10 weeks from the crash. Making progress on med reduction. Roboxin stopped completely. Ibuprofen reduced 67% from 2400 mg per day to 800 mg per day. Oxycodone reduced 50% from 40 mg per day to 20 mg per day. Next step will be to skip one of the four doses per day, resulting in 600 mg of Ibuprofen and 15 mg oxycodone per day. Then dropping to 10 mg oxycodone per day, two 5 mg dosages at 5 PM and 11PM.
In addition, there are concerns about long term use of Tylenol, especially at the 2600 mg per day dosage I have been taking. So, I will reduce it 50% to 1300 mg per day, 325 mg four times per day.
Will address dosage of Tramadol and Gabapenten next week.
Sleeping reasonably well but suffering a bit of back pain or stiffness from sleeping on my back, despite having pillows under knees. Sleeping on side reduces back pain but still waking up after short sleep.
Right leg has responded to PT extremely well. Not far from full extension with little or no pain. A bit of pain in one spot when laying on my side. Left leg is not doing as well. Not noticing much improvement over past three weeks in regard to extension. Discomfort from tissue “clicking” as it moves over screw head on left side of left knee is diminished. Still some pain on left side of knee. New pain has surfaced on right side on left knee. Pain on sides of knee most evident when introducing side stress exercises. Pain level with reduced meds is significant but tolerable for now, assuming pain will subside steadily.
All of the transfers have overstressed left elbow which know has significant pain when bending. Good thing pain is tolerable when legs and arm are motionless.
Felt it time to start leaving the house and going to medical appointments in my own car. The Drive Cruiser X4 is an excellent standard wheel chair. Mine is equipped with all the options including anti tippers front and rear. (Not shown in pic below) But, it weights over 50 pounds and Carol was unable to lift it into the car. We devised a crane lifting setup but decided a light chair would be better. The downside is I cannot propel or restrain myself in a transport chair when away from stationary objects and I feel a bit unsafe.
We purchased the Nova 18 inch lightweight chair from Amazon. It weighs around 25 pounds.
First outing in car on Sunday. Attended church services at Bethlehem Steltz. New light weight transport chair worked well transferring to/from Mini Countryman. Carol was able to push me up relatively steep ramp there. Second outing was in the Lincoln MKC (higher seat) going to get expired driver’s license renewed.
Making slow progress on range of motion (ROM) for left leg. Gained 5 degrees but still short of the desired 115 degrees.
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Still struggling with sleep. Reducing ibuprofen and oxycodone has made arthritis in lower back more apparent. Back pain present in past, but able to deal with it by side and belly sleeping and changing positions during night. Side sleeping is now possible but knee pain is evident when changing positions, so I become fully awake, taking longer to go back asleep. Using pillows, and adjustable bed positions to help.
Now 12 weeks since accident. Ready to try wearing shoes for first time. Normally wear size 11.5 medium, had to go up to size 13 wide to accommodate what is assumed to be the swelling still present. $15.00 at WalMart! Really.
Assessment by Dr. Muccino, my Orthopedic Surgeon, after reviewing my X-rays indicated I am ready for limited weight bearing! Was able to see WellSpan Rehab same day and I stood on legs for the first time since November. 75% weight bearing. Therapist measured strength in several range of motion and determined my strength was more than enough to walk and classified as “functional”. Also, I measured a 95 degree range of motion on my left knee-a significant improvement.
Two days later on Feb 2, another visit to Rehab, I was able to stand with no hands on rails of parallel bars and then walk six feet. Also built strength using special seated elliptical “Nu-Step” machine. No pain other than some discomfort in left knee and minor soreness in right hip. Heating pad eliminated hip soreness. Pain in left knee continues at point where soft tissue is being dragged over head of one screw. Strange sensation standing, a sort of a feeling of instability. I am told this is normal after not standing for a long period. Muscles and balance need to be re-educated. I think the other “weird” sensation is the first application of weight on the feet (lots of bones and soft tissue) that were surely subjected to severe trauma as well as atrophy of ankle and calf muscles that had to work to maintain balance.
Both of my Physical Therapists are shown in the picture. Kelsey and Tiffany.
Continuing standing and walking therapy at home with Drive brand Walker with wheels and slides purchased on Amazon. Transfers now infinitely easier since I can assist using feet.
Goal is now to migrate from wheelchair to using Walker for mobility. Hopefully will be able to accomplish this with three more PT sessions.
Home is becoming to look like a rehab facility. Full size traditional wheelchair; light weight transport wheelchair; bedside commode; shower seat; shower hand bars; traditional walker; toilet rail support.
