodes (enough that I wore my exercise heart rate monitor just to make sure my rate wasn't going too low - it wasn't); but shortly after that it became routine, a basic part of my life that really is no bother at all.

As for avoiding UTI's or urinary tract infections. I have had several of these, but so far this routine is working well for me. I use Lo-Fric Primo catheters which have the attached sterile water pouch. I take 1000mg of Vitamin C over the course of the morning/early afternoon, and 2 tablets of Cranberry concentrate at 400mg each tablet at bedtime. This has kept my urine acidic enough, and prevented all UTI's since being consistent with this regimen.

While a few with SCI will have regular bowel action, I do not, and require suppository use. Without that, despite adequate fiber, fluids, visualization... nothing will happen even after 3 days of no suppository use. This is not a "sponsored" endorsement, but this doctor recommends The Magic Bullet - quick acting, effective and so forth. All credit is due my wife for her creation of the new word "suppositate", which is defined as the reflective, thoughtful time one has whilst awaiting the action of said inserted medication. Safe to say, The Magic Bullet does significantly reduce your suppositation time.

A time to laugh - Act 2

Ernie Franz — Mon, 07 Apr 2008 07:55:30 -0800

I ended up with enough entries in my first write, so decided to split them into two sections of more readable snippets. Enjoy (or at least you will see, as many have noted before, I do have a warped sense of humor)....

Thank goodness for a resourceful wife! In my early days at Harborview, long before I had any arm movement at all, I had to be fed by family, friends or occasionally by Harborview staff when available. On one such occasion I found myself alone with my l lunch tray before me, yet no way to call for nursing or other such help, as I could not even operate a call button or switch. Gwen had realized that no one would be there to assist me that day, so she called the Virginia Mason ER to ask if one of the ER techs could break away from VM to travel the 5 blocks to Harborview to feed me lunch. As luck would have it, one was available as the ER was not busy (aka quiet - a word we NEVER say in the ER itself). So unexpected by me, in comes my co-worker from VM dressed in VM ER work attire, informing me he was sent by my wife Gwen to feed me lunch at Harborview, before returning to work duty in the ER at VM.

I have already mentioned a bit of my bicycling endeavors, still the first recumbent training ride was the most humorous with Keith and I going down twice to the asphalt (now with a bit more details). Again at this early point in my recovery I could not rollover, stand or walk without significant assistance. The first low speed tumble came as we cycled uphill as Keith downshifted only to have the chain derail and fall off. He put his feet out to keep us upright, mine too weak to assist. Then reaching behind and underneath himself he tried with one hand to get the chain back onto a smaller chainring. So here we were on an uphill rise with Keith struggling to balance the weight of us and the tandem, brakes on with one hand so we don't roll backwards, the other hand trying to re-engage the chain behind and underneath him. Myself entertained watching him juggle all this as we slowly began to roll over to our left, Keith struggling with all his might to keep us upright, landing close to the yellow midline of the road. I landed face down as softly as one can land on asphalt, immediately laughing at the situation, Keith was not so entertained. After untangling himself from the bike, he had to roll me face up and get me out of the middle of the road. A couple of passing motorists came to our aid, Keith getting the bike pointed back downhill with me on it, and away we went.

The second spill, which followed the first by perhaps 20 minutes, found us headed up a steep pitch on High School Road, the same road I was originally hit on in 2004. On this occasion my cleated foot came off the pedal causing us to immediately loose all momentum and fall to our right, myself landing twisted against the curb. While lying prone on the street before Keith could sit me upright, an alarmed motorist remarked that I appeared to be seriously injured. I assured her those injuries were from an earlier bicycle accident, and that I would be fine this time. At that point another motorist informed us that on his scanner he had heard the medics dispatched to the scene. My response was that we needed to get away from the scene as quickly as possible; I was not yet ready to see the medics again. So Keith got me upright with my gait belt, we crossed the street to point downhill, myself holding onto mailboxes for stability, we then got on the tandem and rode away from the area to avoid the medics. Little did I know by then we were actually being followed by the chief of police in his unmarked car as we rode into Keith's open garage. Though the officer later told me he was baffled by the sudden closure of the garage door, he figured we must not be hurt and the medics were called off.

