Just Another Blog
Wednesday, August 30, 2006
A Little Bit Better
I feel like I've turned a bit of a corner over the past two days. As part of my check-up on Monday, I got some muscle relaxants. A big part of my discomfort and frustration had been from my inability to sleep. My lower back has been so unbelievably tight and knotted from spending so much time flat on my back and sitting squared with my leg straight out in front of me. At the suggestion of another doctor, I had originally raised the question as to whether an anti-depressant might be a good fix for me. Apparently, anti-depressants are sometimes used to treat lower back pain. My grandmother had some success with Zoloft for just that thing. My doctors said that they really only used anti-depressants in cases of long-term, chronic pain. They recommended a muscle relaxant, flexeril, instead.
While it seems to require a fair bit of lead time to ramp up, the stuff is great. It's strong enough to not only loosen my back up enough that I can doze off but to also knock me into a nice state of wooziness. It's a nice feeling while I'm riding it, though it does invariably takes a good deal of effort and concentration to snap myself out of it when the time comes. But it's totally worth it. I've slept better the past two nights than any other two nights since the injury. I know that as I sleep more and better my healing will begin to accelerate. As I get stronger and more flexible, I'll be able to move and do more and need the relaxants less. I also find that I'm in a much better mood with more sleep. No surprise there, I guess.
Before my accident, I had always appreciated my ability to sleep soundly, long, and well. I know there are a lot of people in the world with sleep difficulties. Given the proper bedtime, I could count on my ability to consistently sleep 9 full hours in a night. (In actual practice, I rarely cashed in on that ability as I tend to not adhere to the bedtime that would be necessary to facilitate such a snooze.) I tend to sleep soundly and to not have any recollection of any dream activity. It is most restful to wake up feeling as if your mind was at complete rest for the duration. The pain, discomfort, and restlessness that came with the recovery process really stunted my sleep ability. I am most grateful to be inching my way back to restful nights.
So, I'm popping one now, doing my last hour on the CPM, and getting ready for, hopefully, a third consecutive good night's sleep.
Tuesday, August 29, 2006
You probably won't want to watch this video right before or right after eating. Some of it is pretty gross.
I took video this yesterday morning at the doctor's office. My leg is in an ace wrap, but they were changing the dressings, so I got my first look at the leg since my last surgery.
The stitches on the inside of my leg came out yesterday. The other, newer incision is held closed by twenty-eight staples that will be removed next week. You should still be able to make out the four holes, two each above and below the knee, where the external fixator was previously attached. The top most pin hole looks rather like a gunshot wound. I seem to have lost a good deal of muscle mass in my thighs. Part of that is that my leg has been in the ace wrap for so long and the whole leg is just a bit compressed. This also explains why the skin is somewhat mottled
Saturday, August 26, 2006
Just to clarify, I reviewed the xrays with my Dad, and we count four screws coming from the smaller, medial plate and ten screws securing the larger, outer plate. The pictures make it look like they pierce the bone all the way through, but I guess they just go right to the very edge. It's amazing technology, and I hope you never have the opportunity to take advantage of it.
In the week leading up to my most recent surgery this past Wednesday, I was very optimistic and spent most of my time being relatively comfortable. Surgery #2, which placed the first plate in my leg, had relieved one of the major sources of pain that I had been feeling. I went into #3 thinking that things were just gonna get better.
Not exactly. This was the biggest operation yet in terms of time, complexity, and work to be done. Even the surgeons really didn't know precisely how bad things were until they came in from this angle. They knew what they were going in to do, add a second plate, but they didn't know what other issues they might find with the joint or how much groundwork they'd have to build so that the plate could be secured. Turns out things were pretty messed up in there.
Both the cartlidge of the knee and the meniscus of the knee had essentially flopped open and out. They called in a sports medicine surgeon for a consult during the surgery and were able to get those pieces pushed and trimmed back to what they described as almost good as new. They had to do a significant amount or bone grafting. Since grafting from the pelvis brings about all sorts of complications, they use artificial bone. They take pieces of sea coral which has a porosity nearly identical to human bone. On to the coral they paint and blot a calcium sulfate compound and thus create artificial bone. Within five minutes the stuff is strong enough to sink a screw into. Eventually, my bone will grow around, absorb, and replace the artificial stuff. They had to use a lot of it.
