Saturday, May 25, 2013

Broken Leg Timeline April 15th-May 25th

Sorry about the delay with updating my blog, some online classes have started for me and I've been a bit busy working on those whenever I am on the computer. I am in the home stretch of finishing my degree! I was planning on graduating this Spring, but postponed taking my final classes to this summer due to the craziness involved with moving. The timing for the start of classes in Spring really did not work out. I only have an online English class and a chemistry class to take and I am DONE. Luckily, LSUS offers in-state tuition to military dependents so my chem class is actually LESS expensive than it would have been back home at the college where I am getting my degree. I found that pretty ironic!

Anyways, here is a bit of the story of the follow-up with my leg. On April 13th, a Saturday, I went to the ER. Since my fibula was broken all the way through they were not sure if I would need surgery or pins put in to ensure a proper recovery. A specialist would have to determine this, so on my paperwork they wrote that I needed to see an orthopedic specialist ASAP, first thing Monday morning. Those exact words. They also only put a short-term temporary cast on my leg.

Well, I am on military insurance. Nothing ever works smoothly on military insurance. Ever. Here is the timeline of what has been done so far.

April 15th-16th
Monday morning, I called the base clinic as soon as they opened and they said I would have to see my primary care manager (my main doctor) before I could get a referral to see an ortho. She couldn't see me until the afternoon. They also required me to get the exact same x-rays done at the base hospital due to procedure even though I got a copy of mine from the ER. This is the original x-ray of my leg:

The x-ray above is basically looking straight at my ankle, so the bone on the upper right (the broken one) is my fibula. No, that "S"-shaped crack going all the way through it is NOT supposed to be there. I highly recommend against doing this. The S-shape is basically indicative of a severe twist.

After going through this entire process with the base clinic, they decided that yes, I did have a broken leg (really?) and that I needed to see a specialist. Tuesday afternoon, they put in the referral to see the on-base ortho. Yes, another 24 hours after seeing my PCM they provided the referral. The base specialist's earliest appointment available was the following Monday. Yes, nine days after I broke my leg before a specialist would make sure that it is lined up properly and put in a protective and long-term cast.

On Tuesday night, April 16th, I actually returned to the ER because I completely lost feeling in my toes and they turned bright blue. This was even while elevating my foot above my heart. The ER was worried I might have compartment syndrome, so they took the cast off and did more xrays. Fortunately, I did not have compartment syndrome. The temporary cast they had put on my leg on Saturday was actually wrapped too tightly and was cutting off the circulation. So, that night they gave me a new temporary cast that was tight, but not AS tight and more painkillers. The xrays basically indicated that my leg was swelling pretty badly, and that was why the cast became too tight. Really confusingly, the ER provided me paperwork that basically said all the symptoms I had were reasons to return to the ER.

April 17th
On the 17th, we found out the reason I could NOT get a referral off base was because the ortho specialist on base accepted my case. Since he chose to see me even though I couldn't fit in right away, that meant I could not go elsewhere. If he had decline the case, I would have been given a referral off base right away. My doctor basically told me to go to the ER in hopes that they had a specialist on duty. I feel like that would be a purposeful waste of the ER's time when I should just be getting a referral to go elsewhere.

My husband's commander was really confused as to why I hadn't seen a specialist yet and my husband worked with him to get me through the system throughout the 17th. By the end of the work day, I finally received a referral to go off base. Unfortunately, it was two days AFTER the ER wanted me to go and I received the referral in the afternoon. So, I could not get an appointment until Thursday afternoon. I feel like this would have been a less expensive (for my insurance), less stressful experience if they had just followed the instructions on the ER's paperwork and let me go on Monday. At this point I had been to the ER three times in a few days: the original visit, a visit that night due to a reaction to the painkiller (switched my meds), and the visit on Tuesday (we spent about 6 hours there because they were busy). My husband would have missed a lot less work, too.

April 18th
Of course the day of my appointment it was POURING. So, I had to wrap my temporary cast in plastic bags and TJ had to run into a CVS and get me knee-highs to hold all the bags in place for my appointment.