A time to laugh - Act 1

Ernie Franz — Wed, 02 Apr 2008 22:38:07 -0800

In this section, hopefully you may find a few good laughs from my experiences. As said in Proverbs - a good word brings health to the bones. Beyond even a good word, laughter just deeply feels so right.

In early November 2004, I was to be transported from the rehab facility in Silverdale to Seattle to see my spine surgeon. If my neck and arms were found to be stable enough, I could qualify to be transferred back to Harborview for additional rehab. I had thought we would take the ferry to Seattle, but it was not to be. The ambulance transfer crew arrived late for my pickup with plans to drive around through Tacoma and up I-5 thinking it would save time. We had to hustle to make the appointment, and heading north on I-5 across from Boeing Field in the HOV lane at 60+mph we had a left rear tire blowout! The driver maintained control, but alas there was no shoulder. So we parked it in the HOV lane and called for another ambulance as there was no possible way to change the wheel; the tread had somehow caught the rear bumper pulling it into the wheel rim. All this time I am facing backwards, watching the rapid traffic come up from behind, thinking we were at risk for being rear-ended in the HOV lane and on a curve with limited sight distance. Visions of my legs which were close to the rear window being thrashed in a collision seemed possible, with myself having no way to move them out of harms way. 30+ minutes later another rig arrived, the back doors popped open and one of the attendant rescuers was an off-duty ER tech that I worked with at Virginia Mason! So timing my move with traffic, I was moved in the HOV lane of I-5 on a wheeled gurney from one ambulance to another. In fact making it to my appointment only a few minutes late.

While there have been many episodes of bowel and bladder dysfunction, a few are perhaps worth mentioning, others not fit for publication. Briefly, though everyone with a spinal cord injury has different levels of ability to control bodily functions, I was able to begin re-learn at least bladder control while on Harborview Rehab. Given my lack of mobility this meant lying in bed using a urinal. One particular day while lying on my hospital bed getting dressed, my nurse left me ONLY with the urinal and a small washcloth (yes, like 6x6 inches), and not a stitch of clothing on. While awaiting the nurse's return, without warning my mother-in-law pulled back the curtain and walked in simultaneously announcing her surprise visit finding me there with only my bit of a fig leaf in place.

Though I went home wearing Depends, my control was gradually getting better. Yet even to date I get very little warning of the impending fullness of my bladder, that urgency striking suddenly, so quickly I often have only minutes before risking incontinence. Though by then I had graduated from Depends, in the summer of 2005 on a hot day Gwen and I were headed over the North Cascades Highway to Winthrop for a bit of a getaway. The iced Latte I had consumed before the long stretch of mountain pass road suddenly hit my bladder, and I told Gwen that we must find a place to stop ASAP. We both figured there would be a gas station or restaurant along the way as we were getting close to Winthrop. But nothing appeared. Our peace of the day, time together and the amazing beauty of the mountains now replaced by one thought - empty that bladder. There were not even any indiscreet places to pull off for me to mark a tree or other object. Finally, myself now in a full sweat with lap belt off to avoid any extra pressure, a side road appeared, though admittedly it was a little too late. Gwen pulled quickly down the gravel road getting out of sight of the highway and I finished relieving myself amongst the shrubbery. Oh what relief!! As we pulled out from the side road back onto the North Cascades Highway we both saw the road sign, we had turned down Dripping Spring Road - and that is just what I had experienced.

