Sunday, 8 May 2016

What I've Learnt From A Broken Wrist

As I write this, it has been exactly three months since I fell and broke my right wrist. I've had my fracture attended to in two hospitals, endured two rounds of surgery and countless therapy sessions. 

My life changed after a fall in February. 

I was taking a stroll after dinner and slipped on a pavement where puddles of water had collected from the rain earlier. I fractured the two bones in my right wrist. Somehow the bananas I was carrying fared better than I did. 

It happened overseas and I had to stay overnight at the hospital so the orthopedic surgeon could temporarily fix it. Through an external reduction procedure, he manoeuvred my displaced bones back into position and immobilised my arm in a cast, until I could have surgery back in Singapore.

I've had my fair share of bumps and falls in the past. My passion for the outdoors plus my flat feet have scored me the odd tumbles here and there. I once fell off a Segway and seriously sprained my upper right arm. I've parasailed, snorkelled, trekked and cycled, torn my skin and sprained my ankle more than once. 

So I'm used to bruises, cuts and sprains. Broken bones, hell no! There's always a first time and I hope this is the last.

A broken right wrist is one hell of a curve ball, especially when it's the hand I depend on for simple tasks I'd taken for granted. The hand I use to eat, drink, write, swipe my iPhone and iPad, hold my computer mouse, brush my teeth,  wash my face, switch TV channels and open the door. 

You get the picture.

My broken wrist, before and
after surgery
I was unlucky to break both the radius and ulna at the distal (wrist) end of my hand. My surgeon diagnosed it as a distal radius fracture and distal ulna fracture. The radius is the larger of the two bones of the forearm. It rotates around the ulna, allowing us to rotate our hand, turn our palm up or down, bend and straighten our wrist and elbow.

At the time, I felt no immediate pain even though my wrist was bruised, swollen and lost its colour pretty fast. My forearm felt numb and looked grossly odd, bent near the wrist. Not a pretty sight.

The impact of the fall had compressed the median nerve which controls sensation and movement of the hand. 

It's also the reason that until today, I still feel pins and needles in my fingers and wrist, and I wake up each morning to a tingling wrist, stiff fingers and a tight grip-like kind of feeling in my forearm that takes several minutes to ebb away. 

Broken but not beaten

With my dominant hand broken, simple tasks like dressing and eating slow me down and take double the time and effort. But then I learnt to cope. I just get creative,  improvise, adapt and get on with it. 

At first, immediately after surgery, even walking outside took getting used to. I was afraid people would knock into me. I'd be anxious when I see slopes and wet surfaces ahead. Walking painfully slowly, I'd grip my husband's hand as my heart beat faster. Whereas the rain didn't bother me before, now I'd rather stay indoors when it pours. The phobia stays, although I'm not as anxious as I was then.

After my wrist has been in slings and splints to immobilise it for that long, my hand is so stiff I can literally bounce a ball off it. 

My therapist has prescribed exercises to regain my hand's range of motion. These can be painful but tolerable. The  tendon and muscles in my fingers and forearm are weak and lazy from slumber, and scar tissue has clung around my wound. So the exercises are necessary to stretch and keep them flexible. She has yet to start me on a regime to build wrist strength. That will come next, once my surgeon gives the green light.

Despite the pain, inconvenience and frustration, I'm not complaining, really.  

I'm lucky I still have my hand. 

As a freelance writer, I once interviewed a teenager who went through limb salvage surgery after a bone cancer diagnosis. I'm also in touch with a stoic Ewing's Sarcoma survivor. Although her doctor managed to save her leg, the the cancer spread to her lung. She has been cancer free for five years, but her lymph nodes are suffering the late side-effect of radiation therapy, and she now walks with a limp.

I've read of victims of shark attacks and road accidents whose limbs had to be amputated. Not to imagine how others fighting to save their limbs from life-threatening conditions like diabetes and osteosarcoma are coping. 

For these people who have little choice but to bravely face a fate worse than mine, I can't even imagine how their lives must be. So what if I must keep up the scar massages, wrist flexes and extensions  several times a day? 

One surgery too many!

I've been seeing my surgeon and occupational therapist regularly over the last three months and if it means getting my hand back to normal faster, I can't wait to see them again. 

I've had surgery, twice. The first time here at the new Ng Teng Fong General Hospital,  my surgeon performed an Open Reduction Internal Fixation (ORIF) procedure. He inserted a titanium plate held by screws to my radius. This holds the bone in place as it gradually fuses and heals. Imagine this plate as strong glue. It holds broken porcelain pieces together. In almost all cases of distal radius fractures like mine, the plate stays in permanently. What a souvenir.

