MEDICAL UPDATE:
Here are the bullet items from my appointment with my surgeon, Dr. Fulkerson, yesterday (Thursday 10/6/11):
- I experienced a BI-LATERAL tibial plateau fracture (TPF). This was new to me. I thought only the lateral side was crushed but the medial side had a huge fracture down the entire length, splitting it off into a triangular piece. I became fully aware of this on Thursday when Dr. Fulkerson, Alon and I looked at the pre-op x-rays together. This is the first time I had seen the pre-op x-rays - they were troubling and interesting to say the least.
- Medial: closer to the body's midline. Lateral: closer to the left (in my case) or right side of the body.
- There is a Roman Numeral scaling system for TPFs that goes from I-VI (least severe to most severe). When you have a bi-lateral TPF both sides of the plateau are fractured and you are in the range of IV to VI, based on my internet research and chatting with my doc. I was likely a V. Had both plateaus (instead of just the one) been crushed or broken off completely I would have been a VI and likely a candidate for a full knee replacement! Holy crap, right? Imagine if I came out of the operating room with a scar from mid thigh to mid shin and a truly bionic knee, not just a plate and a 6 screws? This new news, increasing the realization of the devastation of my injury and need for a major comeback scared me immensely and totally overwhelmed me. As I write this (one day later), I still feel scared and overwhelmed.
- My injury: The medial side of the tibial plateau was severely fractured (like the picture of the left knee in the link above) while the lateral side was severely crushed (just small pieces of bone fragment and chunks of cartilage flaking off - patches of cartilage gone for good) - the latter was the primary concern during surgery.
- Lateral TPF: This is the side that was crushed, bone graphed and plated. The top contour, from front to back, of the lateral side of the tibial plateau was congruous (smooth) which is great, yet still lower than the lateral side which is, well, not so great but not surprising. The surface formation was also good. Dr. Fulkerson's goal was to raise that crushed side up as much as possible to its original state using the bone graph and plates. She did her best, and a great job at that. It is what is now and she is satisfied with the outcome. My call to action now is to strengthen the crap out of my left leg so I'm not weak in that area and have less of a "knock-knee" (that she predicts).
- Medial TPF: This is the side that had the jagged break that created a triangle piece of broken bone. Looks like it's healing ok. No surface damage or crushed bone here like the other side. Still SHOCKED that this side was busted too... oh well!
- Other fractures: There were two fractures along the shaft of the tibia that were clean breaks and are healing if not healed by now. The fracture at the top of the fibula that connects to the lateral plateau: same.
- Weight-bearing: The non-weight bearing issue is basically related to the crushed plateau and how quickly that heals. It is possibly that I might be weight-bearing at ten weeks instead of twelve. Exciting! We'll see at my next follow up appointment in four weeks (Nov. 7th), which will be the ten week mark.
- Ligaments: The meniscus tear was in the back on the medial side. Dr. Fulkerson said she had to cut some of it in order to do the repair. She said there was an avulsion of the meniscus. The ACL, as I mentioned before, was not visibly torn, but instead tore off with a piece of bone attached to it. She gently, accurately placed the puzzle back together and is hoping for a complete recovery. She said it is possible that there were micro tears in the ACL, but of course impossible for her to tell since she is an awesome orthopedic surgeon but does not have microscopic vision. At this point, there is no way of knowing how either ligament is healing. We'll know more as I go through the physical therapy, etc.
- Physical therapy: I received a prescription from Dr. Fulkerson to start out patient physical therapy next week (exciting and scary!), one to two times a week until they can progress me to more visits per week. Part of me is thinking "Well, it's about a 3 mile walk to PT. I wonder when I can do that?" Then, a friend or loved one gives me this stare down like "You're crazy. Give it time." And I am reminded to "be in the moment!".
- Prognosis: Overall, Dr. Fulkerson is "reasonably optimistic" that I will make a "near full recovery". So that's about the best news you can get from the mouth of a reasonably cautious, very talented doctor.
- There is no additional surgery needed at this time. My assumption is, sometimes there could be additional surgery at this time if someone is healing properly. I have been encouraged to bend my knee as much as possible to avoid having surgery to "scope out scar tissue". Yuck. I am currently bending at about 85 degrees, but could go to 90 with an extra dose of courage (much needed at this point!). My goal is to advance my range of motion (ROM) by about 5 degrees every day. We have a new technique for this (see "gravitational flexion" below).
PHYSICAL/MENTAL/EMOTIONAL UPDATE:
So speaking of bending my knee. I am feeling very disconnected from this part of my body right now. I have been feeling this way for the last few days. Disconnected from my left leg in general. For six weeks I have been lifting my leg with both hands in and out of the brace or on and off the CPM when necessary or up onto a bucket to rest when I go pee, as if I was a paraplegic. This is incredibly frightening. The entire experience.
