The Super Cool Pre-Op X-Ray of My Completely Obliterated Tibial Plateau!

Okay, so here's what you are looking at in the picture below (the most obvious injuries):

• Femur up top (thigh bone, the human body's largest bone) and tibia (shin bone) beneath it.
• See how the femur is slanting to the right (my body's left lateral side)? Well, it's supposed to be straight up and down.
• Look at my tibia. Your right (my left side of body) is crushed. The femur has sunken into this crushed space of the tibial plateau. Crushed from the compression fracture. Pretty sick!

 

What is a little bit harder to see is the medial (your left) side of the tibial plateau: the flared top part of the tibia that meets the femur/knee joint, is also fractured. Nearly split off from the shaft. The fibula, which is the smaller bone behind the shin, connects to the tibia at the top lateral side (the crushed side). Because of the crushing fracture, the fibula broke too. Oopsie! There's a fracture in the shaft of the tibia, lower down, not visible here. The medial meniscus tore (was cut and sewn), and the ACL, still intact, took a chunk of bone and split right off of the knee joint.

Anyhow, I'm keeping the faith. I'm 31 years old. I've got a plate and 6 screws in my left leg. Nothing like this has ever happened to me before. This accident happened on August 26, 2011 while riding my bike going less than 10 mph, doing nothing fancy, just taking a turn I've taken a dozen times three blocks from my home. Freaky things happen! Life happens. I'll make a 150% recovery because I plan on being in bad ass shape after this "recovery" is behind me.

That is all.

A Night on the Town

Alon and I had slept in til almost noon on Saturday, thank goodness, catching up on some much needed Zz's. He made us baked french toast with black berries and warm maple syrup. The afternoon wizzed by and I got gussied up a bit to meet a friend, Mary, at the Trident Cafe & Booksellers for tea. It was a reunion of sorts, as I immediately bumped into 3 or 4 people there who I hadn't seen in months. All good. Afterwards, Alon and I treated ourselves to some delicious sushi and wonderful service at Kasa Grill & Bar (http://www.kasainboulder.com/). We really enjoyed ourselves and it felt nice to be treated out on the town and see people, even though it happened to really feel like winter last night for the first time!

6 Week Update: Medical, Emotional, Mental, & Physical

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!

Choose your own Target adventure...

Today, shamefully yet willingly, I entered Target for an outing. I don't like supporting Target because of their support of anti-gay politics. Anyways, I went with my care provider (Suzanne) to get a few household items. What convinced me to go to Target was the fact that they have wide aisles I can maneuver in easily AND I didn't have to bring my own wheel chair to get around. They have POWER SCOOTERS.

These F'ing "power" scooters barely work. They barely hold a charge. They stop, go, slow down, stop. When you want them to go, they won't. When you need them to stop they go. Like when Suzanne crashed into the door trying to park the thing at the end of our adventure. 

For some reason there is a note on the handle bar that says "If green light is not lit, ask for assistance." OKAY - how are you supposed to ask for assistance when you're stuck in the corner of the Kleenex aisle far from anyone? And what are they going to do? Bring you another crappy scooter? Thank God. 

The best thing about the POWER SCOOTER is that they can't make turns greater than 10 degrees, so I was constantly backing up (which makes the thing go BEEP BEEP BEEP, like a F'ing school bus), straightening out, and proceeding forward. I think my laughing out of frustration and disbelief made me look like a mad woman at times... but I also got a few other strangers to laugh too. Slap stick comedy, still funny!

Yes - the experience often reminded me exactly of Austin Powers doing his 20 point turn in the hallway of whatever factory place he was in, just bumping into walls going forward and hitting them trying to back up. Getting nowhere. Fortunately, I did not hit anything or anyone... but it came close!

I narrowly averted t-boning this one woman in her own custom scooter (very fancy, deep purple)! I was cruising (for a moment), coming out of the aisle where I grabbed trash bags and a piece of glass Tupperware. I immediately took my finger off the throttle (there is no "brake") and flipped the switch to REVERSE. Phew. BEEEEEP. BEEEEEP. BEEEEEP. She and I laughed. She said, "Bless you child," for some unknown reason and laughed with her little cute pumpkin face. And I said, "Woah, we nearly had a major collision here!" To which the lady replied, "I only run over men, and SINGLE men at that. Leaving my tread marks on them. So I can slow them down enough to catch 'em!" Suzanne and I cackled and this lady sped off past the Kleenex as I sputtered around the corner. Backing up, going forward, backing up - making this wide-ass turn as difficult as possible. BECAUSE THESE STORE SCOOTERS SUCK. But, boy, am I ever grateful for these things... Suzanne and I laughed our asses off!

So here we go:

A picture of my anger

I think it was Wednesday last week... two weeks ago now. I've been sitting on this update for a while; not wanting to return to it or even re-read it for typos and what not. Anger is a tough one to write about because it require reflection and it just kind of sends me spinning in a way. 

