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Elena Perea

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About Elena Perea

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A Human on Stall Rest, Vol. III: Risk Assessment

The subject of an Amateur’s Corner interview in 2021, Elena Perea is an Emergency Room physician who balances work, family life, and competing in Area II. In her latest blog, she brings us an update on her recovery. If you missed it: Vol. 1, Vol. 2

Hacking yesterday with me. Photo by Elena Perea.

At 6 weeks and 5 days post-op from the Biggest Should Repair Ever I saw my surgeon.  I was doing well—“almost too well.”  He looked me in the eye and said “you can’t screw this up because I can’t fix it again.”  It was sobering, as we discussed the literature that includes a 50-90% chance of repair failure, and the fact that the failure risk is greatest in the 3-to-6 MONTH postoperative period. I couldn’t stress the bone anchors with lifting more than a pound of weight until the scar matured.

“Why didn’t we talk about the risk of failure being so high before I had the surgery?” I wanted to know.

“Because you didn’t have any options.  None,” he replied.

He’s not wrong.  I couldn’t lift my arm from my side when I had the surgery, and it wasn’t going to get better.  At this appointment, I was able to hold it at about 45 degrees from my body, although I was so weak, I was trembling instantly.  So.  I can’t screw it up.  Fear installed.

At 7 weeks and 1 day, when I was officially liberated from the sling, I hooked up the trailer, put Beezie on it, and drove to Aiken for the Busiest Horse Weekend EVER in which I Did Not Ride.  Saturday started early, with my friend riding with William Fox Pitt at 7:15 (who was kind and signed an autograph for my kid).  I went and watched Beez do a short jump school so she could be perfect for Sporting Days the next day.  We saw the inimitable Kathy Viele ride a beautiful Grand Prix dressage freestyle at Stable View. We watched the Grand Prix of Eventing Showcase at Bruce’s Field.  After I pulled myself together after Annie Goodwin’s horse won it all (and Boyd waved at my hero-worshiping son with his million-dollar smile–thanks man), we walked Beezie’s Cross Country course for the next day.

Sporting Days Preliminary with John Michael Durr. Photo courtesy of Elena Perea.

Sunday, Beezie completed her second Preliminary, although my 60-pound spawn just wasn’t cutting it as a substitute for adult-male-sized JM at home, and she came home with a fatigue-related stop.  It was apparent we were going to change things up with her conditioning work.  I spent the drive home thinking I needed and wanted to get back on a horse.  Early in the 8th postoperative week, I convinced myself I could do it.  My physical therapist had ramped up my exercises and declared me ahead of the curve.  She gave me exercises that included pulling on bands like you would on reins.  You can’t hurry tendon healing.  I still couldn’t get my arms above shoulder height, and definitely wouldn’t be lifting more than the aforementioned pound, but felt like I could do it.

Life is about risk assessment, and I’m literally a professional at it.  Every time we make decisions, we weigh the potential benefit against associated risk.  I know the donuts could potentially make me fat; the pleasure of the sugar outweighs that risk almost every time.  There is real fear that I will ruin the repair, and need another big surgery with a less desirable outcome.  The likelihood is a non-zero number.  However, I’m not pitching a baseball or bowling or playing tennis.  The risks associated with riding include ruining the repair, although there isn’t any real direct stress to the shoulder.  My horse is quiet, has a soft mouth, doesn’t pull, I have help tacking up.  I am pulling on “reins” for physical therapy.  I could fall off and ruin my life, but that risk is unchanged today, a year from now, and in a decade.  The benefit of regaining some joy and independence, and of helping my horse be prepared for the next Prelim, far outweighed the risk when I did the math for myself.  The same risks might be present for another person who makes a different decision than I did, and that’s ok too.

And so, 8.5 weeks after having my shoulder pieced back together, 13 weeks after I took it apart, I got back on my horse.  It felt like coming home.  I did a 12-minute trot set and could not walk the next day.  I’m taking it slow, and mitigating risk by riding only my horse in only controlled settings with supervision.  I am not lifting my saddle, and am bridling with my left hand (which, by the way, is very strange).  I’m not jumping, and I’m giving the arm a lot of breaks.  It’s not “normal,” but it’s keeping my head in the game.

I’ll tell the surgeon when I see him again in 4 weeks.  As with most things, it’s better to ask forgiveness than permission.

A Human On Stall Rest, Vol. II: Hand-Walking

The subject of an Amateur’s Corner interview in 2021, Elena Perea is an Emergency Room physician who balances work, family life, and competing in Area II. In her latest blog, she brings some unfortunate chronicles on the trials of being a human on stall rest. To read Vol. I, click here.

