Week 10: Not so blah at all

It feels like forever since I last updated about my leg, but that is probably because I travelled for 38 hrs and moved halfway around the world. BUT, not before lots of exciting leg things happened!

First, I saw my doctor on Wednesday. He took another set of X-rays, which I would post a picture of except that they are on a CD and my laptop can’t read a CD. I was kind of nervous about the X-rays, because while I can do all the PT in the world, I can’t control how well my bone comes together. The good news: it is coming together swimmingly. To quote my doctor, “actually, you have much more bone growth than we’d expect in an adult at this stage.” Which probably does have to do with being so active with it.

The doctor also recommended that I start standing up on the spin bike, and start ellipticalling, though “at an easy pace.” I tried to elliptical on Wednesday, but if you know me, you know that I am not going to do things, “at an easy pace,” so I hopped off and rode the bike because I could feel some pain. Standing up on the bike is kind of cool — at first I was terrible at it, but it got much better and easier each time I did it.

In PT, my therapist showed me a lot of progressions that I can do now that I am going to stop going (too expensive to go where I am now). I also waked on my toes, which is exciting since the last time I tried that, I collapsed immediately. He also had me do a one legged deadlift with a 10 lb kettleball, which was nearly impossible, even with terrible form. But not totally impossible. 🙂 All of this was a big boost psychologically, and my leg definitely hurts less. My balance is also getting better — which I judge by how easy it is to get into my pants in the morning. Pants are still hard, but I don’t even notice my leg putting on my underwear. (TMI? Sorry) I can also feel my quad on my bad leg recovering fro the total mush state it was in.

Then I moved, and spent 18 hrs on a plane and 38 in transit. I did my PT during my unforeseen layover when I got put up in a hotel, but have been slacking — I will admit — on it since. I also did some jumping at the hotel, though I was definitely  favoring my good leg on the landing. Despite slacking on PT, I probably about three miles in total yesterday? And it still feels better everyday. But today I am joining a gym so that I can get back on the spin bike, and then the elliptical, and then the treadmill! (Not to mention so that I can save/rebuild my remaining upper body strength.) 

The only picture I have for you this week is one of my lovely flesh colored compression sock that I bought because you can’t really wear a black one in the tropics/with a bare other leg. It is so attractive, I know!

i forget what I predicted before — that I could start climbing by the beginning of March? Or was it the beginning of February? Beginning of March seems really reasonable right now.

Goals:

• start to elliptical
• lose my limp
• do all of my PT exercises

 

Week 3: And Then There Was One (Crutch)

Everytime I think I have reached a short plateau in my recovery, something new happens. It is really amazing.

Highlights of the week:

Day 15

I went to see my doctor for the first time, exactly two weeks after my fall. They took some new Xrays, which showed that my tibia is aligning perfectly. My fibula, which was a segmented break (two places), is not quite so perfect, but my doctor was unconcerned about that for the time being. Also took my stitches and staples out.

Most importantly, I got to ask questions about what I would be able to do with the rod in. The answer was everything, and that only in rare occasions do they take them out, despite everyone on the internet wanting them out. I think I was a little too afraid to ask about bouldering specifically, because I didn’t want to hear that it would be a year before I was able to fall on my leg again. (Somehow I think everyone thinks that I fell accidentally onto a hard surface while roped in, and doesn’t even know what bouldering is.) But it is clear that bouldering is in the cards at some point. I asked about taking another similar fall and he was like, “well, your leg will just be that much stronger with the rod in.” Lesson learned: don’t believe the internet.

I asked about running directly, and he said that most people take 9-12 months. That’s obviously a long time to wait for someone who had run consistently for 15 years, I am hoping that I will be on the short side of this, since I am in such good shape? I honestly think that I will be able to top rope in January — basically once I feel like I can put my full body weight on my leg. (Unfortunately I will be out of the country from Jan 15 – May 15, and my only option where I am going is bouldering.)

My doctor also asked me if I had walked at all without crutches, to which I replied yes — a little. He asked me to show him, and then muttered that I was still doing something or other, but suggested that I go down to one crutch. I was hesitant, because sometimes I need to go all the way across campus, and I’d be so slow on just one crutch. I also wasn’t so sure about stairs.

Finally, I got a prescription for physical therapy, which I will start this coming week.

