Femur, Interrupted

So, here's what happened. On Friday evening (Feb. 1) I was in a group lesson on James. My recollection is that he was a little squirrelly about steering as we cantered right, maybe because he didn't like the puddles. Anyway, I didn't see what, if anything, set him to bucking. I don't think I had much of a chance: he launched me pretty effectively, and I came down on my left side, basically landing on my thigh. Right away I knew I wasn't going to just get up. The muscles in my left leg simply weren't working. It was pretty clear that the rest of me was okay (my head never even came close to the ground, my right leg seemed to be fine, and my left arm wasn't involved in breaking my fall). The thing is that any attempt to move my left leg at all resulted in excruciating pain. But I could wiggle my left angle and move my left toes, so I was still thinking this was just a really bad injury to the muscles. Big thank-yous to Carrie, Dee Dee, Carol, and everyone else who helped with keeping me comfortable and helping to get the paramedics out to me. The paramedics put me onto a board to move me, and there was some pain involved. Once we got into their truck, they started to cut off most of my clothing and gave me something for pain. I recall explaining very clearly that they did not have to cut off my boot, they just had to make sure the zipper was all the way down. They engaged in a discussion about whether I was a candidate for a field traction device known as a "Sager". It wasn't until this point that I realized they were quite certain the leg was broken. Anyway, they said the Sager could reduce the damage done by the bone ends and would also help reduce the pain, and I told them to go for it, so they went ahead and hooked it up. Then we headed off to the Stanford ER.

A Scale of 1 to 10

Before we even headed for the ER I had to start answering the question that would be the question of the week: how is your pain on a scale of 1 to 10, where 1 is none at all and 10 is the worst pain ... wait! Is it the worst pain you've ever had? The worst pain you can imagine? The worst pain you can imagine staying conscious through? If you find out for sure, let me know. I learned eventually that my answer had to be adjusted to meet expectations, so I didn't really answer based on my 1 to 10, I answered based on "this hurts pretty bad and I could use something for the pain," which seemed to be 3-4, or "this really hurts and I need something for the pain now," which seemed to be more like 4-5. Knowing that clinical studies of pain medication also use this kind of unscaled self-reported pain as data doesn't do anything for my faith in pain medication research. Somewhere along the line here, one of the paramedics was running down a summary of my status, and he said that I came off a horse and wasn't wearing a helmet. I got very indignant (at least, that's the way I remember it), saying, "Of course I was wearing a helmet. We took it off before you got here! Do I look like an idiot?" Okay, I can't swear that I actually said that last part, but I was thinking it.

Wet Behind The Ears

At the ER, the doctor looked awfully young. He looked at radiographs (yes, I will post them when I get copies) and said I had a spiral fracture of the femur. He explained that they needed to apply traction to my leg, so he'd be drilling a hole through my tibia just below the knee and putting a pin through it. Apparently this is better than doing it from the outside (with an ankle cuff?). After a nice big shot of lidocaine, he proceeded to drill a hole through my leg, which was interesting because it was like being at the dentist and feeling him drilling into your teeth. There wasn't any pain, but I could clearly feel that he was drilling through my bone. I didn't get to see any of this part, which is just as well. But I felt them attach the weights to me. I would be in that position until 8:00 am the next morning, when they actually performed surgery. (The thing I remember about that night is that I would drift off to sleep and wake up whenever my leg muscles decided to spasm. Not the best night's sleep ever.) Speaking of young doctors, the ones I interacted with during prep for surgery definitely were wet behind the ears. One thing I noticed is that having previously told them I'd never had any major medical problems, when I told them I had spent my fair share of time in hospital rooms, they looked confused. Clearly, they were too young to be dealing with parents' health problems yet. One of the joys of being at a university hospital: When I told the doctor that my major anxiety was not about the surgery itself but about general anesthesia, he assured me that things are much better than they used to be. In fact, he said, if a young healthy adult like me were to die, it would be so unusual that they would write a paper about it. Good to know my death would be publishable. So I went into surgery around 8:00 am Saturday and the next time I was aware of a clock it was 1:00 pm in the recovery area. The doctor said the surgery went well, and before long I was ensconced in the (private!) room that would be mine for the next five days, along with a PCA (patient-controlled administration) drug system giving me hydromorphone ("Dilaudid"). My primary task was to push the green button when I wanted more drugs and periodically wiggle my toes, flex my ankles, and confirm that I could feel when my toes, instep, and sole were touched. (And when I say "before long" that is almost before Michelle even knew that I was out of surgery.)

