Outdoors Again

We took our first local vacation trip since my injury. We used to take at least two longer trips per season but until now I have not been up to it. We enjoyed a ride to the top of Pike’s Peak on the cog-railway, a short hike through the rock formations that make up Garden of the Gods park, and took a horse ride to see more terrain than I could manage with my cane. It was great to be back in the wilderness and I think it won’t be long before I am able to hike short distances on real trails with the assistance of walking sticks. To top it off we drove down to see the Royal Gorge bridge.

I’m hurt…

It seems as though all the souls in that hospital are crying out…

Story at: http://www.nytimes.com/2009/11/19/nyregion/19hurt.html?scp=1&sq=elmhurst%20hopsital&st=cse

If it is good enough for Chuck Norris….

I recently began a new therapy move, the simulated jump. This involves “jumping” while lying down in a leg press machine. It is good because it forces my leg / knee / quads to catch my body weight, thereby building strength, and just as importantly, confidence. If I try to jump while standing I invariably land on my good leg first b/c psychologically I won’t let myself land on the bad leg. When I am horizontal it is easier to let go and allow my bad leg to catch my weight. While using the jumping machine at my therapist I expressed dismay that the school gym does not have a machine to simulate jumping. This is when my therapist told me I should get a Total Gym. Even though I have not watched the infomercials for this machine, somehow my subconscious knows that this is the gym approved and marketed by Chuck Norris and Christie Brinkley. I guess that tells you how successful their advertising has been – I already know what it is even though I don’t recall ever looking for one. Where can I find the Total Gym? Online it sells for hundreds or thousands of dollars, with different versions having higher or lower quality materials and a different variety of possible exercises. Obviously I don’t want to pay retail, and given that these sell on late night television I figure that there must be hundreds of them collecting dust in basements all over America. Craigslist to the rescue! Within 24 hours I buy one locally for much less than the retail price, and it comes with the expected dust from lack of use. I cleaned it up and started jumping. It seems like it will do the trick. I don’t know if I will bother with the other exercises if offers, I do most of those in the gym on better equipment…

Back In The Snow

A big winter storm blew in last night, dumping 10” and counting. Needless to say, we headed out into the wonderland for our first real outdoor adventure since I broke my leg. We used to hike or bike in the mountains almost every weekend, but since my injury we have been limited to driving to overlooks or looking out the window at the scenery. But now that my strength and endurance are improving I could not resist getting outside in the snow. The last time I was out in the snow I was lying in the fetal position waiting for the ski patrol to evacuate me to the emergency room. It was refreshing to be back in the snow on my own terms! Enjoy these videos of the experience!

Returning to the scene

I recently drove back to the location of my surgeries for first time since my injury. I scheduled an appointment with my lead surgeon to discuss hardware removal and other issues. It was fun to finally speak to him in my own voice and see him face-to-face, rather than looking up at him from a hospital bed and trying to talk through the fog of the drugs. After our visit I went next door to the hospital where I spent 14 days way back in January. It was strange to see the place in its entirety. When I was there I was always on drugs and usually viewed the facilities as I was being wheeled down hallways towards the surgery rooms. The only time I saw the world outside my room from a vertical position was near the end of my stay when I was required to struggle down the hall – with three people helping hold me up – to the rehab room where I mustered my last remaining ounce of energy to walk up three steps. This procedure was the exit exam for the hospital, and it was a miserable exercise in pain and struggle. But when I returned I was upright and the place seemed cleaner, brighter, and smaller than I had imagined. I met a few of my nurses and thanked them for their help, and I stopped by that rehab room to speak with one of my therapists, the one who got me up those stairs and out of the hospital. It was strange to be back. As I peeked into my old room I recalled the world of misery that revolved in that room. I wondered how many people had suffered in that space before and after me. Strange that so much pain and struggle can be compressed into 14 days in one room. As I exited through the front door of the hospital, the same door through which I was wheeled in a stupor 9 months ago, I was thankful to have come so far but mindful of the long road ahead.

My old room, awaiting its next patient.....

Forrest Gump Dreams

Lately I have been having what I call Forrest Gump Dreams. Remember that scene in the movie “Forrest Gump” where Forrest is a boy and he is running from bullies but struggling to get away because he is wearing leg braces? Jenny yells “Run Forrest, run!” As he struggles to run the screws begin to come out of the braces and they break free and he sprints away as his pursuers toss their bikes in disgust. Except for the pursuers those are the kind of dreams I am having. For example, I may be walking (limping) down a street and suddenly I start to go faster and then I am running and in the dream I think to myself “wow, so I can run even though I can’t walk! This is great.” In another dream I am on my mountain bike flying down a canyon without any concern for my injured leg and I think “even though I cannot walk I can still go all out on the bike!” Alas, although I am riding my road bike like a man possessed, I cannot hit the trails yet because I cannot stand up on the pedals, and that is an essential pose in mountain biking. At least for a few moments in my dreams I can do those things that in real life are still quite far away.

Back in the saddle

Just 6 weeks after getting on the trike, I no longer need the training wheels and I am back on my regular bike. The trike was essential for getting me used to moving along the road without having to worry about my balance. Also, over the last 6 weeks I have made good strides in strengthening my leg such that I can now step off the pedals and stand up at stoplights if I have to. I miss the cargo space of the trike but the single gear made for slow going and the three wheels made horizontal slopes tricky and parking a challenge. But I am glad for the trike because it was a key step in getting me back in the saddle. I feel like my flexibility is not improving much but strength is coming along slowly. I have also ditched the cane. I cannot walk too far before I am worn out, and I have a big limp, but now that I can stand the pain and have the strength, it is time to go for it!