Day 16

Well, so much for my initial one crutch fear. In the middle of the day, I needed to run an errand that was about 0.3 miles away, and I decided…let’s do this on one crutch. And I did. Having a free hand to carry things was amazing, and I never went back to two. I also decided to start using no crutches in controlled situations, like inside my apartment for example. This was also the day when the feeling that something was stabbing me at the top of my ankle as a walked went away.

Day 18

Decided to walk 0.3 miles (each way) to get coffee, without any crutches. Coffee place was closed (!), but I did it! (very, very slowly) I tried stairs too which weren’t bad at all. Also, I was able to go up a stair or two without matching feet — holding onto a handrail. Very slowly rode a stationary bike at the gym — just to see if I could.https://instagram.com/p/-m8WEfvM0x13u82p4laTy6Rgz-Sy4ljZNSr-M0/

 

Day 19

Took a shower standing up for the first time. Discovered that I can do bodyweight squats — though probably unevenly weighted. Did a very long flight of stairs without matching feet and without crutches — going up only.

Day 20

Did 30 minutes of water running and 15 minutes of kickboarding in the pool. (Am also doing upper body/ab workouts). This was the first time that my leg muscles were really engaged in anyway. Left leg is really starting to atrophy, and I still can’t really fully lock my knee, which I believe is due to the fact that they cut into your patellar tendon in order to insert the rod. I hate the pool but I can tell that this is a great way to strengthen my ankle muscles, and I seem to hate water running and kickboarding less than actual swimming.

Other notes: 

1. A friend of mine got in touch about her own tib/fib break, which was much worse than mine, and the progress of her recovery. Here is what she wrote:

I broke my tib and fib VERY BADLY on Nov 1st, 2010. I had ORIF with 11 screws, 2 plates, 2 hooks, and wire in. It just looked bad. I almost threw up when they removed the cast after 2 weeks and put me in the boot. I cried. Then I got really strong arms from crutches. The winter sucked, but I made new friends who gave me rides and helped me shovel a path to the bus stop.

I went to the pool as soon as the wound healed, one month after surgery. I swam a lot. I put my foot down on Jan 1st. I was bike riding by late January. I could not walk until I completed therapy in March. But I was doing a lot of pilates. I was walking in April. Walking with no pain at all in June. Hiking in July in the mountains and jumping.  Little running in August and a lot of walking. Completely running in September. Removing all the screws and plates and metal stuff in late September.

2. I don’t really understand why so many people have had the same IM nail surgery but were told to keep all weight off of it for an initial period. I mean, I surmise that there have been recent studies that have showed that WBAT is useful in healing, but I feel terribly for people who had to go through that.

3. I feel very lucky to be able to keep my foot relatively elevated — and most significantly, to be able to ice it throughout that day. I think that icing is REALLY helping.

4. I’ve really been trying to do as much crutch free walking as possible, but the transition away from one crutch is not going to happen this week. I can tell that the muscles in my legs are just not strong enough yet for me to properly pronate. Additionally, and probably relatedly, my balance is terrible. All of this makes it hurt at the fracture site when I walk entirely crutchless. On the other hand, I am using the one crutch very lightly, as much supporting me in the horizontal dimension as vertical.

Here are some pictures of my healing yet weakening leg(s). I know that the atrophy isn’t that pronounced, but if you let your eyes go a bit blurry, you can definitely see it. Random question that I’m interested in is will my toe bumps from my climbing shoes, which you can kind of see in the second picture, go away with my break from climbing, or are they permanent?

Also, here is a pic of my knee range of motion. This is actually very similar to that of my right (good) leg, but it is definitely stiffer.

Psychological:

My doctor’s appointment and going down to one crutch were pretty exciting and motivating, and at the beginning of the week, I felt like I was crushing everything. Now that it’s the end of the week, I’m feeling like my life is more or less back to normal — though a new, slower normal. This is good in some ways, but also makes me less super motivated to go to the gym, watch what I eat since I’m not burning nearly as many calories, etc. I am doing those things, I just don’t get the same dopamine rush out of them that I did when I was like, I can’t believe this is happening! I’m also able to focus more on my work, particularly after my doctor’s visit, which is good.

