Intro to the Big Second Surgery and the CPM

Here I am, day 3 in the hospital, showing a little leg outside of my ever-so-thexy hospital gown. My left arm is inside the CPM machine, which I was strapped into immediately following surgery.

Unfortunately (?), this is the only picture I have of my CPM machine.

CPM stands for "continuous passive motion" and, like it sounds, the machine moves up and down, up and down with my elbow strapped inside. I could control the speed as well as (and most importantly!) how far down and how far up the machine went. The greater the degree of up and down, the more it stretched my range of motion. (At first, I could only move my elbow up and down a few degrees. The goal was to gradually increase the range with the machine, as much as I could tolerate the pain).

The purpose of the machine was to continuously keep my arm moving in order to reduce swelling, get the joint moving as soon as possible and get blood flow to the area to speed healing. Because I had broken a joint, which is much trickier than just a bone, it was imperative that the joint be moving as soon as possible.

Up until this surgery, my arm had been in a splint for 10 days, immobilized from the previous and first surgery. So after 10 days of not being moved at all, and especially following such a high-trauma injury where scar tissue would be fiercely developing, it was even more crucial that this elbow be moved as much as possible, despite the fact that it had, just hours previously, been reconstructed in terms of bone and ligaments.

For three days in the hospital, I was hooked up to the machine for 24 hours. Those three days in the hospital, alone, require several blog entries.

So yes, I slept with my arm going up and down, up and down. The only perk was that the hum of the machine was somewhat like soothing white noise.

In order to endure the pain of the machine, I was not only on some of the best narcotics known to mankind, but had a nerve block going to my left arm, which was, in and of itself, kind of an odd and creepy thing. There was some flexible kind of wire that was poked into my skin, just below my collar bone and then shoved through the muscle tissue until it was touching the brachial nerve (as memory serves). There was some kind of button I pushed on my IV as well to help monitor the pain but it would only give me doses every half hour so I couldn't OD. In my mental state, I can't quite remember all the details, but let's just say all of these attempts didn't quite cut the pain.

Far more painful than the actual fall and breaking of my elbow was the first night I had to sleep with this machine moving my arm. Because moving my arm inside the machine could change the pressure points on my arm from tolerable to excruciating, it meant I couldn't move in my bed all night long. At one point, I did. The pressure point changed and was suddenly rubbing something wrong and that was, by far, the most intense pain I'd felt in my life.

So I'm not quite sure why I'm smiling in this picture. Habit, I suppose. Despite the pain meds, I wasn't "blitzed out," unfortunately.

And the viking hat? That was brought to me by my dear friend Carol Joy- it was a great start to getting this recovery off to the right start.

So this CPM machine, which first became attached to me immediately after surgery, also went home with me from the hospital and remained attached for me for a solid month.

The month of CPM. That calls for its own entry as well.

Shame and Triumph

So I've begun to think more about why I've been blaming myself for the accident.

These days, I think I can sum up my emotional state as:

"I'm still not proud of how I got there, but I am proud of how I got out of it. I'm still somewhat ashamed of how diminished I had allowed myself to become at that point in my life, but I'm intensely proud of- even moved by- the strength, hard work and determination I somehow drew from in order to not only beat the odds, but to break medical statistics and records." 

In this entire process, this 10 month ordeal, it is these two spectrums of thought that make me the most emotional. 

Shame and triumph. 

Let me elaborate a little. 

When I injured myself so greatly, and when I think about the possibility of how much worse it could have been, I just honestly and simply feel like I really failed myself. I feel like I really let myself down.  A part of me really believes that I never would have gotten injured if I hadn't lost myself to such a degree, if I hadn't allowed myself to become so diminished.  I could just have easily hit my head or back in my fall that could have paralyzed me, even killed me.  So, even though I recovered way beyond what anyone predicted, I still feel like I failed myself by getting hurt in the first place. 

However, with the same intensity of emotion with which I hold myself responsible for how miserable I'd become, for how lost and crushed I'd become- and I've always been a person with an intensely rich inner life and emotional landscape- I found equal, if not greater, determination and belief in myself. 

Somehow, maybe out of nowhere?, there was a fire that began to burn in me again. Maybe it was my survival instinct. Maybe I was just so sick of feeling like crap. Maybe I just wouldn't stand for it any longer and so I sure as hell wasn't going to let this accident keep me from realizing parts of my life I dearly loved. Maybe it's *because* I was in such a low- and frankly, shitty- place in life, that I was finally able to say, "That's it.  I'm not staying in this place. It's only going to be uphill from here, I don't care what they say."