Yes I Cane

Today I have a few landmarks to announce. As of this week I am walking with a cane. I am putting significant weight on the cane but it is the final step to walking without assistance. Here is a video of the cane in action.



Second, I achieved my rehab goal of swimming in the ocean while visiting family last week. My wife escorted me into the water, serving as a human crutch, but after that I was on my own, riding waves, swimming, having a good time. We also took a ride on my father-in-law’s boat. All-in-all it was a nice vacation, our first significant amount of time away from home since the accident. Here is a shot of me on the boat.


Third, I had an x-ray yesterday and it shows significant healing in the bone so I have the green light to push it as hard as I can on the weight machines, etc. Compare this image to the one at the top of the page to see how much healing has taken place.


Fourth and finally, I start work next week teaching two classes. It will be good to get back to work but challenging to maintain my rehab schedule at the same time. Obviously rehab is most critical so I will have to make that a priority. At least I can now ride my trike to school!

Little by little

I have no major news to report, just the slow grind of trying to build a little bit of muscle. I do not notice much change in a few weeks but I find that I can look back a month and say, “hey, I am a bit stronger than I was at this time a month ago.” Lately my knee has been feeling very good, so much so that I am able to ride a stationary bike at a reasonable speed (1.15 miles in 10 minutes, with some resistance). Flexibility still needs work but at least my muscles and ligaments are all now fully awake and working their way back to normal functionality. I am still using one crutch because when I try to take steps without it I have intense pain in my shin after just a few steps. That tells me I need to get stronger before I drop the crutch. Hopefully another month of intensive rehab will do the trick but I would not be surprised if I am not using a crutch for two more months. Due to the still-healing state of my broken leg, I cannot simply pile on the weights and go for it as I would if I were trying to bulk up a healthy limb. The injury forces me to be very deliberate and increase resistance/weights at small, manageable increments. If a higher weight limit causes lots of pain, as opposed to just muscle soreness, then I have to back off to a slightly lower weight. Chipping away in this fashion is a slow road but it is working…slowly. Here is Cairo helping me with my morning extension stretch. I put ankle weights on my bad leg and lie on my stomach to stretch it as straight as possible. Cairo sometimes lies beside me but today she decided to stand on my back!

The Great Trike Experiment

I decided to get an adult trike because I realized that I will not be confident on a regular bike for some time, due to issues of strength and balance. An adult trike or tricycle is a full-sized bike with two rear wheels and just one gear. Adult trikes are designed for easy cruising along flat pavement. The large basket on the back makes trikes ideal for schlepping groceries or other loads, and the three-wheel configuration makes it possible for persons with impaired balance to ride a bike. Thanks to Craigslist it was a simple matter to find and obtain a lightly used trike in just a few days. In this video you can see me giving it a test ride.



I am still pedaling rather slowly because going fast is uncomfortable for my knee. That said, I have noticed marked improvement in my knee over the last month and I am hopeful that in a short while I will be able to pedal much faster and at a constant rate. By then I should be used to the trike, which I will use to commute to school once I start teaching again in late August. The main thing you have to learn about trikes is that the two rear wheels closely track any slope in the pavement – if the road has a slope you will feel it as the bike leans in that direction. This feels weird at first but I learned to lean in the up-slope direction when on significant slopes. Also, if I need to turn across any change in elevation I make sure NOT to go obliquely, but perpendicular to the greatest shift in slope. This is important because if you get one of the rear wheels up high and one down low, you might tip over! I think the trike will be my training wheels for transition back to my regular bike sometime in the fall…unless I get addicted to the using the trike to haul all my books!

Forever Rehab

I used to marvel at persons who recover from a horrible injury or complex surgery and go on to run marathons, climb mountains, etc. I still do but I am beginning to understand part of how they do it. I am at the stage in my rehab where I spend several hours a day lifting weights, stretching, riding a bike, swimming or some other activity. I will most likely have to keep up this activity for at least a year just to keep the gains I have made. By that time I will be in the habit of doing so much physical activity that if I keep it up beyond a year then I will be in top shape. Perhaps persons used to such a routine keep it up beyond their full recovery, leading to increased athleticism and ultimately, marathons. I do not see myself attaining amazing heights in sports, but I do believe I will have to keep up regular physical activity just to keep my knee from stiffening again. Before my injury I was active because it was fun. Now I am active because it is necessary to gain and maintain a basic level of movement. Hopefully as I recover I will eventually get back to the fun part…

Walking,....sort of.

This week I had another breakthrough of sorts: I am able to walk with a little hop-step. I still use a crutch during the day but sometimes at the house I use the hop-step to get from one piece of furniture to another. I am a long way from really walking, but it is encouraging that my leg is now strong enough to hold me up for a short time while I catch my balance. Other than that news, I am just continuing with rehab, swimming, lifting weights, stretching, etc. It seems like my days all revolve around my next work out.