Lovely, right? It's called improvising! I was lucky in the fact we had a ton of plastic shopping bags in the car we had earlier planned on taking to recycling. 

My doctor at Highland was super nice, but he was really confused as to why it took so long for me to get in to see a specialist. The temporary cast I was in also had my foot turned in slightly and could have led to improper positioning/healing if left on longer. Luckily, he decided I did not need surgery. He put me in a hard cast to protect my leg and keep me from bending my ankle. He then told me to keep my leg elevated above my heart as close to 24/7 as possible and to come back in two weeks. I was only allowed to move around on crutches and only to do things like go from a chair to the bathroom, to the bed, etc. Swelling from keeping it down would slow down the healing process, cut off circulation, and generally be painful. The first week or so really sucked because my leg would swell up in the short time it took to go to the bathroom, etc. The hard cast was SO much more comfortable than the temporary cast. I never thought a cast would feel comfortable, but compared to the original, it was a pillow. He basically told me I'd likely be stuck keeping my foot up for eight weeks along with doing nothing due to the break. He was happy that it was lined up still and the 'gap' was pretty small. Both good news for healing properly. The pain went down significantly from putting it in the temporary cast and I actually got some sleep that night. Obviously it isn't very easy to sleep with pain from a fractured limb combined with weird sleeping positions  involving keeping your leg elevated...

The cast was even a pretty emerald green color!

April 24th
I ended up needed to return to the ortho specialist on the 24th (much sooner than the two week follow-up), because my skin under the cast felt like it was on FIRE. It burned and itched so bad that I couldn't sleep. Well, when the doc put the cast on I had some scrapes that needed patched up and he had applied antibiotic ointment and band-aids to them prior to putting on the cast. I developed a reaction to the adhesive in the band-aids. Little itchy red welts on the front and side of my leg where the band-aids were. No big deal, nothing major. He did remove the cast and put me in an air cast. Most of the time, they do not put you in an air cast until you can put weight on your foot. Some people refer to them as 'walking boots.' It was pretty neat though, because he wrote a prescription for it and then I had to go to this little 'store' in the hospital that had all sorts of casts, crutches, walkers, wheelchairs, etc. The lady working there was super nice dealing with a ton of paperwork for us and fitted me into a boot. I greatly prefer this to the hard cast, it makes it SO much easier to bathe since I can actually remove it for that. I can also open it up and ice my leg (as long as I'm not moving or in danger of being bumped, etc.). So I've been in the air cast for a month now. I've gotta say though, if I go outside on hot days the black, thickly padded cast REALLY soaks up the sun. Good thing I can take it off and clean the inside....

Here's a pic outside the hospital on the 24th with the aircast. I appreciated the close parking for those of us who are temporarily impaired and don't qualify for the handicapped spots...

May 8th
My last doctor appointment was on May 8th as a follow-up. I was given the good news/bad news on the recovery thus far. They took new x-rays, which I got to look at. I do not have a copy of them to share with you, but basically my leg looked a lot like that original x-ray at the top of the blog except the crack was much narrower/almost closed. It was obviously 'filling in' but you could still distinctly see the crack. Which meant I am still helpless. I still cannot start putting any weight on it and have to keep it elevated as much as possible. 

The past couple of days my leg has actually been hurting worse than it has in the past couple of weeks. This is probably due to the bone-growth healing stage. The swelling is down significantly and my foot no longer looks like a bruise rainbow. I can't seem to find the picture I took of my foot when it was really nasty but for a few weeks there from my toes up to above my ankle was a range of colors from jaundice yellow to black. This is a pic of it on April 24th, but it actually got some darker colors around that time as well:

 Most of those colors have faded. I still have a little bit of the yellowing and a couple red spots (I think from pressure from the cast) but other than that it looks a lot better. My ankle is also looking more 'defined' and ankle-like, though the swelling is not entirely gone. 