However, it certainly wasn't as simple as just setting my mind to success and everything after that was a bowl full of cherries. Not only did I have serious physical healing and rehab ahead of me, but I had unprecedented emotional healing to do as well.  The process was arduous, physically and emotionally-painful and it tried every ounce of resolve and patience in my being. 

But, as I've come to see it, the magical thing this predicament did do for me was to turn my attention completely towards myself. Suddenly, my body needed every shred of care, love, attention, patience, compassion and understanding I could muster. These were precisely the sentiments I could not summon for myself previously. 

So maybe my arm is what showed me how to love myself again. Perhaps it was shattering my left elbow that allowed me to put my heart back together. 

And it was a long, long road with lots of tears and reflection. But cradled by love, love from family and friends and love- finally- for myself, I was able to slowly crawl out from my dark hole and into the light. 

...which brings me to a metaphor that hit me awhile ago.... 

When you hit bottom, say like the bottom of a swimming pool, then you have something to kick off from... you've got that solid surface under your feet, because you sure as hell can't go any lower. From that solid surface (of hell) under your feet, you squat down and take one giant leap- like a springboard. From the bottom of the pool, you can only go up. 

So that's what I did. 

TT-Terminator

I must describe this photograph first. I took home a film from one of my x-rays, held it up against the window in my office and took a picture of it with the camera in my cell phone. This is why you see green foliage and some hands in the reflection, behind the x-ray. Now that we have that clarified....

With all the metal that was surgically implanted in my left elbow, I took on many new names.

Terminator.
Robo-girl.

Robo-Radius.
(for those who know what the radius bone is).

And one of my friends joked that as long as they were putting such hardware inside my arm, couldn't they at least give me something cool in the process? You know, like a retractable Swiss Army knife? A wine bottle-opener? Something Inspector Gadget-like?

While that metal plate and 8 screws came out a little over a week ago, that thing that looks like half of a dumbbell is the metal prosthetic radial head and will be there for life. Or until it wears out.

Now, I've had enough x-rays by now that I glow in the dark. If I had to count how many times this poor arm has been photographed, I'd say it's a serious contender for Britney Spears. Oh, that's right, it's like my elbow has its own medical paparazzi.

There were the x-rays right after the fall ("could you please bend your shattered elbow this way so I can get a picture?") then there were the x-rays taken during surgery to see if the radial head was lining up properly (it was being a real "bugger," I was told), then the x-rays right after that surgery. Then there were at least another 20 taken for the second surgery, post-surgery, all during rehab, then before my third surgery. And I'm sure next week, when I get the stitches out, there will be more photographs.

I guess I need to come up with a special autograph for the "Terminator Elbow, most photographed body part this side of the Mississippi...."

The Snowshoe Brace

Ah, the snowshoe brace!

The snowshoe brace got its name from one of my coworkers, PR, who shows up in other posts on this blog. Because of the metal loop going around my hand, she described it as looking like my arm was trapped inside of a snowshoe.

This was a custom-made brace my OT (occupational therapist) made for me so that I could regain my palm supination and pronation (palm up, palm down motion).

After six weeks of only moving my elbow like a hinge, with extension and flexion, I started working on trying to get palm supination and pronation back. After surgery, my arm had been "frozen" in the position of thumb pointing up. I could turn my palm down a little bit but could barely move the other direction so that my palm was facing up. It took about 4-5 weeks for me to be able to get my palm down enough to begin to use my hand for typing, although my hand was still at an angle, just barely turned down enough to reach the keypad with my fingertips. I became fluent at one-handed typing since I do quite a bit of writing for my job.

So the snowshoe brace was a uniquely grueling stage of the process. I was told by several hand therapists, "Don't expect to get back all of your range. You'll probably never be able to turn your palm all the way up again."

I'll never forget my first appointment with my OT, a peppy middle-aged woman whom I really came to adore. She asked me to set some goals for myself for regaining movement. Granted, this was after I'd spent a month being on a CPM machine ("continuous passive motion", explained in another post) and now was going to be given more exercises for extension and flexion, before the snowshoe brace came into being.

When asked what I'd like my goals to be, I started throwing out things like, "I'm going to sea kayak again, I'm going to climb again." She gave a boisterous laugh and said, "how about, for now, something like being able to put your earrings in?" I chuckled back, "Okay..." feeling a little embarrassed. It was true- at this point, I had so little range of motion, I could not reach my ears to put earrings in, nor could I wash my hair, feed myself or brush my teeth with my left hand because I simply couldn't bend (flexion) my elbow enough to bring my hand up to my face or head. For a long time, I could only get my elbow at 90 degrees down to about 45 degrees.

