Ramblings on healthcare, medical education, and life with a spinal cord injury
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I Broke My Knee

That’s right, I broke my right knee. Let me tell you the story. A few weeks ago (just after I last posted, so about three to four weeks), I was walking on the walker with a PT and Richie, one of the aides. After about thirty or forty feet, my right knee buckled and Richie caught me. The right knee had been feeling a bit strange prior to that, but nothing so unusual that I was worried about walking. After catching me before I had the chance to hit the ground, I sat and rested for a bit while collecting myself.

When the knee buckled, I was taking a step with the left leg and thus had all my weight going through the right. So there was no chance to brace or catch myself with the left. If it weren’t for Richie, I would have landed hard on my knees and probably sat backward on my legs – something that we already know isn’t good for me.

But that’s the whole reason I don’t walk alone just yet, and exactly what Richie is there for. :)

All of this is compounded by the fact that I still don’t feel pain normally below my injury level, so if something does go wrong, it’s not as simple as noting whether or not it’s a sharp pain or a dull pain. All I’ve felt in the right knee is a sort of tingling and tightness. Sometimes it feels like the same kind of tightness that accompanies a sunburn. I felt that again after the knee buckled, and when attempting to walk during a subsequent session, the knee was much weaker than it had been, and I continued to have that strange tingling/tightness.

I couldn’t put any weight through it, and had to use my arms a lot while walking – something was definitely up. The area just below my patella felt warm to the touch, and more gelatenous than the left knee. It wasn’t a large area, but there was a noticable difference. And since I still had numbers from when we had measured my knee last summer when it was acting up after I slipped getting out of bed and fell on it, we had a basis for comparison. Unfortunately, the amount of muscle mass has changed drastically since then (well, that part is fortunate) – so the comparison wasn’t useful. It was clear, though, that the knee was swollen.

I decided to take a break from walking for a few days to see how it progressed, and when it was still swollen after a couple days, I made an appointment to see Dr. Ragnarsson. His concern was a fracture in the knee, as apparantly they are common for anybody who sits a lot, with or without a wheelchair. So I went for an x-ray.

The next morning he called me back: I have a small avulsion fracture of the right knee. The bone is not entirely avulsed, as can happen with type of fracture, but there is a very small crack in the bone.

Now the upside – it’s not a new injury. The radiologist who read the image noted that it was an old fracture, and the images and report were viewed from last June when it was also x-rayed. Sure enough, it was present then too – and also noted then as an old injury. So it seems like when I hurt my right leg back when I was in the hospital that I may have also caused the avulsion at the same time.

Dr. Ragnarsson said there were no other issues with the x-ray, and he cleared me to return to walking and weight-bearing activity after my nearly two-week hiatus. The first session back was tough – my legs were stiff and not used to being upright. It’s amazing how as short a time as two weeks can have such an impact.

And it wasn’t just a physical impact. During those two weeks, I became increasingly agitated and angry. I didn’t realize at the time exactly why, I just knew that I was feeling really down. The weight of life in a wheelchair felt so heavy on everything I did, and I started to find frustration in every part of life. But I couldn’t explain why all of a sudden.

Then the first day I returned to walking, it all went away the instant I stood up. The weight was gone and a smile once again returned to my face. I’m very much an optimistic person, always trying to see and reach for the barely visible goal off in the distance. But at the same time, I try to remain pragmatic. Each time I walk a bit further than I had in the past, it’s a very strong emotional high. One year ago at this point in time, I couldn’t even move a toe. Now I’m walking with a walker and no assistance from anyone. So even adding just ten feet to my own record makes me feel amazing. In a sense, I’m very much bouncing from each high to the next.

Now, I realize that every day can’t be a record breaker. And I realize there will be down days along with the up. So I don’t sweat it if I have a couple bad sessions where I’m not able to walk as far as I had in the past. Even if it’s significantly less, it doesn’t matter. My focus is always on the continued upward trend. I’ve been interested a great deal in finance and the markets over the past few years, and unless you’re a day trader, investing will drive you crazy if you look at each up- or downtick. It’s the same thing with rehabilitation.

But not walking for two weeks, that was just incredibly upsetting. At least now that I’m aware of the impact, should I have to take a break from it again in the future, I’ll be more prepared to anticipate and deal with it.

Since then, I’ve managed a top distance of somewhere between two hundred fifty and three hundred feet on a walker.  No assistance at all.  My sit-to-stand is still pretty rough, and the stand-to-sit is even rougher.  But we’re working on them and my glute strength is steadily increasing.  Nobody knows if or where my progress my plateau, but I intend to continue pushing forward as far as possible, even with school starting in just a few months.  Egad.

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