Monatsarchiv: November 2009

Further Update – Shoulder injury — and random thoughts on cycle commuting and Japanese health care

Further Update: Checked in to Tokyo Medical Center on Tuesday afternoon.  On Wednesday, they were able to reset the shoulder with me under general anesthesia … without making an incision or cutting up my muscles/tendons.  I’m out of the hospital this morning, with my upper arm heavily taped to my side/back for the next 3+ weeks so it does not „pop out“ again.  Seems like everything went smoothly, and the usual pleasant surprise with a bill that is probably 10-20% what it would have been in the U.S. and leaves one scratching one’s head as to how they can possibly pay salaries of the docs and staff.


Update:  The shoulder movement was not returning as quickly as it should have — I cannot turn my arm outward or lift it up. I had my 2nd follow up visit yesterday to the doctor and still nothing showed on another x-ray — so he had me CT scanned. The CT scan shows very clearly (1) a portion or the back side of the „ball“ joint of my arm into my shoulder socket was crushed in the impact against the shoulder socket — nothing that won’t heal with time and still plenty of bone left all around it, but also (2) the arm is dislocated … not all the way out of the shoulder socket, but about 1.5-2 cm shifted back from where it should be, and the jagged edge of the damaged part of the „ball“ joint is riding/catching on the edge of the socket, which is why I have very limited movement, and also which prevented it from „relocating“ to the right place on its own.

I’m going in Tuesday afternoon, for surgery, general anesthesia, Wednesday morning. They will try to „relocate“ the shoulder and if that works, they won’t need to make an incision.

If it does not, or looks like it risks further damage … then they will do surgery to achieve the same result. Seems like the doctor wants to do this ASAP, says the longer I wait the harder the relocation will be/more damage to the non-bone parts. So I’ll just get it done … at least it is a major medical center with a good reputation from what I know (Tokyo Medical Center – Komazawa) … rather than hunting for the best shoulder doc in Japan or hopping on a plane to get someone in the U.S. to deal with it (as some of my colleagues have said I am crazy not to do, given their perception about the difference between the higher end of orthopaedic surgeons in the U.S. and Japan, as well as their desire for an English fluent doctor). We shall see.

P.S. Maybe next time (if there is a next time) this doc will believe the patient when he says it hurts so much there must be a break or dislocation — turns out there was both!


Original Post:

Komazawa Dori was a solid line of standing traffic on Thursday morning last week around 9AM. After passing Komazawa Park, at the Jiyuu Dori intersection, I could see not only the line of cars but also taxis blocking the shoulder that usually serves as an informal bike lane, so I went onto the sidewalk at the far side of the intersection, in front of the National Medical Center, slowing my pace.

The sidewalk is at an angle, tapering as it moves away from the corner, and a signpost of some kind blocked my view straight up the path. As I rounded the sign post, I came face to face with a college student (Y.O.) on a mamachari, going at full speed as he rounded it from the other side, starting to get a proper line to cross the intersection (late to class?). I swerved to try to avoid him, but we brushed left shoulder to left shoulder. At my very slow pace, and with my motion already to the right, that brush was enough to drive me off the bike and shoulder first into the pavement. … If I had hit Y.O. head on, I probably would have done some serious damage to him, helmetless and probably 1/2 my weight, but as it was, he stayed upright and came back to see if I was alright.

I was not — I lay on my back, a stinging pain in the shoulder immediately following impact. I could not move my arm. Anyway, Y.O. helped me over to the conveniently located National Medical Center, and spent the next 2 hours with me as I went through check-in, then by wheel chair to the orthopedics department, then down to x-ray/radiology, then back up to the orthopedics department, then to the sign out line, then the cashier. The bill was 6240 yen (US$70) without insurance. Then we walked across the street to one of several conveniently located pharmacies to get two types of pain killer and another medication to take to counteract stomach problems from one of the painkillers (another 3000 yen — under US$35).