Since we are on the topic of water, I will relate my first swimming pool experience. Weekly, Harborview rehab patients have the opportunity to travel to a community pool for therapy. My first such episode involved getting from the wheelchair into the water by either a chair power assisted device, or via walking down steps to the water. This was at a point in my rehab when I could not walk, and had not yet tried steps. Yet my confident energetic African American therapy assistant was sure he could handle the steps with me and my 139 pound frame. He was after all still a buff muscular ex-athlete. The plan was to stand from the wheelchair arm in arm and face to face with Mike as he would support/carry me as he backed down the pool steps, I moving forward upright in his arms. Problem was, I could not feel my feet, and my nylon pressure stockings were still on. Once I hit the water and those tile steps, my feet and legs were sliding every which way; I had no control over them, nor could I even see where they were. Yet I felt like, and Mike's face confirmed, we were on the edge of losing all control. Desperate, I was looking for something, anything to grab onto - and all I could see were Mike's disappointing short and tightly curled chest hairs. His strength and ability saved the day, but I'll never forget the loss of control I felt and the overwhelming desire to grasp at something, anything to achieve stability - with the only option being those black, short, curly African American chest hairs. Mike and I had a good laugh over that.

Quotations

Ernie Franz — Tue, 01 Apr 2008 17:30:42 -0800

“Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.” Isaac Asimov

Shaking your head? Here are my honest unvarnished impressions. Although I nearly suffered a traumatic death, which in the ER we all have imagined as a horrible way to die, I can say from experience when you don't see it coming, and it strikes in an instant as John Donne remarked - it may not be all that bad a way to pass from this world. Yet as a survivor of a sudden change, an alteration to worse, I have found it is the transition that is indeed most troublesome. In my case, thankfully, it was a transition back to finding life, a life that is again (mostly) pleasant!

To follow this are quotes from all sources, on a variety of topics, presented hereafter without any additional comments...

"Life is getting up one more time than you've been knocked down." John Wayne

"There are two ways of spreading light: to be the candle or the mirror that reflects it." Edith Wharton

"There is only one thing that I dread: Not to be worthy of my sufferings." Fyodor Dostoevsky

“The only reason some people get lost in thought is because it’s unfamiliar territory.” Paul Fix, actor

"I am not what I ought to be. I am not what I want to be. I am not what I hope to be. But still, I am not what I used to be. And by the grace of God, I am what I am." John Newton (1725-1807)

"Kind words produce their own image in men's souls; and what a beautiful image it is. They soothe and quiet and comfort the hearer. They shame him out of his sour, morose, unkind feelings. We have not yet begun to use kind words in such abundance as they ought to be used." Blaise Pascal

"I found myself at peace with God, and rejoiced in hope of loving Christ. My temper for the rest of the day was mistrust of my own great, but before unknown weakness. I saw that by faith I stood; by the continual support of faith, which kept me from falling, though of myself I am ever sinking into sin. I want to be still sensible of my own weakness...yet confident of Christ's protection." Charles Wesley

"My son, oftentimes a man vehemently struggleth for somewhat he desireth, and when he hath arrived at it, he beginneth to be of another mind; for man's affections do not long continue fixed on one object, but rather do urge him from one thing to another." Thomas a` Kempis

"God hath thus ordered it, that we may learn to bear one another's burdens; for no man is without fault...no man is sufficient of himself; no man is wise enough of himself; but we ought to bear with one another, comfort one another, help, instruct, and admonish one another. Occasions of adversity best discover how great virtue or strength each one hath. For occasions do not make a man frail, but they show what he is." Thomas a` Kempis

"What is it, therefore, to believe in him? It is in believing to love, in believing to delight, in believing to walk towards him, and be incorporated amongst the limbs or members of his body." St. Augustine

"It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and a corruption such as you now meet, if at all, only in a nightmare. All day long we are, in some degree, helping each other to one or other of these destinations. It is in the light of these overwhelming possibilities, it is with the awe and the circumspection proper to them, that we should conduct all our dealings with one another, all friendships, all loves, all play, all politics. There are no ordinary people. You have never talked to a mere mortal. Nations, cultures, arts, civilization--these are all mortal, and their life is to ours as the life of a gnat. But it is immortals whom we joke with, work with, marry, snub, and exploit--immortal horrors or everlasting splendors. This does not mean that we are to be perpetually solemn. We must play. But our merriment must be of that kind (and, indeed, it is the merriest kind) which exists between people who have, from the outset, taken each other seriously. Next to the Blessed Sacrament itself, your neighbor is the holiest object presented to your senses." C. S. Lewis

"Science without religion is lame, religion without science is blind." Albert Einstein

"The great use of life is to spend it on something that will outlast it." James T. Adams

More to come...time now to read and discover more to share.

