Adam Rice

My life and the world around me

Tag: hip

Milestone

Today is the tenth anniversary of the day I broke my hip for the second time.

The story of Adam’s second broken hip

First installment: 19 Oct 1999

I am writing this exactly two weeks after the accident, which happened on 5 October 1999, almost exactly four years after my previous broken hip. It is somewhat difficult to give a good linear account of what happened, because I sustained some head trauma in the accident, and as such wasn’t sure what happened to me until later, when I remembered.

At first, all I knew was that I had gotten into an accident riding around my neighborhood on my commuting bike. I didn’t know exactly where or what the circumstances were. I also didn’t appreciate the extent of my injuries at the time: I just thought I had a lot of road rash, although I was dazed. Jumping ahead a bit, after I was released from the hospital I found the backpack I was wearing at the time of the accident. I had just purchased a nice bottle of scotch to give to a friend for his birthday; when I pulled it (intact!) out of my backpack, everything came back to me. I had been riding westbound on a nearby street (41st St), coming from a liquor shop. This street has a healthy downhill, and at the bottom, a dip and a bump. I have ridden this way many times before, but this time I hit that bump exactly wrong and went flying. A woman following saw this happen, and insisted I let her drive me home. I was reluctant at first, but assented. Someone else rode my bike home for me (the bike is fine, incidentally). Upon arriving home, my then-wife Jenny quickly realized my mental status was altered. She mentioned an event in the recent past; I had no idea what she was talking about. She asked “What month is it?” I thought about it for a second and responded “I don’t know.” She put me in the car and headed for the ER. I was complaining of hip pain, so we brought my crutches. At that point, my recollection gets very fuzzy.

Once in the hospital, it was discovered that my head was basically OK, but my pelvis basically was not. I had two major breaks and some incomplete fractures. My short-term memory was almost completely shot. I would reportedly ask “Have there been x-rays taken?” Answer: “Yes.” Question: “Have I seen them?” Answer: “Yes.” Repeat every three minutes. Obviously the fact that I had seen them did make some deeper penetration, since I had the presence of mind to ask about it, but that’s about it.

My surgery was on Wednesday. I was in traction until then. Surgery lasted five or six hours. I had ten screws roughly 1″ long each, along with a chain, inserted to hold the two pelvic breaks together. I was in the ICU that night, and friends came to visit me. I don’t remember actually seeing them, but I remember their presences, and vaguely remember conversing with them. I told the hospital staff that I couldn’t eat much solid food, so they put me on what is evidently a fixed liquid diet of oatmeal, jello, and juice. I could have managed some fruit, but that wasn’t part of their plan, evidently.

Thursday I was in a regular hospital room. I was still pretty foggy, but I was able to hold thoughts in my head for more than three minutes at a stretch. More friends visited, and this time, I could actually remember seeing them, if vaguely. The hospital experience was largely as I remembered: a regular schedule of things being put into my body, mostly through two shunts, one in the back of each hand. I received two units of blood, which concerned me, but was evidently necessary. I had two huge surgical incisions: one running from my left side below the ribcage to a point south of my navel, the other running vertically up my left butt cheek. Blood drains in each. I felt like I had been opened up like a christmas package. Jenny wore an outrageous outfit to help lighten my mood, as she did each day of my hospitalization.

Friday, I had my foley catheter removed. That’s a relief. I also had my shunts unplugged from full-time drips, although the shunts stayed in. Someone from Physical Therapy came by and got me up on my crutches. I had plenty of practice with this, and was able to maneuver pretty well, so they were satisfied with me. A good thing I got up too: the massive quantities of laxatives they had been pumping into me (anesthesia can put one’s guts to sleep, evidently) were starting to work their magic. I made five trips to the can that day. Beats using a bedpan, I tell ya. I began refusing the laxatives, and started eating normal food.

Saturday I spent almost the entire day sitting in a chair, rather than in the bed. This is a big improvement. I could tell I was just about ready to leave the hospital.