Brace-be-gone, Russian Stim, Walking the walls

Brace-be-gone
It seems that these days each week brings significant improvements. The big change this week is that I finally ceased wearing the leg brace seen in the picture on the blog homepage. In truth I have not been wearing this brace at home since early March. But I was wearing it when out and about until such time as my leg felt strong enough to hold me up – even with crutches – without wavering to the point of fail. In the month since I have been putting more and more weight on the leg, I have developed significant strength in my muscles. I am not yet able to walk without at least one crutch but I am getting closer each day.

Russian Stim
This week in rehab we tried “Russian Stim” to get my muscles moving. Russian Stim is “2500Hertz at 50 pulses per second. This means that 50 times a second a 2500Hertz pulse stream is sent to your muscle. The benefit of this is a deeper penetration of the muscle and more intense contraction. This type of stimulation is commonly used by doctors for treatment of: Rehabilitation, Scoliosis, Spinal Cord Injuries, and chronic muscular pain syndromes.” (http://www.tens-store.com/ems/ems-faq.htm)

Basically Russian Stim involves attaching electrodes to your muscles and cranking up the electricity to the point that the muscle contracts fully and sustains the contraction for a set period of time. I was on RS for about 15 minutes with 10 seconds of juice and 10 second pauses between. The experience is like being stung by a whole bunch of bees at once, except that the stings are less prickly than they would be in real life. When the sting begins, the muscle contracts very firmly. I found the experience odd but useful in that it forced my entire quadriceps to engage. The good news is that I was not very sore that evening or the next day, which indicates that I have already been using the full extent of my quadriceps in my daily exercises.

Walking on the walls
A final recent development is my ability to walk around the upper floor of our tiny house almost entirely without crutches by using furniture or the walls to support myself. This is a spectacle to behold but oddly liberating and it demonstrates increased strength and stability in my leg.

All in all it has been a good week!

One Crutch

This week I had a big breakthrough: I managed to walk with just one crutch. This involves using only the right crutch and leaning to the right a bit when taking a step with the left foot. I am not strong enough to sustain this for very long and usually my step is more like a shuffle than a full step-through, but it is a start. I try to walk with one crutch at home and sometimes when out and about, if I have the energy. Although my step is not normal with one crutch, it forces me to put more weight onto my left leg. I have also been going to the pool nearly every day and increasing the amount of walking and swimming I am doing in there. I can feel some strength returning to my leg but I also know I still have a long ways to go before I am walking without any crutches. Still, it is nice to finally be on the road to walking again. I still have problems with extension and my max flexion is only about 115, but hopefully that will improve with time.

Handicapped Parking and other forms of solidarity

Now that I am injured, I notice persons with physical limitations more than ever. Often we encounter each other while parking in adjacent handicapped spots. We show concern for each other, ask how we were injured and part with wishes for a full recovery. Of course, may people are permanently disabled and a full recovery is not possible. This does not stop any and all persons from expressing their solidarity with my injury. Many times shopkeepers or shoppers will stop to ask about my injury and then recount their own tale of recovering from an ACL repair or knee replacement. Just the other day I was in the pool practicing walking when a woman on crutches came to ask if she could use my lane because it was closest to the ladder. I explained that I too was on crutches and we embarked on a ten minute discussion of her broken foot, my leg, strategies for recovery, etc. Unfortunately as we go through life we often fail to understand the experiences or perspective of other people because we are so entrenched in our own life history. Thus we are wary of or oblivious to the struggles of new immigrants, persons of different economic or political persuasions, or those with physical limitations. If there is any positive outcome of my injury it is that I now understand more than ever what it is like to lose the use of a limb for a time, or to be unable to do things we often take for granted, things like walking, jumping, riding a bike, hopping out of the car, going up or down stairs. As I struggle to get into and out of buildings that have heavy doors, no ramps, narrow passages or otherwise limited handicapped access, I think of the persons who are permanently disabled that have to deal with these issues not just for a year but for life. We exchange knowing glances as we pass one another through the day – knowing because each understands something of what the other is going through. I hope that through this blog those without such experiences can begin to know something of what it is like to experience these things, while those in the same boat will know that they are not alone. I wish that we could all overcome such barriers and open our eyes to the perspectives of others. Every human being is entitled to have an opportunity to live life to the fullest, even if physical limitations make it necessary to provide a wider doorway, a ramp, a shallow step into the pool, or slip-free flooring. We are a much better community when we include all our members.

If you like your physical therapist….

My doctor told me early on that if I like my physical therapist then I need to get a new one. His point is that you want a therapist who pushes and challenges you to do what you don’t want to or think that you cannot do. My first therapist, the one who came to the house, was perhaps a bit too easy on me but in fairness the injury was fresh, I was very weak, in a lot of pain, and I could not do much without fear of aggravating my injuries. By the time I started to go to a clinic for therapy I was healed enough to be pushed harder. I have worked with several therapists but the one who usually sees me pushes me pretty hard. Often about halfway through the appointment I start thinking about going home because it hurts so badly! But I know it is for the best and as I improve I am better able to tolerate the pain and discomfort. So yes, on one level I do not like my therapists, but on another level I really love them! Everyone recovering from a bad injury needs a coach to tell them to get in the game, push harder, go further, and come back for more!

Today’s update: We measured my flexion today for the first time in a week. Now, two weeks after my third manipulation, I made it to 118 degrees. Needless to say that is a record and it is very encouraging, especially because it was painful but not super mega painful, which gives me hope that I can attain this angle with some regularity. I have also been going to the pool for several days now and I can already feel some strength returning. The big problem is extension – my leg still is not straight – so I have a lot of work to do there.