I had gone without ANY narcotics from about May 5th until yesterday. They help a lot with the pain but I really hate the intestinal and mental side effects I get with them. I even have some strong anti-nausea meds I take with them and they still make me feel terrible at low doses. Unfortunately, I haven't been able to sleep the past two nights without them (even with melatonin and tylenol PM-what I had been taking for sleep). The pain has made my leg way too uncomfortable to continue refusing to take them. Hopefully that is a good healing sign though (the increased discomfort) and my bone is finally really closing up that gap. The pain is much different than it was previously, too. It is mostly discomfort instead of the shooting pain and it isn't from swelling like before. My toes also don't hurt anymore to wiggle around in my cast--so that's exciting! It's the little things ;) 

My next follow-up is next week and I'll make sure to post an update from the doctor on my recovery time. Hopefully I'll at least have a good idea by then of when I can start physical therapy and putting weight on my foot. It will probably be in the air cast for quite a while more. I'm just hoping to be slightly more helpful around the house and able to enjoy summer a little bit more. I also can't wait to get back into working out--but that will definitely have to wait. 

Saturday, May 4, 2013

Mud Fears Me + Broken Leg

It has been a while since I posted an update, but that is because it is incredibly uncomfortable to sit at my computer. I broke my leg and have to keep it elevated pretty high so I am currently in this weird position at my desk where I am sitting in one chair and have a stack of pillows in another chair to rest my leg on. This leads to me sitting at a weird angle with my body turned one way and my leg another. I felt I should let everybody know why I haven't posted, cooked, or done any gardening though.

On April 13th, my husband and I participated in Mud Fears Me.You can read more about it at here.Basically, it is a 5 kilometer long course of mud and muddy obstacles. It was a load of fun--despite the fact that I literally 'broke a leg'! The reason I wanted to do it was because it looked like a blast, I had recently gotten into much better shape than I had been (since January I had lost 5 pounds and was running regularly), and it was something TJ (my husband) could do with me.

The initial challenge was a swim in FREEZING mud water. What a way to get things started! I actually ended up swimming to the side and walking about half the length after I got kicked in the chest by a swimmer in front of me. It knocked the air out of me, and swimming in freezing water is difficult already without the muddy water with shoes and about three layers of clothes. I wore a swimsuit, capris, a long sleeved shirt, plus shorts and a tank top since the morning of the event was cold and I knew I was gonna get wet. It was an incredibly unflattering outfit, but I wasn't really there to look good.
Pre-race photo.

Ready, set, go!

Everybody realizing how cold the water is, but having to jump right in anyways!
The swim!

The next set of challenges showed how important it is to run this event with a partner or team, or at least help out strangers. There was probably a kilometer or so of mud trenches of varying depths (which you could not tell the depth until you took the plunge since they were opaque and muddy). There was a lot of slipping and sliding going on, and the occasional person yelling "Help, I'm stuck!" I got stuck a couple times, and TJ had to help pull me out. One person who ran along us got stuck up to his waist and we both had to help yank him out! It was pretty hilarious. After that stretch there were some obstacles that you would think of as more typical of an obstacle course -- rope climbs, wooden ladders, monkey bars, balance beams, tire climbs, one steep hill 'run' climb, and a few crawling through/under obstacles. All, obviously, covered in mud. There was one steep trench that was really long in the middle of the course that had me doing some 'high knees' to pull my legs up out of the mud. The water went up to my neck and the mud was a little deeper than my knees and probably 30 yards long. That was quite the workout, but that mud was warm so it felt great that morning! Between all the obstacles there was jogging and a few water stations.
I'm in the upper left, and TJ is jumping down on this obstacle. We had to climb up on top of this container and then jump into an 8 foot deep mudwater pit -- then climb out of the pit.

After a tire pile climb, we came over a crest in the course and could see the tents at the finish line, we were almost done! We had once obstacle to crawl under barbed wire - army crawl. I think the purpose of the obstacle was to ensure we were covered in mud head to toe. Then, we had to climb a ramp and slide down into a pit of mud.
The slide -- with the end in sight!

Then there were only two obstacle left after climbing out of that pit: the bridge and another army crawl under nets. The bridge reminded me of those lily pads you see at water parks. Except a bit trickier. They were over a mud 'pond' and were wooden platforms attached to each other by rope and to either end of the pond. You had to really have momentum to run across (a lot of people wiped out in the water). I was basically rockin the bridge, I kept my momentum up running and jumping from each one until I got to the very end.
The fateful bridge.