The day was coming to an end. I was somewhere between restless and getting ready for bed. Alon was preparing "cold therapy machine" for the evening ( Breg Polar Care 300: http://www.breg.com/cold-therapy/polar-care-300.html ). I may have started a little PT or just started the routine of changing into my pj's. A sharp jab of pain through my left shoulder ignited. The waves of emotion and pain can come on so suddenly and so intensely. As I mentioned in a prior post, at least 1-2 times per day, I get teary.

This time was different. Pain preceded anger. I was feeling straight up ANGER, with notes sadness, coursing through me like boiling hot water. The anger was thick with pain. Mentally, I felt as if I was suddenly walking along a delicate precipice where I could plummet from hopeful to hopelessness in the blink of an eye.

I cried so hard and so loud I could barely breathe or recognize anything familiar. In the moment, the feeling reminded me of how hard I have cried when someone I loved has died. It was this incredible experience of anger, hatred, and the loss of control in my life. I could barely catch my breath. Sometimes the tears wouldn't even come; it was so cathartic.

I pounded this poor, defenseless feather pillow on my bed with a gentle fist. Truly gentle. I had this other image of digging through sand on a beach and just flinging the sand high into the air.

Alon walks in, continuing to set up the ice machine. I know he is not ignoring me; I know he is just letting me express my anger and sadness - uninterrupted and unhindered. He finally walks over to me and sits on the bed, looks me in the eyes, his big beautiful brown eyes, and says simply, "It will all be okay. You're doing great." Then he said something funny that made me laugh.

Friday was another one of those days last week... a learning experience between me, my doctor, my doctor's assistant and Alon. Boiled down to advocating for oneself and seeing my Alon step up and advocate for me. He is such a rock. I don't want to get into the details now, but thought I should post this since I've been sitting on it for over a week now. There was a lot of anger, rage in this little episode as well.

And then most recently, this past Thursday... a complete release (trauma response?) during a massage from my friend Bree. Everything was going great. Bree is a wonderful new-ish friend. We were in a good space; chatting; breathing; relaxing; finding those sweet spots that needed attention in my body. She is able to help me work through some fears and insecurities about my body as I know it and more specifically, to the injury as it heals and we explore "the hurt area" more. Then a little massage in a gentle circular motion with her thumbs around my left knee cap. And I just started to shake, cry, and nearly hyperventilate. I was so glad to be in her loving, caring, comforting, capable hands a presence. It was kind of wild. I got so cold so fast and my body remembered more about that day, August 26th at about 3:30pm, than my mind could comprehend. More to talk about and think about later I suppose...

Being "The Client" & Personal Power

A few words to describe how I feel today: 

TIRED.

GRATEFUL.

HEALING.

This week has rather flown by in a busy sort of way. Alon and I met with the Care Manager of Homewatch Care Givers of Boulder County on Monday. We were both really impressed with this agency and the people we spoke with. I have since had three care givers come to my home this week: Suzanna, Pauline and Grace - all very charming in their own ways, helpful and hard working. And friends! Every day! So wonderful!

Scheduling the paid care givers, coupled with friends and coworkers stopping by has really made for a full week. Alon and I are still in the process of finding a balance between what we can do for ourselves and what we need help with and when. Regardless, everyone who has stepped through our door has provided comfort, companionship, entertainment, or help in some way that truly touches our hearts and relieves some stress... we are so grateful. Now all Alon & I need to figure out is how to get more than four hours of sleep per night.

Since taking the step to bring in professional care providers there have been several occasions where, in my mind, I have slipped into this place of "I am the client now". I am the one unable to do a lot of things or having to do things differently or having to ask for an inordinate amount of assistance. Really. And this isn't the moment for your interruptive thoughts to offer me an alternative, optimistic view point or boosting of spirits. These are just the facts. 

This feeling of BEING THE CLIENT happens when I eat breakfast, lunch and dinner with a tray in front of me; tray balanced on my lap. With a towel between my plates and the tray so that nothing slides off. One care provider thought of that; brilliant. Food awkwardly scooped to my mouth. Drinking from a bendy straw. Making sure I am propped up enough with a zillion pillows to digest my food properly. Later, pushing myself to raise my voice to get my care provider's attention - to beckon for personal assistance nonetheless - while she cooks or cleans in the other room. This feeling of being a client happens while sitting out on the back patio. A friend follows behind me, carrying pillows and a blanket to make sure I'm comfortable on these small, wooden patio chairs. At least for a little I can change up the scenery (from bedroom or living room) and sit in the sun with the cool September air touching my skin. 

Thankfully, a wonderful friend said to me yesterday, after a long conversation about fear and will power, "Erin, you are of sound mind and you are brave." I just thought I'd interject that here so you don't think I've gone off the deep end or something :-)

Sometimes I reach for my cat, Ozy, who nonchalantly struts past me. Just her tail touches my hand, slipping through my fingers. I long to be her... for that freedom to stroll and strut, go in and out of someone's presence without a second thought as to how I made it there in the first place. 