Sunday morning I agitated with all the doctors who looked in on my to sign off on me, so that I could be released. One doctor seemed somewhat reluctant, pointing out that I was still experiencing discomfort. I replied “Look, I can experience discomfort here, or I can do it at home. I’d rather do it at home.” By the time Jenny showed up, my release was ordered, and I was getting ready to go. I was home early that afternoon (Oct 10th), and went to a bridal shower at a friend’s place. That friend was the one for whom I had bought the fateful bottle of scotch, the discovery of which triggered my memories.

I met with my doctor the following Tuesday, and he was pleased with my status at this time. I met with him a week after (the day of this writing), and he is still pleased with my status, but he is being much more conservative with my recovery program than before. I won’t be starting physical therapy for at least another two weeks. I had my staples out today.

I am getting around on crutches, which is a big inconvenience. In case you are wondering, I wasn’t in a cast at any point. Sometimes my pelvis just feels uncomfortable as a result of sitting around, but it isn’t an intense pain. I have weaned myself off the pain meds I was prescribed, but I am still taking a potent anti-inflammatory drug.

Second installment: 19 Dec 1999

I am writing this about 11 weeks after the accident.

I made good progress on my recovery following the previous installment. While I was not allowed to put any weight on the bad leg, I gradually recovered some strength and flexibility in it, and my general level of discomfort decreased. I resumed my daily trips to my neighborhood coffee shop about a mile away.

Four weeks after the accident, I had a visit with my orthopod. X-rays were taken, and he was so pleased with how they looked that he was almost giggling. He didn’t allow me to start doing anything new, or start physical therapy, but he was obviously happy with my progress. He and other people at the office commented on how well I seemed to be moving around, and how I seemed to be in generally good shape. One barometer of my progress was that before, in my trips to the coffee shop, I was taking the bus both ways. Around this point, I started to ride the bus one way and gimp the other.

Five weeks after the accident, I finally got over the occasional weak spells and dizzy spells I had been experiencing.

Eight weeks after the accident, I saw my orthopod again. He took more x-rays, and again was happy with my progress. He commented that one of the two breaks wasn’t even visible anymore. He told me to get up and walk without my crutches, which I was able to do with considerable wobbling. It felt physically very weird, since I hadn’t put any weight to speak of on that leg in eight weeks. The doctor told me that I could start as much weight-bearing as I could tolerate, but I should continue using crutches for stability–two crutches for two weeks, then one crutch for two more weeks, then none. I was allowed to drive, but not a manual, so I traded cars with a friend. He finally started me on physical therapy. I began augmenting this with rides on my stationary bike. Around this time I started gimping both to and from the coffee shop.

Once I started weight-bearing, I quickly got re-accustomed to it. After only a day or two, I upgraded myself to one crutch, and increasingly around the house, I would use no crutches. I was making daily progress in terms of strength, balance, and comfort. After about ten days, I felt emoldened to leave the house without a crutch on one or two occasions–I was still walking with a limp, but not bad. My sessions on the stationary bike were getting better–higher speeds, less pain, faster warmups. By the day before my next appointment, I could walk without much of a limp.

Ten weeks after the accident, I saw my orthopod again. No x-rays this time. He asked me how I was doing and I said “Better than either of us would have imagined.” He told me to walk, and I got up and walked quite normally. He was blown away. He even showed me off to his colleagues.

At this point, I can walk all I want, and I am walking about 2 miles a day (to and from the coffee shop), in addition to physical-therapy excercises and stationary bike rides. I am not allowed to run (not that I want to try that yet), jump, or ride a real bike for another three weeks, the time of my next appointment. I still don’t feel completely recovered–my left leg is still significantly weaker than my right leg, but that only comes into play when it is stressed. I still have some pain, especially at the end of a walk. I don’t have quite as much flexibility in the left leg as in the right. But I continue to make improvements each day.

