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Bill Klaproth (Host):  Marin County is a very active community which includes many people on bikes. So, let’s talk about common bike injuries, treatment and what bike riders can do to protect themselves with Dr. Edward Alfrey, Trauma Medical Director at MarinHealth Medical Center and a General Surgeon at MarinHealth General & Colorectal Surgery, A UCSF Health Clinic.

This is The Healing Podcast from MarinHealth. I’m Bill Klaproth. Dr. Alfrey, thank you so much for your time. So, first off, can you share some quick background on yourself?

Edward Alfrey, MD (Guest):  I originally started out in the city and county of Denver working as a paramedic before going to medical school. And then I went to medical school at the University of Colorado and trained in surgery at the University of Arizona and then the University of Pennsylvania in transplant. But for most of my career, I’ve been involved in trauma services and in 2011, I can to MarinHealth Medical Center to run the trauma services.

Host:  You’ve been around and we’re happy to have you here in Marin. So, Marin County as you know, is a very active community. So, let’s talk about biking and bike safety. Do you see a lot of bike accidents in the Emergency Department?

Dr. Alfrey:  We do. If you just look at all trauma centers around the country, we see about six times the number of bicycle accidents per trauma patients as other centers and that may be because of the weather, it’s sort of a year round sport here. It’s very popular in Marin County and also, we have a lot of visitors from San Francisco that ride across the Golden Gate Bridge and then enter Marin County after crossing the Golden Gate Bridge. Part of the problem with those riders is I think they fail to realize the deep and rapid descent that comes after you cross the Golden Gate Bridge and we sometimes see patients from those bicycle crashes going way too fast because they’ve lost control of their bicycle after they cross into Marin county from the city across the Golden Gate Bridge.

Host:  Yes. I love that ride, by the way. It is gorgeous and beautiful, and I know what you’re talking about. So, speaking of bikes and injuries, what types of injuries then do you usually see from bikers and can they be serious?

Dr. Alfrey:  Yes. The injuries from bicycle crashes run the gamut from having abrasions on their legs. The most common injuries, quite frankly, are patients will have a couple of rib fractures, a clavicle fracture which is the collar bone, and a concussion. Concussions actually are the leading injury that we see after bicycle crashes.

Host:  What does treatment and recovery typically look like for those types of injuries?

Dr. Alfrey:  Usually, we see a concussion plus other injuries which include some rib fractures, and maybe a broken clavicle. Those types of recoveries can take anywhere from a few days to recover to several weeks because again, concussion, I know there’s been a lot of media attention directed to concussions recently because of the NFL and other types of contact sports. And that’s what we see is injuries that can range from just having some headaches and photophobia for a few days to where it takes several weeks to recover because of the loss of ability to focus and that sort of thing. And then regarding the rib fractures, pain from a rib fracture can usually be pretty serious for up to three or four weeks. If you have an associated collapsed lung as well, then that extends the recovery even a bit more.

Host:  And speaking of concussions, what role do helmets play in protecting people from concussions?

Dr. Alfrey:  It turns out that a helmet doesn’t prevent a concussion. What the helmet does is it prevents serious head injuries. So, the percentage of patients with serious head injuries after bicycle crashes is significantly improved. You are four times more likely to have a skull fracture if you’re not wearing a helmet and you are about four times more likely to have a major head injury if you are not wearing a helmet. So, the helmets do prevent serious injury. They just don’t really prevent a concussion.

Host:  Okay, well that’s good to know. I’m glad you explained that to us and then speaking of biker safety, what else can bike riders do to protect themselves?

Dr. Alfrey:  Well, the first thing they can do is they can know their geography. They can recognize the terrain of course because things like gravel causes injuries. They should understand the bicycle that they’re riding, and they should be careful because not all bicycle crashes into cars are the fault of the car. Frequently find it’s the bicyclist that’s not riding in the lane properly or riding too fast or decides to not stop for a stop sign. I think sometimes bicyclists fail to realize that stop signs mean anybody that’s moving, not just the car. And so, sometimes we see the – an innocent driver running into a bicyclist because the bicyclist shoots through a stop sign or a light.

Host:  And then if a biker does have a fall, is it necessary to get treated right away?

Dr. Alfrey:  Because there’s so many of these patients have concussions and other injuries, we think it’s very important to at least be evaluated if there’s any sort of significant impact. That doesn’t mean if you are riding along and you stop and grab your water bottle and fall over that you should come into the Emergency Department. But we do see some patients that come in several hours after a bicycle crash that have serious injuries and they get home and then their family notices that they are slurred speech, or they are not breathing very well, and they bring them in. I can’t really comment on everybody that crashes in a bicycle, but if there’s any question at all, the safest thing to do is to come in and be evaluated and just make sure that there’s not any serious injury because sometimes, for example, a collapsed lung is not apparent initially on any symptoms. In other words patients feel like they are breathing fine, they might have a little pain in their chest from a rib fracture, but the collapsed lung can expand relatively quickly and if they are at home sleeping and their lung collapses even further, they can be in trouble pretty quickly. So, we do feel it’s important if there’s any question at all to just come in and be evaluated and make sure that there’s not anything more serious going on.

Host:  So, when in doubt, check it out. And then lastly, Dr. Alfrey, any other thing you’d like to address when it comes to biking and bike safety?

Dr. Alfrey:  I firmly believe that bicycling is a very good form of exercise. But I think also in knowing that like any other form of transportation, it’s very important to understand the road you’re riding, to be familiar with your bicycle, to make sure that you check it out just like you would your car if the tire looks low, you should put air in it and make sure the brakes work properly. Understand that the front brake is not the right brake to pull if you’re going downhill really, really fast. And so, I think that bicycling is so much part of our lifestyle that we just walk out in the garage, jump on our bike and off we go. But make sure it’s safe, it’s tuned up, that the brakes are working, that the tires are filled properly and know where you’re riding.

Host:  Some really good points Dr. Alfrey. Obviously, check your bike out. I know I don’t do that but I’m going to start doing that after you mentioned that. And earlier, you said know your geography as well, which I think is a great point and thank you for sharing that information with us. And thank you for your time today. We really appreciate it, thanks again.

Dr. Alfrey:  You bet. Thanks for having us on.

Host:  That’s Dr. Edward Alfrey and for more information please visit www.mymarinhealth.org, that’s www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.