The plate they put in has a dozen screws that run at various angles all the way from one side of the bone to the other. I've got a great xray picture of the setup and if I ever make it back to my own house, I'll get it up here. Essentially, the six inches immediately below my knee are a lot more metal than bone nowadays. The first plate had, if I recall, five screws coming in from the other direction.
I woke up without the external fixator - those rods and pins that had been sticking out of my leg. That means that my leg is now floppy again and that if I lift the top part of my leg, the bottom part swings at the knee. It also means the knee can move laterally which is a most scary and extremely painful occurrence. The last thing they did to me while I was under for surgery was to gather up all of the muscle in the room and force my knee to bend. Keep in mind that I had been locked in place with no movement at all for two weeks. The doctor said that it was very difficult but that they were able to crank it down to an angle of 120 degrees, which is apparently very good.
During the surgery, in addition to the general anesthetic, they also used a femoral and sciatic nerve block. Basically what they do in a nerve block is to find the high point of the nerve in your leg, and then insert a catheter that drips mordacaine sporadically onto the nerve. That then prevents any of the lower pain from traveling any further up than the block: your brain never gets the message that there's a whole ton of pain lower down.
I was scheduled to be sent home around 7 AM on Thursday morning, but around 5 AM the nerve blocks started to wear off. By 7, I was writhing in pain. The pain was a heavy, intense pressure inside of my leg where the plate had gone in, plus the shearing pain in my knee from having it bent so dramatically during surgery, plus the fire from the long incision and related sutures and staples along the cut line. On top of that, my wound drain had clotted off and wasn't working. They had to yank the drain out and resort to catching the blood with pads and gauze and letting it run back into my body for absorption. This required unwrapping and re-wrapping my leg and every little touch, twist, and manipulation added to the fire. I was miserable.
The surgery was at the surgery center instead of the hospital this time. They don't always have people stay overnight. The first night, I was the sole patient. They had no one scheduled to work Thursday evening. There was much back and forth as to whether I should be sent to a hospital - where they would be able to give me a PCA pump (patient controlled analgesic - morphine!), whether they could get me stabilized enough to go home, or whether they would be able to scramble and get the two staff - one nurse and one aide - that they would need to keep me over night. While that debate raged, so did the pain. They pumped me full of more drugs that day than I might have expected to be possible. But despite the femoral block, the front-side sciatic block, blocks on the nerves at the surgery site, oxycontin, percocet, fenterol, verced, and demerol, I still couldn't get caught up to the pain.
It was the demerol that eventually won the day. The first shot made me really loopy. The second one about knocked me flat. By then the decision had been made that I would stay at the center another night. I got my regularly scheduled oxycontin and then percocets every four hours. With each dose of percocet I was able to sleep for two or three hours. I woke up the next morning feeling like I was finally out in front of the pain.
So they set about to getting me out of there at about 7:30 AM. Unfortunately, I still had to deal with a pair of nurses who seemed bound and determined to make my physical departure as difficult as possible. Over the previous two weeks with lots of good help and instruction from the physical and occupational therapists, I had gotten quite good at getting in and out of beds, chairs, wheelchairs, and cars. Suddenly these two were completely changing everything I had been taught. Getting from my bed to the wheelchair was a painful nightmare as they lifted and twisted and pushed and pulled at me in ways that just didn't make any sense. It was infuriating. At least by the time we got out to the car I had the sense to tell them to just back off and let me do it my way. Still, I went from ahead of the game to behind in 20 short minutes.