Photo by Elena Perea.

I feel a little bit like a Star Trek episode. “Star Date whatever the hell day it is and I’m still in this stupid sling.” #nerdalert.

The shoulder doesn’t hurt anymore, I am sleeping more or less normally, and my resting heart rate has recovered to something less than a rodent’s. I am going to physical therapy twice a week, and my terrorist-I-mean-therapist says I’m where I’m supposed to be. When you think of PT, generally you think of throwing balls and lifting weights; I’m stuck lying on a table letting her passively move my arm while I tell dumb jokes and swear.

I own a prelim horse. Beezie went to Jumping Branch (by the way—awesome job, new Jumping Branch property owners/course designer/volunteers! Jumps were beautiful, course was great, everything went smoothly). It was supposed to be a good move-up, but ended up being fairly stout. She gained the nickname “Perfect Princess” in Durr Eventing’s world, and lived up to it. While she will always struggle to get her shoulder up (“I was bred to race, not do this fancy prancing nonsense”—you can literally see it in her eyes), she will also always try her crooked little blaze off. The stadium jumping involved some galloping, which was a good warm-up for the XC, which she looked like she has been doing for years. She beat some nice horses and finished top half of the pro division.

It was sort of fun because I got videos and texts from friends.“She looks amazing!” “She’s so confident!” “You are going to have such a great time with her when you get back in the irons!” JM’s parent-teacher conference (his term, made me laugh out loud) was similarly reassuring, full of ideas for how to make the come-back easier on my bum wing, etc. And we entered her in two more Prelims.

JM Durr competing Beezie. Photo by Christine Quinn Photography.

There is no doubt she will be experienced and confident when I’m able to ride again… but what if I can’t ride her? Not because she’s too hot, but simply because I lost a step? The anxiety surrounding my slow progress is pretty overwhelming sometimes, perhaps slightly compounded by the fact that my horse is 1) perfect and 2) talented. I once took 3 years away from riding when I was raising tiny humans, but that was different, and I was 10 years younger. Then, I didn’t have an agenda or a horse, while now I have both. I have no doubt Beez will be patient with me, but will I be patient with myself?

Staying in the moment, practicing mindfulness, has been key to not going down that dark hole of “what ifs.” For right now, she’s home, friends are helping me keep her ridden, and I get to kiss her as often as she will tolerate. Winston Churchill was good for a quote, and I think my favorite one right now is “If you’re going through Hell, keep going.” I get to start hand walking soon–next week, I get out of the sling and can officially drive. I’ll need some help to hook up and unhook the trailer, but I’m taking Beez to Sporting Days (for JM to ride), and get to see her do her thing in real time. I’ll get to watch the William Fox Pitt clinic, see the Eventing Showcase, catch up with friends, all on a longer leash, but still tethered.

Hopefully the next update will include tack walking.

A Human On Stall Rest, Vol. I: Send Reserpine

The subject of an Amateur’s Corner interview in 2021, Elena Perea is an Emergency Room physician who balances work, family life, and competing in Area II. In her latest blog, she brings some unfortunate chronicles on the trials of being a human on stall rest.

Elena Perea and B.E. Isabella. Photo by Courtney Cooper.

The year 2021 was, in a word, uneven for me when speaking about my horse pursuits. I’ve previously written about the number of times I was eliminated in the spring (three), the number of shoulders I cried on (many), the number of people who lifted me up (the same many), and my triumphant top 10 finish of the American Eventing Championships. I was lucky enough to have a second-place finish at Stable View in September, followed by successful completion of the long format Training Three Day Event at Hagyard Midsouth in October.

We took November off, and I was just getting “Beezie” back jumping in mid-December, with grand thoughts of a Prelim debut in the winter of 2022. My trainers and I had put a sketch of plan together, and were cautiously eyeing a successful season.

In an effort to save some time after finishing a Sunday shift in the emergency department, I took my horse out to the jump field with me to set fences before I got on to ride. In the process of leaning to grab a jump pole, I tripped over my own my own feet, and found myself on the ground. My right shoulder was not where it was supposed to be, I calmly observed. Luckily, I had seen all of the Lethal Weapon movies (and also gone to medical school), so I made the quick decision to reduce the dislocation without too much fuss while my very confused horse watched from above.

I have some pretty lax joints, and had subluxed both shoulders before. This felt different, but I was hoping I would bounce back. Three days later and still unable to sleep at night or raise my right arm, I went to the orthopedist, had an MRI, and was told “We usually see this injury in 80-year-old women.” (I think I heard that three times from three different people, and should be praised for not smacking any of them for inferring I was the equivalent of 80.) “There are large complete tears of the supraspinatus, infraspinatus, and subscapularis muscles. They are fully detached from their insertion. The long head of the biceps is displaced medially.”