I’m not sure if there is a secret to a successful recovery; I imagine everybody needs a different approach. But what seems to work for me is doing as much as possible, living as normally as possible, without overdoing it. Don’t be defeatist about the recovery, don’t be passive, but don’t get obsessive either. Just be determined.

The story of Adam’s first broken hip

The original story

It happened on October 19, 1995. Jenny and I were out for a ride eastbound on FM 969, towards the neighboring town of Weberville. We were a little east of Route 183 when a pickup passed me. It passed really close. It was hauling a trailer, which I guess was a little wider than the truck. It hit me. I went down on my left side. Ouch. It wasn’t immediately obvious that I had broken my hip–at first I tried to get back up on my bike, but quickly realized that wasn’t going to happen. There was a lot of traffic (this was around 4:30 on a Thursday, so we were in early rush-hour). A lot of people stopped to help, there were some witnesses. One of the first people to help was an off-duty emergency medical technician. She jumped out of her truck with one of those neck braces just like you see on ER, got me immobilized, and took charge of the situation until an ambulance showed up. There were plenty of people with cellular phones to call 911. So the situation was not too bad.

>I was admitted to the trauma center at Brackenridge hospital, where X-rays showed I had a clean break in the neck of my left femur. You know how the femur has a ball at the top (that fits into the hip socket), a narrow neck that flares outward, and then the long, straight part? I broke it at the neck. I was rather surprised and dismayed to learn this–after all, 29-year-old men aren’t supposed to break their hips. An orthopedic surgeon, Dr Adams, was summoned, and I went into surgery around 10:30 PM that night. They put three 4-inch long pins in my femur. I came out of it around 1:30 AM. Jenny and my friends Chris, Tracy, Dave, Heidi,and DuShun were all waiting for me. I was, needless to say, a bit groggy. But I was still really glad to see them. Tracy passed out during the visit, but was OK. I learned that I had puked while under (evidently almost everyone who goes into surgery with anything in the stomach pukes) and I had been intubated as well, which left me with a sore throat for a few days.

On Friday, another friend, Marty, dropped by to visit and my folks made plans to come down for a few days. My hospital routine began. The routine is centered on when certain things are put in you or removed from you. Every morning around 6:00 they would draw a blood sample and then a urine specimen. Twice a day, before breakfast and before sleep, they would give me an oral stool-softener (evidently constipation is a big problem with people who spend a lot of time in bed) and an injected anti-coagulant (evidently blood clots are a big problem with people who have had major surgery). Morning, afternoon, and night I was given an antibiotic through my IV. Friday I was hooked up to a demarol IV drip. This was interesting: they give you a really low-level drip, and if the pain becomes really uncomfortable, you can hit a little button that will dispense a booster. It will only dispense one every six minutes. This is called a PCA–patient-controlled analgesic. I generally went easy on the pain button. Also on Friday they got me out of bed and hobbling around behind a walker. Evidently I was doing pretty well to even stand up. That night I even got out of bed and tried to take a crap. The nurse suggested a bedpan but pride prevented me. I managed to get to the can, but it was a false alarm. Life is reduced to challenges on the level of going to the bathroom.

On Saturday, they took me off the demarol and put me on an oral painkiller, vicodan (sp?). They also got me moving around on crutches. This was somewhat scary at first, but I got the hang of them pretty quickly: the physical therapist soon decided that I was able to get around fine on my own, and said that as far as she was concerned, I could be released anytime. My parents arrived. At first I was opposed to them dropping everything and coming, but ultimately I think it was for the best: they could reassure themselves that I was not on death’s door, and they also helped out around the house some. I also learned a bit more about the accident. The guy who hit me was indeed caught. He was on company time working for a small landscaping firm in the town of Manor (that’s pronounced "may-nur" in case you aren’t from around here), and his boss called me and assured me his company insurance would take care of my medical. That’s nice. Of course, he is obliged to do so, but it was nice that he made the first move.