Arriving home, my given goal was to instantly begin physical therapy. On Wednesday night, while all of the blocks and pain killers were still working, I had been introduced to the CPM: continuous passive motion machine. This is a sling like device that I lay my bad leg in and it moves up and down ever so slowly. Under the nerve blocks, I rode the thing for two and a half hours all the way to a sixty degree bend. Thursday was such a bad day that I didn't use the machine at all. Yesterday, I could only manage a bit more than two, one-hour sessions and only up to about 40 degrees. Actually, it turns out that so far the upper limits aren't where I feel the pain. It's when my leg gets down to flat, 0 to 10 degrees, that it really pulls and hurts the most. My goal is to spend four hours a day in the thing eventually working it up to 120 degrees over about the next three weeks. Soon, I'll get more of a physical therapy regimen and this will just be part of it.
So far today, I have managed two, one-hour sessions on the CPM. The first went fairly smoothly, but the latter was much more challenging especially in the last 20 minutes. The next two sessions are going to be a bear. I've moved out into the living room for a little bit this afternoon. Last week I was zooming back and forth from the bedroom to the living room. Now that my leg is not as stabilized, it's a much trickier proposition as every waggle of my knee hurts intensely.
I kind of feel like I was blindsided coming out of the last surgery. I really thought I was well on my way to a quick recovery. I realize now though that I have a long, painful road still ahead. I don't mind a bit of hard work, but the pain really sucks. The doc told me to expect to have to rely on narcotic pain killers for at least another month. At least the surgeries are done.
Tuesday, August 22, 2006
The Vacation's Over
When I busted up my leg two weeks ago, I had nine unused vacation and personal days left at work. Yesterday marked my ninth missed day at work and the exhaustion of my paid days. I should get short-term disability payments for the next seventeen missed days using a calculation that grants me one day for every month employed. There's been some sort of major foul-up with the processing of my claim, and I'm a bit worried that it will not be fixed before the next payroll is processed. My company doesn't give employees any paid sick time, so this is all that I will get. If my recovery takes more than another seventeen business days, it is my understanding that they will continue to recognize me as an employee but will place me on unpaid medical leave.
I was supposed to be traveling to Chicago next month for the fabulous, three-day Touch and Go 25-year anniversary extravaganza. This article is a doleful reminder of what I'll be missing out on. I cancelled my plane ticket yesterday and will be mailing my three-day pass to Vince presently. Missing the show is tough enough and missing the chance to party with everyone in Chicago is even worse. It sucks to have spent the balance of my vacation recouperating from my fall.
Monday, August 21, 2006
Well, the general comment seems to be that I am getting around better and better. I'm still using the walker instead of crutches, and, frankly, am not looking forward to the transition. I'm sure I'll get the hang of crutches soon enough, but they are a lot less stable. Using the walker really makes me respect the hell out of those little, old 80- and 90-year old men and ladies that you see trudging along behind the contraption. The thing takes plenty of strength and determination to use. It strikes me too that having eight to twelve weeks of crutches use ahead of me most likely means that I will have to deal with them in the snow. I'm probably worrying too far in advance on this one. Heck, come late February, a significant portion of the Colorado population is up on crutches and dealing with the winter weather. I guess I'll get the hang of it too. Maybe I'll just need to fashion some bad-weather nubbins for the feet of the crutches.
"Getting around," really only means my ability to make it back-and-forth to and in-and-out of my bed and chair without assistance. My folks found an old wingback chair at a garage sale that, when combined with my rolling footstool, makes for a good place for me to spend my time other than bed. Yesterday, we moved the chair and stool outside to the back patio so that I could spend some time in the fresh air. It didn't cure my trapped-in-a-coop feelings, but it helped. I can make it up and down to the bathroom myself though I rarely need to: the constipating effects of the narcotics continue to provide a minor challenge.