Fortunately, the orthopedist gave priority to a large foreigner writhing in pain and I did not need to wait long. I was skeptical when told there was no sign on the x-ray of a broken bone or dislocation, even though I could see the xray myself … but was assured that, yes, it really could hurt THAT MUCH!!!!, even without either a break or dislocation. … I’ve since heard colleagues mention scary phrases like „rotator cuff“ (an injury one received upon being slammed shoulder first into the boards while playing hockey … with a four month recovery period including rehab?). Maybe I will get my first MRI after I stop back at the orthopedist on Wednesday for follow up? Doesn’t everyone get an MRI at some point in Japan (where the government-mandated cost is something like 10-15% the equivalent in the U.S.A.)?

The pain has gradually subsided over the intervening 4 days … but it is only today that I can type at all with my right hand reaching the keyboard, and only with my arm very carefully positioned and without much stamina. And I’m still on painkillers and wearing a sling for the rest of the week–I hope no longer than that.

1. I may have a warped perspective, but I think Y.O. bears at least 75% of the blame for this accident, because he was going way too fast for an obstructed view part of a sidewalk, and did not seem to take evasive action. That said, my bike was not harmed, my insurance will cover any of the (modest, in Japan) medical costs, and I really did not see the point of calling the police or filing a report for an accident that occurred on the sidewalk, as opposed to going straight into the hospital for treatment.

2. I blame myself for deciding to ride on the sidewalk. I thought this stretch of fairly broad sidewalk, with very limited access from either side and relatively low traffic after passing the hospital entrance, would be safe, but sidewalks are a much more dangerous location than streets, in my view, since you are much more likely to have a Y.O. appear immediately in front of you, or to have a high school kid with gym bag come running out of a stairwell just as you pass. The only way to ride safely is to preserve an ability to defend oneself, and that is harder on the sidewalks.

3. Even when I stay in the street, however, I often recently come face to face with cyclists riding the wrong way on the shoulder, forcing me into traffic to avoid them. I always try to scream „hantai houkou“ (wrong way) as I pass … but I’m fighting a losing battle against the umbrella-bearing, mobile-phone-screen-viewing, wrong-way traveling cyclists of this town. There are more and more cyclist commuters in Tokyo with each year, most of them quite responsible, to the point of being ridiculous — waiting at red lights at minor intersections even when there is no cross traffic nor a policeman in sight! In general more cyclists are a good thing because cars are more likely to expect and anticipate you — but it is not so great when there are no bike lanes or other real accommodations. And I see more and more cyclists zooming right in front of pedestrians who are trying to walk across the street, terrifying them like something out of a Lucas Brunelle video of messengers racing across Manhattan, flitting through lines of traffic and pedestrians like schooling fish (There were 3 of these Brunelle videos among the short films I saw at Bicycle Film Festival, even crazier, much crazier than this one on Youtube — music by ÜBERDOSE! — from a few years back). UPDATE: You can see more Lucas Brunelle videos and material at his official site, including similar Stockholm and London rides … but not yet the new NY rides I saw at Bicycle Film Festival.

4. I also am painfully reminded that the traffic, and risks, are much worse if I ride in at 9AM than if I leave home at 7:30AM. Now if I could just teach the clients to keep early hours, I would be fine.

5. The National Medical Center is impressive in at least one way. I have never seen so many elderly Japanese in a single place — the equivalent of at least 10 or 15 country villages all sitting in the waiting areas around this hospital complex. Average patient age must be creeping over 80. Is this what the restaurants and trains of Tokyo will look like in 30 years? If it is, I don’t think I want to be here to see it (at age 77).

6. What a great business the pharmacies across from the medical center have — the one I visited, Terada, had an endless stream of customers, keeping 8-10 pharmacists busy at all times filling prescriptions. The shelves and bins were overflowing with more prescriptions, just waiting to be picked up.

I’ll provide an update when I have a better idea of whether this is a 2-week, or a 4-month recovery and rehab path, and when I know what my injury is called — something more technical than „tenderized/smashed up soft bits inside shoulder area“).

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ALERT — Transalp Sign up – Tuesday Dec 1, Noon CET (8PM Japan time)

Family schedule next summer does not permit me to sign up for the Transalp for 2010, but I hope to try it again in 2011. In the (unlikely?) event that anyone is going to go for it in 2010, online sign up is tomorrow, Tuesday, at 8PM Japan time (Noon CET). Here is the Transalp website in English, and in German (Ludwig? MOB? Tom?) … in case there are any takers. Of course, you need a 2-person team!