On Sunday, another orthopod (not the one who worked on me, but an associate of his) stopped by and declared me fit to leave. I was really happy to hear that. Although I was really happy with all the people I encountered in the hospital, I certainly didn’t enjoy being there, so this was great news. I was out of the hospital and on my way home by about noon. This was a day sooner than the most optimistic forecast the doctor had given for my release, so I was happy about that too.

Monday, my first full day back at home, went well enough. In the morning, my cousin Joel called. Joel is a cyclist and also a lawyer. He offered his services (as a lawyer, not a cyclist, wise guy), and I gladly took him up on his offer. That afternoon, I got a call from the other guy’s insurance adjustor. As soon as he started asking specific questions, I told him "I’m sorry, you’ll have to talk to my lawyer" (as I was advised to). He was visibly crestfallen, even over the phone. He said "You already have a lawyer?…I usually try to get to people before a lawyer does." Yes, he actually did say that. I was rather amazed. He was further dismayed to learn I had me one of them fancy big-city lawyers up in Chicago (if he had found out Joel is Jewish, that would have made his despair complete, I think). It’s nice to be able to say "You’ll have to talk to my lawyer." Jenny got a copy of the police report. The driver was charged with failure to pass with adequate clearance. He was also driving without a license, expired plates, and no brakes on the trailer. He may also be lacking a green card, for all I know.

A week after the accident, I had my first follow-up visit with the orthopod. He said that things were coming along nicely. Shortly after this visit, they removed the staples that held the surgical incision shut (and which were ghastly to look at). I also began physical therapy, which was a real slap in the face at first. I’m a cyclist, so I take strong legs for granted. When it becomes a challenge just to lift my left leg, the feeling is…well, it is hard to put the feeling into words but it is not pleasant. Its frustrating, physically painful. By a month after the accident, I had recovered a lot of mobility and strength, and with every PT visit, they had me doing something more strenuous. I eventually wound up doing stuff that was hard for my good leg.

Three weeks after the accident, I had my second follow-up visit. The doctor was quite pleased with my progress and allowed me to put some weight on the leg: for ten days I was putting 60 pounds on the leg. For the next ten, I was putting 120 pounds on it, using only one crutch, with increasingly vigorous physical therapy. Moving to one crutch was a big improvement, as I had a free hand to carry things with.

At my subsequent office visit, the orthopod was not satisfied with the level of new bone growth, and kept me on one crutch for another three weeks. This was frustrating, as I had been hoping to get off it at that time. At the end of that three weeks, the doctor decided my bone was sufficiently knit up to tolerate walking without a crutch, so I did. That was in mid-December. At the end of December, I ended my physical therapy.

As of this writing (4 October 1996), my condition is pretty good. I do have less strength in my bad leg, but this is only revealed when attempting relatively obscure tasks, like standing up from a low chair using just that leg. There is still some pain when I lie on that side and there is pressure on the affected area. I can run a little–enough to get across the street–but when a friend came by a while ago and suggested we go for a jog, I had to laugh. That is out of the question for the time being. But, hey, I can ride my bike fine. I haven’t been on it as much as I should be, but I can’t blame that on the accident–just my own laziness.

About ten months after the accident, my lawyers came to a final settlement on the case with the other guy’s insurance. This was less than they had initially projected, but probably as much as I could realistically expect to get. And we kept it out of the courts, thank goodness. All kinds of people told me “you should sue!” Life’s too short for that.

The doctor who worked on me says that a complete recovery to my prior condition is unlikely: there should be less range of motion, less strength, and more pain. I have chosen to disbelieve him, though my progress seems to have tapered off somewhere short of “perfect.” More ominously, he has warned me that I may develop a condition called avascular necrosis (AVN), which would mean that there isn’t enough blood getting to the top of the femur, and that part of the bone dies. If this happens, I’ll need an artificial hip. And since artificial hips wear out after about five years for a young person, I’ll be looking at a lifetime of replacements. This is the thing that worries me the most, and there’s no way to tell whether or not it will happen right now. The doctor said the bone could knit up fine, and I could still develop AVN five years down the road. Scary.

