Resonance

The physiotherapy tales are getting a little repetitive, so I'm just doing one post for this week. The Tuesday session was much like the previous one. The focus was on strength and improving wrist motion and flexion. Resistance was provided by a rubber strap anchored to the front of the table. Flexing hurt a lot during the session but didn't hurt that much afterward.

On Thursday morning, I went to the hospital early as I had my sister drop me off on her way to work. I didn't want to take a cab since it was a pretty short distance from my house. Of course arriving at 8:30am for an 11:00am appointment results in a pretty boring couple of hours. Fortunately I had just downloaded Angry Birds Rio recently, so that helped to pass the time.

At 10-ish, I went to the Imaging Department for my MRI scan. After a short wait, they ushered me in and weighed me - 74kg (getting fat!). I answered their questions mostly about metals in my body, then I emptied my pockets of anything with metal, even my belt, and put them in a little locker. I cleverly opted not to wear a watch that day.

The MRI room was cold, very cold. A (poorly) simulated skylight showed a blue sky fringed with cherry blossoms and other pretty tree parts. The MRI machine was a Siemens. It looked stubbier than I imagined, but was suitably impressive. The technicians and radiologist (a group of 3 people) made every effort to make me comfortable as I lay on the bed. The radiologist asked if I could stretch my arm towards the sky and I said yes, so that's the position I took while lying down. My knees were elevated by a special spongy thingy and my head lay on a thin pillow. My arm was strapped in place. A noise-dampening headset, a blanket, and a panic button completed the paraphernalia.

As the motorised bed was raised and slowly inserted into the tube until my head was barely in it with my hand at the centre of the machine, I thought of many things including how the machine worked, how cold it was, and how on House, something awful always happened during MRI scans. I thought about the massive amount of EM energy being generated by the machine and I imagined I could feel my molecules absorbing the energy. But really, all I felt was cold while the machine made a series of weird humming, buzzing, and knocking noises. It took longer than I expected and I began to regret taking the arm-over-head position as my arm started to get tired, cold, and a little numb. My muscles weren't all that strong yet so my fingers were involuntarily shivering I guess. They had to repeat the scans a few times and the radiologist had to come in to put another blanket on my arm and let me rest a little. Finally they got what they wanted and the radiologist promised over the headset to let me out after one more 2.5-minute scan sequence (I swear it was way longer than that). It was quite a relief to move my arm again as it had really gone numb.

The whole thing took 40 minutes from entering the room to exiting it. On the way out, a woman going in asked how it was and I just told her it would be really cold.

After the MRI, I had two hours to kill before getting the results, so I had a rather weak lunch of a 1901 hot dog (yes there is a 1901 hot dog stand in the hospital, along with a Starbucks and a Baskin Robbins). After lunch, I went up to the orthopaedic clinic for my physiotherapy session which was much like the Tuesday session. My flexion still needs a lot of work but they focused mainly on strengthening the biceps. I went back to the imaging department and foolishly waited an hour before asking if the results were ready. It turns out they were waiting in a tray all along.

MRI films in hand (they're huge, by the way), I went back to the clinic to see the doctor. The MRI confirmed that there was a fracture of the radial head, joint effusion, and possibility of injury to the annular ligament. All these conditions were expected due to the sprain and fracture. The doctor looked at all the films and concluded that all was well. He prescribed a 10-day course of anti-inflammatories and continued physiotherapy as my flexion was still poor. He said he'd see me in a month which would probably be the last visit. Good to know he's confident at least.

Personally I think I've come very far since the initial visit 3 weeks ago. My extension is practically full and flexion is improving. I'm quite confident that I'll eventually regain functional if not perfect range. Time heals (almost) all wounds.

Rango

There is a small pile of unreleased movie reviews in the Blogger post list. I guess I'll write them up eventually even if they're old news. For now though, I will take a short break from arm stories to write a little review about the last movie I saw: Rango.

***Spoilers, blah blah blah***




Animations, be it CGI or hand-drawn, generally contain at least a few cute characters, songs, colourful backgrounds, and kid-friendly themes and dialogue. This is not one of those animations. Helmed by Pirates of the Caribbean director Gore Verbinski, Rango tells the whimsical tale of a pet chameleon who gets tangled in the socio-economic intrigues of a small frontier town (weird I know).