I recommend gathering all the necessary information in advance so you can sign up within a few minutes of the site opening to assure a spot — worked for Jerome and me this year). They have posted „screenshots“ of the application form on the site, so you can see what is required. … once you get a space confirmed, they give you several weeks or more to wire the payment — which, I must say, was a real bargain given the support and organization involved for a weeklong race in 3 or 4 countries.

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Congratulation to our (undisciplined) team member Manfred von Holstein
(below right, with his friend captain Rumpelstoss and two Narushima riders)
on the occassion of his 40. birthday today.
There is nothing a German officer cannot do.“

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We are planing to have our traditional (since 2008) first training ride of the year on January 2nd 2010 together with Tokyo Cycling Club. A gruesome ride from Tokyo (Kawasaki? Yokohama?) along the coast to Odawara and finally up the hill to Moto-Hakone. All the way followed by a bunch of incredible fast (and incredible young) university students ….. running.
Who will make it up to Ashinoko before they overtake you?

The reward for those who make it: The mother of all downhill rides: Route 20 from Hakone Pass over Jukoku pass and Atami pass down to Atami. And the mother of all quick returns.

January 2nd 2010. Mark the day.
[please also mark January 2nd 2011, 2012 and 2013 in case you bought calendars already]

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Temples and Shrines

This being the last ride in my 30s, I made yesterday a pilgrimage to some (semi-)important temples and shrines around Chichibu. Chichibu is full of them, so I had to be selective.
My first stop was at Shiofunekannon-ji, just outside Ome.

At 8am it was still so early no visitors were in sight.

I then cycled into the most southerly mountains of Chichibu, up an increasingly steep road (the steepest part must be at least 20 degrees) to Nenogongentenryu-ji – a first for me, but a temple which Tom visits quite frequently.
I was greeted by two devils guarding the entrance, and there were already a few hikers who had made it up the mountain (elevation 600m).
After a rapid descent to route 299, I cycled it up to and then through the 2km long tunnel – not a lot of fun with so much traffic, and in particular with so many dump and other trucks taking this route. It always amazes me how much dump truck traffic there is on route 299 between Hanno and Chichibu-shi. But then seeing that Chichibu basically sacrificed its house mountain and turned it into a huge quarry, it is not surprising what all these trucks must be doing. This place may well have the highest density of dump truck drivers in Japan!
Down in Chichibu city it was time to visit a shrine, the Chichibu-jinja.
Soon I was heading towards the last and arguably most important stop of my pilgrimage: Mitsumine-jinja. Somehow I felt well in shape and it took me only 1.5 hours to ride the 40km in distance and 900m in altitude from Chichibu to Mitsumine. At 1,100m the air was crisp and the many visitors were complaining how cold it was: something like 5 degrees. The sun had disappeared behind increasingly dense and dark clouds that were accumulating in the mountains around – the Chichibu plain itself was still in bright sunshine, clearly visible from up there.
I then rode on to try out a new rindo which according to Google should take me back onto the main road towards Chichibu-shi – or so MOB and I had discovered while studying the area online the night before. Indeed, not only did the rindo exist, it was open to all traffic, had surprisingly few warning signs, and turned out to be well paved and almost completely free of debries or leaves. After climbing to 1,200m, I reached a long and dark tunnel – one of those that threaten to unleash evil spirits on my fellow riders MOB and Tom, but usually leave me alone. After a bit of down and up there was another tunnel with another ascent, and then it was a very long and very smooth sailing down to the main road. Next time, I will definitely cycle up that side and take the main road down from Mitsumine. It makes for a nice loop.
Back at the outskirts of Chichibu-shi I was tempted to return to Ome via Arima-toge, but abondoned the thought as the long crossing (including the unpredictable building site Tom, David and Nishibe-san discovered the other day) would have meant I would have reached Ome only in complete darkness. Instead I took 299 up to just before the tunnel (and while it was full of traffic, thankfully all the dumb tracks were on their way back to Chichibu rather than heading up with me) and then headed up Yamabushi Toge. On my descent I caught up with two cars and one motorcycle which were preventing me from getting one minute faster to Ome, so much to their surprise I passed the mercilessly in corners and steep long sections.
I reached Ome station at 16:35, not long before complete darkness. 210km on the road, with something like 2,200m of climbing. And most importantly plenty of omairi to get me into a new decade.