The last surgery really took care of the most painful part of my leg. The shattered bits, which are to be reigned in on Wednesday, are only occasionally painful. I continue to have a fair bit of pain associated with the point where the pins drill through my skin, but this is now limited almost exclusively to the uppermost pin, square in the center of my thigh. My leg pulses and surges as I go from horizontal to vertical, but I'm finding that I need to move into the vertical position more and more often for comfort; I think my leg likes getting the rush of blood. I have some itching and occasional, mild burning along the incision line from the last surgery. But, mostly, it's a matter of general discomfort. My leg is still wrapped, and it feels hot and sweaty and itchy and too tight and just generally like it would be better off unwrapped. My lower back is a tight mess of a knot largely, I think, from my inability to sleep in a position other than on my back. I wake up every morning with my arms asleep and on fire from the position that I sleep in. Although my sleeping patterns have improved somewhat, it is rare that I can put together more than three consecutive hours of sleep. Most nights I do manage to get three hours and then, after a hour or two of tossing and not turning, an additional two or three hours. The sleeplessness certainly plays a big role in my greater restlessness.
I continue to receive great care bordering on pampering. Hope, my parents, my brother and Miguelina, and my sister all continue to heed my every beck and call. I am certainly lucky to have the support network that I do. It makes me feel more than just a little bit guilty that I have such a terrible desire to get away from it. Oh, to be independent again! I'm glad to be back to the point where I can poop on my own, but I am longing for the day when I can bathe, move further than fifteen yards, shop and cook, and otherwise take care of myself again. It is humbling to rely so heavily on so many others for so many things. I haven't been so dependent since probably before I first got my driver's license. I've always prided myself on my independence, and losing it is hard. I reiterate, however, I am deeply thankful for the help that I have. I quite simply cannot do these things on my own right now.
Saturday, August 19, 2006
I had my second surgery, the first repair surgery. They placed a plate over the long crack in my leg bone. Doc says that it went very well and that the geometry of my leg is back to where it was. The surgery seems to have relieved one of the hotter pain spots that I was feeling. I'll do it again next Wednesday. The external fixator was replaced after the plate went in. So I'm still stuck with these painful pins sticking from my legs. Due to the surgical incision, the leg is staying wrapped this time.
I learned that they won't even consider any possible damage to my knee for six months or, more likely, a year. Basically, the damage to the weight-bearing bones is so severe, they don't care about the joint. Since the surgeries are likely to leave behind arthritis and scar tissue, they only care to get the bones fixed first.
The occupational therapist told me I was spending too much time in bed and not enough time up and about. I rented a walker this time, so I can try and pace the hallway physically and not just in my head. The walker is a little easier than the crutches for me, but it is still no walk in the park. It still hurts every time I go from horizontal to vertical, but I've essentially been told to suck it up. The wrap on the leg helps a bit in terms of how much everything moves about the pins, but the wrap often seems hot or itchy or too tight and is just generally uncomfortable.
Despite fixing one major pain area, I am still terribly uncomfortable as well as somewhat anxious and most restless. I hope that somehow I will be more comfortable after next week's repair and the removal of the pins. The meantime is going to be gruelling.
Monday, August 14, 2006
My second night in the hospital brought me a new roommate. My first roommate had been discharged after what I believe was something similar to the operation I'm about to have. He had broken both legs in a forty-foot rock climbing fall. My next roommate had just barely survived a multiple rollover car accident in which he was the drunk driver (I heard him admit as much to a nurse). He was in the ortho ward following a surgery that placed twenty-three pins in his left arm. The guy was bruised and bloodied and must have been in enormous pain. I later heard his wife describe having been told only a couple of days previously, first, that he was unlikely to walk out of the hospital, and then, that he was likely to be on a respirator for weeks, not days. By the time I was leaving, it sounded like he would be out the following day. He seemed to handle his situation admirably.
The man snored. And that first night we shared a room, he was particularly swollen and prone to snoring. I actually heard him tell the nurse as he was being delivered into the room that he feared his snoring would keep me awake. She told him not to worry that I was already asleep. A strange comment given that I had recently discussed with another nurse the ineffectiveness of the pain meds I had been receiving.
As soon as he was asleep, he began to snore. He rumbled with every exchange of air. The only time it stopped was when he would wake up. He was facing serious pain and concerned nurses, so that happened relatively frequently. He had no trouble dozing back off though. And the guy was loud. So loud. I've heard talk of people who snored excessively loudly, but had never actually been present to hear much more than repetitive snorting and the mildest of percusive sleep apnea.
