I took my eyes off the road

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I Took My Eyes Off The Road...
Or, What I did for Christmas 2001
Now of course there are more details than that, but basically I took my eyes off the road. The next thing I know my car is in a ditch and I have a broken leg. I spent Christmas in a lovely hospital in Cedar City, Utah. What follows is my tale so far. For the record it is three plus weeks after the accident and I am doing pretty good so far.

Quick Links:
UPDATES: WEEK 5 WEEK 8 WEEK 9 WEEK 12 WEEK 12.5 WEEK 19 (May 1)
9 Months (Sept. 12) 10 Months (Oct. 16) 11 Months (Nov. 21) 1 Year, 4 Months (April. 24 2003) 24 Months (Dec. 4) 3 Years (Jan. 5, 2005) 3 Years And Beyond!
Lessons I learned from my adventure.
Recovery Notes and Guidelines for Future Patients.
For the adventurous and medically inclined: X-Ray pictures.

It was about 10:00 at night on the 20th of December. I had just pulled back onto the highway after stopping at a gas station to enjoy a banana and walk around. I was about 8 miles south of Beaver, Utah on my way to Las Vegas. My CD had run out and I needed to change it. The music keeps me awake and focused. (There is a bitter twist!) My rental car only had a single CD player. No cassette, no changer. (Remeber this, it is one of the important lessons.) For some silly reason I decided to fiddle with getting the first CD back in the case before getting the next one out. I turned on the inside light (Big Mistake!!) and grabbed the case. Now here is where I cannot tell you exactly what happened other than that was enough to cause the accident.

It is interesting about accidents. The brutal part really does happen so fast you really don't know what hit you. I have tried to reconstruct things based on the information I have. I have four ideas and guesses at their liklihood.

I fell asleep at the wheel. It is possible, but I do not recall feeling sleepy. I have driven at night a lot and usually know when sleepiness is around. I also was quite alert when I was aware I was on the shoulder.
I hit a patch of ice and slipped. It was not in the report. I think the sherriff would have mentioned it.
I aimed the car on the wrong direction. There are line shortages on the road in the middle of Utah. Snowplows wipe out the lane markers. I could have aimed for the shoulder and glanced down then went off the road. This is one of the more likely scenarios, but not my favorite.
The cruise control went off and I drifted off the road. Modern cars have limited road feel. Too many times I have been shocked at the speed I was travelling. That includes times I have not noticed I was slowing down. Based on the limited amount of "activity" after I hit the shoulder I feel I was not travelling 75 miles an hour when I went off the road. Therefore my best guess is that either I tried to set cruise control and it did not catch or else I tapped the break and it shut off. When I glanced down the car slowed and drifted off the left side of the freeway. (Yes, there were two lanes and I was travelling in the left lane.)

So I hit the shoulder, wiped out a little reflector stand, over-corrected across the freeway, and spun out in a snow bank on the right side of the freeway. I looked down and saw an angle in my left leg that wasn't supposed to be there. I straightened it out and held it in place. A very considerate stranger saw me spin out and pulled over. (Wherever you are, whoever you are, Thank You Very Much!) He had a cell phone and asked if I need help. I told him I had a broken leg and help woudl be much appreciated. Within 15 minutes an ambulance arrived. I held my leg in traction that whole time.

I was taken to the hospital in Beaver, Utah. There they took down all sorts of details and took some X-rays. It was a nice clean break. They check with the hospital in Cedar City. The orthopaedist was on duty that night and could fix me up that night. I was transported by the same ambulance crew. The odd thing was when they asked if I needed any pain medicine. I thought about what hurt and the greatest pain was the muscles in my hands. They had held the leg aligned for 15 minutes and were really sore.

They checked me into the hospital in Cedar City. I agreed to the current in vogue procedure for femur fractures. They insert a rod down the middle of the femur and lock it in place with a couple of screws. This way you are able to get up and start rehab the next day. Unfortunately my leg did no twant to cooperate with the procedure. The halves did not want to stay aligned while the rod was inserted. After several tries and a few mroe fractures the had to cut in from the side and align the bones. This cost me a lot of blood. Rather than getting out the next day or two I spent six days in the hospital recovering some of my blood supply. I did try and stand of the next day, but turned a "shade of grey" and quickly fainted. Quite an experience actually, my vision turned into turquoise and orange spots and the next thing I know I am sitting on the bed sweaty and weak.