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For those of you who want to get out in the mountains tomorrow

and are not afraid of a little adventure…here’s the alternative to the well-trodden routes of Okutama & Chichibu…


RdV: 7:00 a.m. at ONEKAN / 18 intersection

Course: Lake Tsukui → Doshimichi → Inukoeji Pass → Lake Tanzawa → not decided yet (possibly return via Odawara ~ Enoshima coastline and then upward)

Tomorrow’s ride includes „dreadful“ Road 76 with long, tire-bu(r)sting unpaved gravel stretches not suited to road bikes. The Inukoeji Tunnel on top (1,060m) is pitch dark. Climbing tempo expected to be brisk. Anyone (still) wishing to join (in spite of my attempt at threatening/discouraging), should bring lights and put on sturdy tires/wheels….

Perhaps some other time?

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Pinchers from Hell

The last weekend ride has been already covered very well on the blog, however I would like to add some photos and comments in addition nevertheless.First stop on top of Otarumi Toge. Tom making photos of the landscape, Ludwig of me. Thierry probably resting on his bike in the back and David and Jerome still to come.Ludwig in shiny neon claded, still alive at the shores of Yamanaka lake with stars in his eyes and basking in the glory of double championships.
I practiced the characteristic „David Millar movements“ with my bike at Yamanaka Lake in front of mount Fuji. In case I ever want to get rid of my bike, I will make sure to do it at this spot.Ludwig pulled underground by the pinchers of hell, disguised as monument to traffic safety. Tom is trying everything in his power to hold him back, but the weight of his sins (too many red lights crossed) is too heavy. Last time we saw him. If you meet somebody resembling Ludwig now, it will probably be Manfred.Then it got me. Could barely escape at the last moment to come home and tell my children about the terrible experience we made. As in case for the invisible octopuses living in the vault of the Sasago tunnel, they remained largely unimpressed by my stories of blood and gore.Oden heaven at the PE-approved Seven Eleven in MotoHakone. Oden to the people.


Here we can see improper eating behavior of two foreigners in front of a (PE approved) Seven Eleven in a semi-urban environment.And here we see proper behavior in comparison. Please note that Manfred is eating again a bowl of Oden which is neither proper nor improper. Both foreigners have moved away from the (PE approved) Seven Eleven in a less than semi-urban environment. The elevation of the eating place is significantly higher than the mighty Van Hai Pass (but irrelevant).

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Saiko Race TV Review

Just watched the Asahi TV program about the Saiko race this afternoon. As expected the program focuses on the adventures of the two attending „talentos“, Yoshizawa/Morning Musume in the W class and „forgot his name“ in C1. The performance of both is also something to be forgotten soon; both of them were dropped within the first lap, both of them finished in the forties out of less than 50 riders.

Basically I disliked the program as it was promoting bicycle riding in a strange way. Sure, it is nice to have a lot more people riding bikes than to see them in cars and trains, but I am not sure if I want to meet them in races when, among other things, my health is at stake.

I also found it somehow unfair that both of them had a (non-competing) helper at their side to support them throughout their races.

OK, perhaps I am to strict with them.

No shots from our races. But we could see James in full profile with Tiger and a little bit in the back Tsukino and Henri at one point. I recorded the program on our HDD and I hope I can manage some DVD copies if somebody is interested.

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Year in Review – 2009 Passes and Hills

Three or four weeks ago, I went into the Starbucks in the basement of my building for coffee. They were serving „Christmas blend“, and the music playing was definitely Christmas carols. It gets earlier every year. … so I guess November 23 is really not too early for a „year in review“ post.