Jenny helped out a lot, in little and big ways. For a while there I was not allowed to drive, so she finally broke down and got a driver’s license. She drove me to my appointments et al. She also took care of a lot of little stuff around the house that was too much trouble for me to do, like fetching a cup of coffee. Fetching a cup of coffee!! Yes, that was too much trouble for me. Try carrying anything liquid while on crutches. Doesn’t work.

Update: 26 November 1997

Two years down the road from the accident, I decided it was about time to get my screws out. I could have had them out one year after the accident, but somehow never got around to it. Funny that I wouldn’t be anxious to undergo surgery again, isn’t it? Anyhow, I decided at the beginning of this month that Now is the time. So I scheduled surgery for November 14. A consult with my orthopod, Dr Adams, the day before, and some paperwork with the hospital as well, which sent me chasing around a bit and did not fill me with confidence in their administrative skills. “No food after midnight,” they tell me. They draw some blood and ask some questions to make sure I am fit to undergo surgery. Many, many people confirm what procedure I am supposed to undergo, exactly. This is a good thing, I suppose.

My surgery is scheduled for 1 PM, and they tell me to show up two hours before that. When I show up, they have me put on a hospital gown and hang out in a room while a procession of medical-type people file through and ask me largely the same questions. Eventually they have me lie down on a gurney, they roll me into a holding pen, where more people ask me the same questions. “Which side are we working on?” “Left, there’s a big surgical scar, you can’t miss it,” I tell them. Eventually an anesthetist sticks a little IV in the back of my right hand and they start wheeling me off to surgery. I think less than a minute elapsed before I blacked out.

I vaguely recall coming-to in a room with a few other patients, and asking a lot of questions like “How did the surgery go?” etc. I don’t recall what the answers were, if I actually articulated the questions in the first place, or what the questions exactly were. Some time later I became reasonably alert in the same room where I had gotten into the hospital gown. I was still pretty groggy, to be honest, but I did want to get home. Hospital staff always want to make sure one can hold down liquids, and I drank some water and apple juice, so they let me get dressed and go. I got to keep my screws, which are stainless steel, 95 mm long, 4 mm thick, cannulated (that means they’re hollow like beads), with very serious looking threads rolled into the tip and a 4 mm allen-key socket in the head. That night I was not able to hold down water, and my dressing looked pretty bloody, but by the next day I was wolfing down pizza and the bleeding had pretty much stopped.

On the 24th, I visited my orthopod and my staples came out. I still couldn’t get used to looking at them, at least not when they’re in my own skin.

As of this writing (Wednesday, 26 November 1997), I am on crutches, and will be for about two more weeks. My orthopod wants the voids in the bone left by the screws to fill in so the bone can regain some strength before he lets me run around with my full weight on that leg. This is really frustrating, because I feel like I should be OK, but when I saw him to have my staples removed, the first thing he said when he saw me was that I shouldn’t even think about getting rid of my crutches yet–he had another patient in my situation who quit using his crutches early, he fell, and wound up injuring himself quite badly. Oh well. I’m relying on Jenny to fetch cups of coffee for me again. Other than that, the doctor thinks I am doing pretty darn well. He thinks that odds of AVN developing at this point are minimal. That’s a nice to know. I used most of my share of the settlement (after my lawyers and my insurance took their cut) to make a big downpayment on a house that Jenny and I wouldn’t have been able to afford otherwise.

Update: 02 January 1999

Having my screws taken out was one of the best things I ever did. After my accident, I had suffered low-level chronic pain, and a small loss of strength and flexibility. I always assumed this was a consequence of having broken my hip. It wasn’t: it was a consequence of having big-ass stainless-steel screws in me. Once I had recovered from having the screws taken out, I felt like I was 100% back to normal. No pain, no diminishment in strength, and none in flexibility (or near enough to none as makes no difference). I couldn’t run with the screws in me. I can run now.

Another benefit of having the screws out: I can show them to friends and really freak them out.

Well, that is pretty much the whole story. My advice is "Don’t break your hip."

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