In the field

Due to my injury I had to cancel all my fieldwork plans for this summer. As you might imagine, fieldwork is the most exciting part of being an archaeologist. Getting outside, getting dirty, looking for the answers to research questions, finding things, and making new friends are just a few of the things that make fieldwork so much fun. Today I had an opportunity to go into the field to observe a magnetometry survey. I was planning to do the same type of work this summer but my leg will not allow it. Even so, it was nice to be in the field, high in the still snow-capped mountains, enveloped in the scent of sagebrush. I sat in the back of the truck and watched from afar, venturing out every now and then to practice putting weight on my leg and to chat with my friends. At one point we tested the magnetic properties of my steel implants by removing all my metal-bearing accessories (crutches, brace, and shoes) and walking over me with the magnetometer. Good news: my implants did not affect the machine’s readings, which means that even if my they are still in place next summer I can do magnetometry without worrying about interference from the screws and plates.

As we drove up and back to our field site today we passed frozen lakes and crossed high mountain passes covered in snow. I felt an eerie sense of going back in time, back to the winter, back to the day I broke my leg. If only I could turn back time by driving higher and higher in the mountains then I could undo my fall and rewrite the story of my life. On the day I broke my leg we were supposed to go to lunch with some friends but they canceled so we kept skiing. I wonder, what if the lunch was not canceled, would I have broken my leg anyway but on some later ski trip? It is no use to ask such questions but they arise from time to time. At least for a while today I felt like my old self, arising early to go into the field, traveling to a remote location, wearing all my field gear, getting dirty, and returning home exhausted but happy.

Continuous Passive Motion

This strange-sounding post title is the name for a range of devices that move your body parts for you, i.e. passively. A continuous passive motion machine (CPM) may bend your arm, flex your back, or in my case bend your leg at the knee. Four months after I brought it home from the hospital I still have my CPM because it still helps me push my flexibility to higher levels. Generally one would not use a CPM so long but my injury is so severe and my scar tissue so aggressive that it has been a huge struggle for me to regain flexibility. The idea is to move the leg even when it is too weak to bear weight or otherwise be exercised. Movement is important to combat scar tissue and loss of range of motion. If you just go home and sit in a brace for 8 weeks then you will gain scar tissue and lose range of motion. The CPM is supposed to help, although some studies say it is not any better than a good physical therapist. I like it because it is done at home, can be used for long periods of time, and psychologically you feel like you are making progress. There are various machine designs but my model, a “Legasus” (ha ha ha) pushes the knee up from beneath. There is a controller with which I can increase the angle of flexion (bending) and extension (straightening), as well as the pace or speed of the up and down motion. In truth the machine does not really push me to zero extension or the highest flexion b/c believe it or not, scar tissue and tight muscles are stronger than the motor drive on the machine! Although it pulls my leg towards straight, my knee stays up in the air at about 15-20 degrees. And at the high end of flexion, when it reaches the limit of my true flexion, the machine slides down the bed away from my thigh. I try various tricks to combat the weakness of the machine, the most important of which is to be sure I am properly situated within the machine with my knee at the axis of flexion, my foot securely in the foot pouch and my hip aligned with the axis there. By slowing increasing the angle of flexion I slowly gain more range of motion. The main drawback of the machine is that when you are very weak you need help getting into the machine, as I did for the first month at home. After that I was strong enough to get my leg into the machine properly. Another drawback is that the machine is lined with faux fleece, which is soft but hot! The foot pocket completely covers your foot in fleece, which is great if it is cold but horribly hot if it is warm. I think they need to design winter and summer versions of the padding! The best thing about my CPM is that it appears to date to the late 1980s with its neon colors on the controller and the body of the machine. I found that in the first few weeks I could barely tolerate more than an hour at a time in the machine. Now I can sit in it for several hours if necessary. The problem is that since it fails to get me to zero extension, if I stay in it too long then my extension suffers. To combat this problem I put in an hour or so, then stop and stretch extension for a while before repeating in the machine. It helps to distract myself by sending emails, watching movies, talking on the phone or reading a book.

Boys Don’t Cry

This blog title pays homage to a classic THE CURE song about the emotional struggles of boys, found here for those needing a refresher: http://www.youtube.com/watch?v=l8CDERzun4k
In this song the protagonist is really sad over losing his girlfriend but he has to hide his tears because “boys don’t cry.” To be more specific what this song should say is that “the socialization of boys in American society includes the oft spoken rule that ‘boys don’t cry.’ So if a little boy falls and hurts himself he is supposed to suck it up “like a man” and hide his tears. Of course this is baloney because males are emotional creatures too and crying is one of the most cathartic things you can do. Nonetheless I have been to funerals where men stand around trying to hold back tears while the women cry freely. Why must we hold back? Fortunately I inherited fast tears from my grandfather and father, both of whom can tear up simply by recalling a sad or emotional memory or moment, not to mention a present moment of such magnitude (a great skill that actors use all the time). This is important because when you hurt yourself like I did, when you are in such pain and confusion, tears come easily and it is best to let them fall. The drugs I am taking also cause stronger emotional swings. During the first four weeks back from the hospital I think I cried at least once every other day. Sometimes the tears would come over something like excruciating pain, other times they would come when I tried to do something and realized that I could no longer do it by myself, and finally the tears might just come out of nowhere, gushing randomly over no apparent spark. The bottom line is that the tears helped me release pain or stress and made me feel better. So to all the boyz out there, yes you can cry! It is normal, natural, and good for you.

