Week 24: Running and Bouldering

PART 1

I am no longer walking with pain. I have some pain going down stairs, but that is about it. It is glorious.

Here are some thoughts and tips:

• The lateral elliptical is amazing. If you are reading this because you are recovering, I can’t recommend it enough, if you have access to one. Particularly if you use the “X” mode, it is a great workout that really works on your leg muscles, both for stability and strength.
• Generally, my advice is to get on an elliptical as soon as you can — the spin bike is great for cardio, but all it does is build your upper legs. With the regular elliptical, there is still no lateral movement, but it’s much closer to walking/running and you get some calf work in there. I think that switching to the elliptical this week has been huge for me.
• My running is progressing so well, which is keeping me super motivated. It’s almost like the beginning of the recovery process when things moved so quickly. Within five days I moved from 0.2km to 0.8km, and dropped my min/mile time by 4 minutes. I am running with a limp for sure, but it is really cool to have bigger and bigger strides each day, and be able to toe off more and more, as opposed to doing a super exaggerated heel strike. Would not be at all surprised if I could run a mile at a 10 min/mile pace soon. Though my goal is simply to be able to run to the climbing gym (0.4 mi) when I get back. I have no idea if running outside will be different than on a treadmill.
• I have a bump on my knee — and have had since surgery — which feels like the head of my tibia sticking out too far. It prevents me from doing things like kneeling on a hard surface. My physical therapist said that it was swelling, which seemed hard to believe, since it felt so hard/like bone. But indeed, it has gone down. I can probably kneel on a hardwood floor at this point, though it wouldn’t be particularly comfortable. But still, progress.
• If you google tib/fib fracture, you’ll find a lot of people on the internet really really keen on getting their hardware taken out. If not the rod, at least the screws. I am convinced that my surgeon was really good, but these thoughts don’t even cross my mind. As far as I can tell, I have no irritation from the screws, and certainly the rod is just in there doing its job with no side effects. Just writing this here so that people know that not everyone wants their hardware out — probably just a vocal minority.

 

PART 2 (because it slightly contradicts Part 1)

Also, I went…BOULDERING! (indoors) I went to a climbing gym, rented a harness (didn’t bring mine with me on this trip) planning to spend at least half the time autobelaying, but after hating the first two routes I climbed, I was like, I’m going to go see what it’s like to fall. At first I climbed up so that my feet were about 4″ off the mat, held onto some jugs, and let my feet off the wall so that I was dead hanging. And dropped. It was fine. I did this a few more times, getting higher and higher. Luckily this was a pretty short bouldering area. With a pretty squishy mat. (Squishier than my home gym for sure.) I wound up bouldering for about an hour and a half, until I got a flapper. I had at least one uncontrolled fall. And was fine.

Honestly, the real problem was exactly what it was last time I climbed, which is pushing up on the toe of my bad leg. I am not going to lie and say that that didn’t hurt at times, and that it didn’t cause some pain while walking both last night after I went, and this morning. But it was definitely better this time, and bouldering is actually easier on the leg than top roping, in that so much more weight is typically on your arms. At least when you climb overhang, which is mostly what I did. Oh, and I heel hooked, which was a tiny bit sketchy because the muscles/ligaments around my knee aren’t 100% yet, but was pretty okay.

And here are some pics! Also, I calculated this morning that I have probably done around 1400-1500 pullups in the last 3.5 months. Hence my arms, ha. I have lost all of my endurance and finger strength, but my upper body strength is all still there.

Confidence building: not too far to fall, and it definitely won’t be on my leg!

Muscles: in tact! 

 

 

Week 2, Pt 2: Psychological Recovery & Research

Psychologically I’m doing pretty well, and I am trying to maintain as positive of an attitude as possible. I am super motivated to crush recovery  and stay in shape, and am treating this like any other kind of physical challenge that I’ve undertaken. I’m also feeling grateful that it’s just a broken leg, no joints involved, I can still do everything with my arms/hands, not to mention it not being anything worse, etc.

Particularly at the beginning of the week, my emotions were pretty volatile. I was really thrilled about how quickly I got rid of the boot, and how quickly I could take steps on my own, and then I would have moments of very quickly getting very sad and shedding some tears. Or even shedding tears at happy moments, like when I walked. This has subsided to some extent, and I’m happy to say that there are now moments when I even forget that my leg is in the state it’s in (and then I stand up), and that generally my life is starting to feel normal again, even if it is a new normal.

On Sunday I worked out at the regular gym with another injured climber, which made the prospect of a lot of weight/bodyweight workouts in the future seem much more bearable. I no longer know how people work out on their own.

However, this week I got a bit obsessed with the question:

Will I be able to boulder again with the rod in?

This led me to do a lot of internet research, despite knowing that I should stay off the internet.

The answer to this question of course is: wait to ask my doctor at my two week appointment. But come on, who can wait for those things? So, I will summarize what I’ve found.

First, this was a freak fall, but uh…not. I can’t help but think of this part of the first-timer’s tour at my climbing gym, which I’ve heard over and over, during which the employee says, “climbing is an inherently dangerous sport.” Indeed, it is. There are definitely a number of people posting about tib/fib breaks from bouldering on the internet.

One of the first things I found while still in the hospital was this Rock and Ice Q&A article, which calls the IM nail an “in situ spear,” having the potential to jab into your knee or ankle should you take another bad fall. The article thus essentially recommends not bouldering on it until you get it removed. Sad face, because it seems like removal can happen, at the earliest, around 12 – 18 months.

I also found a number of other forum posts and what not about having the rod and screws in, what can be done on them, and whether to get the hardware out from climbers, skiers, more skiers, and runners. But let’s face it, people who aren’t having problems with their rods aren’t posting about it on the internet.

On the other hand, the person who asked the Rock and Ice question continued to boulder on his rodded leg without incident, though he got his screws out and continues to want to get the nail out. He is even now motorbike racing, which puts him at even higher risk for an injury than climbing, and is okay with it. Hat tip to Peter who took the time to give me a detailed account of his recovery process when I wrote to him to ask questions.

Also, when I ran into the PT climber I know, who was very familiar with the surgery, that I can weight-bear, etc., he seemed confident that I would be able to boulder again, and mentioned a formerly close to professional climber friend of his who also did a tib/fib break and got a rod, who boulders all the time with it in.

So, who knows. I came to grips with the idea of not being able to boulder for something like two years early in the week, and then heard the very convincing better news from the PT friend later in the week, all of which adds up to a “let’s wait and see” state of mind for me right now.

If you are interested in understanding what happens during an IM nail surgery, here is an animated and not particularly graphic video.

If you are interested in hearing exactly what I sounded like when I fell, and what my floppy foot looked like (Solution and all), here is a pretty disturbing video of Peter’s fall.

Something that I’d also like to know is how quickly I will be able to walk unassisted again. Strangely, there are very few accounts out there of people who have immediate weight bearing status after their surgeries. I found one set of videos on Youtube, but that was about it. So, hopefully my account of this will be useful to someone.

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.