Tibia mostly healed, Physical Therapy, out of bed, foot blister slowing up recovery, sadness and loneiness

Well I am out of bed and I would like to stay out of bed, except for sleep time, that is.  I am reading that it takes up to a full year for a tibia to fully heal, but three months to be able to bear weight.  After two months, my orthopedist gave me a boot to put on, but I couldn't stand with it.  Something was going on with the bottom of my right foot [the side of the fractured tibia], but I didn't know what it was.  Well, I was distraught thinking that I still couldn't stand and in the back of my mind I thought maybe I would never be able to stand again.

The next morning, the aide on duty went to clean the bottom of my foot and noticed a blister, right in the spot where the cast ended. So it seems that the rough edge of the cast was apparently rubbing against the skin.  I had an appointment already planned that week with my primary doctor and she looked at it, told me to see a podiatrist, and gave me a light antibiotic in case it was infected.  The day I finished the antibiotic, I saw the podiatrist who said the blister was not infected despite th pain and there was nothing serious doing under the blister.  But it would take a few weeks to heal.  He lanced and drained it and I had weekly visits for the next month until it totally healed.  Needless to say, I was in bed an additional month.

Finally, I am standing almost as well as I did before the injury but I have home physical therapy to exercise the leg to strengthen the joints around the tibia like the ankle and knee.  When you're in bed for more than three months, the muscles atrophy and have to be "woken up" again.  All in all, I was lucky that this happened during the cold winter and apart from doctor visits, I didn't have to go outside.  Going outside for the doctor was difficult, since my toes were exposed and sticking out of the cast.  One time, we missed Access-a-Ride because we were fighting with a too-small elevator coming out of the orthopedist's office.  There was no courtesy phone call; she just pulled away right in front of my aide.  And when the aide ran after and caught up to her at a red light, she [the driver] refused to come back around or wait.  So we walked from 66th and Second Avenue to 60th Street to catch the Q60 MTA bus and my toes froze.  Luckily we were near the Q60 that goes from Manhattan to Queens.  But then we had to walk/roll from the bus stop to my apartment, toes exposed again.

There's nothing that gets you thinking and reflecting more on your life than being stuck on your back in bed.  And there is nothing lonelier. I really found out who my friends were and they were few, but I consider myself lucky.  More on that later.  I also have certain emotional addictions [more like obsessions] that reared their ugly heads during this time, and I had to pull myself off social media in order to not feed into those addictions.  Social media can be very dangerous for me, especially when I can see the wonderful fun other people have and how they are surrounded by loving friends and family.  Not that I wasn't lonely in my healthy able-bodied days, but I could get out and do something about it.

Month three of broken tibia and blister woes and wheelchair cushion problems

So it's coming in on the home stretch of the three months of recuperation from my tibia fracture. I enter to my two month follow up at the orthopedist and he removed the shorter cast? Which went below the knee. This was an improvement on the first cast, which went well above the knee so imagine my delight when they cut off the second cast and gave me a boot thing aka soft cast -- and told mr I could stand using this new improvement. I couldn't wait to get home and do all the things that the ability to stand, allowed me to do.

That happiness was short-lived, however. I tried to stand and the leg with the broken tibia produced the most blood-curdling yelp when I tried. Something was going on with the bottom of my foot and it wasn't good. Was it something wrong with the bottom of the boot? I had no idea. Not to mention that the good leg wasn't perfect either. You see, after two months of lying in bed, my muscles had atrophied and needed building up again. I realized how important it is for me to have physical therapy. Suddenly, my aide looked at the bottom of my foot and saw a huge cyst-like blister.  Oh hell, I thought. Great!! I happened to have an appointment with my internist a few days later and she looked at it and said it seemed infected nd gave me a one-week round of Amoxicillin.  She doesn't like to give antibiotics recklessly and for that I love her.  So I loaded up on probiotic capsules and drank kombucha to compensate.  And I made an appointment with Aadvanced Foot Care, who had solved my plantar fascitis many years ago.  The podiatrist determined I didn't have an infection, but a pus-filled blister.  He lanced it and told me to put bacitracin on it and see him in a week.  It improved but still hurt.  I went yesterday again and he said I could try putting my weight on it.  So when I came home and had to use the commode, I decided to try.  My aide had trepidation, but I did it!! It wasn't great and my leg muscles have atrophied somewhat with three months of bed-rest.  I have a prescription for physical therapy to help me build the muscle, and I also found a website with exercises for a post-fractured tibia.  I have to decide if I want to go outside for PT or have home PT.  I have had both and each has its pros and cons.

