An apology and an explanation (11 broken ribs)

Firstly, an apology.

I really should have explained this one a while back.  So I will apologise now for not having done an update recently or have explained why since November last year I have been a little less active in getting posts gone.

So what happened and when?  Back at the tail end of October last year, I took what I thought at the time was another one of those falls.  I regularly fall.  I have done ever since L5-S1 had a catastrophic failure (to quote my UK senior consultant) and left me with 90% loss of feeling and use of my right leg, over night.  That happened on 5th November 2014.  An easy date to remember.  I finished a telephone conversation with Stuart, put the phone down on the drawers at the top of the stairs and turned to walk away and it went.  I fell and stayed where I was in agony until Stuart got home a couple of hours later.  Several surgeries later and my fighting and physio on my behalf and I have recovered roughly 80% of what I lost.  I still don’t have great feeling in the leg, and there is some loss of sensation as well.  Most of that is around the knee area on the outside, but there is some on the underneath of the foot as well.  I find the leg gives way on me and my balance isn’t always what it could be.

I used to fall +10 a day.  Now I only fall maybe once every 10 days, finding the ground type fall that is.  I regularly catch myself and prevent a fall by always having something to hand (a wall, a piece of furniture, Stuart etc) and generally when there is not something like that, or I need to sit for any length of time, I am in the wheelchair.  It is less painful, it is faster and I can go further, do more and generally not worry too much about falling.  When speed and distance is not an issue, I use the crutches but that is slow and difficult at times and has caused issues with a bony (?) growth on both elbows.  One crutch is now padded out with water pipe insulation which has helped considerably.

However, around the house and gardens, I don’t use the crutches.  And the wheelchair is simply not practical because of the layout of the house, the steps in and out of just about every room and the fact that it is on the side of a mountain.  What is the ground floor at the bedroom end of the house, is the first floor (or would be if there was something underneath it) at the chook house end of the house.  There are in fact stairs leading down to a very small ‘cold’ room and a way out of the house which now has the door always open and a mesh screen on it for ventilation without chook or snake access into the house!  I only use the wheelchair in the studio for something to sit on because I actually find it more comfortable that any chair I have yet come across and unlike any other chair I can sit in the wheelchair for more than 60 minutes without ending up in agony.  So the wheelchair is my desk chair at home, and the desk is height adjustable (from IKEA) for that very reason.

So what happened at the tail end of October last year.  Well I took another fall.  I knew straight away it was worse that others.  I got almost straight back onto my feet and did the usual pat down to check for damage.  I found some.  My right knee was bleeding badly and it was clear it was not going to stop without me sitting down and sorting it out.  It also needed a very good clean up if it was not to get infected.  I had fallen on a soily patch of ground where the path I had been using was undermined by water running off the mountainside and exposing the large rocky slabs that make up the paths around the garden.  I had also winded myself and grazed my abdomen.

I went back into the house to assess my knee.  It was bleeding well, so I let it continue to bleed.  It was a good way of flushing bacteria and the likes from the wound.  And I needed time to prepare some Dettol solution up to flush the wound properly.  Cleaning the wound up, two things became obvious.  One was that the skin was missing to the bone and two was that it was a sizeable piece of skin missing – roughly 2cm or almost an inch in diameter.  It was nowhere to be found in my clothing.  It had simply gone, not that anything could have been done with it, but even so, it vanished without trace which was perplexing.  I had had tracksuit bottoms on, but the wound was still full of soil.  I showered it off under the shower, then copious quantities of Dettol was used to clean the wound out.  It never hurt once and never has done.  There was little feeling to be had there anyway and the wound itself removed anything else, but still flushing and cleaning the wound should have hurt.  It didn’t,

Once I had done that and got a dressing on it, bandaged the leg and got ice on it and elevated it, I rang Stuart.  He couldn’t come home, but said I sounded OK.  However he still rang me every 20 minutes to check I was OK.  I hadn’t banged my head, and there were no scratches or bruising to indicate that I had.  It was just shock and the winding that had taken its toll.

The next few days were basically spent me doing nothing.  I felt desperately guilty about it, but I simply couldn’t.  I was in increasing amounts of pain for now obvious reason and 6 days later, gave in and made an emergency doctors appointment (well Stuart made it because he has to take the time off work, come home pick me up and take me there, so it is better he knows what time it is and he knows when he has meetings he simply can’t get out of and ones he can rearrange).  The doctors appointment resulted in a considerable increase in my morphine dosage and a chest X-ray.  Fractured ribs were suspected and they wanted it confirmed if possible.  We went that afternoon and got the X-Rays done.  The radiologist confirmed there and then that there were fractured ribs.  L6 & L7 were visible down the outside (where the collar bone meets the shoulder – there is a name for it, that line down the side…) And she thought that there was at least one on the right hand side.  The report (by a consultant later that day) confirmed 2 broken on the left and suspected another two on the right at R7 & R8.  A week later I was back for another set of X-Rays because the pain was increasing not decreasing.  One of the right hand side ones was confirmed, and the other ‘suspected’.

