Fixing my body

Keep in mind that dates assigned by Google for posts have been manipulated in order to make blog more like a book than a blog. Actual date is November 9, 2022.

As I stated. I will never pilot an airplane or ride a motorcycle again, but I do expect that I will be able to heal sufficiently to walk normally. This is the story of the repair and healing of my body after the crash.

Dr. Michael Dillenkofer put (set) my legs back together in the emergency room of the WellSpan York Hospital. Soon thereafter on November 9 and 10, Dr. Paul Muccino repaired my legs further in the York Hospital OR by installing three titanium rod implants with many screws. The two femurs had very severe “complicated” comminuted fractures with the bone in multiple (4-5) pieces. The fractures in the left tibia were also complicated but more conventional spiral fractures-still a challenge to repair. The fracture of the left fibula was more conventional and no titanium rod was installed.

Right Femur top

E

Right Femur lower

Left leg knee

Left lower leg and ankle

Left Femur top

With the orthopedic repairs completed, I was transferred to the WellSpan Rehab Hospital. The repairs to my bones did not address the obvious large scale injuries to muscles and soft issue. The focus on Rehab will be to address healing of both bones and soft tissues. Further X-rays and possible MRI scans may be necessary as we progress.

A major part of this process is pain management. The brain has powerful ways of reacting to potential and actual pain. Any movement that increases pain will create fear and avoidance of further movement. Healing rehabilitation requires movement.

The pain balls block the pain from the femurs and high muscles near the hip. They do not block the pain from the knees and below. We are still running a pain management program using oxycodone and ibuprofen. Both of these have side effects and their use must be minimized. Oxy is addictive and reduces bowel function. Ibu can damage kidneys and accelerate cardiac malfunctiona. Pain is monitored by my anecdotal state of pain in the range of 1-10.

I was given my normal dose of oxy and ibu at 6:30PM hoping to go thru the night. At Midnight, my pain was so severe it woke me from my sleep so I was given another dose of oxy. Goal was to wait until 7:30-8:00 for the next dose to prepare for “movement” by the Therapy Team at 9:00 AM.

Surprise! At 8AM. A team of nurses arrived informing me that I had to be transferred by crane to a wheel chair so I could be wheeled to a seat in the cafeteria. I had been moved like by crane st York Hospital but the “surprise lift” created some anxiety. The issue was I had chosen 8AM for the time to receive my pain meds. So off I went for breakfast with a fresh dose of pain meds. (It takes at least 30 minutes for meds to “kick in”. ) 

As I was eating breakfast I felt faint and almost passed out—my blood pressure had fallen to dangerous levels. Returned to room and a IV was introduced to raise my fluids, and I drank a substantial amount of liquid. I am told the condition is called Orthostatic Hypotension. Mostly caused by me being moved from lying down in bed to sitting upright in a chair.

I had three physical therapy sessions. Transferring from chair to bed and from bed to chair. Left leg is able to bend, right  had to be held up off the floor. Pain meds worked well alternating between oxy and ibuprofen alternating. 

Next morning I was encouraged to take half the oxy. I had not had a BM in seven days. I was able to finally go Thursday AM. Another 3 hours of PT started with a sliding board transfer from bed to beside commode. I again experienced Orthostatic Hypotension with BP falling to 70/50. Recovered quickly and the transferred to wheel chair Another wheel chair driving test, then turned over team who introduced some upper body strength exercises. More transfer board transfers.  

The alternative to sliding over the transfer board was to use the crane and body harness which I had used once at the hospital to transfer to a reclining chair. I preferred the board.

At this point, one week after the accident, my left leg can bend enough to fit on edge of bed but my right leg cannot bend that far without high level of pain. More time needed. Back to original dose of oxy. Will still need assistance transferring until that right leg heals a bit more.

My little dog “lollipop” was allowed to visit me. What a joy. 

In addition the food at WellSpan Rehab Hospital is very good. Here is steak with crab cake for supper.

