Barts-MS rose-tinted-odometer: ★★★★★
Despite posting an update on my progress just a few weeks ago I am still getting daily texts, emails and social media messages about how my rehab is going. So here is my final update.
Once you are over the initial 4-6 weeks after polytrauma things, at least in terms of improvement, slow down a lot. So not much has actually changed in the last three weeks since my last update on the 22nd of January.
I was clearly overdoing it and yes I admit you told me so. When I had an x-ray of my pelvis a few weeks ago the fracture of my left superior pubic ramus was not healing. Probably because I was doing too much exercise, which was causing some movement at the fracture site and non-union. I have been advised not to do anything that makes the pelvic pain worse.
I weaned my anti-inflammatories only to find that were masking a lot of my pelvic pain. As a result, I have dramatically cut down on my walking, stopped using the exercise bike for cardio work-outs and I am limiting my lower limb exercises to those that aren’t painful.
Things were going well until I volunteered to be a pallbearer at our friends funeral on Monday; the additional weight-bearing strain on my fragile pelvis has made my pelvic pain a lot worse. So much so that I had to restart my anti-inflammatory medication this week.
The good news is that I am continuing to notice and improvement in the range of movement in my right or injured hip. I still have limitations with hip flexion and internal and external rotation of the hip. Any rapid movements in the hip, particularly flexion when the hip is externally rotated, is very painful. I have worked out that this likely to be due to activation and contraction of the pectineus muscle that is attached to the superior pelvic ramus where my fracture is. Could this be one of the muscles that are causing my fracture line to move ever so slightly and delaying it from healing? As a result of the pain, I now walk with a noticeable, albeit a slight, limp. In neurology jargon, we call this an antalgic gait.
My major concern is whether or not I will be able to run again. I was told by my orthopaedic surgeon not to attempt running for at least 6 months, which will take me to May. I really can’t imagine a life without running, but who am I to complain when so many of my patients with MS have had to resign themselves to never being able to run or even walk again. I think I am beginning to understand the mental toll MS places on people when they realise their physical and mental disabilities are worsening.
During the accident, I had a hyperextension injury of my left ring and middle fingers. This injury is now causing me a lot of trouble with swelling of the interphalangeal joints of both these fingers and the beginning of hyperextension-flexion contractures in these figures. I suspect the latter is due to an imbalance in power between my forearm muscles and the intrinsic muscle of my left hand. Yes, I still have mild weakness in my C7 and C8 innervated muscles of the left arm. The imbalance on power causing clawing of the fingers is a common mechanism that afflicts many people with peripheral nerve problems. The good news is that my muscle strength is returning slowly, particularly around my shoulder and scapular, for example, the winging of my scapular has almost resolved. I hope my finger deformities improve as well.
The most recent CT scan of my cervical spine shows my vertebral fractures are healing well. I am not using a neck brace, but still have stiffness and pain in my neck, particularly when I move it quickly. My stamina in terms of sitting and standing is improving and I can now manage about 6 hours before needing to rest my neck muscles. I have reclining chairs with headrests in both my offices at work and at home. Another reminder that you need to have resources, essentially money, to ensure you can return to work with equipment that allows you to function without too much pain.
I am now back at work doing remote clinics, catching-up on teaching tasks and generally doing what I used to do, however, all at a much slower pace. My physiotherapist has adapted my exercise programme so that I can do most of my exercises, at least my upper body exercises, in my office during the day and has truncated the programme to make it less time-consuming. I am still sticking to the programme in the hope I will get back to normal.
My attention and concentration are still relatively poor. I am having problems tackling big creative writing tasks. As a result, I am not nearly as productive as I should be. However, things are improving and I feel that by being back in my office, without distractions, I am achieving a little more each day. Yes, I am back doing endless zoom calls.
Overall my attitude remains positive; I still feel lucky to be alive without a major disability. I also realise how privileged I am to be able to afford private rehabilitation and to be able to purchase the necessary equipment for my rehabilitation. As ever I am grateful for living in a country where universal healthcare is a basic human right. The NHS is such an extraordinary institution, which most of us take for granted. I would urge you not to take it for granted; you only have to look around the world to understand why the NHS and its staff need attention and care.
Finally, can I please make this the last update for the next three or four months? As far as my clinical and academic activities go I am back working full-time and want to be treated as such. You will find me saying no to a lot of things mainly because I have reset my priorities. If I ever do another update it will be when I am back running again, or not.