I took some friends who had never climbed indoor bouldering at my gym on Saturday, since it was free for first-timers, and they loved it. The whole experience — hanging out and helping, and just seeing them get into it — really made me happy, and thinking about it does motivate me to try to return to bouldering by the time I get back to the States on May 15.

Looking ahead, I am excited to start physical therapy, and I am really hoping to be able to go crutch free within the next week. Of course there is nothing more that I can really do to achieve this goal, but I’m hoping anyway.

Week 1, Pt 2: The Hospital and Surgery

I got to see a very calm third-year orthopedic resident in the ER about an hour after I got to the hospital. At that point they had started an IV for me with antibiotics since I had an open wound, and I believe they put some morphine in there pretty early, since the risk of interaction with my other medication is not a problem in a monitored setting.

The doctor elevated my leg on a “hammock” he made by stringing gauze from one bed rail to the other — apparently his colleague invented the technique and published a paper on it — which allowed him to make a plaster splint for my leg. He also straightened my floppy foot out, which hurt, but not as badly as I thought it would.

It turned out that since I had an open wound, even though it was small, I would get to go to surgery as soon as possible, which turned out to be the next morning. I didn’t sleep much, and had a moment when I just kind of broke down psychologically after getting a super sweet email from a climbing friend. A nurse came in to talk me out of it, which I totally appreciated. They came to get me at 7 am, took me to a prep area where I met my surgery and anesthesia team. The anesthesiologist was very enthusiastic about giving climbing a try, and I gave him some tips about where to go, and tried to convince him of how awesome it is.

The doctor the night before had explained to me that there were two options for surgery: either a rod that went down the center of my bone, or a plate and screws. He seemed to think that the rod was slightly advantageous, but told me I would discuss the options with the surgery team in the morning. It turned out that there was nothing to discuss, and that I was getting the rod. Which I learned later is definitely the better option. The best thing about the rod, technically known as an IM nail, is that it is completely load bearing from the moment they put it in. In other words, the only thing between you and walking again is pain and soft tissue damage.

One of the doctors also asked me about my healing fractured rib that showed up on my chest xray, which I actually never knew about. I mean, I knew that I had a painful overuse injury in my rib area from about five weeks before, but assumed it was a pulled intercostal muscle. Oh, climbing.

I got carted into the operating room. I was a little scared but was just telling myself how routine this was. The next thing I knew I was in the recovery room, and oh my god, I was in pain. I rated the pain of the bone break a 6 when I came in, and a 9 after surgery. I cried from pain for the first and only time of the whole ordeal, and told them they had to give me more morphine, which I guess they did, and then I fell back asleep.

That evening I got into my own room, and stayed there until two days after the surgery. My leg was simply wrapped up in an ace bandage, and elevated on pillows. The pain was better than in the recovery room, and I had been taken off morphine and put on oxycodone. For some reason I was only being given 5 mg of oxycodone every four hours, instead of the 10 that I was also allowed to have. During my first night, the pain was pretty bad, and I finally got some Demerol intravenously, which was great. The next day my pain had reduced a good amount — I was down to a three on the pain scale — still taking either 5 or 10 mg (as necessary) of oxycodone. I saw a physical therapist who, given the strength that I had in all of my muscles in his initial diagnostics, thought I would be able to go home that day. I got an aircast boot, and we did some crutches training, but I didn’t do particularly well and got dizzy. So no release for me yet.

At 10 that night I took the last oxycodone pill I would take in the hospital. The next morning I had very minimal pain — maybe a one on the pain scale — and tried again with the crutches/pt guy. He was pretty sure I was going to be released by noon. I tried walking to the end of the hall, and got very dizzy this time. Because my blood pressure was 80/40. So: back to bed, and they pumped me up with some saline intravenously. My blood pressure went up, I did some crutching and some crutching up and down stairs, still felt a little dizzy, but was cleared to go home. I have to say that I was pretty scared about how I going to be able to manage everything once I got home, since I felt unconfident on the crutches, and in the hospital someone could attend to my every need.

Psychological take away: the pain, and your desire to get out of the hospital, will probably facilitate this for you, but don’t think about when you will be climbing — or whatever exercise you are missing — again. It’s going to be a while. Let it go, and move onto when you are going to be able to go home, when you are going to be able to shower, when you will get your staples out, etc.