What does “Recovery” look like?

 

Now more than 10 months since the accident, progress over the last month has been very slow if there has been any progress at all.

I am walking with one cane. I have two types, the Strong Arm Comfort cane (see video in previous post) and a simple wood cane that I have modified with a cushioned tip and cushioned handle. (See pic below) I like the simple cane best, but the Strong Arm cane is better if I need to put more of my weight on the cane, for example for longer walks. I can navigate stairs having a railing using a cane. I can drive my car. I can even walk without a cane with an almost normal gait for limited distance.

I have a considerable leg muscle strengthening exercise regimen that I complete daily. I have been receiving Physical Therapy weekly.  I walk 3-4 miles weekly. I use an iPhone app to record my steps vs a goal of at least one quarter mile per day.

I am able to perform useful construction and maintenance tasks (not requiring a ladder) around the house—including some digging and spreading of crushed stone. These tasks often require standing and bending for extended periods as well as sitting and rising 20-30 times or more per day. 

But, I still experience substantial discomfort, pain, and inflammation in both knees related to any use of my legs other than standing straight. While my strength has increased, this discomfort, pain, and inflammation has not decreased. This discomfort, pain and inflammation may be related to scar tissue, but more likely due ti mechanical interference with titanium screws in the left knee, and probable traumatic arthritis in both knees. 

Fortunately, there is no pain standing. The impact in my accident occurred as I was seated with my legs bent 15-20 degrees. If I am weight bearing with legs at that angle, I experience pain. This angle is what occurs when climbing stairs, bending down (squat) and/or standing from a sitting position (sit to stand). I can do sit to stand maneuvering from a 24-26” seat, but not from a 22” or lower seat without using my arms to assist.

It is possible that these issues may be permanent unless a Sports Medicine specialist can resolve them surgically.  The healing of my bones has progressed quite well and a November X-ray review should show considerable remodeling and mechanical strength. (I continue to take prescription Vitamin D2 and an OTC calcium and magnesium supplements and eat a diet with lots of protein.) A CT Scan will be scheduled afterward. Hopefully, the scan will allow an accurate diagnosis.

In any case, I am beginning to prepare myself for dealing with being handicapped—having to use a cane regularly, and that activity requiring leg exercise with bending will be painful and will cause significant inflammation—to a point where continued mobility causes severe pain. Ibuprofen relieves the inflammation but long term use of more than one daily 200 mg dose is probably dangerous. The use of other pain/inflammation remedies will be explored. There are no good options for chronic pain if the underlying cause cannot be treated. Having to use a cane is not an issue, but chronic pain is tough to deal with. Every pain medication had serious side effects—kidney or liver damage from Ibuprofen and Tylenol, constipation and addiction from opioids.

Preparing for this outcome is only possible with faith In Almighty God, a relationship with Jesus Christ and daily prayer. It is very difficult to deal with the loss of “normal” abilities and chronic pain. Fighting oncoming depression is a regular and continuous challenge.

I am told by others that have “recovered” from injuries and surgery that the body does heal slowly over the 2-3 years post trauma,  So pain may subside over time.  Sometimes, dealing mentally with the situation requires great patience.

Last week in Sept 2023, almost 11 months after accident, I finally felt comfortable with trying out my ability to hit golf balls. I optimistically joined Bon Air Country Club in March, but did not feel safe walking from my car downhill to the driving range tees until now. When I showed up, the range was full of high school boys getting ready for their tournament.

