It was a good day for a ride on January 5th—clear but a little chilly (mid-forties when we left). Several of us old timers met near the Clinton Presidential Museum at 9:00 for a ride of about 30 miles. We biked through downtown Little Rock, south toward College Station and Sweethome. I made it only about 4.25 miles before I crashed.

One question, actually the biggest question, is what caused me to fall. One possible cause was syncope, which is a temporary loss of consciousness from insufficient blood flow to the brain–fainting. The doctor in the ER mentioned this as a possibility, and I saw the word several times on my medical chart. From my health record at UAMS the doctor knew I had had an episode of supraventricular tachycardia (SVT), which is a very fast heart rhythm. Syncope can be caused by SVT.  However, I don’t think that SVT could have caused me to pass out, because I believe I would have felt it coming on.

I ride with at Garmin 820 Edge bike computer. I have a chest strap that syncs with the Garmin to record my heart rate. The Garmin collects heart rate data, GPS and other data.  The data automatically syncs with a Garmin website where I can review the uploaded data. From this data I can gain insight into what happened at the moment of the crash.

I’m pretty sure I would have recognized a symptom of SVT (weakness, when I had it before). I usually keep my Garmin set on a screen that shows heart rate, distance, speed, average speed, cadence, and grade.  If I had felt anything unusual, I would have looked at my heart rate monitor to see what my heart rate was. The Garmin data supports my theory. My heart rate at the time of the crash was 111 bpm, and there was no indication that my heart rate got anywhere near the SVT range (176 bpm during my previous episode). Several minutes before I crashed my heart rate was 150. That’s pretty high for me, but not unusual. And it came down quickly when we stopped for a bit to wait for some riders behind us.  It is interesting to examine the graph of my speed at the time of the crash.  The data show that the speed drops precipitously to about 3 mph, and that it took another 40 seconds to reach zero.  I assume that after I crashed the rear wheel continue to spin, which would explain why the Garmin recorded speed even after I had apparently crashed.  I was traveling about 20 mph at the time of the crash; we had just gone down a pretty steep hill, which would account for our fast speed, although the spot of the crash was rather flat.  Hitting the ground at that speed could hurt a fellow.

The only other way to evaluate what could have caused the fall is from eyewitness reports. Jim and Scott were ahead of us and didn’t see the crash. I was just ahead of Janice, so she saw what happened. She texted me her account:

You might want to also tell the doctor that when I got to you (immediately ) you were on your back and you were unconscious. Your eyes were partially open, but not awake. Your breathing was shallow and irregular and sounded raspy, noisy, (like low pitched snorting or snoring) and did not not sound normal. Also you were foaming at the mouth, drooling a little.  Coreen probably has a record of how long she was on the phone with 911 which might give you a better estimate of how long before you recovered and gained consciousness.

In a second text, she added more insight:

In talking, the group is concerned that maybe you fell off the bike because you passed out.  I was so close that I didn’t have time to really see. There was a dip in the road, but it looked like all of a sudden you fell off the bike.  Coreen and Mike were behind me and they had a different perspective.  But you were unconscious several minutes.  It seemed like a long time.

When I talked to Mike and Coreen, who were a bit behind me but saw the crash, they thought that I just fell over for no obvious reason–syncope.

Carl was the other eyewitness. He was just behind Janice. He visited me in the ER, and we talked about what he saw. He also described a dip in the road associated with a pothole that could have been hard to see. 

I went back to the place where I crashed to look for the dip in the road.  I was able to locate the crash site pretty precisely using the Garmin GPS data and pictures that Jim took at the site.  I believe I found the “dip in the road” that Janice and Carl described.  It’s not a huge pothole, but certainly big enough to cause a wreck if I hit it unexpectedly.   We will never know for sure. I hope the pothole was the cause; I would hate to think I could pass out for no obvious reason. What about while driving a car?

I have no recollection of anything before or after the crash. I remember being in the ambulance. Apparently, I sat on the tailgate of a pickup truck while waiting on the ambulance, but I don’t remember that. In the ambulance the EMT asked me who the President was. My answer was Obama, either because I was really confused or I was wishfully thinking of times past. In a few minutes I realized that I had given the wrong answer and told the EMT; I’m sure he didn’t change his assessment about my confusion.

To have had such a concussion-producing crash, I wasn’t in much pain. I had a small abrasion near my right elbow, which hardly bled. My right shoulder was sore for a time, but not that much. I had a sore place on my right rib cage that I didn’t even notice at first. After a few days my rib cage started to hurt–it hurt to take a deep breath or to move very much or exercise the muscles like doing a sit-up.  But, that pain only lasted one or two days.

I was taken to UAMS ER where I was given the following tests:

• ECG 12-Lead—Normal
• Basic Metabolic Panel blood test—All tests results were in normal except my glucose was a little high
• CBC without Differential—All tests results were in normal range
• CT Head WO Contrast—Basically normal. No intracranial hemorrhage or drainable fluid collection is seen.
• X-ray of my shoulder was normal
• X-ray of my chest was normal
• 3 time-sequence tests of troponin—These tests show whether I had had a heart attack. I had not.

I was taken to the Clinical Decision Unit, another area in the ER where you go for observation, and I thought I might stay there all night. But, when the third and final result for troponin was normal, they let me come home with instructions to followup with my PCP and to have a nuclear stress test. The stress test conducted 2 days after leaving the ER was normal.

When I saw my PCP 5 days after the crash, he decided that I should wear a heart monitor for a month. I did that, and what a pain in the ass that was. The monitor consists of 4 electrode leads stuck to my chest connected to a battery pack and control module. I wore it 24/7. I only took it off to shower. Of course, sleep was frequently interrupted when I would roll over on the control module or pull off an electrode, causing the thing to beep.  The results didn’t show any problems:  No arrhythmias were detected in this 30-day event monitor.

 

 

There was very little damage to my clothing. My outer jacket was torn in a couple of places. There were no scuffs on my gloves. (Click on the image to see a larger version).

 

 

 

 

 

 

 

 

My helmet was also broken. I noticed a small crack and an indentation in the helmet on the back of the right side.

 

 

 

Later, I noticed the foam padding inside the helmet was cracked. Even before I noticed the crack, I bought another helmet, because I had heard that if you ever crash with your helmet you should buy another whether you see damage or not. I believe I have a good helmet, which is equipped with MIPS (Multi-directional Impact Protection System) Brain Protection System.

 

 

 

My bike was not seriously damaged, thank goodness, because it’s a new beautiful bike. It’s an Allied Alpha with just about everything made of carbon and is light as a feather. I took it Meteor Bike Shop to have it checked for damage. The right brake lever was twisted but not broken. There was a scratch on the seat and on the brake handle but nothing major.  The mechanic said I must have sacrificed my body for the bike, because there was so little damage.

 

After the crash, I didn’t ride for a few days. One reason was that I had a migraine headache that I don’t think was related to the accident. I have a history of having migraines, and this one seemed to be a normal one for me. For the next month, I kept a normal winter riding schedule. I rode the trainer in the garage or the stationary bike at the fitness center when the weather was bad.  I rode outside if the weather was good. I missed several days when we were in Hawaii and a few days when I had a cold.

I noticed no decrease in my performance, and I felt fine until February 20.  That’s when the shit hit the fan.

Story to be continued.  You can read the rest of the story here.