A close relative of Fred Gregory, the famous pilot and African American Astronaut, Dr. Hugh Gregory is the leader at WellSpan Rehab Hospital. He’s Dr. Gregory met with me and my wife asking for feedback. Because of his family’s interest in aviation, he was interested in my flying and the details of the crash. He took action to help our “pain management program” to be easily understood and implemented. He will hold a Zoom internet virtual meeting with me, my wife and others to review my progress. This personal attention to detail by the attending physician is why WellSpan Rehab Hospital is so highly rated and ranked.

Continuing the pain management program with 3 more tough physical therapy sessions-enough confidence that I am now authorized to use the “board” transfer method with nurse assistance. In addition the pain balls have run out of fluid,. The pain catheters removed as new dressing put on the sutured area. Dr. Gregory added a addition to the pain management program to make up for the pain balls.

My third day of therapy, I came to realization that I essentially could not move my legs other than my toes and ankles. I could not lift my leg which means even if I could put weight on my legs I could not walk. A scary place mentally.

Pain Management has become the most important part of my rehab. Essentially, the Attending Physician prescribes a list of meds that are administered by the RN’s according to a schedule. Then a limited amount of Oxycodone is provided “PRN”  (Latin for as needed and appropriate) that I asked for. Everyone, including me is aware the risks of Oxycodone, so use is limited. 

Getting this “right” has been difficult—for each of the past three days, I have exceeded my pain threshold to the point of unbearable paini. When pain becomes “”unbearable” there is usually some form of release—screaming, weeping or a combination of both. In most cases blood pressure rises to dangerous levels. In any case it should be avoided. On my 6th evening at the Rehab Hospital, I finally made it thru 24 hours with pain under control. Legs still hurt constantly, but the pain is “bearable”. 

Over the weekend had several visitor’s including I my 94 year old Mom. 

My physical therapy has reached some milestones. With assistance moving my legs. I can “transfer” from bed to wheel chair and from chair to toilet. Range of motion is improving slowly. As mentioned, I cannot lift my legs yet.

The next hurdles are related to bowel movement and urination. Both the bowels and bladder tend to shut down after trauma. Usually a catheter solved the urination issue. Getting the bowels to move requires laxatives and stool softeners—in my case a suppository was required. Once started  BM movement daily returned. Next, is removal of the long term catheter. In my case, I could not urinate normally, so several more “one time” catheters followed to “train” my bladder. Typically I would void about half of my bladder volume and then be catheterized for the rest. After 5 failed attempts to fully empty my bladder we went back to the more permanent catheter.

Additional PT has helped and I can now move my legs, but still with lots of pain. The PT Team has helped to identify and procure  the devices I will need at home: wheelchair, bedside commode, shower chair and grabber. They are also teaching me how to bathe myself and put my pants on using the long grabber.

My daughter Ava and her family from Houston Texas visited. They were checking out University of Pennsylvania and having Thanksgiving with my mother, so stopping to see me was “on the way”. 

It is now Thanksgiving Day two weeks after the crash. I always knew that there was a risk of infection. I was especially concerned with the high number of catheter insertions which can scrape the prostrate and subject it to bacterial infection. At about 5AM my temp began rising to 102F. Immediate action by staff called specialists and more experienced nurses and my charge physician who initiated a “push” of Cefepime, an antiobiotic used for life threatening sepsis. My temp climbed to 104.6 F before the Cefepime kicked in.

More antibiotics throughout the day. My wife, Carol was distressed, as she thought my life was in danger. My speech was slurred and in coherent. We had  Thanksgiving Diner for lunch. IV antibiotics throughout the day and night. Waiting for the culture on the urine sample. Physical therapy progressing.

Feeling better the next day with full PT schedule, including a ride in my wheelchair outdoors. Leg movement slowly progressing. Still painful, but now testing possibility of reducing ibuprofen or oxycodone. Infectious Disease MD consult ordered a CT scan of my belly area to check for kidney damage and condition of the bladder and prostrate.

