Showing posts with label fracture healing process. Show all posts

Right after the fiber glass cast dries on top of the pillow, and right before scheduling a follow-up appointment - those are the seconds my own fracture management a.k.a 'healing time' begins in my mind. I'm sure biologically the bone cells are regenerating and all of that magical science-y stuff, but in my mind when all is stabilized and I am no longer sweating bullets, my mind and body can actually focus on getting better.

When I say that my mind is focused on getting better it probably sounds like a lot more work than it is in reality. In reality I try not to use the part of my body that has been immobilized, and even that effort doesn't take much conscious thought for me. The weight of the cast, the bulkiness of it, and its general unwieldy presence doesn't really lend itself to being too tremendously useful for me. It ends up getting in the way more often than not: that piece of cast that wraps around my thumb and four fingers prevents me from gripping that twist-open Snapple bottle cap, the straight long leg cast makes bending forward to pick something up like some acrobatic move, and a sling for that fractured collarbone makes zippering a jacket something that requires a sleight of hand like a magic trick. After the first few days I eventually learn to not have full-use or access to that part of my body for the next several weeks. In my mind that is my fracture management: leave it alone, keep it stabilized, don't get it wet, and let it do its thing.

But during the minutes between a dried cast and scheduling a follow-up appointment my parents begin their own fracture management. From what I've observed it starts with a very long and worried face, hand wringing, hovering over the cast like they're protecting a golden egg, and this constant attention around the immobilized limb as if it might speak up for its own needs at any moment. As evening set there was apparently some whisper of sweet nothings for more pillows that the cast demanded. When morning arrived there would have already been clothes laid out that could be easily put on. Then in the bathroom all toiletries and soaps were placed somewhere that required no effort to reach them. In the car I would sit in the seat where no one would have to come anywhere near me when they entered or exited. In a spica cast showers to wash my hair would be arranged with the shampoo that wouldn't sting my eyes. All of this -- and so much more -- were all things that went into Their fracture management. During the first few days all of this would be done with a look of distress, because maybe somehow the gap that existed between the cracked bone had sucked my parents' attention and care into that vacuum of space, and under extreme duress mom and dad were at the every beck and call of those invisibly and imperfectly formed collagen. But I have the liberty of just "letting it do its thing.."

Meanwhile I am usually just learning to adapt, carrying on about my regular day, and occasionally getting frustrated with not being able to tie my shoe laces or write as legibly because I have a cast on. Once I was upset that my left sneaker would look cleaner than my right because I couldn't be patient enough and wait five months to wear both, at the same time. If it seems like I've simplified things it's because I have. I've left out the nightly muscle spasms, the sticky churning sensations in my stomach from the pain medication, and the itchy spots way down at the bottom of my heel or in the crook of my elbow - the places where no amount of bending coat hangers or pipe cleaners could ever reach. But those are all things that happen without my control, things that I have no obligation to cease and desist. I could either learn to adapt or ignore it. Either way, I knew that my body and my bones would heal on their own time.
But for my parents they did have an obligation to me - and that was reflected in their fracture management. Their fracture management was carried out in a way where they couldn't just ignore me, or it, and everything that they saw happening before their eyes. They had to manage it because otherwise, what else would they have done? Sat there and watched? Sat there and twiddled their thumbs and said: oh well, I guess we'll just have to wait around until six weeks is up. Of course not! For them Their fracture management, while it may have at times been a little too suffocating and overly-intense for my patience, was how they dealt with OI (at least in part).

As I got older I learned to recognize what they were doing for what it was. And they learned that as I got older there were things that I would just need to learn to do on my own.

I think I've said it before in some post but I'll say it again: there are moments when the most effective medicine is time, and that's all we can give and all we can receive. It'll happen, all in time.

We were getting ready to move to a new house, a new town. It was a time of overlap: revisiting what we experienced in this setting to shift into a brand new environment. I remember labeling shoe boxes with "Sandy's Fragile Stuff" and "Middle School Box" - I surveyed my childhood room, the toy chest overflowing with plastic gadgets or plush dolls I was ready to part with. My parents had asked me to put my clothes into open cardboard boxes, but I was decidedly "not in the mood" to deal with my clothes, instead I crawled up the fourteen steps to the second floor.

Mom was sitting on the floor in front of the linen closet next to the bathroom, surrounded by clear plastic bags stuffed with ace bandages, slings, old casts, bi-vals, and varying braces.
"Look at all this! There's so much here, you don't even fit most of it. Time to throw away a lot of it."