Now of course I would never wish for an experience like this, however it will qualify as an extremely memorable Christmas. In hindsight I recommend doing something utterly different for Christmas once in a while. Tradition is great, but variety gives both perspective and memories. Christmas Eve I had three different groups of carolers come down the halls. I've never heard carolers at Christmastime. It was a delighful experience. Of course to get through it all I decided the whole adventure was going to be a delightful experience. A positive attitude made the whole adventure enjoyable despite the pain and aches. The odd thing still is that the greatest pain has not been the fracture, but the effects on the muscles around it. Swelling has caused lots of pain and aches. Weakness from disuse has been the other great source of pain.

WEEK 5 - Update: Week 5 is nowheresville. You are right in the middle of your 4 week x-ray cycle. There is no external validation of how well you are healing. On the one hand you have to mentally wait for information on how the fracture is healing. On the other hand you have to do about 4-6 hours a day of various little exercises, icing, stretching, massage, hot soaks, heating muscles, trying to stand and do more weight bearing. The more consistent you are the better and faster you can heal. Each category has the most minor of progresses. You have to learn to celebrate that you can hold your leg in the air 14 times for a 3 count instead of 12. Range of motion that is a mere 2 degrees better than two days ago is cause for celebration. Last night I think I had a sleep stretch longer than three hours. Woohoo! Keeping the spirits of and making slow steady progress is the goal. Accept little setbacks and occasional off days. Something, no matter how little, will get better each day if you keep working on it. Keep that positive attitude working!

WEEK 8 - Update: Did I say week 5 was Nowheresville? I've got to stop talking. I keep eating my words here. I used to say I didn't ski because I could think of cheaper ways to break my leg. Silly boy! Anyhow I got my week 7 x-rays last week. They showed very minimal signs of bone growth. I was hoping for lots more, but possibly due to the force of the accident and other issues I am slow to regrow bone. Now I get to wait four more weeks to see how things are doing inside. I still cannot walk without pain. Something in the bone still needs to heal. Here again is a lesson in keeping inspired with small progress. In this case we are doing a lot of massage therapy work. I have scar tissue of the most intruiguing sorts. Everybody who has worked on me is thinking, "Cool! I don't get to work on such complicated messes very often." I could probably provide a massage therapy class with topics and practicum for several weeks. Okay now I suspect I am grossing out the readers.

Back to the spirits and motivation. You need to be able to look at very small signs. Getting a four inch stretch of skin to behave like skin instead of summer sausage casing is progress. When you have scars all the layers fuse together. You need to have the skin move freely, the fascia, move freely, and the muscles behave normally. Any of those signs is progress. I have one muscle, the vastus medialis, that has been on vacation for seven weeks. It took a whole week of little exercises just to get it to twitch a little. It will take another week to get it to show any signs of useful strength. Useful strength is being able to move the lower leg at all. Right now it only show signs of strength in the pool where the leg is floating. Still, for a weeks worth of focus you take small milestones like that. "Progress not perfection." That applies to most things in life. Have goals and keep working forward.

WEEK 9 - Update: Today I walked out of the pool! One small step for me. I had been walking in the pool to practice proper gait and to build strength. The shallow end is 3 feet deep. There is a ramp leading out of the pool from there. In 4+ feet I have almost normal gait. In 3 feet I limp a lot. Today I limped up the ramp and out of the pool. It was a great emotional milestone. Now I have to go back to the five foot level and do exercises to build strength so that I can maintain proper gait in shallow water. I will work my way back towards the shallow end again. My new goal is still to walk out of the new pool. The same goal as before and the same process to reach it, but with new conditions. Only now I have a better sense of what the process is like. Start with a sub-goal, understand the process, dedication, and patience that go with meeting it. Repeat all the steps for a larger sub-goal. Progress not perfection.

