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. 

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