I watched as she gently folded the slings I refused to wear, the blue one my friends decorated after I hurt my arm in a game of four-square during gym class. She set aside a small bi-val cast that was for my left tibia, it now looked like it would barely fit my ankle. There was the ace-bandage, the yellowed velcro was bespeckled with pieces of lint wedged between its teeth. That was the bandage my parents first put on my leg when my younger brother fell on me as we played in his crib. Stacked in a small pile off to the side she had rolls upon rolls of white medical tape, tape that I knew she had stealthily learned to pocket each time we went to the cast room. It was the tape she would rip between her teeth, handing each strip over to my dad as they put an old splint back on to stabilize a break on the way to the hospital. My casts had faded sharpie drawings on them, each one had squiggles, pictures, made-up signatures, and smiley faces that reflected my changing group of friends over the years (the friends who stayed the same from 3rd grade to 8th grade) - and, more noticeably, when it was we learned how to spell "feel better soon" correctly.

For my parents I imagine cleaning out this bin of medical supplies, and emergency braces held a different meaning. They didn't see the crowd of kids who swarmed me during recess, each one eager to write their initials on the ridged cast -- many of whom I had never spoken a word to. My parents didn't see the days in middle school when I secretly slipped out of my sling during study hall. They didn't know when I would loosen up the bi-val splint during the bus ride to school. They didn't know about the time the nurse gave me a plastic bag of ice, and it had leaked - the cold water dripping past my toes and settling in the heel of the cast. For them these old bandages probably meant how fragile their daughter was, and even though I didn't grow at the same rate my brothers did - it was clear from the tiny bandages that I had grown, but perhaps more apparent was that I had done a lot more healing in the process. Cleaning out this closet may have also offered some sort of tangible relief for my parents; for them it was also a time to clean out the past injuries and think look she got through this one, and look she healed from that terrible break too - oh and how she fussed and cried when they put that on her.

Regardless, for the both of us, the empty casts and bandages that surrounded us had become artifacts of history, a history that in many ways would remain the same but served to remind us that better days exist. 

These incidents happened more than a handful of times, but not too frequently to make them a regular occurrence. But every now and then a fracture would happen and my parents couldn't get me to my orthopedic right away.
When these injuries happened it meant my parents would put a temporary brace or splint on the fractured area. They would help get me into a reclined position on my bed, keep my brothers from playing near me, put a stack of books and a bronze bell in case I needed anything near by. Going to sleep this way was the toughest part of the whole situation for me. Despite the temporary splints and braces, the fractures was still fresh and sensitive to any movement or the slightest touch. Fresh fractures also seem to be the breeding ground for muscle spasms, and though I wasn't physically moving it felt like my muscles were tripping the light fantastic till the break of dawn. I would go to sleep repeating in my head, "don't move in your sleep, don't move in your sleep, don't move in your sleep..." hoping that maybe I could teach my body that having brittle bones can be less painful if it would just understand: don't move. 


Eventually after drifting off and then jolting awake, and then slightly shifting my body weight, or itching a spot, or cracking my back, or ringing the bell for another glass of milk, or flipping the pillow over again -- I would fall asleep. Finally I would reach some sort of compromise between the fresh fracture and my body's clear exhaustion. Both would collapse across some invisible dotted line that stretched between Point A: Moment of Fracture to Point B: Moment of Healing. The two parties are completely zonked out, snoring, drooling, deep into la-la land - it translates into some rest for me.

And then morning would come. Usually I would try to wake-up before my parents awoke in an attempt to enjoy the calm before things started being moved around again. Even to this day, there is nothing I despise more and find more uncomfortable than a fresh fracture being moved. I hate it. I would rather repeat all of high school math than be moved around with a non-stabilized broken femur. Please, spare me. But that dreaded moment would come. When I got older, around middle school, I would tell myself it needs to get much worse before it gets much better. And that was the only thing that I kept in my head as I gritted my teeth while my parents, inch by inch:
Transferred me from the bed to the chair. And then from the chair to the toilet. And then from toilet back to the chair. From the chair to the car.. (all the while I am whimpering like a baby)... and on until we had arrived in the x-ray room, and are well on to making a little bit of progress towards Point B: Moment of Healing.