WEEK 12 - Update: Got new x-rays last week. Small signs of healing could be found. Did get permission to go out and exercise harder to get my leg strength back. Made it a goal to go to the gym every day. Did four days in row before being attacked by a serious need to nap. It did feel good to exercise. Went out the next day and walked a lot with my one crutch. Forgot to ice my knee that night. Two days later my knee still hurts in two places. Went back to two crutches to rest the leg. It was mentioned early on that rehab can be like that. Two steps forward and one step back. Not only does the knee hurt, but several of the muscles seem weaker. Its good to remember that there might be setbacks and to embrace them. Heard a good quote a few weeks ago from journalist Linda Ellerbee (part of her Unique Lives and Experiences lecture.)- "Always set a place at the table for the uninvited guest." Don't be frustrated because a new pain shows up and keeps you from exercising. Remember if you can't go to the gym I bet you have a good book lying around just waiting for you to sit around all day and read it. Embrace the chance to rest, relax, and read. Now, if you'll excuse me, Harry Potter and the Prisoner of Azkaban is calling my name.

WEEK 12.5 - Update: "Doctor it hurts when I did that." "Don't did that." They told me I would take two steps forward and one step back. All this time I thought my little off days counted as setbacks. There would be a day I was a little sore and I would take a day off instead of doing workouts. The next day I would be back in gear. This is normal. It is not a setback. Wednesday I learned a powerful lesson. I was feeling good getting around on one crutch. While taking the bus around on my rehab tour of town I twice found myself with fifteen minute waits and seven blocks to travel. Figuring I could beat the bus I took off walking. I had only minor trouble getting where I was going. I would get a little tired every block or so. I had to change grips on the crutches to keep my arms from getting tired. That night I got home and forgot to ice my knee. That is a usual event after any activity. Even if the activity did not hurt, some form of preventive icing is a good idea. Thursday morning I woke up with a nasty pain in my left knee. By Friday it had worsened and I was back to two crutches to try and rest the knee. Several days later I think it is getting better, but it is doing so very slowly. I think this is the one step back they told me about. It feels like a giant step at that. I feel like I am back about four weeks now. That is the last time I can recall being this limited in my mobility. We'll see how long it takes to recover. So what did I learn or relearn?

Nothing is just one thing. (A quote I heard from Carrie Fischer.) Okay my left femur is recovering from a break. I know I have weak muscles in my left leg. I go for a walk and the thing that gets the most tired is my right forearm. So why do I wake up with my left knee hurting? Answers: Weakness in the muscles causes the patella to track to one side of the patellar groove. That abrasion eventually causes pain, or delayed pain in my case. A tight outside hamstring gets to overwork to support my lopsided walk and its tendon also gets some delayed pain. There is a lto going on in the whole body. You need to be aware of all of it in order to help yourself heal in the most efficient way possible.
Delayed onset fatigue ain't just for muscles. I've had workouts where afterwards I felt great, but the next day or so my muscles were very sore. It appears I can do the same things to ligaments, tendons, and joints.
Just because you can do one, it does not mean you can do 100. Taking a step with one crutch is one thing. Taking a hundred steps is another. If you take one step with one crutch this week it may still be several weeks before you take 100 steps. See the next item.
Plan for patience. This one is hard to phrase, but sometimes you need to think ahead about how your are going to be patient with your exercise. In my case I woke up feeling great. I therefore put no limits on what I was going to do. I followed the advice: "Doctor, it hurts when I do that." "Don't do that." Well if is not going to hurt until the next day you won't know when not to do that until after you've done that and hurt yourself. (Gotta love twisted English.) I think you need to plan ahead what the limits of your activity are going to be. Where am I now? What am I aiming to do next? What is too much of the next thing? How can I build my stamina in the next thing I am doing? Yes, it is a lot to think about. Journals help. I have a historical journal going. I think I also need a future journal of sorts. I think that means having a plan, but journaling ahead might work too. "Today I walked 30 yards at a stretch. Tomorrow I walked 1/2 a block at a stretch."

WEEK 19 - Update: May 1, 2002. Sorry I have not updated it in a while. There was an intermediate update on the x-rays page at week 15. That is when I found out I had bent my screw. (As opposed to the screw that I always have loose.) The pain at week 12 was a stress fracture in the knee cause by the nail trying to poke its way out. That set me back about 6 weeks. I think I caught back up in four though. The last three weeks I have been trying new rehab tricks and range of motion tricks. I like them better. I am using weight training to heal and stimulate bone growth rather than walking. The next x-rays are in two weeks so I have more time to get my leg muscles better and hope that helps my bone. [For more detailed background reading on this see the Bone Growth With Weight Training page I worked up a few weeks ago as I was developing the theory.]