One interesting aspect of CT scan was it revealed that L4 vertebrae had been compression damaged in the crash—I will be shorter in height. The other untreated damage is the tibula platform for the miniscus which may produce some knee pain on the right knee.

The CT scan also called for referral for my to a Urologist who indicated no changes in care were needed. I have a long history of urological issues. Bottom line is the urological issues extended antibiotic treatment. Regular doses of Cefepime continue.

Noticing some difficulty falling asleep as I am pretty in bed flat on my back. I generally fall down asleep on my side or stomach, and then roll into several other positions. 

A side effect of the antibiotics seems to be nausea and alteration of taste. I no longer could tolerate the taste of water and I felt nauseous. A med for nausea was very effective and my taste tolerated fruit juice and fruit. I was given Zofran which was very effective at eliminating the nausea. Continuing with a low grade fever of 100.1 addressed with additional doses of Cefepime. By end of day Saturday 11/26 felt normal even after going without oxycodone for 10 hours. PT had actually coached Carol and I to transfer from wheel chair to our Lincoln MKZ suv. And back to chair. 

Noticing some difficulty falling asleep again. I had assumed some hallucinations  experienced earlier were due to the oxycodone, I now suspected the Cepepim. Sure enough warnings were written in the hospital’s protocol regarding kidney disease and hallucinations

Given my known kidney disease, I question the use of Cefepim (Maxipim) and especially the continued use after my reported difficulty sleeping. 

I was given my dose of Cefepim Saturday evening and the hallucinations got worse. Mostly limited to when I close my eyes, but also when awake I see figures in my peripheral vision. It is impossible to sleep in this condition. I have ordered the Hospital to stop any further 1000 mg doses. 

Hopefully when the urine culture is completed and the bacteria identified, another antibiotic can be used for continued treatment. Cipro has been used for my previous infections, but probably is not appropriate now because of its side effect related to tendons and ligaments considering my accident. The bacteria has been positively identified as e-coli

I am looking forward to sleeping without pain and without infection. Also without nausea or hallucinations.

Resumed antibiotic  treatment with different med, Ceftriaxone, which is similar to Cefepim but different and substantially reduced dosage from 4 grams per day to 1 gram per day. 

Slept well for several hours, no nausea or hallucinations, so I tolerated the Ceftriaxone well. Success! No PT on Sunday. Legs seem to have less swelling. Slept very well Monday morning. Finally had to take Oxycodone at 5 AM after 13 hours. Everything looking good Monday morning.

Ultrasound on my kidneys and bladder done while in bed. X-rays on all of the repaired areas. Sutures removed. Wounds will continue to have dressing for two more days. Catheter will stay in when I am discharged. Discharge date set for 12/1 and will be confirmed after Tuesday staff meeting.

Nights in a hospital can generate a feeling of loneliness. You are almost helpless and pushing the call button does not generally result in immediate response. If you are in pain, for some reason it seems to be more acute than during the day. After a long stay, your body will be sore from laying in just a few positions. Sleep would be a welcome escape, but the pain and discomfort are relentless and usually limit sleep to short “knaps”. All in all, nights are tough. 

Lots of PT today.  Most important was honing my skill transferring from wheelchair to recliner chair at home. Staff decided I would be discharged on 12/1.

Finally able to sleep well at least for 1 1/2 hour stints. Last day before discharge Occupational and Physical Therapy staff tested my abilities and reviewed exercises and techniques for continued recovery at home. 

Got my new wheel chair adjusted especially for me. It is the narrower 18 inch model and can be folded up for transport. Unfortunately, it is too heavy for my wife to lift, so transferring to our car is possible, but transport of the wheelchair is not—so we will hire a wheelchair van service to move me to doctor’s offices.

The next chapter will be recovery at home.