It's not all bad

I've been thinking about this thread for quite a while. My experiences have not been all negative. Not only did I get time to catch up on some reading and movie watching, I could relax a bit and appreciate the small things, and to adjust expectations. My plan for this time of year was to get in great shape and complete my first triathlon. That won't happen, swimming half a mile will be impossible, but life goes on. 

But of course, my relaxation was my wife's extra work. 

The extra sleep I got after the first four weeks sleeping in a chair has been very beneficial in general. Whereas virtually all my friends and colleagues have been sick from viruses, I've made it thus far. I was also able to decline night-time events without any complaints from colleagues. This has been a time to appreciate the important parts of my life: family and health. To focus less on the trivial aspects of work has been mostly positive.

I've met quite interesting people at the hospital, both medical staffers and patients, some of whom in much worse condition than mine. I have connected with colleagues who also broke a bone at some point. It feels like a secret society, like the Free Masons of fractures.

At this point, when there is daily progress, along with spring approaching, I have an incredible sense of optimism.

Financial Implications

Although it's far too early to assess the complete financial impact, I can make a few observations: As of the end of February, I ran up a tab of close to $4,000 from the orthopedic clinic, emergency room, and an x-ray consulting service, most of which was for the day of the accident and the first visit to the clinic. Each follow up is less than $100. The ambulance bill was $350 and I got as much Percocet I ever wanted for $8 (I've been extremely lucky regarding the pain, and haven't touched the stuff for at least four weeks, and used less than half of my 110-pill supply). I have paid some $300 out of pocket, thus far. The rest has been covered by insurance. Each visit to the clinic is relatively simple: Two x-rays and a five-minute examination, not exactly rocket science. $200 is my deductible for physical therapy. I don't know how much they charge yet, but one visit could last one hour those days I have both PT (working on the shoulder) and OT (Occupational Therapist, working on the wrist and elbow), and they're dedicated professionals who take their jobs seriously. 

It's a lot of money in absolute terms, but not that much in the twisted world of American health care. The advantage from a cost perspective seems to be that this is an established kind of injury that follows the rule book: it's not a hard-to-diagnose decease with many different methods of treatments and testings. The recovery is long and hard, but relatively straight forward. It can be measured in the abduction hight and rotation angles, and the increase in exercise weights.

I'm lucky to have a physically light job, and very understanding management, that allowed me to work part time for a couple of weeks without any salary cuts. The financial impact could have been huge otherwise.

Week 9

February 27. As I keep bombarding my PT with more or less trivial questions, I get some important information. Q: "when can I perform push-ups?" A: laugh, "in three months." In his assessment, the bone is not the issue, since people with a broken leg are encouraged to walk on it after eight weeks. The issue is muscle strength. When I asked him when to begin with weights, I was told that a bigger muscle mass is not important at this point, not until the range has been expanded. Muscles could retract and prevent increased motion. Good to know. When I asked him what would happen if I didn't come for PT, he told me about frozen shoulder. It was simply terrifying to listen to his description, but highly motivational for working hard. I also asked if it is possible at this stage to damage anything by the exercises I'm doing, he said No. The weakness of the muscles would prevent me from overdoing anything, and the bone should be strong enough for carrying out any task that only involves the weight of the arm itself.

So I keep working on the shoulder range in all directions: chicken wing (laying down on the side and lift the elbow, first by resting the hand on the right hand fist, and then without support), external shoulder rotation (I'm not using a weight as in the video, but I turn it much further), wood rod bench press but now with extension of range over my head (not possible in my case yet), laying on my stomach lifting the hand, and then lifting the arm straight holding it parallel to my body. 

Week 8

No more Mr. Nice Guy. The second week of PT began with hard exercise: lifting the arm in different positions. My favorite was the quarter pound bench press--a simple wood rod that felt like lead. I managed ten pathetic reps... I am now working with a sports PT who's used to high effort. He told me a rule of thumb that I'd expected to be true for quite some time now: for each day the arm has been immobilized, it will take three days for the muscles and joints to get back on track again.

He noticed though that my range had extended in only three days. I still can't life the arm up to 90 degrees while standing, which according to aofoundation constitutes a complete healing of the fracture (albeit not a complete recovery), but I'm above 45 degrees now.

I'm also working with an Occupational Therapist on my underarms and hands. It's certainly not as urgent as the shoulder--two-hand typing is no problem, and has never been--but I do want to be able to play violin again.