I jumped off the last platform heading to the land and my foot did not find solid ground. I landed hard on my left foot and slid into the water--I had hit either the edge of the ground or the mud gave way, but either way it came with a severe twist to my ankle. I could not put ANY weight on it and had to be helped up by a lifeguard and my husband who sprinted across that bridge behind me when he saw me fall. I was probably less than 50 feet from the finish line, and only one easy obstacle was between me and it, but I could not finish. The on-site paramedics insisted that I don't move, but they gave my shoe with the timer on it to my husband so he could run it over the finish line (I had already practically finished, right?).

TJ crossing the finish line.

They put my leg in a temporary splint and lifted me onto a golf cart. They then took me to the car, where TJ met us and we then mapped on the GPS the nearest ER: Willis Knighton South. Pretty far from home, but close to the event. Since we obviously could not take advantage of the showers at the end of the race at this point, the car got muddy both inside and out and we were both still soaking wet since we could not change our outfits. TJ put my nice finisher's medal around my neck though, to make me feel better. The entire time the paramedics assumed  I had sprained my ankle. I don't show pain well, but I told them it hurt a lot pretty matter of factually. I am a HUGE baby when I'm nauseous or vomiting and will cry but when I'm in pain all emotion just shuts down and I tend to appear more angry/frustrated or matter-of-factual. My dad actually has accused me in the past of doing this on purpose so the doctors never believe me when I'm in pain. I guess when you just look at them and tell them you are at a level 9 of pain or something they don't take you seriously unless you have tears streaming down your face?

Well, this theme continued in the ER. I went in laughing about it, but when they asked how much pain I was in I said 9 and the nurse basically said if it were that bad I probably wouldn't be laughing, but she gave me some strong painkillers anyways. Then I sent TJ to find a store nearby and buy me some dry clothes because I was FREEZING and the shivering was making me feel worse. When he brought them and helped me change they actually had to change all the bedding in my room because it was soaked through and muddy. I looked like a mud monster or something.

The nurse basically thought I had sprained my ankle until she took off the temporary splint the on-site paramedics had put on me. Her diagnosis of my ankle after unwrapping it (imagine this with a thick southern accent): "Well, honey, that just don't look right!"

I think we can all agree with the nurse that the left ankle does not look right.

TJ had a laugh at that since I basically told him in the car in the past I had torn ligaments, sprained, and fractured bones and I could feel the pain of this was on the end of fracture or worse. I basically 'called it.'

Well, the x-rays came back and the doctor basically asked what the heck I had been doing and agreed that at least the story was good. I had found the perfectly wrong way to land while jumping and managed to fracture my left fibula. Clean break, all the way through.

Since it was a Saturday and they did not think I really needed surgery, though they said it was borderline for some pins, they wanted me to see an Orthopedic specialist FIRST thing the following Monday (i.e. in two days). I believe the discharge papers said "ASAP Monday." I was given crutches, a copy of my x-rays, painkillers, and told to keep my leg elevated above my heart. I also could not get the temporary cast they put on my leg wet at all. So, TJ had to help me wash all the mud out of my hair when we got home.

The temporary cast.

Overall, the Mud Fears Me race was a blast and the money went to a good cause. I would be willing to try another mud obstacle race at some point (there are many different versions with different companies), but I do not think I'll be doing the Mud Fears Me one again. It was fun, but I don't think I should tempt fate with it. Also, some of the climbing obstacles were nearly impossible with the spacing for somebody of my height (5'0"). I couldn't even reach the monkey bars from the top ladder rung. I am looking at a long recovery with the leg though, so I am going to have to basically start over with the getting back in shape and everything. My next goal is to do a color run 5k. In September my husband will be running the Air Force Marathon, and I definitely won't be able to run the marathon but I'll be able to cheer him on. When I told my dad I had a distal fibula fracture his response was "Jeeze, you'd do anything to get out of that marathon!"

I'll continue the story of the misadventures with dealing with military insurance the following week in my next blog post, along with the specialist visits and recovery so far.