A cat is a man’s best friend

Recovering from an injury like mine is difficult and it helps to have a boon companion. I had always been close to our cat but when I came home from the hospital I found that we had much more in common: we both spent most of our time lying around, only getting up occasionally to seek food and drink! For the first month, when I was mostly confined to bed because I was too weak to do much else, our cat laid beside or on me keeping me warm and cheering me up! Even though I am more mobile now she still follows me around to find my lap. Apparently she now regards me as a heated piece of furniture. I don’t mind because she keeps me company and puts a smile on my face even in the darkest moments. For the first few weeks after I returned from the hospital I found it very difficult to relax and sleep because I was very restless. I am not a back sleeper but with my injury I had to sleep on my back. Many nights I would fidget and struggle to get to sleep. Often, the cat came to my rescue by lying on or in between my lower legs. Her weight and warmth somehow calmed my restlessness and enabled me to get to sleep! So if you are injured and stuck in bed, I highly recommend a nice cat to keep you company and help you heal.

Support Network

A support network is an essential part of a long recovery. In my case support begins with my wife, who has made countless sacrifices to help me in a million ways. In the first 6 weeks especially, when I was tremendously weak, she had to do every little thing for me. Now I can handle many tasks myself but I am still useless at carrying heavy things, working in the yard, and many other things for which she must pull double-duty. The next part of the network is family. Although my family lives far away they sent cards and care packages and called many times. My parents came to visit in week 3 to give my wife some time to focus on her work. My wife’s parents came to visit in week 5 so my wife could go to a conference without leaving me alone. The next aspect of the network is friends and acquaintances. During our first month home from the hospital our friends brought us 1-2 meals each week, which removed a burden from my wife who at least for those nights did not have to make a meal in addition to getting my medicine, etc. Friends also helped with random needs, visited to cheer me up, and took over responsibilities that I could no longer keep. Another group in the network is doctors, nurses, therapists, and other members of the healthcare field. These persons helped me change bandages at home, pushed me to “fire those quads,” cut me when necessary and bent me when I would rather go home. To all the members of my support network, thank you thank you thank you!

Manipulation

Today’s post is both retrospective and current because today I had my third manipulation. A manipulation is recommended when flexibility is limited by scar tissue or other factors. In my case I had my fist manipulation eight weeks after being discharged from the hospital. At the time I could not flex my leg beyond 65-70 degrees because scar tissue had completely enveloped my kneecap, preventing motion. For that manipulation I received an epidural (pain killer in the lower back) and a femoral nerve block. The nerve block is accomplished by giving a shot of painkiller to the femoral nerve, located in the groin area on the same side as the injured leg. The trick is that to find the correct nerve they have to stick a wire in your groin and poke around until the correct part of your leg contracts. The other end of the wire is attached to some kind of battery that sends small electric pulses to the nerve, causing the muscles it serves to contract. During this process I felt like a lab rat as first one, and then another group of muscles contracted involuntarily. Finally, the quadriceps (upper thigh) contracted, indicating that they were poking the femoral nerve. At this point they injected numbing medicine, and for my first manipulation they also inserted a small catheter attached to a tennis-ball-sized rubber ball of medicine that gradually deflated over 24-36 hours, delivering a steady dose of pain killer around the femoral nerve.

Once the pain killers were in place they wheeled me in to surgery and put me to sleep. During the surgery they cut away the scar tissue that was locking up my ligaments, tendons, and even muscles. Then they forcibly bent my leg to 130 degrees. The cutting is done through several tiny holes around the knee. Upon waking up in post-op my upper leg was like a bowl of jello from the nerve block. The back of the leg or knee is not affected by the nerve block so it does feel pain unless you are given other medicine via an IV or orally. The first manipulation required so much cutting of scar tissue that they kept me in the clinic for two nights to recover. During this time I had a drain in my knee to let the blood and other fluids escape and reduce the swelling. The drain consists of a clear tube attached to a waffle-sized suction pack that inflates as it sucks out the fluid. This reservoir must be emptied periodically. For those three days and two nights I worked a lot in my CPM machine to flex my leg, and packed ice around the knee to reduce pain and swelling.

Although the doctor was able to bend me to 130 degrees in this first manipulation, I only retained to 90 degrees. For this reason, just over a week later the doctor did another manipulation. This second manipulation only involved bending, not cutting. I received another femoral nerve block but no epidural and I did not spend the night in the clinic. I was in horrible pain after the second manipulation, probably because I still had fresh trauma from the first manipulation. As I sat in the recovery room the pain kept increasing and my heart rate was rising so much that they decided to block the nerve in the back of my leg. Unfortunately, after repeatedly poking me with a needle behind my knee they could not find the correct nerve so they just shot some pain killer in there. This helped a bit but I was in bad shape from the pain and poking.