Important mods and additions are particularly focused on showering and toileting. Swing door removed, opening enlarged to 34 inches and slide door installed. Removed shower door and installed shower curtain with cutout for shower seat. Grab handles installed in shower. Shower seat and toilet arm supports placed. Toilet support arms necessary for transfer as toilet seat is only 17.5 inches high. 30 inches is ideal for lifting using arms to stand and transfer to wheel chair or walker.
Now able to transfer from wheelchair to bed, recliner and toilet without transfer board. Have removed leg supports from wheelchair-feet are on the floor. Exercising muscles in feet, heel, ankles and toes. Was able to walk more than 100 feet almost normal gait with walker in PT today.
Down to only 5 mg of Oxycodone daily (before sleep) and have reduced Tramadol extended release from 200 mg to 100 mg daily. Attending ManCave worship first time since November today. Was able to move using my feet while in my transport wheelchair.
Fourth PT session with full weight bearing has exposed a few issues. A slight amount of peripheral neuropathy in left foot—tingling in ball of foot that goes away after initial loading, Pain in heel probably plantar fasciitis resulting from trauma. Will work on strengthening and stretching. A weakness of calf muscles that prevents normal weight bearing on ball of foot and overloads heel. Finally, a weakness of the hamstring muscles demonstrated by standing from a sitting position without using hands.
Essentially, the calf and hamstring muscles atrophied significantly during the three months of bed rest without weight bearing on the legs. First priority will be to strengthen calf muscles and reduce plantar fascia stiffness to allow normal walking with walker, to eliminate need for wheelchair. Hamstring rehab also important. I think I seriously underestimated the scale of this part of the recovery—it will take longer than I thought to be able to be 100% free of the wheelchair for mobility.
14 weeks from accident (two weeks since weight bearing “as tolerated” authorization) have now had 7 sessions with WellSpan Physical Therapy in Shrewsbury. At first, we aggressively sought to rehab to allow walking with Walker applying nearly 100 weight bearing on both legs. Last three sessions have concentrated more on rehabbing the left foot and ankle-also recognizing that left Tibia and knee needed more time to heal. Stretch, strength and massage therapy has significantly improved feet and most of ankle. At this point, making significant progress using a strategy to limit weight bearing a bit on left leg and to use ice pack therapy to reduce swelling and inflammation. With increased weight bearing now noticing pain in knee and left side of ankle. Left elbow experiencing significant pain from using to carry part of body weight on walker’s handle.
The next challenge will be to re-strengthen my legs to being to stand up from chair without using arms, in other words partial rise from squat-while also working out pain in knee ligaments and muscles during this movement.
15 weeks from accident, foot pain eliminated, ankle pain reduced. Now the biggest challenge appears to be knee pain and weakness displayed in legs when stair stepping or leg squats. This prevents even small steps without Walker as neither leg appears to have sufficient strength unless it is locked. Using arm strength thru Walker or pushing up from seat/chair sufficient now for considerable mobility but still not ready to go without wheel chair as arms and legs tire quickly when using Walker. Practice on 4-5 inch step with icing of knees may rehab the legs. Amazing how much loss of strength from the best rest and not walking!
Here is one of my strength exercises at home using wheelchair and bookcase.
My guess is pain is related to muscle connections to bone in knee. No pain up to a certain lower force but significant pain if exceeding a higher load/force.
Week 17 since accident. Have attended church using Walker and climbing 6 steps using Strong Arm Cane. (Pic above)
Walking with Walker without pain in morning but pain in left knee and ankle begins by late afternoon with use. Pain related to stress as it occurs sooner if I have pushed hard in the wheelchair exercise shown above. I am guessing pains are related to tendonitis; inflammation of connections of muscle/tendons to bone in the knee and ankle as well as my left elbow. The left elbow is related to using arms to support weight when using Walker. Pain seems more noticeable as I have eliminated Tylenol and reduced Ibuprofen to only two tablets at end of day.
I am quite pleased to be moving about without wheel chair but a bit disappointed that pain level has not diminished and strength is so slow to recover. Strength training required to rebuild muscle but same induces inflammation and pain of tendon and muscle connections. (This inflammation calls for continued use of small daily dose—2 tablets of Ibuprofen despite concerns about kidney damage. The pain calls for continued use of a daily dose of 100 mg ER Tramadol despite a desire to end use of opioids.) Finding the optimum strategy is difficult. Will soon be changing Physical Therapist to seek new ideas.
Using Walker or StrongArm Cane. Can also use kitchen or bathroom counter tops for support. Neither leg seems strong enough to provide enough confidence for moving without device. Can “shuffle” without device.
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