We were up to 3 confirmed and a 4th suspected.  But this time round the heart was said to be enlarged, so my normal doctor (whom I saw for the report on the 2nd x-rays) requested a heart scan to be done because my legs were also swollen and she was concerned.  Now I have high blood pressure, I have done since my twenties and one of my meds (bendroflumethiazide) is not available in Australia so I have had to change to another and we suspected that it was simply a case that the dose may not be enough rather than there being a problem but she wanted to play it safe and rule out any possible heart problems.

The scan was scheduled and went ahead, but I had to lie on my left side.  Lying on the left side wasn’t a problem, the problem was getting back up again and that is when the pain started again big time.  I suspect I rebroke some of the ribs on the left side at that time.

Now I had been and still am having, problems lying down.  In fact I couldn’t lie down without help and certainly couldn’t get up again without assistance because I couldn’t roll onto either side to get up with my bad back as well as the broken ribs.

And we had to change how we did things.  Stuart started doing the shopping alone.  I simply couldn’t manage to push myself around in the wheelchair, let alone sit in the car along the track repeatedly.  I stayed at home for several weeks only venturing out for doctors appointments and X-Rays.  I was improving but only slowly.  I had had to rearrange my initial pain management consultants appointment.  I wasn’t up to it, couldn’t face it and couldn’t travel to Canberra for the appointment either.  I was also on much more morphine for acute pain and this was meant to be an appointment for chronic pain management (and I suspect to convince me I didn’t need the morphine).  In fact my morphine dosage had tripled at the insistence of my doctors surgery.  They wanted my pain under control from the rib fractures.  I was in more pain than I should have been but X-rays were only showing the 3 confirmed fractures.

Christmas and the New Year passed and because my morphine dose was coming down and the pain was getting better, my doctors were happy to carry on monitoring things.

During the 2nd week of the New Year, I had that initial pain consultants appointment and he ordered some bone scans and blood flow scans done.  At my request he tagged on to the request for the left rib cage to be scanned, specifying the broken ribs on that side.  It seemed like a good idea to me.  I know that the scans were there to determine that my pain is all nerve pain from morphine usage and withdrawal (I have been on morphine for over 2 years now and have been slowly reducing it as I improved, but I also know that I have reached a level where I can’t get below without being in a lot of pain and keep being told about nerve pain from morphine withdrawal.  I’m not stupid folks.  I have been through chronic pain before.  I know the difference between real acute pain and low level nagging chronic pain… but the medical profession (at least in the UK) don’t want to hear this from a patient.  We are not meant to be intelligent.  We are not meant to know what is going on.  And we are certainly not meant to not get better.)  The pain is real and I know that the acute pain I get in my lower spine, to the sides on each side, and the spasming in my right leg (all of it but in particular the calf and foot) are real – they are not imaginary) . Anyhow, those are the thoughts that crossed my mind.

So I went for the scan.  It involved 2 appointments.  One for an initial injection to make me radioactive for a while and a scan there and then to show the blood flow.  And then 4 hours later for another scan.  It was the second scan that was to prove interesting.  During both scans I got to see a screen which showed me a much smaller version of the scan results.  It was obvious what was being shown.  Certain areas of my body had much higher concentrations of the radioactive isotope than others.  And they were all the areas that hurt, and some others which I have had issues with in the past as well (like my left wrist, the RSI in my right wrist, the base of my neck etc).

4 hours later, the scan results were in colour.  They are like a rain radar map.  Almost exactly the same colour scale, so it didn’t need much to understand them and given that I come from a scientific background and am not daunted by IT and technology, it was easy to see what was going on.  Again all of the hot spots (now bone rather than blood flow and inflammation) were areas that hurt me.  But it was the rib cage that was exceptionally interesting.  In fact it was that interesting that the radiologist (? he could have been the consultant, but until I see a copy of his report (I only have the scan results on disk) I won’t know for definite) came in to ask me about the fall and the broken ribs.  I told him 3 confirmed, a 4th suspected, but personally I felt that there was at least 5 simply because of the areas that hurt me.  He said he thought that there were actually 10, possibly 11 and could he do another scan because he would like to see exactly how good his equipment was and help me out at the same time.

10 confirmed fractures and an 11 probably was how it was to stay.  But at least now we know why I have been in so much pain and why little things like lying down, sitting up, getting out of bed etc have been so very painful.

I had to see my doctor later that day (an evening appointment) for some more repeat prescriptions and co-incidentally some more morphine.  Stuart was able to confirm what I told her, and by some luck, the report had already been done (we had only left the clinic some 2½hrs earlier) and was sitting in the surgery’s inbox waiting to be filed under my name.  After she had read it, there was no problem with a slight increase in my much reduced morphine dosage and getting more morphine at all.

