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In the blink of an eye

Allied Health Care for the Ballarat Region

In the blink of an eye

mick rehab

I’d love a dollar for every time I’ve heard the expression “life changing experience“  but until recently I don’t think I really understood the true meaning of it. As some of you may know I had a bike accident some 7 weeks ago and fractured my hip needing emergency surgery and in the blink of an eye my world changed. The experience has and will continue to have an impact on many facets of my life for quite a while, some physical and some mental. I guess what I have learnt from the experience can be classed as life changing and I hope I’ve gained some perspective from it.

Don’t get me wrong, I’ve had accidents and crashes before, falling off bikes many a time; it’s just part of racing and training. Ever since I took up triathlon racing in my last year of university and had a passion for riding bikes, I’ve suffered many different injuries in multiple incidents. From crushed thoracic vertebrae, broken wrists, ribs, hands and toes through to massive haematomas, various soft tissue injuries in addition to losing skin, there’s been too many to count. The difference with all of my accidents and injuries to date is that they haven’t been as routine altering as this one. Not working or training for near on 2 months is something that I have never done before, unless you count travelling around overseas but that was my choice and I still managed to run most days. Normally I can just dust myself off, grit the teeth and get on with things to a degree. This one has forced me to slow down to the point that you could pretty much call it an abrupt stop.

The first few weeks were a bit of a blur. I don’t think I have ever experienced ongoing pain like it, nor taken as many medications. To that end I didn’t really get more than a couple of hours sleep a night even with the absolute cocktail of medications I was on. Taking on board prescription drugs which included Norspan patches, Tramadol, panadeine forte, Mobic, Asprin and sleeping tablets, I was in a bit of a haze and really struggled to think straight or with any clarity (my kids would argue that I’m like that without drugs). Also because of the nature of the break in my hip and the metal hardware in there the only way I could sleep was on my back, which meant it was hellishly uncomfortable and you guessed it, my previous favourite sleeping position was on that R hip. So I had the bedroom to myself and probably just as well, as I was up every 2 hours pacing on crutches to try and find something to ease the pain.

On surgical review at 2 and 4 weeks, it became clear why the hip was so sore. As the surgeon explained my hip was broken into 4 pieces that weren’t exactly neat so even though he put them back together in near perfect alignment there had been a shifting and shortening of the limb by over 1cm during that time frame as things tried to settle into place with the dynamic hip screws. I thought I was just going soft but one thing is for sure it puts every other painful experience into perspective.

It also gave me the tiniest bit of perspective of what fellow cyclist and friend Christian Ashby must have been going through in those early days of his horrific accident. It’s almost embarrassing to chat to him about my hip fracture when you see the list of injuries and surgeries he has endured. I have to say that even though I saw him in Melbourne a few times in those early days and eventually went for a few rides with him, watching as he had to lay the bike down on it’s side to mount and dismount, it never really had the impact on me as it has now. We all think we can imagine what it’s like to go through someone else’s experience but until you actually walk in their shoes (even if it’s only a relative step) you really have no idea.

The support that Christian has given me during this experience has been quite amazing and being able to chat as a fellow cyclist who is highly driven has really been so helpful. He contacted me very early in the piece and asked if I needed anything and that if I needed a shower chair then he could drop one around. Of course 1 day post op, I thought I was bullet proof and would bounce back like I had done with most of my other injuries and declined in a similar fashion to when the hospital asked if I needed a high chair to sit on or a high toilet seat. No way I was going to need those aids I thought to myself, somewhat illogically thinking I would be different. How wrong I was to be. A day later I was on the phone eating humble pie asking for all those items I thought I didn’t need and then being amazed at how helpful they really were. Yes and this is me the physio thinking I would be different. I even had to get Christian to drop around a device to help me put my socks on.

Not only did Christian provide me with physical aids to improve my ability to cope and get through basic daily tasks a little easier, he gave me incredible emotional support. Hearing Christian tell me his story once more, it was as if I was listening again with another set of ears as it held even more meaning the second time. I never forgot one day when I was having a pretty bad day with regards to pain, not sleeping and not coping mentally with the situation and he spent a good hour on the phone chatting and helping me articulate those feelings and then acknowledging how he had been there so many times and still has times like that. As someone said to me once, you don’t know how much impact one little piece of encouragement can have a on someone’s state of mind. It can literally alter the course of a day or even more, your future emotional state.

The other great piece of advice he gave me which as I knew and advise my clients as well is that the little steps are actually the big steps. Those small gains that are made every few days are the difference between feeling like progress has been made and not. So for me going from not being able to dress or shower myself nor able to get in and out of a car with assistance to a few weeks later being able to get a sock on and be more independent felt like I’d achieved something. Setting these small goals is hugely important and really helps with recovery and mental state of mind.