Cycling Fun inside Harborview!

Ernie Franz — Tue, 01 Apr 2008 16:52:16 -0800

In the late fall of 2007 the Harborview Rehab floor hosted an Adaptive Cycling Seminar. Through a donation made in my name, I was able to help fund the seminar. There were recumbent four wheeled tandems, various makes of three wheeled bikes, and options of foot or hand driven mechanisms. Although this was primarily set up for those who might be riding hand cycles, I did also bring my Moots and seized the opportunity to bicycle down the halls of Harborview. The very halls where I had pulled myself around in a wheelchair using my feet in 2004.

Being a C5 incomplete quad, in addition to my bilateral radial nerve injuries, I do not have the arm/hand strength to either pilot a wheelchair, or a hand cycle; whether on 2, 3 or 4 wheels. So in my particular case strangely, the only option for me is to ride an upright bicycle and pedal with my feet.

My intent was not, and is not now, to encourage those so injured to ride an upright two wheeled bicycle. Every person who is disabled who desires to bicycle will have very different requirements that will determine what is best and safest for them to be riding. Some will do better on various two or three wheeled bi/tri-cycles that are powered by arms or legs depending on your functional level. Others may need a 4 wheeled tandem setup. If you are interested and so motivated, investigate with your PT and/or local adaptive cycling retailers.

Here then are a few pictures from that day at Harborview - enjoy!

Current Bicycling status

Ernie Franz — Fri, 28 Mar 2008 09:18:35 -0800

Well, perhaps you are thinking this all seems too easy, or why did it take him so long to just advance to cycling on his own. You will have to believe me, it was not easy, though I had plenty of motivation to succeed, my spinal cord injury and general lack of balance and strength meant several falls were inevitable. Though Keith and I finished Chilly Hilly 2006 without incident, soon after that I was to experience quite a number of low speed falls. Being however an "experienced" cyclist, I always managed to land on my left (non-drivetrain) side, protecting my bike, yet causing a couple of left hip & elbow bruises along with a few head bangs.

To start on the bike required me to be pointing downhill, problem is though, we live at the bottom of a hill. So I would walk a bit up the hill, supported by another person I would aim downhill and away I went...briefly, because within 40 yards or so I had to make a U-turn and head back uphill before I ran out of road. This sort of worked, yet several hard falls over the course of a few attempts, made me realize I needed to devise some other method. I was also quickly getting tired of going down on my 14.8 lb. Davidson, so I began looking for an even more stable ride that could take some falls.

Briefly, I can tell you I thoroughly researched shifting and braking systems, frame design, cockpit/handlebar alternatives, wheel, tire and gear/drivetrain options. Though I tried a few of these systems out, even putting together one bicycle that just did not quite work for me, I finally settled on a frame design and controls that worked for my specific weaknesses.

While in the process of figuring out a more suitable bicycle, I had a "simple" ground level indoor fall while we were vacationing near Yellowstone National Park. This required left hand surgery once back in Seattle, followed by more hand specific rehab. The net effect was less functional use and strength of my left hand, particularly thumb and index fingers; which made it even harder to brake and shift my Campy Record equipped Davidson. Not to mention, loss of piano lessons and any progression of function I had found to that date.