After surgery: volar plate on the
radius, K-wire on the ulna head
As I also broke the tip of my ulna, my surgeon placed a sharp, smooth, stainless steel wire through it to temporarily hold the broken pieces together. 

The K-wire remained in my wrist - until last week. It's done its job of stabilising the ulna head (sufficient new bone tissue has grown to hold the broken pieces in place), so it had to go. Leaving it in was not an option because of the potential risks.

Laying still on the operating table, I could feel and hear everything 

Removing the K-wire was not the quick out-it-comes and off-I-go procedure I'd imagined. During the first surgery, I was given general anesthesia and was literally comatose.   I slept like a baby and woke up pleading for a stronger dosage of painkiller to numb a very, very sore hand. Rather bland and uneventful, thankfully.

With my husband on the day 
just before my first surgery
Last week, barely two-and-a-half months after the first, I  was back at Ng Teng Fong GH. I went under the knife again. And I was conscious. 

Even though I'm no virgin to surgery, not knowing what to expect was daunting. Just imagining the pain I might have to endure was bone-crunching, gut-wrenching scary.  I'd known I'd be conscious when they remove the K-wire.

I was wide awake and painfully aware of every noise, pull, tug and twist. I was on a bullet train about to crash. My blood pressure and heart rate shot sky high, glaring clues to the adrenaline rush in my body. 

The K-wire that stayed in my wrist for 10 weeks
If you haven't been cut open to have a foreign object nudged, tugged and pulled out of your bone as you remain alert, picture your teeth being pulled out. Your gum feels numb. You feel pressure as the dentist twists and tugs at your stubborn tooth before it finally comes out.

Except, what I went through felt much, much more intense.

The clock hardly moved. I desperately tried - and failed - to picture myself somewhere, anywhere, but there.  My nerves felt raw and on edge. I felt warm and cold at the same time.

I was anxious the anesthesia would wear off and asked the surgeons how long it would last. Six hours, I was reassured. I guess being used to this sort of thing, they  helped distract me with chatter for all of the 20 minutes it took to get the K-wire out. 

Did I feel pain? On a scale of 1-10: 0! Thanks to the fine skills of my experienced surgeon, Dr Mark Puhaindran, and his partner in crime, Dr Renita Sirisena. 

The whole experience was nerve-wrecking but not painful. It could have been worse. The hardest part was the anticipation, not the surgery. 

My new best friend

Meet my new best friend who "protects" and guards my injured forearm. It goes in the shower with me and in my bed when I sleep. It goes to the gym and travel with me everywhere, signalling others to make way for its  injured owner.

My new best friend, my "bodyguard", is a thermo plastic splint that has seen better days. It's kept my forearm from moving so the fracture can heal. 

For the first 12 weeks after surgery, I wore it up to my elbow. Now, it's modified to wrap around only the lower half of my forearm. Our weather's hot and humid so this helps a lot, especially in the gym.

Not only has it kept my vulnerable wrist safe from further injury, my new best friend has turned into quite the fashion statement. 

It has even induced small talk with curious strangers, and neighbours I'd never bothered to chat up.   

Three down, nine more to go

Fracture healing can take up to a year or more. Take away three months. I still have nine more to go before my wrist can be as good as new, if that is even possible. 

My doctors caution I can't expect my right hand to function the same way as before. However, acquaintances who've had a similar experience have regained close to full (90-95%) hand function, so there's hope for me yet.

Fracture healing has been tedious, uncomfortable, boring and time consuming.  Fortunately for me, I could count on my husband of 30+ years to take care of my needs. He hasn't missed a single hospital visit or therapy session and watches over me until I could dress, bathe and feed myself. He holds my (other) hand firmly when we go out, in case I trip. He cuts my food in small pieces so I could feed myself easily enough. He checks how much my hand function has improved each day and keeps my spirit up.  

Nursing a fracture eats into time you could use for stuff like reading and watching TV. I wasn't prepared for the small compromises I had to make. 

My surgical scars a week 
after the first surgery
At the beginning I couldn't even read, write or watch TV while doing my scar massage and the range-of-motion exercises, as I hardly dared to take my eyes off my scars. 

Even now, if I stop the motion exercises for a few minutes, my wrist and fingers stiffen and feel numb. For as long  as it takes to type this, my wrist has stiffened up a bit even though my fingers feel normal from moving them on the keyboard.

Incidentally, if you have just broken your wrist and happen to read this, I hope sharing my experience has helped you prepare for what's ahead.

If, like me, you are nursing a fracture, don't give up. In my next post I will give a detailed account of my progress and my personal tips for coping, one hand, one day at a time.

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