Then there is my wheelchair cushion.  When you're sitting in a wheelchair upwards of 16 hours a day, a comfortable seat is very important.  An uncomfortable cushion is painful and can cause skin breakdown and pressure sores [the bane of all people with disabilities].  I recently got a Roho cushion, which has waffle-like compartments filled with air.  It has to be regularly inflated to ensure enough comfort.  Well, one morning, we found the valve on the floor; it had come off the cushion.  A Roho cushion that cannot be inflated is useless.  In almost no time at all, my cushion deflated and of course the wheelchair vendor technician came to my apartment and confirmed that the cushion was not fixable.  So I am in the waiting period for the insurance process; this means it could be several weeks before I get a new Roho cushion.  I thought about buying a standby extra cushion -- $350.00 -- I don't think so.  The ALS Association will come to my rescue some time tomorrow with a loaner cushion.  Their loan closet has saved me many many times.  One thing I have learned to get used to is a waiting period for any wheelchair repairs or components often exceeding six weeks.  A real pain!!  Since it's painful to sit in the wheelchair with a deflated cushion, I would still find myself stuck in bed.  Instead,  I have learned from these three months that it's beneficial for me to have a couple of hours of "bed time" each day for the post-thrombotic period [after deep-vein thrombosis, or DVT].  Below is a picture of a Roho cushion.  You can see the "waffle" air compartments.  It's considered the "Rolls Royce" of cushions and is not just for wheelchairs; it can help anyone who can benefit from better weight distribution and to prevent pressure sores.  It is great for old folks who might not have a lot of butt padding and compromised back muscles.

My Life Mostly in Bed [Cleaner Than it Sounds] With a Broken Tibia

I have now spent my first month mostly flat on my back in bed.  Unfortunately, this isn't as fun as it sounds.  I am sadly alone while in bed -- what a waste!!  But I have to spend at least another month in this position -- and sadly alone.  I went for my one-month followup with my orthopedist Dr. Radnay and he is pleased with the way my tibia is healing, but not confident enough to let me go cast-less yet.  So I have graduated to a hard cast which stops below the knee; this is a slight improvement on the hard cast I had going past the knee.  At least now I can bend my right leg at the knee -- for what it's worth.  I still can't get into a shower and wash my hair.  Trust me -- dry shampoo doesn't cut it, and for reasons I will elaborate further below, it's not really practical yet for me to go to the salon to get my hair washed.

First, let me state the [seemingly] obvious.I cannot stand or put any weight on my right leg.  And to stabilize the break as much as possible, I have to stay in bed as much of the day as I can.  This usually means coming out of bed in the morning for a short time for breakfast and medication and then back in bed for the rest of the day, unless I have a visitor or a doctor appointment.  I can't go tootling around the neighborhood, especially in cold weather.  My right foot is exposed and I don't have a sock big enough to go over the cast.  Also, traveling in the wheelchair is damned uncomfortable because, without a shoe, the right foot will not stay on the footrest; so my right foot dangles and I have to tilt back enough so it doesn't drag the pavement.  When I tilt back enough, I can't really see where I am going and certainly cannot see what obstacles await me on the ground.  So, in the tilted position, I am prone to getting stuck in holes and cracks in the pavement.  Another accident is just what I don't need.

I also have to ask for every little thing I need.  Thanks to the ALS Association's loan closet, in my second week I borrowed a hospital-style tray table.  But if I put my laptop on the table I can't have a beverage close by or I risk spillage on the keyboard.  So every time I need a sip of tea, I have to ask the aide, a well as every little thing that isn't already on the table.  They don't think I see, but I catch eyes rolling out of the corner of my eye. And the laptop - did you ever try to type on a laptop in bed on a tray table?  I can never quite get the head of the bed in a good enough position to comfortably type on the keyboard.  And, for the best possible position, my head has to be far back to the top of the bed.  I don't have to be reminded that I need to drop weight, but every time I ask the aides to move me up on the bed,  I can sense their pain.  The most private and intimate tasks I will leave up to your vivid imagination. But tooth-brushing is a mess, and sometimes eating and getting the food completely in my mouth is harder than you can imagine.

Thank goodness for Cindy and Nancy who have been assisting me with organizing and clearing out the clutter in my apartment, especially the cardboard boxes.  In case you didn't know, cardboard attracts cockroaches, because they like the taste of the glue that holds the boxes together.  I bought storage ottomans to store some of the clutter and one of my aides and I went through some of the drawers to make up donation bags for some stuff and throw out other stuff I couldn't donate.  Nancy painstakingly put together the cart fro, the box that was the tibia-breaking culprit.  Who needs a man? [although a man would be nice too].  And Cindy helped me with more clutter and gave me homework: I am to go through my file cabinet and bags of papers and put aside what I need shredded.  On March 17 [St. Patty's Day], she is coming to collect shreddables and bring them to a friend who has an industrial-style shredder.  I actually have a load of stuff more than 7 years old to shred and make room in the filing cabinet 

There is a good reason why I have more room in the apartment, and I will give more details next time.  Right now it's time for me to go back to my bed where it's difficult to type. Future projects:  paint the apartment, get a couple of new appliances, and move some other things around.  These things increase my visit-ability, but this is an ironic twist, because as I will extrapolate in future posts, less people have been visiting lately. You win some and you lose some with ALS, although it is easy to lose some and harder to win others.  Back to my bed -- unfortunately, alone.