Percocet and Me

I think it must have been Sunday morning that I was switched from the IV pain drugs to Percocet (oxycodone and acetaminophen). Percocet did not like me. Thankfully, none of the pain drugs I used caused me nausea, which is all too common for the whole narcotic family in some people. But Percocet just made me feel crummy: I felt like I had a fever even though I didn't, it destroyed what appetite I had, and it made me wish I could just sleep through the next few hours instead of experiencing them. I put up with it because I didn't really understand that there were alternatives I could try, and it turns out that Lortab (hydrocodone and acetaminophen, aka Vicodin) likes me much better. Oh, well. I'll know next time.

Out Go The Lights (part 1)

On Sunday, the cheery team from occupational and physical therapy showed and assured me I'd be skipping down the halls (without putting any weight on my left leg, of course) in no time. I was dubious, but they said I'd have a lot movement back within a week. Following their directions, I skooched over to the side of the bed using my arms to propel me and lifting my butt off the bed. We got to the edge of the bed with my legs over the side and I was basically sitting up. All was good. I just needed to grab the walker with my left hand, brace my right hand against the bed, and push with my right hand and leg to get upright. It went really well. Then I fainted. I only lost consciousness for a few seconds. They assured me that fainting on the first time getting vertical like this wasn't out of the ordinary, but it did put a damper on the proceedings. My blood pressure was fine after I fainted, but my pulse rate had been on the high side ever since I came in to the hospital. Later that evening there was an incident where my pulse rate decided to go sky high for no particular reason. It hit 150, and they slapped an EKG on me, but my heart rhythm waveforms were apparently perfectly normal -- just really fast. They gave me metoprolol, a beta blocker that slows the heart rate (my Dad was on this for his congestive heart failure). They also gave me a unit of blood, because of the fainting and a low hematocrit test result.

Out Go The Lights (part 2)

On Monday we repeated this procedure with very similar results. They actually monitored my blood pressure during the process, and it was pretty good right up until I tried to stand up, and right after I sat down again. (I didn't actually lose consciousness this time, but it was close.) Later we successfully got me standing long enough to transfer into a chair, but it was not so great being upright in the chair: I felt dizzy a couple of times. That night I got two more units of blood, and I felt a lot better the next day. (My mother-in-law the nurse said I should feel able to leap over roof-tops after 3 units of blood.) I was able to make it all around the bed and as far as the door.

Where Do We Go From Here?

By now, Stanford was itching to get me out of there. They wanted to send me home with some in-home PT and good luck. Michelle was seriously freaked about the idea and by that time I was, too. The alternative was to discharge to a rehab center (a skilled nursing facility) where I could have 3 days to a week of more intensive therapy in an in-patient setting. We decided that was the most sensible choice, because at that point I couldn't even get in and out of bed without help.

I'm In Rehab, Where's Lindsay?

Stanford looked at places they've had good experience with and places that contract with my insurance, and recommended Los Altos Sub-Acute Rehab. Thursday (Feb. 7) I got sent off with a lick and a promise (well, not really, but I definitely got the sense that Stanford was less interested in me when we decided not to go straight home). So, the average age at a skilled nursing facility is typically going to be on the high side. Most people don't wind up in in-patient rehab unless they're very badly injured or elderly. I was extremely lucky, and got a single room because there were no male semi-private beds available when I arrived. (Lucky because my insurance wouldn't cover the difference.) The one drawback to the room is that it is right next to the nurses station. That means there's a lot of activity and a very obnoxious buzzing display panel that is supposed to ensure that patient call buttons are responded to quickly. (Something is wrong with this design, however, because staffing levels are naturally adjusted to avoid waste, which means no call is ever answered immediately, which means that the damn panel buzzes pretty much continually -- that is, it buzzes once every ten seconds, pretty much all the time except in the middle of the night). My PT (Pat) and OT (May) have been great. They say that my overall good health and strength will make things a lot easier, and that seems to be true. Still ... toe-touch weight bearing means basically standing on one leg when standing up (left leg is only good for balance), and that uses a lot more energy that one might imagine. And two arms are not as strong as one leg, so walking with the walker or crutches tires out my arms pretty fast. But I seem to be able to manage all the important stuff at this point.

Homeward Bound

So, they're springing me from this joint on Valentine's Day, and after that I'll be doing home-visit PT for a while, then eventually outpatient PT. I have a followup visit with the Stanford orthopædic surgeon in a week, and hopefully I'll find out then what to expect in terms of progress.