On 2/21 I went outside without the brace for the first time, against the doctor's order. I just couldn't take it any more. It was slippery and snowing I the thought of falling and breaking the arm again was simply horrifying.

Tips and tricks

For those early weeks when a full shower is impossible: baby wipes can do wonders. My favorite is melon-scented Huggies.

Using regular dental floss is impossible without any aid was impossible, even after two months. Luckily, there are disposable one-hand floss picks, along with other tools.

Weight gain? After weeks of inactivity I was concerned about gaining weight. I didn't, instead I lost a few pounds, some may be due to the loss of some muscle, but the key is healthy eating. I drank quite a bit of kids orange juice with lots of vitamin C, D, and calcium.

Week 7

February 10. The fracture healing has gone very well. The doctor could even feel some hard callus. The took the arm and bent it at the fracture site. It didn't hurt, but it was a bit weird watching it--and it was quite rigid. Next visit will be in three weeks. He believed that that will be the day to remove the brace, which, at this time, only has a protective function, not supporting. In fact, I'm mostly out of brace when at home. If it weren't for the fact that I almost fell once, and got very nervous, I would only wear it at night (you never know what you can do in your sleep).

But now it was time for a referral to Physical Therapy. I got an appointment straight away. The PT was a little concerned, as his copy of the x-ray didn't show that much healing. But we started with the normal exercises I've been doing for some weeks already: leaning forward and make circles with the arm in both directions. He added pendulum exercises, raising the shoulders, and pulling the shoulders backwards. Especially the last two felt good. He also gave me some Play-Dooh-like jelly to squeeze with my hand. Definitely necessary: The power in my right hand was 80 pounds while it was only 40 in the left. 

This will be a major time commitment, as he scheduled me for three appointments a week for six weeks.

Links

There're a number of sites useful for this kind of injury. Personally, I prefer those dealing with real recoveries, rather than descriptions of the physiological process in general. Although there are a few useful general ones: emedicine, the Duke Medical School (filled with detailed medical language and no pictures but x-rays), or the aofoundation. The latter is a Swiss-based organization that pioneered the systematic research on orthopedic surgery. The site is quite elaborate, but very interesting. One can click on the bone of a skeleton, and select type of fracture and treatment. It in the right margin of each topic, there are a number of references to further studies.

These sites are focused almost exclusively on bone healing, but in my opinion, more time consuming and difficult is the muscle recovery.

The first one I read was this one. The injury was quite different from mine (spiral and upper humerus), but the recovery process was quite similar. It did not prepare me for the tedious muscle recovery process.

But this skiing accident provides lots of details for the physical therapy process. The fracture was in four parts and the full recovery was painful. I'm at the point now when I realize that the fracture is not the main problem, regaining motion and strength is. The patient, "doogiedoc," has been a great source of inspiration for me. His determination has been astonishing (like wearing a hat during PT, so that the therapist won't see him cry and then not push him as hard).

Here is another one, which gives a financial perspective. The patient is a business owner, and his accident turned out to be quite taxing for his work.

This link provides a vast amount of accounts, some are quite disturbing, the non-union cases, particular, as when you wait for two months and then realize that surgery will be necessary.  It kept reminding me that this is a serious injury and things can go wrong, but also that I've been lucky thus far.

Here is another one I just discovered from the site discussbodybuilding. It contains a large number of accounts, especially spiral fractures caused by arm wrestling. The great advantage is its large number of x-ray images, and wide range of treatments and PT experiences.

Week 5

January 27 was a big day. I was allowed  to remove the sling and let the arm hang free. This seemed like progress at first, but as so many times previously, it turned out to be two steps forward and one backwards. Shortly after the removal, my hand and underarm started to swell. It seems only natural that the lymph system would have problems given the big callus blocking the return of the liquid. The situation was so bad so I had to call the doctor. He just said it was normal, and not Compartment Syndrome as one friend told me it could be. After three days I found a way to deal with the problem: horizontal position with the hand elevated above the heart.

I was also allowed to remove the brace to take showers and care for the skin. This was a big deal, although the lack of complete showers was never my main concern. The first couple of times in the slippery shower was truly scary.

By now, I was used to the x-ray that showed little progress for the untrained eye, but the soft bone is really apparent. Apparently, the x-ray is two weeks behind what has is happening inside due to its inability to show soft tissue.

