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Yes I know people have been saying that about me for a very long time. But now it is quite literally true. One of the screws that was put into my talonavicular joint fusion has been working its way out. I understand the best explanation for this is that it the bone has been growing and kind of pushing it out of the way. My surgeon says that the CT scan shows that the plate has grafted successfully to the bone, so the screw is at this point superfluous and can be removed without consequence other than that I have to have a surgery, and then I go back into a cast.
For anybody coming to this blog for the first time or who hadn’t seen the overall story let me give you a short version here. You can find all the detail you want at my fall rescue and recovery.
I’m gonna first do a quick update on the state of my physical recovery and then hopefully if I get to this in time I will talk about a little bit about some of the emotional changes that I’ve been going through.
The spine injury is going pretty well
The TLDR Version of incident is that I was on a solo backpack trip in the Ventana Wilderness on my 67th birthday and I fell 30 feet from the top of a waterfall to the bottom luckily I hit water and so I did not die my L1 vertebrae had a burst fracture. The first real notes that I see are from my primary care doctor
67 Y male complains of low back pain s/p burst fracture of T12 and L1 from fall while hiking alone in wilderness. underwent L1 laminectomy and T11-L3 pedicle screw fusion at OSH.
I was rescued And helicoptered to a trauma center in Salinas where I spent several days in ICU and got the surgery on my back. I was then transferred to school nursing facility and then home where I continued to get therapy until we recognized that I also had an ankle injury.
They had not spotted the ankle injury in the initial assessment of me I understand because things were just too swollen up even the CT scan did not show the fractures but I had shattered my talonavicular joint and it needed to be put back together.
Since it was the Kaiser team that found the ankle injury and did the surgery that was very good but the spinal team was simply not up to speed on my injury my case or anything about me.
I actually met the spine specialist at Kaiser for the very very first time just a couple of days ago, seven months after the surgery. Before yesterday all my contact with this surgeon had been via telephone a little bit of email.
In our last phone visit, in November he denied me physical therapy which really kind of sent me off. For one thing I had been getting physical therapy since two days after the surgery had physical therapy in the trauma center hospital had physical therapy at the rehab center back at Freemont and a physical therapist came to my home to get me built back up to strength. But when we found the ankle injury, six weeks after the spine surgery, I told the home therapist to discharge me because I wasn’t going to be able to do any of the exercises anyway. I assumed that once the cast was off my foot I would be able to resume outpatient physical therapy. After the foot surgery I was referred to a physical therapist for the ankle. The same therapist was confident he could help me with the stiffness and soreness that I felt in my lower back. and guide me to rebuild my core strength and flexibility, but was not allowed to do so unless he had a referral.
I never did find out what is thought for denying me the physical therapy at that point was. But I reached a pretty strong conclusion that he had come to an incorrect assessment of me as a person as a complete person because he had never actually seen me or met me.
I tried to enlist my primary care physician who I generally like to get this resolved and to get a referral to physical therapy for my back and that didn’t work at all. My next step member services and file a grievance.
My grievance was approved and I was given a referral for physical therapy from another doctor in the spinal surgery department. I had thought that I was going to be transferred to a different clinician because of the grievance. But about a month ago I was sitting at home and I got a call to set an appointment for myself with the same surgeon. I was pretty surprised. I asked if there was another doctor and was told that I could only do that with a referral from my primary care physician. The person on the other side offered me a choice of a telephone visit an in-person visit or no visit. I thought that the telephone visit last time did not work well so I asked for an in-person visit.
Going to Oakland is kind of a pain and the parking at Oakland Kaiser kind of sucks. But I went and I had overall a good appointment. I think being able to see me gave the surgeon what he needed to make a far more accurate assessment.
The best news is that my hardware is stable! What I feel as the discomfort / pain in my lower back is really a pre injury condition. I’ve had that kind of back pain for decades usually solve it with stretching and exercise and I haven’t been able to do that since the accident because I have been afraid to bend or stretch. The surgeon did caution me that this is the most dangerous time of the recovery because “you feel really good but the graph has not really taken”, and this is when most people have setbacks. I think that is a fair enough warning and I will do my best to do to be cautious in my recovery. I see the physical therapist again this week and I’m sure I’ll get some new exercises to do that will help with strengthening and flexibility. The spine surgeon essentially discharged me and said basically to contact him if I have a problem and then unless I have a problem I am not going to need x-rays again.
Now, as for the foot injury. The talonavicular fracture was not seen when I was assessed at the trauma center. I’ve been told that this is not uncommon and that is likely that I was so swollen up that the fracture didn’t show even with a CT scan. Really only noticed that the fraction existed after I started walking distances greater than a mile on it. I had a follow up appointment set with a podiatrist anyway where it was determined that I would need surgery on my left foot. The surgery was scheduled for August 25. After the surgery I was in a cast for 6 weeks followed by time in a boot and continued recovery. In my latest x-ray it became obvious that one of the screws has started to come out and I am going back in for surgery at the end of this month. It is outpatient surgery but I will be put completely under for it and I will be in a cast for some period of time after. Initially my doctor said it would be 2 weeks but I noticed that she said a follow-up appointment for me one week after the surgery so fingers crossed.
And that’s where I am physically. Back is healing nicely but I need to be sure I don’t push it and cause a setback. The foot is healing with the exception of the loose screw and I’m going to go get surgery for that.
I’m going to publish this here and start a separate post for my more emotional journey
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