Interpretation: big-ass rotator cuff tear and associated badness. No amount of rest or PT would to allow me to lift my arm from my side. Surgical repair would be necessary for any return to function.

Allison Thompson works with Beezie. Photo by Elena Perea.

Four years ago, I broke my wrist, and was back on the horse within a week of having a plate screwed to the pieces of bone; this recovery was not that.The doctor outlined seven weeks in a sling, no driving, 12 weeks not being able to bear any weight or carry anything that weighs over 1 pound in my right arm, 12 weeks more to get back to my original strength. “Maybe you will be able to get on a horse four-and-a-half months postop.”

I spent five years getting ready to move Beezie up to Prelim. This is something that pros do every day with baby horses but something that I haven’t done, and has taken a lot of blood, sweat, and tears (on my and the mare’s part) to approach. And now I found myself on the precipice, and out of the saddle for six months. I was overwhelmed with grief—to have come so close to that goal, and be brought up short at the last minute devastated me.

I’ve spoken before about my Eventing Community, and again, they came to the rescue. My friend/trainer/dressage guru/past winner of the Thoroughbred Makeover with the unforgettable Cactus Willie Allison Thompson lept to my rescue, and took Beezie for the first three weeks I was hurt. She missed no time under saddle, progressed, and I got to watch someone else jump her for the first time ever. Allison goes to Florida for January and February, and I didn’t want Beezie that far away, so I needed to make some decisions about what to do with her.

Allison, my other trainer JM Durr, and I discussed a couple of options. Having her hack with my 12-year-old little boy Teddy and various other catch riders for six months, and both of us come back into real work together, seemed a waste. JM volunteered to have her in his small program and take her to her first Prelim or three. I weighed the options.

JM Durr competing Beezie at Pine Top. Photo by Samantha Drake.

I have significant pride and meaning wrapped up in the fact that I have done all the riding and competing on my horse since she came off the track. I nearly died several times in her 5-6-7-year-old years, but the last three years, we have honed our relationship, and we are a real team. Having someone else take the reins is at once lovely to see, and disappointing. I also know that a positive go from a decidedly non-amateur around a level that neither the mare nor I have done before could be the smartest thing I have ever done for her. So, two weeks ago, in my 3rd week post-op, eight weeks after my injury, I packed her up into my orange trailer and sent her to Tryon. Beez jumped beautifully her last Modified with JM last weekend, and is doing her first Preliminary this weekend.

Now five weeks post-op, I still can’t drive (technically) and am wearing a horrible sling with a pillow holding my arm at an angle from my body to limit pressure on the repair. Taking clothes on and off is the hardest part of my day. Mundane things like feeding myself (did I mention it’s my dominant arm) take a long time. I can’t put my hair in a pony tail. I can’t do anything for exercise except walk. I’m going stir-crazy, am insanely jealous of the people showing in Aiken right now, and lonely missing my friends for our planned VacAiken week. I’m planning my escape from the stall; I’m gonna need to be sedated.

More to come.

On Community and Resilience

Photo by Kimberlyn Beaudoin.

2021 was supposed to be a great year; after last year, we all hoped for it, even expected it. I think I, perhaps more than the average eventer, particularly needed it to be amazing. It started auspiciously with a vaccine and a sense of an end to the very dark time in my career. I had second successful run at Modified in late January, followed by a ribbon at Carolina International in March.

Then the shit hit the fan. Repeatedly. I was technically eliminated at The Fork in April. I was eliminated with two stops in stadium at a schooling show in May. I was eliminated at my first FEI event at Virginia in very early June. And I fell off in my final prep run for the AEC in August.

Photo by Scott Manning.

Resilience is the ability to adapt well in the face of adversity—trauma, tragedy, threats, basic run-of-the-mill stress. We are told that resilience is important. We are supposed to build resilience as if it were wealth, to bank it, to hold it dear, and then use it when we need it. As a physician in a pandemic, my resilience bank account has been drawn upon repeatedly over the last 18 months. It was in danger of overdraft charges filed. Then I had to go and blow up two solid years of forward progress in training and going up the levels. It felt, at the time, like the lights had been turned out, and I couldn’t see the way out, much less forward.

Not to give away the end of the story, but two weeks after I fell off (see picture below), I did go to the AECs, and I did kick ass. I did find the way through that darkness; I didn’t do it alone with some mysterious innate “resilience”.