Despite intensive physical therapy, four weeks after the second manipulation I could only bend my leg to 100 – 110 degrees and the doctor sensed that my knee was locking down again. Thus I went in today for my third manipulation. Once again I had the femoral nerve block but no epidural. They attempted to give me a nerve block catheter but after poking me a dozen times with a needle and the electrodes they could not find the nerve! Apparently they need an ultrasound to find it but none was at hand so I just went without the catheter. As in the first procedure I again had a scope in which they cut scar tissue around my knee. This time the doctor got me to 5 degrees extension, 125 degrees flexion. As in the first procedure I have a drain in my knee and I will go back to tomorrow to have that removed. I just got out of an hour or so in my CPM and now I am working on extension by propping my leg up on a stack of towels, trying to straighten the knee. So far the pain from this manipulation is much less than that from the first two, probably because my muscles and tendons have been increasingly subjected to stress since I began putting weight on the leg last week. Thus, these tissues were less stressed by the manipulation. Of course, once the nerve block wears off I will know just how much pain I really have! At the moment I am about to pass out from the drowsiness caused by the drugs….so I bid you adieu. Hopefully the third time is the charm and I am finished with manipulations forever!

Going Home

A few days after my last surgery the physical therapists started trying to get me to walk to the bathroom, walk across the hall, and even climb mock stairs. Of course this was using a walker or crutches and with two or more persons assisting so that I did not fall down or trip over the various tubes sticking out of me! The problem is I was just too weak. Blood tests showed a low hemoglobin count. It took two transfusions over two days to improve my strength enough to make it down the hall and over the mock stairs that comprised the hospital exit exam. Suddenly I found myself on the way to the car for the long ride home. Sitting in the back seat with my legs extended, every bump in the road was painful. Hours later I arrived home and two friends came to help me cross the threshold. If felt good to be back home but to be honest both my wife and I were a bit scared. In the hospital we had round-the-clock attention from an army of nurses and specialists. Now suddenly we were home alone and sorely lacking in all the fancy tools we had in the hospital. We had no automatic bed, no swiveling table for eating in bed, no handicap-accessible toilet. In fact, I could not even get through the bathroom door in my walker so we had to call a friend take the door down for us. My wife also had to get back to work after missing two weeks to be with me. How would I make it through the day alone if I could barely get out of bed, much less make lunch or get into the kitchen cabinets? As we struggled to get to sleep that first night we thought how in the heck are we going to get through this?

Hospital life

In this blog I pick up where I left off on my May 6 post to offer a view of hospital life. Let’s face it, staying in the hospital for 14 days is no picnic. Each day I felt progressively weaker. Aside from loss of appetite and the combined effect of many drugs, my weakness was heightened by multiple surgeries during which I lost quite a bit of blood. One thing that keeps you going in the hospital is the relentless routine. A nurse comes to check your vitals every so often day or night. Nurses come and go all day and night to administer medicine change the IV, etc. The first nurse to visit each morning is the one who draws the daily blood sample. This is done very early so that the surgeons and doctors have a report of your blood statistics before they visit you. The only things that are not on a rigid schedule are visits from various specialists – breathing experts, rehabilitation experts – and the doctors. They come by whenever they get a chance and catch you awake, reasonably alert, and not otherwise indisposed. Sometimes you don’t want to see them but you know that they are there to help so you suck it up and try to do what they ask. During my long stay I was blessed with excellent nurses, doctors, and other specialists. Once or twice I disagreed with a nurse’s decision about a change to my medication but usually s/he would listen to my concerns and maybe even take my requests. Often I was so mixed up in the head from drugs, pain, and fatigue that I felt a lot like this little boy:
http://www.youtube.com/watch?v=txqiwrbYGrs

Real life

Another post from the present: this weekend I am participating in a three day workshop in Denver. This is the first event I have not canceled since my injury. I was determined to keep this on my schedule so I booked a room in a Denver hotel to save myself the long drive each morning and night. The drive is a problem because while driving fluid pools in my leg and foot, which makes it even more difficult to sit in the workshop all day. Today was very difficult because I had the drive plus eight hours of mostly sitting. I spent most of the workshop fidgeting, with my leg alternatively propped in a chair, laid across my other leg, or on the floor. Despite wearing compression hose my leg swelled by about ½ inch all around. This evening I was about to pass out but sucked it up and did an hour in the CPM machine (more about this in a later blog). The CPM bends my leg for me and it did help the swelling go down a bit. Tomorrow will still be rough, but at least I only have a short drive from the hotel. Also, we will be outside and the cool air should help me be more comfortable than a hot classroom. Although it is painful and uncomfortable, being at this workshop makes me feel a bit like I am returning to my real life, as opposed to this weird life of rehab that I have been living for four months.

Pool time

Once again I interrupt this retrospective blog with some current news. Today I did my first round of pool rehab. Although I still have some unhealed necrotic flesh, I was able to cover it with a waterproof bandage (which failed, but at least the scab did not float away) and get in the pool. The pool is great for rehab because if the water is at chest height then you are only bearing about a third of your body weight on the leg. This meant that I was able to walk around in the pool without crutches or a brace. It was so liberating and I almost felt like my old self. The pool is also good because I can put a consistent amount of weight on the leg whereas on land with crutches it is difficult to put the same amount of weight on the leg with each step. So I walked around the pool, and then used a float to stay high in the deep end while doing bicycle and cross-country skiing moves. All in all it was great to cross yet another barrier and enter the water for the first time in four months!