But yes, my mindset going in was not simply to one day be able to put earrings in again; I was going to set my sights as far as possible.

In terms of numbers, it had been guessed or estimated by my OT that at most, I might only get back about half my range, meaning that my palm would never turn completely up, but only half way between thumb pointing towards the sky and palm all the way up. As a pianist, drummer, climber and aspiring sea kayaker, this would pose a problem.

As I understand it, these sorts of custom braces are rare. Few OTs know how to make them. Most people in my position, with serious reconstructive surgery, end up struggling on their own to regain range of motion (ROM). Being blessed (or cursed) with a trusty stubborn streak, when a particular OT told me that I would probably only regain half my ROM, *if* I was lucky, I looked him in the eye and literally said, "You don't know me very well, do you?" He smiled and walked away.

While I understand that there's a point where a PT or OT is trying to prepare a patient for the worst and not build up false expectations, I deeply wanted a more positive outlook, something closer to, "we'll do everything we can to get you back as much range as possible!" So I became that cheerleader for myself, once again. It's really the only way it works, though- you've got to believe it yourself, that you can do it, no matter how many people are cheering you on.

Here's how the snowshoe brace worked, since the photo is from only one angle: There was a hard pocket which my elbow sat in. Attached to the hard pocket was the metal looped shape bar. Then I had a separate hard "sleeve' which I slipped over my hand and which went up my forearm. Attached to this sleeve were velcro straps which could then attach to the outside of that curved metal bar. Using the velcro straps, I could slowly twist my thumb outwards, forcing my palm to turn up. I could tighten and loosen the tension with the velcro straps within my pain tolerance. I tried to sleep with this thing on but it was too uncomfortable so I committed myself to wearing it 5-8 hours a day.

To recap from other posts, the reason I needed the snowhoe brace was because I'd had complete ligament reconstruction surgery on all the ligaments that surround the radial head. I also had a prosthetic radial head inserted into my radius bone because I'd crushed my own. Since I had a prosthetic radial head as well as all of the ligaments constructed around that, the palm movement was extremely stiff. My surgeon did not want me working at this range of motion for the first 6 weeks after surgery because working on it would stretch out the ligaments he had recontructed and we needed to make sure everything was healed well before working the arm that way. That meant that after 6 weeks of really hard work at extension and flexion, exhausting in and of itself, now I had an entirely new challenge starting from ground zero.

Within the first month to six weeks, as I recall, I think I was gaining about 10 degrees a week with the snowshoe brace. After that, progressed dropped dramatically and it was very challenging to stay positive, especially when I kept hearing each week, "yep, that's probably about all you're going to get." It took 5-6 months to get back the majority of my range; after the initial spike in progress, I think I was averaging only 5 degrees of gain every 2-3 weeks. I remember the regular, sinking feeling when I would go in for my appointments, be measured and find that even in wearing my brace 5--8 hours a day, I'd gained nothing.

I used the snowshoe brace for about 3 and a half months, total. At the time I stopped using it, I believe I still had about 15-20 degrees to go in each direction, both on the supination and pronation end. Eventually, using my arm in everyday activities helped me gain more and more.

As of January 2008, about 9 months from my fall, I had regained all but 5-7 degrees of range on both palm supination and pronation, depending on the day, how cold it was outside, etc.. This was extremely exciting, since again, all the "experts" warned me I would probably lose about 20-30 degrees on both sides. I just can't capture through words how grueling the process was... the emotional highs and lows, wearing this ridiculous-looking, awkward thing around town, trying night after night to sleep with it on, knowing that the more I could tolerate it and keep it on, the better long-term results I would have. But wearing it was fairly uncomfortable and when I really worked hard at it and really cranked down on those velcro straps, it could be unbearable.

This is one of the places in my journey where my patience was tested over and over. I wanted to excel, to be an overachieving patient, to prove them all wrong, to work my butt off- and I did. And at the same time, I had to be patient with my body and be careful not to cause further injury by pushing it too hard.

As uncomfortable as strange as it was, the snowshoe brace was crucial to my recovery. It did me well in the end. After months of using it, the therapy and exercises didn't end there. Right about the time I was finishing up using the brace (mostly because I just couldn't take it anymore and because I couldn't get enough tension on it to really stretch my arm), I started hearing more of, "that's probably going to be it for your progress." So I found another PT and then another OT and then after that, a final PT whom I really felt like gave me the right combination of hope and practicality....