I was having trouble sleeping for other reasons too. Primarily, my problem was pain. 48 hours or however long into this process I was, and I was regularly rating my pain at a ten and otherwise at a nine (on a scale of 1 to 10 with ten being the worst pain you've ever felt). That was also a busy night for the helicopters. The landing pad was the floor above me just diagonal from my room. I saw and heard every landing and takeoff of the flight for life choppers. The view was great but that night the frequency was disturbing.
My nurses seemed unwilling to do anything about my ability to control my pain or to sleep. I couldn't control the helicopters; I had limited ability to think the pain away; I cruelly decided that I could stop the snoring by waking the patient. I was hooked up to an oxygen saturation monitor which is just a little clip that goes onto the end of your finger like they have on an exercise bike. If your saturation gets to low, an alarm sounds loudly. I began removing the clip from my finger for short periods. The saturation would drop, the alarm would sound, the snoring would stop, and I'd put my finger back in to quiet the machine.
I must have woken up my roommate a dozen times over an hour or two. None of the nurses or aids ever reponded to my loud alarm. Eventually, his IV alarm, which sounds nearly identical, sounded and a nurse actually responded to his side of the room. I gave up my dirty tricks feeling rather bad about having been such a dick. It would be another three days before I slept for longer than roughly ninety minutes or two hours at a stretch.
What's Another Day?
Tomorrow's surgery has been moved to Wednesday evening. I have a sneaking suspicion that the surgeon actually forgot to put me on his schedule at al. When I hadn't heard from the hospital by one this afternoon, I called surgery scheduling only to find out they had no record of me being scheduled at all. The surgeon's office got it resolved quickly, but I'm learning that you really have to take complete responsibility for the management of your own care. It would be tough if you were elderly and alone to guide yourself through the healthcare system. And I haven't even had to begin to deal with insurance yet...
Sunday, August 13, 2006
On Tuesday, I went with Hope, Alexa, and Johnny 6-pack to watch King Kong (the new one) at Red Rocks. The others had seen movies at the giant, outdoor screen at Red Rocks before but had not seen the movie. I had seen the movie but never any one at Red Rocks.
We prepared a picnic dinner of chips, deli sandwiches, pasta salad, and gooey-caramel-cookie bars that we were going to eat under the stars while watching the movie. You can't bring booze into the amphitheater, so we enjoyed Bud Light and raspberry-lemon daiquiries in the parking lot before going in. (The daiquiries are a recent, delicious concoction I've developed: Bacardi Limon, Chambord, and sour mix - a splash of club soda is recommended, but optional and not practical for travel (most excellent).)
Recognizing the apt convergence of theme, background, and possibility, I handed my camera to Hope and told her to take a picture of me up on the rocks climbing around like a big monkey. As I approached the rocks, Alexa and Johnny portentously yelled to me that they would not be taking me to the emergency room and that if anything happened, they were going to see the movie. I assured them that the movie was definitely worth staying for regardless of my fate.
I scrambled up a few feet to a small landing area that had eroded out of the wall of red sandstone. As I turned around to face my photgrapher, I slipped in some of the silty sandstone dust. The fall to the ground was about eight feet. On the way down, I used my hands to gently push and guide myself away from the rocks so that I didn't smack my head or bounce off the rock wall.
I landed on a clear, almost flat, dirt surface, and immediately bellowed a deep, exhaustive, "AAARRRGGHHHHHHHH!" Something very bad had happened.
I instantly grabbed my left hamstring with both hands and pulled as hard as I could in a useless attempt to relieve the stress and pain on my lower leg. When I finally brought myself to actually look at my leg, the deformity confirmed my fears. Although nothing had broken through the skin, the bones below my knee were bulging out most unnaturally. The pain was excrutiating. My friends ran for help and provided comfort and encouragement.