I remember this exact "cat" behavior from a client I used to serve. He would just barely be able to reach his cat as the cat walked by his chair and had learned to bring her cat toys right up onto his lap so that he could play "fetch" with her. Ozy comes to me for treats. I am the treat master now. What a shock. This kitty of mine has so much freedom and strength and gentleness. I kind of think she is the epitome of balance and happiness. Yes, it's true... we all want to come back as a well-cared for house cat. I melt into the softness of Ozy's fur and the sweet kindness of her little cat body when she hops up and burrows into my lap to deliver her healing cat powers and love :-)

The other piece for me this week has been the sensation of PERSONAL POWER and EMPOWERMENT that can come from learning to ask for help and the actual act of asking for help and working with others to meet my needs (or the needs of Alon, the house, Ozy the cat, etc.). It's subtle... but it's there. Feeling empowered is something I've struggled with quite a bit in my life, for one reason or another. Haven't many of us? Whether it's personal, societal, relationship-based, financial, or whatever! It's been helpful to taste that empowerment in these certain situations... that SILVER LINING... how there is very much a sense of personal power in bringing people together to help one another or myself and even in being "unable to do" some things.

So without fail, this time in my life proves to be a time for PERSONAL GROWTH and HUMILITY. Nothing planned, nothing contrived, nothing forced... totally genuine and real. Complete respect for my body, myself and the people around me. Just as I had started to explain on my first blog post on the morning of August 26th. Just as things as started to roll out in January of this year... a great year of growth... who knew it would involve bone graphs?

Also, 4 weeks today since the accident marks 1/3 of the way to 12 weeks = the day I can walk on all two feet again! Who knows, maybe it will be sooner :-)

Epic day... milestones reached!

1. During physical therapy this morning I managed to do ten unassisted leg lifts with my left leg. First 5 were slow and grueling... I wasn't sure if I could even get to four with a shooting pain going through my knee cap every so often. Docs said to work through the pain, so I am. Second 5 were quick and crazy. It felt kind of unbelievable the relative ease and quickness of the last five. While Alon stood in front of me at the end of the bed, watching, worrying, asking, "Is it time for me to spot you or do you want assistance yet?". I grit my teeth like I was biting down on a leather swatch, scrunched my face up, closed my eyes, tears streaming down my cheeks, and replied, "No not yet, honey, thanks." Before each leg lift I tightened my abs and took in breath to my belly, to my solar plexus, and up into my chest. I read about this in "Poser... my life in 23 yoga poses" to really gain strength and focus. It was cool. I'm sure I wasn't doing "it" (whatever it is) perfectly, but it still kind of worked! After all exercises were said and done, I said, "Good job leg, good job body" out loud. I just held and caressed my leg and cried. Alon came over congratulated me and gave me hugs and said something like, "I guess that's what it's like to work out really hard!". I was like, "Um yea, I guess so!". It was all pretty awesome and very fulfilling.

I am so thankful for this body's ability to heal and be strong and triumph over adversity!

2. Talk about inspired... after PT I was like, "Let's go for a walk... no let's go out for breakfast!" I couldn't believe it. Alon piled me into the back seat, with my wheel chair and crutches in the trunk, and we scooted off. I really just felt ready to go out. Like I could handle an hour out on the town. I called ahead to Tangerine (www.tangerineboulder.com) explaining my predicament: that I was either going to be in a wheel chair with my left leg up and out straight or propped up on pillows and a chair. They don't usually take reservations, but they managed to "save" us a booth so I could just swing my leg up there on the bench seat and be comfortable. Alon brought pillows from home (kinda silly but whatever) and helped me get more comfortable. Did I mention how amazing and wonderful Alon is??? Thank you Rose (hostess) and Jackson (General Manager) for being so awesome, checking in with me and wishing me all sorts of healing love. Our server was also super sweet and genuine... didn't get her name though.

I am so thankful for the kindness of strangers. Plug for Tangerine.... www.tangerineboulder.com ... everything on the brunch menu is great, especially the fresh squeezed OJ and multigrain pancakes :)

3. Pain meds are steady at about 3.25mg oxycodone/160mg tylenol every 8 hours or so. Plus an occasional 500mg of additional tylenol or 400mg of ibuprofen. I definitely feel more in my own body and mind now, which is much different than being on 5-15mg of oxy every 6 hours! I've also got symphytum (thanks to Denise), Inflamyar (arnica+herbs) (thanks to Bree), and some other Chinese herbs (thanks to Dale) to promote good circulation, healing, and bone growth!

I am so thankful for a variety of healthy remedies... eastern and western medicine, homeopathic remedies, which all help to facilitate a healthy, balanced system.

4. We had quite a few visitors today after our epic morning. Some of Alon's family: Aunt Lynn and cousins Josh, Jenny and their kids Wiley and Felix all visited today. That was really nice, and they are a great bunch of people. Also, friends Ernie and his partner Bob visited who are also awesome. We shared a lot of stories and just friendly getting-to-know-each-other-better time... as well as oogling over Bob's new iPad and fancy magnetic cover. Tech geeks that we all are :-)

I am so thankful for family and friends!

5. After all that, Miss Erin took about a 3 hour nap! Not that that is a first or unusual these days, but goes to show that I did a lot and needed the rest today. The stars and planets and friends and loved ones were aligned for me today... giving me great strength, resilience, and determination... as well as lots of smiles, gratitude, and feelings of being my normal self.

I am thankful for sleep and rest :-)