In the spring of 2007 I placed an order for a custom Moots bicycle. This was then built up and delivered to me by Classic Cycle on Bainbridge Island. I was involved a bit in the frame design, then also hand picked all components, this time with success! At the heart, a cyclocross frame the Psychlo-X YBB, built to take more than a few hits. Curved and sloping top tube to allow ample standover height for weak legs; built-in rear suspension that keeps me stable over road bumps and ruts. GripShift shifters which I can operate with both hands; V-brakes which have excellent stopping power and require less lever movement to activate than road brakes. A carbon fiber wheelset to keep rotating weight as light as possible, with TUFO diamond tread 700 x 28c tires at 90psi and plenty of sealant in the tires to prevent flats. Compact 50/34 crankset with 11 x 32 rear cassette, which gives me a gear ratio I can get over most hills, AND most importantly allows me to avoid using a triple chainring!! Weight under 18 pounds.

While I was awaiting the building and arrival of my Moots, Keith Heinzelman, my PT, and I had time to prepare; the goal was to teach me how to ride completely independently without assistance. If the following description may be helpful to some of you, Keith and I have thought about shooting a brief video of this. Basically the pushing off and mounting the saddle motion had to be dissected into pieces I could learn, then put together to be able to ride away. (Note: I found early on, I must use clipless pedals and cleats due to barely feeling my feet, particularly having very little idea of where my left foot is in space. If anyone is interested I can give details as to how I chose a pedal/cleat system after trialing several of them.)

For learning this motion, we went to the High School grass sports fields. Straddling the bike, hind end not on the saddle, two hands on the bars, one foot clipped in, I repeatedly only tried to push off with one foot over and over. For me, left foot clipped in at 9 o'clock position ready to push down, right foot on the ground ready to push off. Only attempting to get enough motion to travel a few feet through the grass. No attempt was made yet to pedal or ride, only repeating the motion over and over of pushing off with the one foot on the ground, and pushing down with the left clipped in. After perhaps 30 attempts I had learned to travel further and further with each push off.

Next, was combining the push off with placing my rear on the seat. No attempts yet to pedal circles. It was push off to get momentum, then lift the hind end a bit forward to clear the saddle nose, before sliding back to sit on the saddle. All the time in the grass field. Repetition was the key, each time the movements became easier and more coordinated.

Now it was time to combine them all, and after a few attempts I was able to ride away, adding the last part of clipping my right foot into the pedal. A few more times on the grass and we transitioned to the HS track rubberized surface. Wow! Hardly any rolling resistance compared to thick grass, and immediately I could push off and ride away! Moments later Keith and I were on the asphalt roads and I was good to go!

Soon afterward the Moots was delivered, and the setup turned out to be perfect! That was in late summer 2007, and within 8 weeks I had almost 600 miles on the bike. My only fall to date being an attempt to do again a very low speed U-turn. I have finally learned that if I am to turn around, simply stop, walk the bike around to face the new direction, push off and I'm on my way.

The last weekend in September is the Mike Utley Dam2Dam bicycle ride which raises money for spinal cord research. Mike himself is quite a personality, a C6-7 level quadriplegic, injured as a Detroit Lion in a pro football game in 1991. Our whole family signed up for the ride, which offers routes with various mileage. Even my trustworthy PT Keith Heinzelman showed up for the ride (which is about 150 miles from our home). Total family mileage for the 5 of us that day was over 260 miles! Keith, Evan, Gwen and I each riding a bit extra to get to 100km, or 62 miles! My goal for 2008 will be to get to 100 miles for the day. Here's a photo of most of us with Mike (missing middle son Daniel who was sound asleep in the car after riding 50 miles).

So that just about brings you up to date with my cycling adventures. I did ride Chilly Hilly this year 2008 on my Moots with son Daniel; thankfully the day was dry and warm enough. I plan to continue in group spinning classes usually 3 days per week, schedule permitting. I get on the road as often as I can when it is dry and above 45 degrees, often riding alone with my helmet mirror, rear flashing light, and cell phone in my jersey pocket. If I were to suffer a flat, it will mean using the cell phone. Clinchers or tubular tires, either way, a flat will end my ride that day as I do not have the hand strength to change a flat. So far, I am very happy with my TUFO tubulars and the sealant.