The mental and physical sensation of pain is always going to be overwhelming. What's more is that it's only ever going to be an overwhelming sensation that you can understand. You're the one who knows how big it is, how persistent it is, when it will appear, when it fades, why it comes, or when it goes. So with all of these facts in mind, what are ways that we can better manage the pain? There are a million pain management techniques and tips out there. There is only one that I have found that works, for me, every single time. Inch-by-inch and bite-sized pieces:
When I lay in bed with a fresh fracture thinking about how I need to somehow get from there into the car, and then onto the highway with all of its swerves and bumps - I will only want to curl up into bed and refuse to move. However, if I think - now I need to move 4inches over and into my chair. The pain seems far more bearable and less infinite. In fact, the pain becomes finite because soon I know I'll be able to say: now I need to move from my chair to the examination table so he can put the cast on and it's all done. Destination Point B: Arrived. 

Special Note: This is my 100th post! Let's hear it for 100 more =) Thanks for reading & for your support!!
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"Does having a broken bone slow you down at all?" My high school journalism teacher asked me. To this day I don't know what spurred her to ask me this; maybe it was because that time I had my head down, and was heading to my next class away from the rest of the crowd - taking care that my broken arm wouldn't be further jostled.

I have often re-visited the question my teacher asked me in my head, do I have a 'fractured' mentality? One that is more than just taking extra care, moving about with caution, and taking care to keep the cast dry in the shower? And if I do have a broken-bone mentality, how do I make that transition from being 'whole' and in my 'normal' state to one who is injured?
When a fracture has just happened I get very quiet. I stay away from the group and generally prefer to be left alone. In this state I definitely do have a 'broken-bone' mentality in that all my energy is focused on assessing the injury, stabilizing it, and 'getting used to' the feeling. A fresh fracture heats the surface of my skin and is sensitive to the movement my body makes with every breath that I take. Aside from the extraordinarily annoying distraction that comes with the pain and discomfort a broken bone brings, I think around this point I'm already trying to figure out how to "move on" from the fracture. I talk myself out of being totally succumbed by the pain and annoyance of the fracture:
It's just another fracture. Bones grow. Bones heal. This isn't going to be forever. Be calm. Ignore everyone else. Make sure no one touches the broken bone. Defend and protect it. 


I am only 40% listening to anyone who is not a doctor or a nurse when a fracture has just happened. Don't get me wrong, I always appreciate friends and family who are there with a comforting word or are trying to help - but my world suddenly becomes limited to the fracture and managing it the best way only I know how. There is an underlying fear in me that if I get distracted by other people talking to me I won't be paying attention to the broken limb. I won't be holding on to it the right way. I won't be paying attention to when my skin has stopped heating up. I won't notice when someone accidentally bumps into me. All of these slip-ups on my part can cause a lot of pain that I have somehow taught myself can be avoided. From this point on whatever pain can be avoided I will leap towards! If it means waiting for my orthopedic doctor to come back from his vacation before setting the bone again, I'll wait. In my 'broken bone' mentality I will only do things that I am most comfortable with, know the outcome of, and take no risks; this is pretty much 200% contrary to how I usually am.

After the broken bone has been stabilized and there is a cast over it I try my best to get right back into my usual routine. Of course there are things that will need to be adjusted. The way I transition from the toilet to my wheelchair. Or the way my family or friends carry me. The technique I use to open doors while in my wheelchair might need to be adjusted. The way I get dressed. There are a thousand things that need to be tweaked a bit but because I am old enough, have had the experiences, but most importantly have learned -- I usually do these things now without a second thought.
Aside from all of the day-to-day tasks my 'usual' routine has also consisted of school, work, hanging out with friends, volunteering, going out with friends, hanging out with friends, and did I mention hanging out with friends? Here's the biggest obstacle for me whenever I have a broken bone: FATIGUE. I sleep a lot when there is a fracture, and usually almost immediately after a cast is put on I am fast asleep. It's hard for me to accept that I am not able to do as much with my day. It's annoying to admit that I need to stop and rest. The toughest part of this part, for me, is when I am resting I realize that I am resting because I broke a bone. During these moments it's usually just me and the cast, and right then at that moment - Yes. I hate to admit it but yes, my life is slowed down a bit when I have a broken bone.

I s'pose the title of this entry is inaccurate. My mental state is never fractured and I wouldn't say that it is at all slower when I have a fracture. The lull moments are when I realize how fortunate I am, those are the times when I am teaching myself how to be stronger, when I am 'talking' to my body and telling it to heal quickly; these are the moments when I am learning how to roll with the punches and adapt quickly but cautiously. All of these are things that I carry with me long after the doctor has taken the cast off, I might not remember every fracture incident or every bone that I have ever broken - but I do remember the things each one has taught me and how each one has subtly shown me more of life than I am otherwise conscious of.