When they were finished, I carefully walked down the hill and hit three shots with my 8 iron and was pleased with the results using my new “arms only” swing. I was confronted by the Club Pro who informed me that I was in violation of the dress code because I was wearing jeans and my golf shirt was not tucked in. I apologized for my oversight and asked if I could at least hit a few more balls since I had paid for seven months dues ($2400) without playing and this was my first time out since joining. (I was the only person on the range!) He was unsympathetic and told me I had to leave the driving range and accused me of “disrespecting” him by me claiming he was unreasonable. I asked some other members about the situation—one who was actually wearing jeans told me to not to be bothered by the confrontation—another who basically felt I had broken the rules and being asked to leave was appropriate. Yikes! I immediately resigned from the club—archaic rules; mean spirited staff and members; and a course that was “unavailable” for open play much too often. Prohibiting work wear jeans is one thing—country clubs have an irrational view regarding anything denim as somehow undignified for the elite who play golf at country clubs—but having to tuck in your shirt is just plain silly. (Most middle aged non athletic men look much nicer with the shirt untucked.) Being removed from the range was against written club rules-violations are to be handled by the board.

The above is OK at Bon Air but almost brand new light weight dark blue Levi’s with a nice untucked golf shirt is not! Once shorts of any style (other than inseam) or color are allowed, without proper over the calf socks, the dress code has become very casual and banning denim and requiring tucked in shirts is just a silly attempt to pretend to be upper class. Some of the most wealthy “upper class” men now wear denim as casual business attire.

There are several fine golf courses in close proximity—Pleasant Valley, Heritage Hills, Oakmount, and South Hills—all with reasonable “casual golf” dress code. And an excellent driving range at Black Horse. I will not miss Bon Air Country Club. The only attraction had been free driving range and close proximity, only 7 miles from my home.

The next day after the confrontation at Bon Air, I went to Black Horse at hit 65 balls for $5–6 and 8 irons, pitching wedge and 5 wood. I hit the 8 iron about 120 yards and the 5 wood nearly 150–this indicates I reached a club head speed of about 70 mph. Not bad for arms only. More practice is needed as I tend to pull the shots left. Golf will be one sport I will be able to play with my disability.

Well, maybe not yet for golf. Apparently, even with an arms only swing, I was putting quite a bit of stress on my right knee which started exhibiting pain the next day. 

Trying to build muscle too fast as I created severe tendonitis on medial sections of both knees. Two weeks rest and pain has subsided. Added exercises to build muscles on medial side of knees. 

Was able to drive long duration ride and enter/exit a motorhome. Will be buying one soon. 2019 22 foot Coachmen CrossFit on Ford dually chassis. Looking forward to doing some long distance traveling with dog and maybe also with cat.

Exactly one year after accident; “waddling” without cane—short stride around house and outside for short distance without cane. Back to walking more than 1/2 mile per day with cane. First time in a year I took the garage cans to the street—50 yards. 

Final visit “one year after surgery” to Orthopedic Surgeon for review of fracture healing. Femurs, Tibia and Fibula now healed with solid bone entire length of femurs although not 100% surrounding the rods. Possible that continued remodeling will occur for some time to “fill in” some of the “gaps” however with solid bone in combination with titanium rods, the legs are quite functional except for extreme stress from jumping, falling or other trauma. Surgeon indicated screws needed to remain for another year—indicating he expected additional bone growth and remodeling. 

The issue now is really all about pain. Muscles seem strong enough but significant pain and soreness during movement—walking, sit to stand, and stair/curb climbing and descending. I am able to ignore or work thru the arthritis like “stiffness” but tendonitis like pain makes me want to limit movement. Possible that pain is perhaps related to nerve damage or pinching. Use of cane is quite helpful and as mentioned, the cane probably is my long term helper.

Not a lot of research or conclusive info on healing for my type of injury, especially for someone my age. Youths and athletes younger than 30 seem to recover from broken femurs within a year. But, even then, very few if any injuries mentioned are similar to those I experienced. Most are simple fractures compared to my seriously comminuted fractures with multiple pieces and complex fracture interfaces. The combination of bending moment and impact to legs with the pelvis restrained in seat belt harness creates a rare injury scenario with unknown damage to the knees. This is surely the issue as pain and soreness are now all about knee bending and muscle/tendons involved in knee movement. 