Yesterday, with Dr. Fulkerson we tested my range of motion in this way, Gravitational Flexion: sit up on the examination table, scoot to the end so that the knee is past the edge of the table. Brace removed, Dr. Fulkerson rests the heel of my left foot in one of her hands with her other hand supporting near the top of my calf. My leg is now out in the open air, supported solely by this woman, who I thought I felt trust and respect for. However, I was scared. My reaction to this test: I start to cry, shake, hyperventilate, tell to her stop, ask her what she is going to do next. NOTHING BUT FEAR. So much fear came over me: it felt like someone was pushing me out of an airplane with no parachute.
Dr. Fulkerson immediately identified with what I was feeling. Told me it was understandable and reasonable, that she would probably react the same way AND that FEAR was going to be my biggest obstacle right now and then I HAD to get through it/over it. It was an earful - but she was right! Yes, I need to listen to my body (and I do) but the mind is a powerful thing that has the ability to convince of something that is not true or prevent me from progress, in this case. We talked about how my leg would not snap off and break in half, that the plateau fractures would not get re-injured in this way, and that I was okay and I was going to get through this.
We graduated to a bent leg of 75 degrees, off the edge of the table, allowing gravity to do it's work. It was actually easy in a sense. There was NO PAIN, only fear.
The mental trip was this: I was dangling my limbs off the edge of Half Dome (a 2000 foot flat faced rock at Yosemite National Park - a favorite spot for experienced rock climbers - otherwise a place to embrace one's fear of heights reconciled by natural beauty). Dr. Fulkerson said I could likely bend to 90 degrees right then but she thought she had traumatized me enough. We both laughed! I said, "We could try 90," with like ZERO conviction. She said NO and slowly raised me back up to 180 degrees. Where I kind of shuffled to get back into my security blanket, the leg brace.
So I think I have some stuff to work with!
Alon had his hand on my back the whole time I was with Dr. Fulkerson. I could feel his gentleness and strength right there coming through his hand. It reminded me of a Hakomi (type of psychotherapy practice) workshop exercise I had done with a partner, where the precise placement of a gentle hand on someone's back can fulfill a need and provide the exact comfort one desires. Alon somehow knew exactly where and how to place his hand. I imagine the experience might have practically brought him to tears watching me, but he seemed okay. Alon shared later that I made a huge step toward normalcy today and that I was very strong overcoming more fear and uncertainty and re-discovering ability! Yay! for positive reinforcement!
I do have some leg muscles left; coupled with desire and will power. I am able to do leg lifts and slides much more easily than before and so I have been trying to shift my behavior from this assisted lifting with my hands to mindful, coordinated action of: engage the core, tighten the glutes, tighten the quad, flex the toes, lift the leg. Go. Annnnd REST. There is no question that this process is tiring, frustrating, strengthening, and courageous. Whether I'm doing some sort of necessary bodily function or activity (like walking or bathing) or doing PT or modified yoga poses, THIS extreme attentiveness is what it looks and feels like. Eventually, it will all become second nature again and I can bend my leg more and do things with but for now I have to be completely present with whatever action I need my left leg to do or it won't happen or I risk hurting myself.
Despite all this, despite my modified yoga poses in the sunshine in the backyard which give me a few moments of bliss and accelerated heart rate... I still feel very disconnected from my leg, from my body. It sucks. It's depressing. It's scary. It makes me angry. It makes me sad. I feel lost and overwhelmed right now. I balled my eyes out this morning, soaking the shoulder of Alon's t-shirt with my tears. Alon and my care provider, Pauline, agreed after that moment that I've been so strong and positive up to this point, it's okay to be in this space, in fact, it is NORMAL in my situation to be exactly where I am right now, emotionally. Not the normal I want but the normal I've got! So, okay... I'll just keep putting one foot in front of the other, take one day or moment at a time, and breath in all the loving support that my friends, family, co-workers, care providers, strangers, and neighbors have to offer.
Alon, my love and support and sanity and saving grace through all of this assures me that I just need to keep doing what I'm doing and that I'm healing great, even the doctor said so!
The other night when I was going to bed all could think about was the bi-lateral fracture. So I needed a way to get out of the negative thoughts and into the positive. I asked Alon to give me something else to think about and he said, "Think about your muscles and how strong they are going to be." He's also said that I can probably put a 70 pound pack on and go back packing in the back country again someday. That these activities are not off limits. And I soon drifted off to sleep, thinking of my soon to be Wonder Woman figure :-)
There will be days when I'm climbing up hill both ways in a blizzard and then there will be days when the wind is at my back. Nevermind DAYS. Try MOMENTS. Moments in my day when the "wind is at my back"... these are the things I need to try harder to keep track of and relish in, and to talk about and think about. Like all the positive aspects of physical therapy and being around all these people who love and support me (and Alon).
Each of us experience our share of suffering, loss, challenge and chaos. What about the moments when we truly feel supported, at ease, progressing, and happy? Whether those feelings come from within or surround me in my immediate environment, this is a difficult time in my life where it is imperative to deeply acknowledge those good feelings which can put that wind back in my sail propelling me through the rougher patches of open water.
Thanks everyone for taking this journey with me on my blog; and I hope some one else with injuries or challenges like mine find my sharing of my experience helpful in some way. I know I have gotten a lot out of the stories you all have shared with me recently in relationship to past injuries and recoveries you've made. Our bodies and minds are amazing! Love to you all!