Skin Graft

After installing the metal implants we waited for the swelling to go down enough to close my lateral incision (beneath the wound vacuum). Alas, after several days of waiting for the swelling to go down the doctors decided that they would have to cover this hole with a skin graft. Taking three thin slices from the surface of my upper thigh, the surgeons used a special machine to construct a roughly 7” X 4.5” almond-shaped skin graft. In the process, they embedded the graft with small holes, like a fishnet, with the idea that skin will grow from the netting to fill in the holes. This structure also makes the graft very stretchy/flexible, enabling it to be stretched across the gap. Since the graft is made from the surface of the skin it creates just a rather sun-burned looking scar at the “harvest site.” For the first month or so after receiving the graft we had to change the dressing once or twice daily. After it had completely scabbed over we changed the dressing less frequently. As it slowly healed the graft shrunk to match the reduced swelling in my leg. At present the graft is completely healed, and only about 7” X 1”, although one bit of necrotic flesh at its edge remains a scab. Necrotic flesh consists of portions of my original skin around the graft that died and turned black during the time between the initial surgery and the time that the skin graft was attached. It is very weird to have dead skin just sitting there on your body, but eventually new skin grows in behind it and takes its place. Now that the skin graft is healed it looks like burn scars I have seen on other people. Over time the colors may gradually turn from reddish-pink to just plain pink, masking the scar to some extent. Although the skin graft was inconvenient in that it required dressing, and kept me from resting my leg on its side, it usually did not hurt. The main problem with the graft is that until it heals completely I cannot go into the pool to do water rehab. Water rehab is nice because you can wear a float around your waist and “walk” without putting much weight on the leg. You can also jog and do other exercises that build muscles due to the resistance of the water. Overall skin grafts are weird things that make me feel like a lizard whose tale magically grows back. The body really is an amazing thing!

Man of steel

After a few days of hanging out with my external fixator and wound vacuum, it was time to work on the bones. In a 5 ½ hour-long surgery, a team of surgeons re-set my bones using two metal plates and 16 screws. Working from a plan they based on the CAT scan and other factors, they managed to get me back together pretty darn well. I imagine that this surgery involved as many clamps, power drills and extension cords as scalpels and scissors. They tell me that the tourniquet was around my upper thigh for several hours, apparently the limit for such things, and I had a dent in my thigh for a few weeks after the surgery. The good news is that I did not tear any ligaments. That said, the piece of bone into which the ACL inserts was apparently smashed such that the ACL had to be sutured back into position. Waking up from this latest surgery I was free of my towel bar, but the wound vac was still with me. Great, so I am fixed, how long until I get out of the hospital? Well, that all depends on how long it takes to get the swelling down enough to close up the gaping hole beneath the wound vac…

CAT scan

After attaching the x-fix, it is time for a Computed Axial Tomography (CAT) scan so that the doctors can get a better idea of just what they will be facing when they go in to fix the bones. A CAT scan yields a 3-D image with false color to make it look as much like the real thing as possible. I am wheeled into a small, dark room with a large machine. In go my legs and after some period of time I am out of there. I do not see the result until after I return home from the hospital. The first time I looked at the CAT scan I broke down in tears. From these images you can see how the top of my lower leg (Tibia) was crushed and shattered. It is scary to see and even today I wonder if I will ever be “normal” again.

News Flash: The wait for weight is over!

I interrupt this retrospective narrative for some current news: the wait for weight-bearing is over. My doctor took an xray today and cleared me to put weight on my leg. Just a week shy of four months after my injury I can finally put my foot on the ground for real! Of course this is no simple task. I have to rebuild my muscles and learn to trust my leg. My foot is not yet flat and I cannot straighten my leg beyond 15 degrees, so my walk is more of a stoop-shimmy. But at least I am putting the foot down and hopefully in 4-6 weeks I will be walking without crutches. There is still a long road ahead of me but today marks a major milestone. And yet with each step forward comes a small step backward. My flexion is topping out at 110 so I will need another scope and manipulation next week to force me to 125-130 degrees. I am not looking forward to more surgery but at least it will improve my flexibility by cutting my knee loose from the scar tissue that is keeping it from topping 110 degrees. Also, in the xray my fibula does not appear to be healing much at all, something my doctor called “a cause for concern.” I suppose that could mean another surgery to reset the fibula but I sure hope not! For now I will just put my foot on the ground and work for the best.

External Fixator and Compartment Syndrome

At this point in the story my memory gets a little sketchy because I was full of drugs. I know that they briefed me before the surgery, but if not for my wife’s notes I would recall nothing but signing the consent form! The first order of business was to install an external fixator to stabilize and straighten my leg. This is basically an expandable towel bar that they bolted to the lower end of both my lower and upper leg, safely bridging the area of trauma. Once installed, the bar can be expanded to stretch the leg and help pull the bones and muscles back into place. Shortly after I came out of surgery for the towel bar I had to go back into surgery because I developed compartment syndrome. This is a condition where the muscles swell up so much that their compartments, thin sheaths of skin (?), can actually constrict blood flow and cause the muscles to die. Fortunately my surgeon identified the problem and solved it by cutting open the compartments to relieve the pressure. I woke up with new cuts in my leg and a wound vacuum stitched over a gaping hole on the outside of my leg. The wound vacuum is a small device that sucks fluids out of the wound, helping relieve pressure and swelling. One must periodically empty the wound vacuum’s bag so that it can accept more fluids.