I thought this morning that I would try to list up the passes (峠) I have ridden in 2009 so far. I’m sure that some others (Tom, Ludwig and Michael, at least) have ridden more and further, and could come up with a better list — leaving aside Transalp! — and Jerome might match me, including Transalp, but my list is not too shabby. The great thing is that has been my 5th full riding season in Japan, and I still managed to ride lots and lots of places I had never gone before. … and there are already plenty of new potential rides on the list for next year, not to mention a few that I might get in by year-end. Here is the list.

Passes/Hills of 2009
[blue text means ridden by me for the first time in 2009]
1. Otarumi (Kanagawa border)
2. Wada (Yamanashi border)
3. Kobu tunnel (Yamanashi border)
4. Kazahari
5. Umegaya (Jerome Hill)
6. Nikka-zuka (next route to the East of Jerome Hill – not sure pronounciation and thus the romanization)
7. Fue-Kami (heading into Chichibu — just past Higashi Oume toward Nariki)
8. Ozawa (tunnel into Naguri — Tokyo/Saitama-Chichibu border )

9. Yabitsu
10. Shiroyama-ko (Hon/Moto-zawa Dam – the short climb NE of Tsukui- ko)
11. 三増峠 Sanzou Pass (S. of Tsukui-ko on Rte 65 – first leg of Kanagawa Brevet)
12. Hakone Pass (Shizuoka border)
13. Ashi-no-yu Onsen Iriguchi (Pass on Rte 1 at top of climb – Odawara to Ashinoko – name??)

14. Tsuru
15. Tawa
16. Matsuhime
17. Oo-toge
18. Kamihikawa
19. Yanagisawa
20. Odarumi (Nagano border)
21. Yakiyama
22. Hinazuru (not Suzugane!)
23. Mt. Fuji 5th stage
24. Yamabushi Touge (the same name as the pass in Chichibu – but also the name of the pass/tunnel at top of Doshi Michi)
25. Dosaka (Pass between Doshi Michi and Tsuru)

26. Yamabushi (the “real” Yamabushi)
27. Shomaru
28. Nenogongen
29. Karibazaka (on the Green Line)
30. [Hannari] (not sure pronounciation/romanization — on the Green Line)
31. Buna (on the Green Line)
32. Arima
33. [Nitazan] touge (pass on the Naguriharaichiba Rindo)
34. Shigasaka (on border w/ Gunma)

35. Mugikusa Touge(麦草峠)
36. Suzuran Touge
37. Yagawa Touge (矢川 – on the Gunma Nagano border,
approaching Karuizawa from the South via “rindo”).
38. Jukkoku (十石峠on Gunma-Nagano border Rte 299)
39. Tsuetsuki Touge/杖突峠
40. Bunkui Touge/分杭峠
41. Jizo Touge/地蔵峠
42. Hyoko Touge/兵越峠

Shizuoka [no Izu rides this year beyond Atami!]
43. Jukkoku Pass (十国— on rte 20 Hakone to Atami)
44. Atami Pass (Rte 20)
45. Naka-no-Kura tunnel (中之倉) [at top of climb up Motosu-michi to Motosu-ko — WNW side of Mt. Fuji on Rte. 300 during Brevet]
46. Fuji Safari Entrance – high point on Rte 469 on S. side of Fuji (pass between small Mt. Kurodake and big Mt. Fuji)

Europe (German, Austrian, Italian Alps)
47. Oberjoch
48. Alter Gaittpass
49. Hahntennjoch
50. Arlbergpass
51. Bielerhohe
52. Tobadill
53. Pillerhohe
54. Timmelsjoch
55. Stelvio
56. Passo Foscagno
57. Passo D’Eira
58. Passo Gavia
59. Passo del Tonale
60. Mendelpass
61. Fai del Paganella/Andalo
62. Passo del Ballino
Forgotten , added later:
63.  Nokogiri
64.  Kazahari Rindo 

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Guys, please mark already January 2nd, 2010 (2011, 2012 and 2013) for the traditional


As usual we can expect thousands of spectators lined up along the streets that will cheer us up all the way from Tokyo [or later] through Odawara to Moto-Hakone. An additional highlight will be the a suicidal fast downhill from Hakone to Atami on spectacular route 20 plus (hopefully) the Shinenkai afterwards. An event not to be missed.

More infos will follow.

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