Once I had my 4 week review with the surgeon and mentioned I wasn’t sleeping he put me on a new drug to help (bearing in mind this was on top of all the others I mentioned above) with this. The amitriptyline which is sometimes used to treat depression as well as nerve related pain did the trick. I managed to get through the nights a little easier. Whilst I woke up I could still get back to sleep reasonable quickly. The side effect was that I felt groggy for half the day, even more so when combined with Tramadol and Norspan patches. I now have first hand experience of why opioid drugs aren’t something you don’t want to be on long term. I also found out a couple of weeks later why coming off them is so hard.

I remember thinking that I needed to stop taking as much of the medications and making a conscious effort to stop them gradually. First the patches, then the tramadol dose reduced and lastly to stop the amitriptyline. A couple of days after stopping the patches I remember feeling queasy and as if I had the flu. This lasted a couple of days. I was tempted to go back on them but held fast. The same went for the other 2 medications and it took quite a bit of willpower to not slip back and start taking them again to prevent feeling so sick. It is only now that friends can tell me that I looked pale, almost green for a few weeks there and I’m sure it was the medications. That combined with the lack of sun plus the fact that I was vitamin D deficient meant I was pasty white. Interestingly bone only heals well in the presence of vitamin D and with mine at 29 nmol/L when it should be at least 50 nmol/L at the end of Winter and up to 70nmol/L in Summer meant I had to take some supplements. Not surprisingly half of Ballarat is probably vitamin D deficient given our glorious winters. The other learning curve was mixing opioids and alcohol is not recommended. Of course as a health professional I’m aware of the need to avoid alcohol and medications but I was thinking 1 glass of champagne shouldn’t be that big a deal. As I sat staring at the carpet for a good 30 minutes before I realised I wanted to go to sleep, I made a note to self not to have a tipple until I was off the drugs.

When I mentioned life changing experience earlier a couple of things that are worth mentioning are if you lose the things that define you to an extent it can be pretty demotivating. I spend a lot of time at work as a physio and in the practice as well as on my bike. The accident stopped both those things immediately and the decision was out of my hands. Christian mentioned the same thing but again until you go through it you don’t fully appreciate what it feels like and I can’t recommend it. Throw in not being able to drive and do what you want when you want and relying on others and life is not much fun. That being said the positives out of not being able to work or cycle meant that I got to spend more time with my wife Paula and kids and appreciate the friends and family that were and are still there for me.

At last review with the surgeon I had some better news. Whilst my right leg is over 1cm shorter and will stay that way, it looks like the fracture is stable and starting to lay down a tiny bit of callus and unite (knit). I can increase the loading and use 1 crutch for another 4 weeks, plus I can drive. There are a number of people punching the air with this news, including my wife, practice manager and parents as they no longer need to chauffeur me around. I’ll include myself in the air punching brigade as until you lose your independence and can’t drive you don’t realise what an imposition you are on other people and how restrictive it can be. Whilst I’m pretty slow getting in and out of the car and need to hop around to get a crutch out of the back seat, you won’t hear me complain about it. I’m also off all drugs except some melatonin for sleep and the vitamin D for my bones.

In the last few weeks I’ve tried to keep some degree of fitness up by cycling with 1 leg and doing some upper body workouts as well as weights on the good leg. Studies show that there is no need to punish the good side when we have an injury and also that there is actually some degree of neural carryover and benefit to the injured side by keeping exercise up on it. It Even with daily workouts and exercise the degree of muscle wastage and lack of strength is quite significant and it will take a lot of hard work and effort for me to get even close to where I was a couple of months ago. In fact the bone itself may take over a year to fully strengthen and remodel. To quote my surgeon “ok at 3 months, pretty good at 6 months, almost perfect at 1 year and hopefully perfect 3 years“. So there’s a long road ahead but I’m prepared to put the work in. My family, friends and work colleagues have been amazing at picking up the pieces around me and supporting me so I will be forever grateful for the support.

So whilst my life has been turned upside down in the blink of an eye and I will have a shorter leg on one side for the rest of my life, compared to what so many others have been or are going through my experience pales into insignificance. What I have learnt is perspective and to look for the opportunities to focus on the positives and the small gains along the way. The down time has allowed me to realise how generous some people are with their time and that family is everything. Work and life carries on without us and you soon work out who is in your corner to guide and support you along the way. If this blog allows just one fellow human who is struggling with their own injury to relate to the article and draw something useful and relatable from it then it has been worthwhile. Good luck with your own journey.

Michael Pierce
Sports Physiotherapist / Director
Lake Health Group


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