 

2016 Started With a Bang -- to My Tibia , Cast Over My Knee, Bed Bound-- Forced to Sit Still for Three Months

It started with a box that came from Target.  It contained a 3-tier metal trolley that I could load things on, things that have been sitting on top of my dresser and causing ugly clutter; things like creams and cosmetics and nutritional supplements.  But I couldn’t find anyone willing and/or able to put the trolley together.  My building porter agreed, and I planned to give him an extra $20 to do so.  But then Juan was promoted to building super and found out what a busy job that was, and just didn’t have the time to do it.  So, in the meantime, my aide Cheryl found a cheap plastic trolley for $10, which I used for my BiPaP ventilator and there wasn’t any room for anything else.  So I would still find use for the Target trolley, but decided I would return it.  But when I checked the website for the receipt, I learned that the trolley was an “unreturnable item”.

So the box sat on the floor, where it still sits now.  And I went to get something off the top of the cluttered dresser and didn’t realize how fast the wheelchair was going and banged my foot on the box.  My knee bent and I heard what I thought was a crunch, but figured I just twisted my ankle and it would get better.

On Saturday January 16, I had some pain when I did my usual “stand and transfer”  but I assumed it would get better and it seemed to.  By Saturday night my aide was using a “u-sling” for transfers because it doesn’t require me to stand.  My leg was so painful I couldn’t sleep that night.  Because I am taking the blood-thinner Xeralto, I cannot take any NSAIDS [like Advil, Aleve, aspirin or Motrin], so that leaves Tylenol, of which two extra-strength caplets barely took the edge off.

By Sunday afternoon, I knew I had to go to the local ER [North Shore/Long Island Jewish Hospital in Forest Hills] about six blocks away from my apartment.  But I couldn’t drive there myself because I had to tilt the wheelchair back to raise the painful leg, and that’s not a good driving position.  So we called one of the volunteer ambulance corps and they referred me to another team because they thought I was going to Cornell.http://nyp.org/facilities/weillcornell.html  The second team brought me to the basement and we waited for one of the EMTs to come around with the ambulance.  Two hours later, after the ambulance wouldn’t start, we were ready to go six blocks.  We made the initial call at 2:00pm and reached the ER door at 4:30pm.  I was done by 6:30.  I had x-rays and the doctor [Dr. Rachel Morris, who was wonderful] told me I “broke a bone in the foot” and gave me the option of staying there overnight to be seen by an orthopedist the next day, or go home with painkillers and see an orthopedist of my own choosing.  Now I knew that the next day was Martin Luther King Day and there was no way I was going to be seen at that hospital by any kind of decent specialist on MLK Day.  I chose to take the painkillers and go home and call my doctor at Cornell on Tuesday morning.

My friend Debbie Wolfe called my primary care doctor -- Dr. Susana Morales -- at Cornell and I was referred to Dr. Craig Radnay,  an orthopedic surgeon on East 66th Street that Thursday.  Dr. Radnay’s office took their own set of x-rays and they showed I broke my TIBIA [pictured above]!!  As it is risky for an ALS patient to go under general anesthesia, he wants to see if the bone will heal without surgery.  So I have a hard cast up to just past my knee.  I am to be in bed as much as possible, and keep transfers with the lift to a minimum.  So here I write this with my limited time out of bed at my laptop.  I spend about half of my waking time in bed.  Those who know me, know that’s not my style.  I am learning how to watch TV on my mobile devices.  Truth be told, I am most comfortable in my bed covered by my warm comforter and with my legs elevated.  

I am scheduled to see Dr. Radnay again on February 11, and I am hoping and praying that the  bone is healing with the cast, which I am predicted to wear for three months. I am also in less pain while in bed.  Starting today, I reduced myself to ½ Oxycodone every 4-5 hours.  Oxycodone makes me very sleepy and one of it’s fun side effects is constipation.  So I will give regular updates; in the meantime, please keep me in your thoughts and prayers for a quick recovery without the need for surgery.

By the way, Chelsea is staying in a wonderful home while I am recuperating….More on that next time.  But so far, she has met a bunny couple and a very inquisitive cockatiel…….pics next time too.