Mending a 'broken' mind:

• Growing up in an environment that encouraged my abilities helped reinforce my coping abilities when I had a fracture as a child. Sure, my parents were a little extreme in that they always sent me to class after they splinted a broken bone themselves - this insanity actually had its benefits!
• It's easy to slip into the "why me?" mentality. And the few times I have done this I have always been frustrated by the lack of answers, and also by the ultimate pointlessness of this thinking. I think that this is a normal process of thinking and one that each person has to figure out on their own, but for me the dead-ends that I always wound up in taught me to just stop asking the question 
• This took me forever and years to recognize and it's actually something I recently have come to understand - but it's okay to cry! It's not a sign of being pathetic or weak, it actually helps get stress out when there's little else that you can otherwise physically do
• What I wrote above is only true for me. Each person has a different way of reacting to injuries and different ways of dealing with your body. It's important to take time to understand how your body reacts to best know how to manage and deal with it! So even though I'm a huge proponent of getting back into the routine ASAP, I know that taking time to rehab and let your body & mind adjust is important to managing fractures
• Surround yourself with people that you enjoy being with and do things for you! 

The one thing I dread most about being discharged from the hospital after an operation or after I get my cast off is the physical therapy that follows. If you are a Physical Therapist I'm sorry, but all the PTs before you ruined it for me. As I am laying on the plush blue mat, they are always kneeling besides me with the condescending smile frozen on their faces:

"Can you bend your knee aaallll the way up to your chest for me?" She says as she tries to collapse my freshly de-casted leg towards me as if it were an accordion. Then it always gets to a certain point where my finger tips are digging into the mat, my face contorts into a wince, and I am trying to wriggle free from her grasp. My body is confused because it isn't sure how to interpret the strange sensation in my leg: is that sharp pain that I am trying to resist really just a muscle that hasn't been used in 5 months? Or is what I'm feeling a fracture on the verge of happening? Because whenever a P.T. is flexing, bending, or stretching me I always assume that she will snap something in half. I start to sweat, my stomach tightens into a knot, and I am literally waiting for that snap and then the burning sensation.
No dammit, I can't bend my knee all the way up to my chest for you! In fact I don't want to do anything for you! But of course I am old enough to know better than to snap at her, have had too many experiences to know that she won't break anything; and yet there I am, my body always resisting what she is trying to get it to do. Instinct? A deep mistrust I have of anyone touching me? Maybe it's because it always feels like she is forcing my joints to break through the rust? And doesn't that just sound painful?
Part of it is also because my body has memorized and internalized a lot of painful incidents. So as the PT is handling the latest traumatized limb or area of my body, I imagine that it is freaking out as she drags it kicking and screaming to re-visit the motions of the injury - except this time to do it correctly, safely, and in a way that won't put me back in fiber glass for another 3 months.

Several weeks later it'll be completely different:
"Wow! Look at that! See? I knew you could do it all along! You've re-gained complete range of motion in your leg again!" They are always right in the end, in my experience anyway.

Every physical therapy session I have attended is always a test to see what my body is capable of. It's probably because of the nature of the OI that this in of itself sounds so terrifying. Because usually when I have inadvertently learned what my body is capable of, it results in an injury, some painful fracture. So as I'm laying on the blue mat for 45 min at a time, I am usually trying desperately to be as mentally positive as possible - anything to make the flexing and stretching easier on me.


On Physical Therapy:

• I have yet to meet anyone who looks forward to attending physical therapy sessions. It isn't supposed to be fun! Having more realistic expectations of what PT is meant to accomplish can make the struggle less challenging
• As I have gotten older (both in part from the lectures my PT/ortho gave me, and from personal experience) I have learned that the rehab time following an injury is just as important as getting a cast on in the healing process
• Regularly including PT in the fracture management process helps young kids understand that rehab and PT are not separate to fracture care. Just because your leg is no longer in three pieces, or just because you have the cast off and everything feels fine - doesn't mean that we are in the clear
• PT sessions are not just limited to regaining range of motion or strength. There have been many instances when my body has gotten stronger than I expected it to, when I came out of PT more physically independent than I thought was possible. 
• And you know what they say, no pain no gain!