Weight Training
Weight bearing is what they recommend for bone growth. That was not helping part of my bone. I noticed that certain muscles were super weak. After reading more about bone growth and asking more questions of more people I concluded that muscle activity across the bone gaps could also help bone growth. My x-rays only show bone growth on the back of the leg. That is where compression occurs when walking. Everywhere else medial, lateral, and front, was not showing growth. I did not have enough strength to generate any compression along those lines. My first goal has been strengthening the quad muscles on the front. Weights were too heavy still so I went to just basic leg extensions with no weight. I just did a lot. I was doing sets of fifty, 4 or 5 times a day. I am now up to a 4 pound ankle weight and doing 4-5 sets of 40 or 50 reps depending on how the leg feels. Every week for the last three weeks the leg has felt better. The pain in the knee is starting to fade and I am starting to feel confident about bone stability. I shall see what the next two weeks bring. I am being more patient and careful these days. I do not want to give that nail any reasons to go further into the knee.

Range of Motion
My other recent goal has been getting range of motion back. Basically I want to be able to kick myself in the butt! Three weeks ago my heel was about 6 inches away from being able to do that. Now it is one inch away! I added a new stretching trick to the repertoire. It is called PNF, or PIR by some folks. Proprioceptive Neuromuscular Facilitation or Post Isotonic Relaxation. You put the muscle in a stretch for ten seconds. In this case lying on my back and pulling the knee towards the chest and the ankle towards my rear. After ten seconds you relax the stretch about an inch or two and try to extend the leg against resistance in the opposite direction. Your hand can provide enough resistance here. Repeat this process three times. The results have been great!

9 MONTHS (week 38) - Update: September 12, 2002. A woman can grow a whole kid in nine months and I can't grow a half inch of bone. Who designed this system? Sorry for the lack of updates here. I had been updating on the x-ray page, but my camera broke last month before the last set of x-rays. I have been in a bit of a funk since then and have not felt like writing.

I have what is called a fibrous non-union. There is stuff holding the parts together, but it is not bone. I can limp on it, but eventually the rod will fail. So far I have gotten two opinions. One suggests rerodding the femur. Take the old nail out, ream the canal to stir up the bone, and put in a new nail. The second, an expert in California, has suggested a bone graft as his first choice. I am afraid to ask for a third opinion because the number of new holes they want to put in me keeps increasing. It seems like I have to know more than any of my doctors to make a decision. Back to the library and the web for research. I want to understand why it has not healed. (If you fail to define a problem, the solution will elude you. $BC 70th law) I also need to know why each option might work and what the respective probabilities are. See my list of questions.

Confusing me through it all is that I still am making about 2% progress each week with my muscles. I can limp up about ten steps, one step at a time, without a cane, now. I still limp when I walk and use a cane a lot, because I tire quickly. However each week brings a little bit of improvement. The rich learning experience continues. P.S. The bone growth with weight training idea from week 19 didn't work. :-) (Well, not yet anyway)

10 MONTHS - Update: October 16, 2002. Yesterday I had a Screw removed...from my hip. This is different from the screws in my brain, which are always loose. (Yes, if you want to make jokes they have to be better than mine. I will give you credit if your commentary is deemed worthy.)

11 MONTHS (On the nose!) - Update: November 21, 2002. How about that? It has been 11 months since the first surgery. I am still not walking well. However there is hope. Today I had another x-ray. It was the nastiest looking one yet. Not of my leg, mind you. They overshot it and it was so dark you could hardly see anything. I also did not have the previous x-rays for comparison. But...

DISCLAIMER: I was reminded of a line in Pulp Fiction where Harvey Keitel says, "Let's not start..." ... sorry, I can't remember the exact line. Anyway he was cautioning against "irrational exuberance." I shall try to be cautiously optimistic in my statements.

The gap between fracture segments seemed narrower. I am guessing 2 mm versus the previous 4 mm. The doctor could not detect signs of rotation of the femur segments. That would have meant putting a screw back in. There are also several new places where there seems to be signs of callous formation. To my rookie eye the forces seem to be traveling through the fracture site and the bone is responding to that stress. So far, deluded or not, I am happy. The next x-ray will be in about 8 weeks. We shall see how things look then. I will be reminding them to reduce the power on that machine next time. I think they really nuked me. (More power = darker x-ray, the doctor said.)