Best “guess” at this point is to continue to use walking, stationary bike and limited stair climbing to stress the muscles and joints to “condition” and “train” them back to normality. Time will tell.

Again, the psychological aspects of this recovery for me and my spouse are significant. Christian faith is strong, but situation still is very depressing. Pain and loss of function is difficult to accept. Couple the injury related issues with similarly serious ones related to aging and the depression is compounded. 

The bone fracture healing of elderly patients is not fully understood other than it is slower. This is especially the case in the later stages of healing after “union” had occurred and hard callus is replaced with hard bone, sometimes called “remodeling”.  The pics below show continued healing during 3 months from July to November—now one year after injury.

July 2023

November 2023

Pain can occur as muscles are strengthened through exercise but connective tissues (tendons) are overstressed and strained. Pain can also occur during the remodeling stage as the bones are deformed slightly during heavy full weight bearing use. 

The right femur fractures seem to be more severe and complicated. The lower screws fractured soon after weight bearing in February. There has been chronic discomfort in the section with the most damage 4-8 inches below hip socket. In addition, there was acute pain during movement on the medial portion of the lower femur that subsided after exercises to strengthen the gluteus muscles—followed immediately by acute pain in the that area mentioned (4-8 inches below hip socket). These acute pain symptoms are most likely a form of tendonitis that presents at the weakest point when the leg is stressed from weight bearing during prolonged walking and stair step climbing. The chronic pain in the section of the femur that incurred the most damage is probably normal and will likely occur for quite some time until fracture lucency is reduced. 

Keep in mind that comminuted fractures take considerably longer to heal. One year is normal for younger patients, but it may take much longer for elderly patients. These fractures are subjected in part to shearing forces—much different than compression forces with “normal” breaks.

Recovery seems to be a “two steps forward then one step back” process that is so slow it tends to create depression.

Using a cane in the left hand to reduce stress on the right leg during walking and in the right hand during stair climbing is effective in reducing pain. Pain (discomfort) in the left lateral knee area when walking is likely to continue as it is caused by interference of soft tissue and hardware in the lower femur. 

The cause of pain in the right medial knee that has dogged me for a few months may have finally been identified. Seems less related to tendinitis and more to the Femoral nerve. Now in December,  about 11 months since weight bearing, I experienced severe pain in my upper leg and thigh. Exercises designed to stretch and “floss” this nerve (leg back, shoulders extended to the side with arm and head raised) relieved this. As did the leg/knee bends while laying on my stomach.  The Femoral nerve is connected to L4 vertebrae that was crushed a bit, continuing over the hip that was damaged in the accident, sliding over the section of femur with the comminuted fractures and past the broken screws in the distal femur. This continues across the medial knee and down the inner Tibia area. I experienced pain down this exact path. I suspect there is scar tissue that interferes with the smooth movement of tissue over the nerve. Hopefully, therapy over time will resolve this and I will feel comfortable putting full weight on the right leg while walking. My use of the cane is mostly due to pain avoidance related to my right leg.

I had asked my orthopedic surgeon and physical therapist about soft tissue damage, but without a CT Scan could not be specific. Given the severity of the fractures and the general trauma, it is not a surprise that soft tissue damage and healing has resulted in pain. The ortho surgeon has apparently assumed that bone remodeling is continuing and may continue to result in some soft tissue inflammation as I increase my physical activity. Ibuprofen is my “friend” as it reduces inflammation and pain quite effectively, however I am limiting my intake to two tablets a day to avoid kidney damage. 

My daily exercise regimen is quite extensive. Continuing the exercises from 2022 regarding thoracic pain and all of the exercises recommended by physiotherapy. About 45 minutes daily. Walking 0.3 to 0.5 miles per day, depending on pain level and weather. Regular visits to motorhome van to exercise gen set and the vehicle as well as “projects” and “improvements”. (swivel table, sleep curtains, and engineering electrical improvements to add another power option in addition to gen set and “shore” power.