I haven’t yet see the pain consultant again, that is not until the beginning of March, but I know from what I can see on the scan results that any thoughts of my pain being morphine withdrawal pain is not the case.  My pain is real and strangely being in agony over +10 broken ribs was also real.

For those thinking osteoporosis, the answer is no.  I had had a DEXA bone scan done roughly a month before my fall and the results showed that whilst I do have below average bone density in my left femur (-1.7 on whatever the score is which is much improved from the -2.1 a few years back). The rest of my body including my lower spin and hips are above average for my age and weight.  These scans are done every 2 years because of my hydrocortisone (steroid) use for adrenal insufficiency (partial secondary Addison’s brought on by my beclomethasone (steroid) use for my asthma).

The first image shows the ‘hot spots’ in various places.  They are the ribs.  The second image and onwards also shows the ribs, but some of the hot spots are also my vertebrae.   The scale is similar, only it continues from red into white…  The whites are the OW zones, that HURTS…. or probably phrased slightly differently….

 As you can see. 1, I hurt and 2, I did a good job!  My spine doesn’t look great either.  My wrists are as expected (I had a fall twenty odd years ago that resulted in 11 ops on my left wrist and the removal of several nerve segments to reduce the pain I was in.  Reducing the pain I was in, didn’t actually deal with the cause of the pain, but that wasn’t and still isn’t possible.  I have to live with it.), and my lower neck is as I expected but I suspect new to the medical world.  But at least I know now where I stand.

I hurt and there is a reason.  That is good enough for me.

So, I have been off my feet for the last couple of weeks, resting and trying hard to deal with the heat wave we are having without the benefit of air-conditioning.  It has been as high as 39°C, with many days, too many days well above 35°C.

We have had a couple of ‘Extreme’ fire risks which are a put your fire plan into action level (level 5 out of 6) because there was a fire locally.  It burnt out 3,500 hectares (that’s roughly 8,750 acres) but for the most part the wind was blowing it away from me (mainly).  There was another which was upwind of us but that was very quickly brought under control.  The big one was caused by a bird flying in to power cables and electrocuting itself.  The feathers presumably caught light and the rest along with the bird is history or toast.  You really can’t do anything about that.  But on days when the wind is OK and the fires were blowing away from the house, then we were simply packed with a suitcase ready and a list in red on the blackboard of the extras to grab.  Capital letters represent the stuff we must pick up, lower case is niceties.  On days Stuart was at work in Canberra and it is level 4 out of 6 (that’s only ‘severe’ not ‘extreme’), then he gets the car, but if he is away overnight then I take him to the airport so that I have the car just in case.  If it is level 5 out of 6 (extreme), I take him to work no matter what so that I can get out if it comes to it.  We had dropped back down to moderate (level 1)  for a few days, but then started creeping back up.  We are back to level 3 again today (down from 4 yesterday – I had the car because he was away and I had plans to see a friend), but we are in the middle of a heat wave and drought apparently and the oh so often heard phrase, ‘the weather is not normally like this’ or ‘this is really unusual this year’ etc…

We have 2 new chooks who I will introduce to you over the next few days – 2 beautiful pullets who should start to lay in the next few weeks.  The 2 chicks are still with us.  CC has yet to decide that they are old enough to live by themselves in the flock so until she does, we won’t pass on the confirmed rooster.  The other we suspect may be a rooster as well, such is life, but until we know for definite we won’t deal with that issue.  The two new pullets (I was hoping for older birds but it wasn’t possible) are to spread HP thinner.  He only has 5 girls to mate with at the moment and some of them are getting too much attention and it is causing a few issues!

We have been to see Stuart’s cousin which I will write about in the next few days/towards the weekend.  We enjoyed that visit last weekend and as you can see, I am getting more mobile and in less pain, but…

We have plans for Stuart’s 2 weeks annual leave in March.  We hope to get camping, but only for a couple of nights at a time, then home again (back to the bed we know I am OK on), then move to somewhere else and a few nights there etc…

We have another house inspection coming up next week (a week tomorrow) so I need to get some planting in the garden sorted, some tidying big time and the house vaguely clean which when the wind is blowing a gale, the ground is bone dry and the dirt in the air visible is easier said than done.

And I have finally finished the monster blanket which has become a bedspread.  More on that later.  The next blanket has been started.  This one is only 200 stitches and is for the settee to match the bedspread.  I will then knit another (100 or 75 stitches) to go over my legs when using the wheelchair so that the car rug can stay in the car.

I’m going to leave it at that because I am exhausted and just have to accept that my body wants sleep and needs sleep, so I sleep when it wants it, which seems to be all of the time at the moment, but I have healed more in the last 2 weeks since knowing the results that I have in the last 2 months.  So that can only be a good thing I guess.

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