I remained in this condition – with wound vac and external fixator – for several days as the doctors waited for the swelling to go down a bit before operating to fix my bones. Needless to say I was very uncomfortable. It is not every day you are graced with a towel bar and vacuum attached to your leg. I was also still in a bit of shock, trying to come to terms with the reality of my injury and the disorientation that comes with being drugged up in a hospital. I had so many IVs and other things hanging off of me that I felt like a fly trapped in a web. If I tried to move in any direction, one of the many tubes would catch on something. I wondered, what next? Can this get any worse?

Holy Cow

After a long trip down the mountain, lots of pain and disbelief, I find myself in the emergency room at Breckenridge. Here I will have my first glimpse of just how badly I broke my leg. Still strapped to the immobilizing board, I am transferred from the sled to an examining table. The first order of business is to begin removing my clothing, start an IV, hit me with a shot to relieve the pain, and take an x-ray. The pain killer helps a lot but only lasts a short time, after which I receive another and another. They take the x-ray with my ski boot still in place. When they place the x-ray film up on the viewer, which I can see, I know I am screwed. Holy cow! This is not some simple fracture. On the contrary, it looks as though I smashed the top of my tibia with a hammer while twisting it and grinding it into my ski boot. That is, the upper half of my lower leg is broken, twisted, shattered, and compressed. No wonder it hurts so badly!

While we wait for an ambulance to take me to the hospital where I will have surgery, the emergency room staff removes the remainder of my clothing and tries to keep me calm. They are very professional as well as sympathetic, and I can tell they do this a lot. Before removing the ski boot from my broken leg they give me a fresh shot of pain killer so I don’t feel a thing. Still, the thought of them wrenching the stiff boot (it is only 1 season old) from my smashed, dangling leg, gives me the chills. Next I have the option of trying to save my silk thermals or having them cut off. Cut ‘em off I say! Luckily my ski pants are the kind that zips all the way down the sides so they can be removed without destroying them. I wonder, when I bought this style of pants was it a bad omen? As I lay pondering my situation, I develop a terrible pain in my lower back due to lying on the plywood immobilizing board for several hours while I wait for an ambulance. Even in the midst of my plight, I find it funny that the board is hurting worse than my broken leg. Finally the ambulance arrives and two kind gentlemen take me over to the hospital, just a few minutes away. As they wheel me into the hospital I find myself once again in unfamiliar territory. I have taken on the role of THE PATIENT: lying on a gurney, watching the top half of people as I am wheeled down long hallways, wondering if this is real or just a dream, waiting to find out how they will fix the pile of splinters that is my left leg.

Last time down

This is the run before the one on which I broke my leg. I fell in the gently undulating area beyond the place I reach when this video ends. This may well have been my last time skiing...only time will tell. If only we had stopped for lunch after this run!

In the blink of an eye

On January 16 2009 I was enjoying a beautiful day of skiing at Breckenridge Ski Resort. The sky was clear, the sun was shining, and the conditions were great on the Imperial Bowl, the highest lift-accessible terrain at the resort. My wife and I took turns making videos of each other skiing the main part of the bowl. Each time we would meet at the base of the difficult terrain and slowly make our way across the relatively easy terrain to the dedicated lift that serves the bowl. One fateful trip I suddenly dropped to the ground as I neared the lift. I rolled a few times, and as I did my right ski came off, but my left held firm. Serving as a brake to my rolling legs, I watched in horror as my lower left leg twisted around in ways it should not. I knew my leg was broken before I stopped rolling, and when I came to rest facing partially uphill, the terrible pain below my knee confirmed my worst fears. Shortly my wife and a passerby stopped to check on me. I told them my leg was broken and soon a ski patrol team was on the scene. As I lay suffering I quizzed my wife and the man who stopped to help. What happened? Did I catch an edge? I did not feel out of control, I just suddenly went down. My wife had not witnessed the accident, but the man said I appeared to be in control until I just went down. Meanwhile the ski patrol asked me, "What is your tolerance for pain?" To this I replied, "I have no idea, I have never been injured like this, why do you ask?" He said if I could not take any more pain then we could wait for a doctor to come and give me a pain relieving shot on the mountain. Alternatively we could start down without the shot. I requested to get the heck out of there, and take my chances with the pain. So they brought up a sled, put me on a board, and hooked me to the waist of a ski patrol member. The hardest part of this process was when they straightened out my leg, because I had assumed the fetal position upon the end of my fall. When they pulled my leg straight the pain was something I cannot even describe. I always imagined that if I ever broke a bone like this then I would just pass out from the pain. But I think my adrenaline must have kicked in to combat the pain because oddly, I was very alert and cogent all the way down the mountain. After sometime they stopped and transferred me to a snow mobile, which towed me to the door of the emergency clinic at Breckenridge. The ride down seemed to take a long time but happen at a fast speed. My wife informs me that it was about half an hour because in contrast to my sense of speed, they were actually going very slowly. I guess things seem faster when you are coming down the mountain upside down. Lying in the sled, facing up hill, seeing only the legs of other skiers as we passed by, feeling the snow kick over my face, I was in disbelief. How did I fall? It had been several years since I had really fallen while skiing. Sure I would lose control every now and then, but I would just cut my edge and regain control. I simply did not fall and roll like I did that day. And why didn't that darn ski come off? I have my bindings professionally tested and set each season, and I had only skiied on these bindings a few times since the last test. So why did the ski hang on? Why is this happening to me? How bad is it really, and what comes next?