I also got more information about my gait, and some new exercises. I appear to have a classic Trendelenburg's Gait. Basically I have a weak Gluteus Medius and a few other things. (Actually every dang muscle in my left leg is weak.) Anyhow I have new exercises that I can measure the progress of easily. I say that because it was too hard for an untrained eye to measure the progress of one of the previous exercises. Doing 12 reps instead of 10 is a measurable gain. Listing one less millimeter to the left when standing on one leg is very hard to measure. Right now I can move about one inch on one of my new exercises, a one-legged squat. Let's see how far I can get by the next update.

1 YEAR, 4 MONTHS - Update: April 24, 2003. You can visit the last item on the x-rays page to see what my new pictures look like. There is callous formation across two of the four gaps. I recall reading that I need three to be considered healed. Also, it apparently takes a while for the bone to look solid. Right now the view is very faint. Anyway there is hope for the bone at this point. I will get more x-rays in 3-6 months. The doctor wants me running by then.

On the muscle side of things, most of my muscles seem to be coming back well. Hamstrings, glutes, and calves are all behaving well on both legs and are getting closer to similar strengths. The quadriceps, the muscles damaged the most by the accident and the surgery, are another thing. Still, they too are progressing. The right leg is still about 50% stronger, but the left leg is starting to come along. I am also walking much better than I have been, and further too. Although the limp remains in many ways. However I am more optimistic this week based on how my exercises are progressing lately. More later!

1 YEAR, 9 MONTHS - Update: September 9, 2003. OY! Sometimes I forget these updates. It has been a long adventure. Still I have minor progress items to report, and much new learning. Two weeks ago I stood on my weak leg and jumped over a stripe in a parking lot! It might sound like I am stretching it there, but that was a big leap from my previous vertical clearance of about 2 mm. (All puns intended.) Last week it was deep knee bends and then standing back up without pushing off of anything. Tonight I walked to the nearby grocery store and back. (About 5 blocks each way.) Usually I take my bike, but tonight I felt strong enough to try the walk. Overall it was not bad. And to what do I owe my progress? Protein!

Apparently I qualify for almost body builder levels of protein since I am rebuilding a whole leg of muscle, while also getting my overall strength back up. Instead of the 80-90 grams of protein the RDA shows I might need, I should be getting between 150 and 200 grams a day! My muscles actually started waking up about a month ago when I upped my intake to 120 grams a day. I think they were very happy to have the extra building material. Last week I consulted with a nutritionist (Melissa at Nutrition In Balance. She does phone consultations too!)) and she recommended the still higher levels. I am still learning how to fit all that into my diet. So for at least five weeks now, my muscles have been growing steadily stronger. I also hurt more at times as my body adjusts to new activity levels, exercises, and ranges of motion. Overall it feels good.

Another glorious side effect of all this protein has been an extreme reduction in appetite and the weight loss that came with it. I noticed over the first couple of days as I kept track of calories and protein, that I would get to the end of the day, not be hungry, but have eaten about 600 calories a day less than usual. In a little over five weeks I have lost about 5 pounds. NOTE: This is not a trendy diet or anything. It is just a more focused effort at balanced eating. Over the last two weeks I am averaging 30% of calories from fat and 20% of calories from protein. I think fat should be a touch lower and protein should be a touch higher, and that is what I am working toward. It is an enormous organizational challenge for me to eat that way, but I know it has been well worth it so far.