Paramedics responded. They needed to use a scoop stretcher to load me up. This kind of stretcher allows them to wiggle each, separated side of the stretcher under me from either side and then to secure the carrier once I am above the cross-slats. As we headed out the winding, bumpy, dirt roads exiting the Red Rocks parking lots, the medic got me started on, what I believe was, my first IV. It took him two go's to get it, but the stabbing was a welcomed distraction from the pain in my leg. They gave me some painkiller, and although it helped with my anxiety, it didn't do much for the pain.
I'm not sure how or why Alexa and Hope decided that I should go to St. Anthony - Central near 17th and Sheridan, but it was a wise choice. We pulled up to the emergency room at somewhere, and I'm sort of guessing here, around 9:45. Triage and admissions had me rolling straight up to x-rays. There was one tech taking the films and one other guy assisting out of sight. They took two or three angles of my knee and then two angles of my hips, including one most indecenct crotch-shot.
Somewhere around the third or fourth back and forth trip between the patient part of the room and the operational part (to change films and take the x-rays), I heard the unknown person say something to the guy helping to get me diagnosed. My tech responded with something along the lines of, "Whoa, dude."
"Man, you wanna see a picture of your leg?" he called out.
It was more than just disloacted, and it was pretty bad: a tibia-fibula plateau fracture. The weight of my entire, falling body had essentially been concentrated through my femur and focused onto my angled, lower-leg bones. The force was enough to crack my fibula for approximately five inches along the medial side. The top of the tibia cracked into a few pieces. That x-ray tech was the first one to let me know I'd be spending the night.
They took a cat scan of the trauma before sending me into surgery. I woke up while they were rolling me into my room somewhere around 3:30 in the morning. Strangely, my first recollection of being awake is that I was already engaged in a conversation. I find this freaky and logic defying, but I understand it to be a pretty common effect with Versed, the anaesthetic.
To stabilize my leg, they drilled two holes into my shin and two into my femur - above and below the knee. Into the holes they sank titanium pins. The pins stand five-to-six inches above the blunt holes punched through my skin. They go straight through the muscle and into the bone. When I shift from horizontal to vertical, I can clearly feel my quadricep muscle shift across the rod which was planted two inches above my knee. The feeling is a bit usettling. Once the pins were in, they yanked good and hard on my leg to bring it back to its original length. Once they achieved a facsimile of the old geometry of my leg, they secured titanium bars above my leg and onto the pins. Essentially, they have locked my leg and largely isolated the trauma site from any musculo-skeletal pressure. Once the swelling abates somewhat, they will initiate the repair process.
I left the hospital Friday, late afternoon. Since my house requires climbing stairs to enter the premises and features a segregated layout with the bathrooms and bedrooms on the second floor and the dining and living areas on the first, I decided that I would convalesce at my brother's house. I'm here until my next surgery on Tuesday. Then, they will patch the medial fibula fracture with a large titanium plate. The following week, after again allowing for a reduction in swelling, a third surgery will place another plate over the front part of my upper lower-leg. After that, it's eight weeks of bearing no weight on the repaired leg while undergoing rehab and getting around on crutches.
There's a lot more bits and pieces to tell about this story. I'll be updating my tales of woe and adding pics as I have the energry. There is just no possible way for me to describe the intense and nearly unbearable pain I have been facing: excrutiating, defined.
I also cannot possibly express the thanks that I owe to Hope, my sister, brother, and Miguelina Hope. I am one stubborn son-of-a-bitch, and this injury has hobbled me, humbled me, and made me most dependent on others. I hate that I need the help but am deeply thankful that I have it.
More to come.
Tuesday, August 08, 2006
The song's ok, but the video is great. What a blast that must have been to choreograph and shoot.
At 196 pounds and just a hair shy of six feet tall, the President and I are both overweight. But I'll sure give the guy credit: he looks much better on tv and in pictures than I. Not sure where he's carrying the weight that pictures suggest I carry in my jowls. I would have guessed that he is a good 10 if not 15 pounds lighter than I am. Maybe I just need a good makeup man.
Thursday, August 03, 2006
I Don't Even Remember...
signing the petition, maannnnn. < / Cheech >