During this visit the doctor extended my recovery one week. Originally, he had estimated a recovery period of six weeks, meaning six weeks until the brace could come off. However, the starting day was not the day of the accident, but one week later when the brace came one. And, of course, recovery doesn't end with a healed bone.

During this appointment, doc told my wife the now famous words in our family: "Don't let him baby that arm." 

Week 4

On January 15 I was able to lose the wrist strap and move the underarm up and down. It felt incredibly strange. The muscles were weak, of course, but moving the arm with the knowledge that it was still broken was psychologically hard. But recently, I'd noticed that the ends had started to fuse. It felt as if they were locked together by muscle tension, rather than collagen matrix. 

Week 3

On my second visit, January 8, the brace had shifted a bit, so it had to be reajusted. This was something I was supposed to have done myself. The tightening resulted in an extra set of x-rays, and the the angle changed from 16 to 14 degrees. And for this visit I started to bring the camera to document the process.

It was still not possible to sleep in my bed--I tried to lay down a couple of times, but it was too painful for my arm--and sometimes the bone ends hit each other and created a painless, but very audible click.

Week 2

My first visit to the orthopedist on December 30 went well, but was painful. Just getting in and out of the car was a major undertaking. Driving was of course a non-option. The whole ordeal took quite a toll on my wife and kids.

The x-rays showed the desired result: The ends of the bones were now facing each other, albeit at an angle of some 15 degrees. But it was good enough to put on the brace--the important thing is the that there is some overlap between the two ends--a hard plastic device that would align the bone ends. It was firmly tightened and felt quite comfortable at first. At this time I had cut down on Percocet to perhaps one a day, but the brace changed all that. It is a device that really compresses the arm and the ends could easily cut into the elbow or armpit. I went back to a couple a day, and especially one or two at night time.

The orthopedic surgeon appeared competent. He had worked in the military and once broken his own humerus in a car accident. There was no sugarcoating: "you're going to have a difficult couple of weeks ahead of you." He was right indeed. Although an orthopedic surgeon was adamant to avoid surgery if possible. There are more things that can go wrong, nerve problems and infections, in particular.

Week 1

I left the hospital equipped with a sling that locked the shoulder in a fixed position. It consisted of straps around my chest held up on my shoulder and fastened at two points on the arm. A quite unstable arrangement for the fracture, but the idea is to let gravity do the work to pull down the lower part of the arm. I was absolutely miserable. I couldn't put any clothes on, but had to leave the hospital in the gown with the open back, this in  freezing conditions.

It was absolutely impossible to lay down. I slept sitting in a reclining chair. I also received 30 Percocet pills. I limited my intake to 1 every six hours. With so much free time on my hands I could read up on wide array of topics, some of which were quite frightening: the use of Percocet as a party drug, its addictive properties, and cases where humerus fractures have serious complications. And this in combination with Christmas time made the entire ordeal incredibly depressing. The first days I was only up on my legs for a few hours a day. Although I was exhausted, sleeping was difficult. I typically spent three hours every night in a state of insomnia, watching movies alone.

The Accident

On December 22 I broke my upper left arm, the humerus bone. I was ice skating and fell backwards. There was nothing special about the accident; I'm a relatively good skater. The ice was not ideal, but good enough. Anyhow, when I got up on my knees, I knew immediately that the arm was broken. My lower arm did move when I moved my upper arm. It's a terrifying feeling, not to mention the pain. Luckily, the closest person in the rink happened to be a nurse. She took me into the penalty box and called an ambulance. She did however tell me that the arm was probably not broken, as she conceived me not to be in enough pain. It was just a dislocated shoulder; I wasn't in the mode to argue.

This were to be my first of many things: ambulance trip, morphine, and IV. The ambulance personnel gave the an assessment on the opposite spectrum: that I would need surgery.

The hospital is small, yet the ER is well staffed with competent doctors. The x-ray showed a traverse mid-shaft fracture of the humerus. It was truly scary, and it still is, to see as the ends were crossing. After consultation with an orthopedist the ER doc told me that there is nothing to be done but letting the arm hang in a sling until the swelling went down, which would take a week. I thought he was joking: I believed that a broken arm was put in a plaster cast. But after a couple of months, a slight inconvenience, and multiple autographs, it would come off and life continued as if nothing ever happened.

That is not what typically happens with humerus fractures. The process to complete recovery is a long one.