24 MONTHS - Update: December 4, 2003. Hypertrophic non-union. Translated: More surgery. Surgery I probably should have had a year or more ago, but I have been foolishly stubborn and optimistic. I also wanted to understand what is going on in my leg. It is not healing properly! All that for such simple wisdom. The surgery I expect is a rerod. They, with much difficulty because I broke a screw, take out the old rod, stir things up and put in a new rod. Someone else might recommend a bone graft. I will try and wait for spring, because I hate limping on the ice, but I may get the surgery before that if my second or third opinions recommend it. Stay tuned. (See the recent x-rays)

29 MONTHS - Update: April 13, 2004. I went to see the people at Colorado Limb Consultants. They have some different options available. For non-unions they can do an outpatient injection of bone proteins that apparently has some success healing non-unions. However the x-rays taken seem to show lots of healing, in particular along the backside in the lateral view. The doctor feels it is making progress and it might heal in a couple of months if I treat it right. I personally am worried about the angle they shot the x-rays at. It is rotated more than the others and might be revealing healing that is not there. I'll keep you posted. (See the recent x-rays)

P.S. Some background on what I did differently over the last four months might help future medical researchers. After I found out my hypertrophic non-union might be caused by excess movement at the fracture site, I removed all weightlifting and other exercises that might be causing excess movement at the fracture site. This included all weight machines where the pad hit my femur below the fracture site as well as anything I did that might be torqueing my femur. The latter included several one legged trunk exercises. Secondly, about a week after I changed my workout my bicycle slipped on some ice and I had to plant my left leg for support. It was a major impact force up my entire leg. The whole femur and its muscles were unhappy for several weeks afterward. I did not feel pain at the fracture site, but the leg felt like it was in shock, for want of a better word. Finally I got some serious tendonitis and phlebitis in my legs two months ago that forced several weeks of bed rest. Any of these things might have helped my leg along. I would tend to rule out the bed rest stage though. That was accompanied by lots of Ibuprofen and Aspirin, and supposedly those interfere with bone healing.

P.P.S. (4-14-04) And of course since it was the 13th, I do have to add a little bad news to the mess. The doctor told me to avoid impact exercises. What do I do? I stepped off a short curb putting my bike on the bus, except it was not a short curb. I travelled about four inches further than I expected and the landing on my weak leg was very abrupt. This morning I have a nice piece of minor knee pain and a muscle ache somewhere around the rectus femoris (also fracture site area). Hopefully it is just strains and bruising. Hopefully.

3 YEARS - Update: Jan. 5, 2005. It has been a long time since this was updated, and only marginal improvement has happened. After trying a whole summer to get it to heal I had surgery October 1. It was percutaneous injection of Osteoset and autologous bone marrow. Big words, I know. They took some pellets of bone proteins (someone else's ground up bones I found out later) and calcium sulfate and mixed it with some liquid bone marrow they took out of my hip. They then inject this mess under the periosteum at the fracture site. It is physiologically similar to a bone graft, but with less invasiveness and a shorter hospital stay. I went home the same day and was gimpy for six weeks or so.

Since then I still deal with the same issues. There are various aches in muscles or the knee. They migrate about. Sometimes it is knee, sometimes it is lateral to the midline, and sometimes it is in my medialis muscle. The doctor believes they are from weak muscles. I am still unsure. A year ago I thought it was weak muscles, but at the same time there was a lot of micro-movement possible at the site and muscle spasms could have been in response to that. Until the bone heals I will not be confident of the source of the aches. That being said, the recent x-rays make me more inclined to believe it is muscle pain.

If you look at the x-rays you can see bone trying to grab along the medial edge (left side of x-ray). The gap is also narrower. These all appear to be signs of progressive healing. What seems to be important now is to not make anything worse. I no longer use any weight machines for my legs. I have also tried to eliminate all major torque exercises for my legs. I avoid climbing hills and stairs. I do not stand up on bicycle pedals, even though the doctor thinks it might be okay. I find with my long legs (6'5" tall) that I really have to bend my legs almost 90 degrees and I think that might be too much. Squats are also out. The only exercises I will do now are biking, but spinning or low resistance only, straight leg raises, and wall-sits, where I lean against a wall, do a partial squat. The doctor thinks no more than 30 degrees of flexion in my knees is the limit. And I really have to make sure when I get out of a chair to not put much weight on the left leg. I still push myself up mostly with my arms and my right leg.

All the updates later 2005 have acquired their own pages for convenience (mine). Text and x-rays appear on the same page.

(May 5, 2005 - Update)
(June 30, 2005 - Update)
(August 30, 2005 - Update)
(January 31, 2006 - Update)
(August 17, 2006 - Update)
(April 17, 2007 - Update)
(February 21, 2008 - Update)
(June 22, 2010 - Update) Same update linked on kurtsimmons.com home page.