Independent Cycling - a dream realized

Ernie Franz — Thu, 27 Mar 2008 20:19:44 -0800

By early summer 2005 I began thinking with my wife and PT what we could do for the one year anniversary of my trauma. Soon a plan was hatched that involved my bicycling past the scene of the crime on the day of the life changing trauma, this time to make it home! Problem was, I had not yet ridden a two wheeled bicycle on my own. By late July, it was time to give it a try.

Keith Heinzelman, my PT, and Kelly Campo, another PT whom had known me for a long time, came over to our house to figure out how we could get me on my mountain bike. We were unsure how my balance would be, what my leg strength would be like, how braking and shifting would work. On that memorable day I kept my gait belt on so Keith could run alongside me and remain attached somewhat to me, as a father would with his child, as I attempted to balance and pedal.

Well, as you can see from this gleeful smile on my face, the plan worked!! That is Keith running behind me, after I had told him "I think you can let go". I had Kelly, my other PT friend, snap the picture and catch me as I headed for the grass. Just like a kid, it did not take too long to gain some confidence and desire to take it to the next level. Keith and I spent the next several weekends preparing for the ride home on August 23rd; mostly figuring out how to start and stop and shift. My main problem was starting; I found I had to have a person beside me supporting me, one foot on the pedal, hind end on the seat, and a bit of a push helped too.

So on August 23rd, 2005, one year to the date post-injury, accompanied by my son Evan and about 20 friends on bicycles including local shop owners, Bill Davidson, Congressman Jay Inslee, PT's Keith & Kelly, three ER docs, and one other member of the "flying cyclists' club", Chris Stanley (both of us hit and tossed by cars) - with a Bainbridge Island police escort, we all bicycled past the spot I was hit, and completed the short 3 mile trip home to our house. The event documented on video and will be etched in my mind forever. We arrived home on that beautiful day to celebrate life, a new life - not a life I ever anticipated, but life all the same. Root Beer Floats were shared by all. A tradition we continue to this day on every 8.23.

Emotionally it was okay, no tears or sorrow, more thanks to our Lord for allowing me to live, to recover, and not to have been hit with a brain injury in the course of events. I often think that if I did in fact suffer any brain injury, it must have been to that area of my brain which would normally be responsible for generating PTSD, or post-traumatic stress disorder, as I seem to not have no evidence of that most thankfully.

Physically it was a challenging ride, though my mountain bike had low gears, my strength was lacking and there were a few good size hills to get over. At the top of High School road my heart rate was 197, a bit on the high side! Yet from there it was mostly downhill heading home.

The next big cycling boost came in December of 2005 with the delivery of my Bill Davidson road bike. Bill had poured over every detail of the bike; having the chainstays and lugs undergo extra machining to take off excess titanium where it was not needed structurally. The finished bike weighed in at 14.8 pounds, pedals included! A carbon and titanium featherweight with Campagnolo Record, Zero Gravity brakes and Reynolds carbon fiber wheelset. Here it is:

Given the time of year I received the bike, it had indoor privileges (as you can see from the pictures) for some time before I had a chance to take it on the road. In the meantime I kept spinning in indoor group classes, or on my own in the garage, to stay in some sort of condition. Though I had only a little actual "seat time" in preparation for Chilly Hilly 2006, Keith and I were able to complete the ride in dry but chilly conditions on my new Davidson. Cycling though was still in many ways sketchy for me, particularly in starting. I just did not have the ability yet to push off and ride away on my own power. I always needed another person to stabilize me for my starts, and still had to be seated, one foot clipped in, the other with a pointed toe touch, while Keith supported me on one side. This all worked better if I was pointed downhill too! Problem is, there are lots of hills here, and not all of them point downhill !

Next to follow, how Keith taught me how to bicycle completely unassisted.