Dear Orthopedic Patient....

To my dear Orthopaedic Patient....,

………. If you only knew what lied ahead in your recovery process, you will never fall. I'm not saying this is your fault or anything, but please lean on the side of caution. I had one patient whose gait was not steady went walking up some steep steps at home and fell backwards one flight down, hit his head on the way down. So you can imagine the bruises, hematomas, fractures, etc...it was a bad fall, and needed hip and arm surgery. So the pain was excruciating he will say. I know, I will reply. How do I know this? I also had an injury. Not a fall, but injured my knee in a car accident where my patellar got fractured. Seems like a minor injury? Maybe. But it was one of the worst pains in my life and my recovery process took four months instead of six to 9 weeks.

So I really do feel your pain. If you fell once, you can fall again. I advise you to..

1)take small steps at home or outdoors where you wear sturdy shoes, 2) use your walker or cane at all times, and adjust it as needed. 3)Whenever possible take shorter routes and use ramps if available. 4) Also urge to put rails where needed in bathroom and around the house. 5)Use bedside commodes, shower chair and ask for extra hand for help when possible.

It's about safety my dear patient! We just don't want you to fall.

There are so many more stories I can tell you, but let me share with you my personal story. I injured myself too. I didn't fall because I lost my balance, but I injured my knee like I was telling you earlier. I want to share this story as a patient and also as a rehab nurse and currently at the Orthopaedic Neurosurgery unit at the University of Maryland. I would have never imagined the range of emotions, fear, doubts, frustrations and pain that came with this injury. So on a sunny Saturday afternoon, I was headed to my sister's house and drove into a congested area and seem like I didn't hit the brakes soon enough. The impact of hitting the brakes forcefully fractured my knee.

(Pictured above is CPM: Continued Passive Motion equipment that a lot of orthopedic physicians prescribe for knee surgery patients to improve and increase range of motion. However, some physicians believe that manual range of motion is enough to promote a natural healing process.) For more information on CPM: https://www.verywellhealth.com/cpm-continuous-passive-motion-2549555

(Collage picture of my recovery from June to October 2018)

So by Friday that same week I had the surgery repaired with a screw, was prescribed a brace and crutches, follow up visit and physical therapy for 6 weeks. To make a long story short. Here are some of the problems I ran into during those weeks:

• My leg from knee to my foot was swelling with 4+ edema first week after surgery. (possibly from too much pressure on the leg and not elevating it enough). Doctor recommended just to keep it elevated.
• Was not making it to the bathroom timely, so end up putting Depends. Even when making it to the bathroom, couldn't sit.
• Getting in and out of cars was a nightmare. Needed someone to support my leg up while I got in the car; could not lift my leg.
• At some point I was getting depressed, thinking I was going to be wheelchair bound, and did apply for disability (which takes 6 months to process).
• Took me a while to get use to the crutches. I end up getting a walker instead.

• My recovery took a lot longer, because my knee was not flexing, but was getting stiff and more painful. Looking at picture above, my knee was expected to flex at least to 90 degrees by 6 weeks. It was not happening. So my frustration and the therapist expectations were growing.

For the pain I took Vicodin, and used hot and cold pack, and Epsom salt soak. I finally got a breakthrough after about 8 weeks when therapist encouraged bicycling motions. (Pictured is cold pack with velcro strap for knee. For more products from Thera Pearl for other joints like back and shoulder, check www.therapearl.com)

Roadblock in the Recovery Process

• With increase pain and recovery not progressing, I was considering alternative therapy, natural medicines including a procedure where I will have my knee manipulated-have it flexed and extended under anesthesia, since my knee felt locked and stiff possibly forming fibrous adhesions in the knee hindering the recovery process. According to BoneSmart, in article link describes

"Manipulation under Anesthesia is a technique for treating stiffness and poor range of motion following total knee arthroplasty (TKA) or knee revision surgery. Stiffness and decreased range of motion after TKA affects approximately 6 to 7% of patients. MUA is a non-surgical procedure performed in a hospital with the patient under general or spinal anesthesia. During a total knee replacement some interior tissues of the body are exposed to the air causing essential lubricating fluids within the body’s tissues to evaporate.

If the fluids are not quickly replenished after surgery, affected muscles which normally glide over each other may bind and form adhesions which can cause pain and greatly limit the ability to move the affected joint. Light adhesions can often be worked out with physiotherapy and therapeutic massage/manipulation techniques. However if adhesions are large, treatment to free the joint may require orthopedic manipulation under anesthesia. The incidence of adhesions and scar tissue requiring orthopedic MUA is low, occurring in 3.9 – 4.6% of total knee replacements."

• However, didn't go with the alternative with the fear that I will break more joints in the process. So I stuck with the original plan, my surgeon's recommendation to join a gym and continued with physical therapy with ATI in Catonsville for another six weeks. https://locations.atipt.com/catonsville-md

I have to give credit for my recovery to my persistent, handsome and intelligent doctor, Dr. Russell Bear. My poor doctor believed in me and in my recovery when I wanted to give up. So this article is a dedication to him, my therapists at ATI, my sister Cathy and family, church friends and family for prayer, support and all my ortho patients.

(Dr. Russell Bear, Orthopaedic surgeon, pictured here: CENTERS FOR ADVANCED ORTHOPAEDICS 200 Hospital Drive Ste 200 Glen Burnie, MD 21061 (410) 768-5555. He also has an office in Hanover, Maryland and is affiliated with the Baltimore Washington Medical Center in Glen Burnie, Maryland. Complete biography is in link below.

• Other problems I encountered in my recovery process is that my health insurance, Blue Cross and Blue Shields only covered some of the therapy costs due to a high deductible. So my bill is about $3500 post therapy. I also didn't get financial help from auto insurance since I was considered partially at fault and had partial coverage on my van. So the bills were piling up. Disability payments from my work disability coverage helped a little but was just enough to get through the month.

So in conclusion my dear patient, please protect yourself from these falls. Take the recommended vitamins and nutrition to strengthen your joint cartilages, bones and muscles. Continue with the suggested exercises daily. The older you get the more you're at risk for bone and muscle degeneration, so take the necessary precautions to prevent falls. Here again are some steps you can take provided by FirstLight Homecare. It covers safety measures indoors or outdoors. For handouts you can printout at https://www.slideshare.net/FirstLightHomeCareCentralFlorida/first-light-homecarefallpreventionprogramhandout?from_action=save

*In conclusion, here's to your health and safety. Stay tuned for part 2 to this Fall Prevention Series where I will go in the reality of being in Rehab. Are you prepared for the vigorous schedule, and possibly more pain that comes with the healing process?. I will share alternative therapy and techniques that Rehabilitation hospitals are now using to help you recover.

Picture: My last day in physical therapy at ATI. I was given the championship belt. I pray and hope that this is my last injury.

Article by Gina DesRosiers, RN,BSN at University of Maryland Health Systems, travel nurse with Maxim Healthcare, www.maximhealthcare.com