This final stage is likely to take a great deal of time. Returning to “normal” according to doctors and other sources is probably more than a year.
To accelerate the process, I will begin using a Rollator—basically a four wheel Walker with wheels suited for outdoor walking. Using a cane is often an intermediate step, but the Rollator is more likely to provide developing of a normal stride.
The Drive brand makes a very good unit but I chose the Elenker 9211 because it allowed a handle height of 38 inches—the height I determined to best keep me upright with good posture when using Walker. I also liked the shock absorbers.
Another version of a rolling Walker is an “upright” version that uses forearm for support rather than just wrist. I chose the lower wrist type Rollator as I considered more stable while walking quickly outdoors. And it is slightly more compact for transport.
I will be spending many hours using my Rollator to regain my ability to walk normally.
I have reduced Gabapentin to two tablets per day. No longer taking Tylenol. Down to two Ibuprofen tablets per day. Taking one 100 mg ER Tramadol and 5 mg Oxycodone before sleep. Will attempt to withdraw all of these except Gabapentin by April 15. (5 months after accident.) Will withdraw Gabapentin once walking normally without pain-an indication soft tissues and nerves are healed and stable.
Week 18. Still slow progress. Visited mother and used cane to walk to in house cafe-around 600 feet. Walked the dog, Lollipop outdoors around the neighborhood sidewalk and back thru grass strip-around 800 feet (half a lap) using Rollator. Rollator works well in grass and going over wedge curbs. Attaching dog leash to Rollator at a low point allows good safe control using brakes. Weaning off of Tramadol-stopped taking the 100mg ER tablet one night with little side effects other than slight change in bowel movement. Took another tablet to taper off the following night. Still taking two Gabapentin, two 200mg Ibuprofen and 5mg oxycodone. Will try to eliminate ibuprofen next.
Can actually walk without aids for very short (5 steps) distance. Left leg sore and weak causes an uneven gait. Can also now go from sit to stand unaided with 24” or higher seat but still need arms to assist for chairs lower than 24”.
Ended PT at WellSpan Shrewsbury. After a week off will restart PT at Madden and Gilbert with Matt Conroy who worked with me on Thoracic pain this summer. Kelsey at WellSpan did help to get me up and walking (and with self monitored home exercise regimen) but I think Matt’s approach to reducing pain will be valuable going forward.
Attended Church using cane only. Rose to stand five times, and maneuver in the pew does not allow moving center of gravity forward. So huge stress on leg muscles. Continued to a restaurant for lunch—all in all a lot of exercise stress. Brings up a concept called “pain induced by exercise and mobilization” or PIEM. Simultaneously weaning myself off of Tramadol led to an overwhelming pain/anxiety situation late in the evening—very similar to previous episodes of medium level pain of several muscle groups, with reduced pain meds.
This is the crux of my recovery dilemma where exercise to rebuild strength or substantial muscle stress leads to a form of tendinitis which increases to “demand” or “need” for pain or inflammation relief-making it very difficult to simultaneously reduce ibuprofen and opiates (Tramadol and Oxycodone)
To help the inflamed connections between bone and muscle in both knees, I have sadly regressed to using wheel chair moving about in the house.
After a day or two of rest a therapy known as Deep Friction Massage (DFM) or cross friction massage developed by James Cyriax is very helpful. Also using ice therapy-see bag of frozen peas and corn.
In addition, use of “soft” hinged knee braces during exercise of quadraceps is helpful. Excess stress overexertion caused pain in the quadriceps and sartorius muscle tendons (right leg) as well as the interosseous membrane in the left. Recovery from the sartorius tendon on the right leg has been problematic.
20 weeks out from injury, have reduced pain meds by 80% from 2400 mg Ibuprofen and 60 mg Oxycodone equivalent per day (200 mg Tramadol and 40 mg Oxycodone) to 400 mg Ibuprofen and 10-15 mg Oxycodone. In the final “tapering” phase out eliminating 100 mg Tramadol and 5 mg Oxycodone. (100 mg Tramadol equivalent to 10 mg Oxycodone) Noticed significant withdrawal symptoms. Attempt to go to only 5 mg Oxycodone only before sleep resulted in overwhelming pain/discomfort anxiety at end of day—mostly pain induced by exercise and mobilization” or PIEM. Similar reaction when attempting to reduce Ibuprofen—pain/discomfort at end of day and difficulty sleeping. Elimination of pain meds will require some level of pain reduction from physical therapy hopefully as I begin new program with Matt Conroy at Madden and Gilbert.
After two weeks without professional PT, Madden and Gilbert visit was productive. Focus was much more on pain reduction. Informed that “recovery” to near normal would not be till June-8-10 weeks from now. Two months of weight bearing therapy is insufficient to reverse damage from 3 months of being bedridden.
Attempts to withdraw from Tramadol has problematic. Pain level is clearly high after PT and or ambitious mobility. Will discuss more with PCP. Premature withdrawal is not ideal.
Mayo Clinic: “When oxycodone is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.”
23 weeks out. Pain med plan and strategy approved by my primary care physician. Blood tests during my annual physical showed OK except the Cancer marker was extremely high. Very scary given my Colon Cancer history. Visit to specialist and retest indicated first test was in error and will schedule colonoscopy later this year.
Very discouraged that pain while walking from right leg near inside of knee-probably sartorius muscle—very painful when lifting foot off ground. Sharp pain also from left ankle if walking very far—probably from interosseous membrane. No progress made with therapy. Can deal with it for limited motion, even walking without device in AM, but by PM, pain becomes overwhelming and sleep is affected. Going back to wheel chair does not seem to be a remedy—limited weight bearing small steps seems more optimal. Beginning to fear that pain free recovery will not occur—without additional new surgery. Puzzled why right leg has become worse over time unless situation is that I can only use legs for very limited time-any significant walking puts too much stress on the knees. Scheduled for Orthopedic review at end of April.
This type of setback and unknown future creates a dangerous level of risk related to depression. Working very hard to stay positive. Lots of praying, despite all my requests for immediate healing denied. God never promises life to be easy. I can relate a bit too, and have developed significant empathy for disabled vets that have lost limbs. Recovery progress and end results are so, so uncertain.
https://skiracing.com/sam-dupratts-road-to-recovery-after-two-broken-legs/
The link above is a story about a skier who broke both legs—he broke both lower legs—less serious than breaking both femurs like my injury, His story shows how long a complicated the recovery is likely to be.
Using a different technique while walking seems to have allowed my right leg to heal enough that pain has subsided. I used a longer stride stretching my right leg muscles and extended my left ankle to stretch the interosseous membrane on the left. I also prayed intensely, asking for relief from the pain. Prayers were answered affirmatively and I more or less have recovered to the point that I was three weeks ago in that I am walking with little pain. Part of the remedy was to add one additional 200mg Ibuprofen in the afternoon as well as one Tumeric supplement at meal time to reduce inflammation. I continue to use ice to fight inflammation daily.
April 25. My follow up with the Orthopedic Surgeon 90 days after weight bearing is authorized. All looks good except the right femur where the surgical screws have broken, allowing the femur fractures to be compressed. Doctor indicates little concern and suggests it may be a positive with the fractures better “fitted” during healing-warns only to monitor pain as an indication of needed action, if any.
I am a bit more concerned than doctor. Not sure when screws failed, but X-rays show significant healing. My concern is that I have felt some pain in upper right leg, as well as near the inside of my knee, but always assumed it was muscular related.
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