I think resilience is not something with which a person is born; I think resilience is a result of the love of people around you.

Photo by Kimberlyn Beaudoin.

I go to shows with my community of friends. This is what we do: we meet at horse shows, help each other, and have a party. When I made a stupid mistake and jumped the wrong jump on cross country, they heard me. I called my best friend, who heard me. My coach, she heard me too. They all listened, and then they responded—they knew what I was going through, and encouraged me to try again. I did, and again, and again, and I repeatedly made different mistakes. Every time, they lifted me up with words of encouragement, stories of their own experiences, and promises to be there. They were the base of my continued willingness to put myself out there.

My community had made plans to go to the AEC last year, were crushed when it was cancelled, and promptly rescheduled. We were going, and falling off two weeks before with no injury was not going to be a reason to not go. So I went. We dealt with a hurricane. One of us had to stay
home with a husband with COVID, but was called and Facetimed regularly. One of us drove from New Mexico. But we went, and we went together, as a team.

Photo by Kimberlyn Beaudoin.

The day of cross country, I was so nervous that I had to take a walk, cry actual tears, and give myself permission to not ride. As soon as I said those words out loud to myself in the parking lot, I knew that my community had given me the resilience to try again, and I was not taking
that out. I went to warmup, my coach told me she’d never seen me ride as well, I left the start box yelling “thanks for volunteering,” and we finished on our dressage score. Our community gave each other love, even when we were in the midst of job changes, even when we were worried about our children and the future of our country, especially when our horses weren’t going well. And the entire aisle in our barn, from all over the country, won ribbons and coolers and money. Every single one. Because we have resilience, not coming from some mistic inner source, but from the love we show each other.

Photo by Kimberlyn Beaudoin.

Resilience should be built as if it were wealth, banked, and used when needed. And we need to help each other to make deposits so there are savings when the time comes round.

After the Pandemic

Three equestrian doctors who thank you for staying home: Christina Cox, Elena Perea and Joanna Newton with her horse Margot Rita. Photo by Mellisa Warden.

Everyone is sick of hearing about how COVID-19 has changed the world — we are living it every day. You can’t go out when you want or where you want. Millions of people are out of work and struggling financially. Parents are home-schooling, or struggling to get childcare.

Perhaps most disappointing to some readers here is the fact that equestrian competitions the world over have been canceled or delayed. Everything from Land Rover Kentucky to Badminton to the Tokyo Olympics will not happen this year. The disappointment from competitors who have worked their entire lives for this was clear, and the arguments against the decision of the USEF and others were voiced on the internet chatrooms and social media sites. “The virus isn’t that bad.” “It’s like a cold for most people—worst case the flu!” “Only the old or debilitated will die—who is old and debilitated that rides?”

As someone who reports to a tertiary care hospital for work every day, I can’t say thank you loudly enough to the USEF, USEA, USDF, and USHJA for heeding the warnings of experts. Every day, my colleagues and I sit down and take stock of what preparations need to be made in coming weeks: we are waiting for the storm we know is coming. It’s not here yet, but we can see it headed toward us, down the east coast, unimpeded by vaccines or sunny weather.

Elena Perea and B E Isabella at the Vista. Photo by Joanna Newton.

I went to medical school, through five more years of training in the field of psychiatry, and have been practicing and teaching for a decade at some of the best medical schools and hospitals in the country. If you had asked me at any point in the last 15 years of my involvement in medicine if I ever thought this would happen, I would have said not a chance. No way would we, the richest nation in the world, ever be unable to care for the people due to lack of beds.

Never would doctors be in short supply in the largest city in the nation. It was absolutely inconceivable. Somehow, however, retired physicians are volunteering for service. My colleagues and I are anxiously reviewing medical texts, trying to remember things we haven’t done since internship, just in case we have to practice a specialty that is not ours, to help the experts do the work of saving our country.

After the pandemic, we will still have horses. Mine is out there now, enjoying the break from competition, enjoying the spring grass. She really likes it when I come to see her and all I want to do is hug her and not make her work! She will still be there when it’s time, ready to go run around a Training, maybe a Prelim with my old debilitated adult amateur self.

After the pandemic, the events will run again. They will fill on opening day, since we will have missed them so much. They will draw spectators that have been housebound, and attract new fans. The events will be reborn, and the jumps will be freshly painted, and we will flock back.

But for now, please stay home, give blood, and thank everyone that works in medicine that you know.

Elena Perea is a physician in southern Appalachia, an adjunct professor at the UNC School of Medicine, and an avid adult amateur eventer.