Lars (Johnny Depp) has always longed for adventure. In the opening shots, we see the well-dressed lizard engaging in a make-believe theatrical production with the help of the props in his terrarium. He dreams of being the hero of his own tale and wishes some great event would occur to throw him into conflict from which he would emerge victorious. He gets his wish when his terarrium falls off the car carrying it and he winds up in the middle of the very hot Mojave desert. He meets a sagely armadillo who points him towards the aptly named town of Dirt. Along the way, he meets a female lizard named Beans (Isla Fisher) who brings him to town. Lars decides to go into full character, inventing a legendary persona for himself as a ruthless killer by the name of Rango. One thing leads to another and he becomes sheriff which leads to a rather wild storyline with a cast of characters including a devious turtle with a cult-leader vibe, a mean rattlesnake, a gun-happy family of moles, and assorted reptiles, birds, and rodents.

The character design is decidedly on the not-cute side. The cutest thing in the movie is Rango's wind-up fish toy which doesn't get all that much screen time. The backgrounds are dull and dusty like a dwindling frontier town should be I guess. All this coupled with the dry dialogue and theme makes for a not kid-friendly flick. Adults with a taste for the slightly bizzarre however, might be more appreciative. The visuals while not colourful, are nicely done with great stylistic appeal and cinematography. The basic story is nothing original, being a rehashing of stereotypical Western themes, but is executed well with a wry sense of humour. The voice work can't be faulted and Depp is always fun to hear/see.

This animation may not be for everyone, but if you sometimes like your cartoons a little on the dark and zany side, you'll probably enjoy this as I did.

Physiotherapy, Part 6 (Featuring Doctor Consult)

This post should have been written a couple of days ago, but I was lazy, so sue me. The last of the first wave of physiotherapy sessions, the sixth one wasn't much different from the last one. We did the same strength training exercise under electrical stimulation. This time however, the manipulation was done by a woman. You'd think a woman might be gentler, but you'd be wrong. She concentrated mostly on wrist movement which was still quite stiff and painful to move. I had not been doing much wrist movement because it hurt so much, but the therapist forced me to move it and used a strap to kinda spiral round my arm to gradually force my wrist to turn. It was very painful but I must say after a couple of days, the range of motion has improved tremendously. There is still pain at the end of the range so it's not quite there yet, but it's heartening. My flexion is still stiff and painful to bend but seems to be improving (very) slowly.

That was Friday.

On Saturday, I went to see the doctor for a consult. Not much to say. My extension is almost full but not quite and flexion is still stiff. He prescribed more physiotherapy and an MRI on Thursday to rule out any secondary injury (apart from the bone). In any case, I had already made physiotherapy appointments on Tuesday and Thursday (down to twice a week now). I've never had an MRI before; I'm a little apprehensive, but the nerd in me can't help but feel a little excited.

Until next session.

Physiotherapy, Part 5

There isn't much to report for the latest physiotherapy session. The usual 15 minute hot pack was followed by some manipulation by the therapist. It still hurts to rotate my wrist and flexing also causes quite a bit of pain. We did electrical stimulation to biceps and triceps simultaneously while moving my arm with resistance provided by a rubber strap attached to the wall behind me. This lasted for about 20 minutes and was very tiring. After the exercise, the therapist performed some more manipulation which again, hurt a lot.

My extension is almost 180 degrees now, maybe off by 5 degrees or so. Letting my arm hang down is almost painless now (apart from the soreness caused by all the manipulation). The therapist says the joint is 90% functional and we need to concentrate on strength improvement. One more session tomorrow...

Physiotherapy, Part 4

Over the weekend, my arm has improved considerably. The extension is at least 160 degrees and there was some improvement in the flexion as well - enough to feed myself with a spoon (but not chopsticks). I even drove to work on Monday after six weeks of not driving (ah the joy of being behind the wheel in a traffic jam). Today however, I didn't drive as I knew my arm would be in pain after the physiotherapy - and boy was I right.

After the requisite hot pack, we worked on flexion with a rubber strap providing resistance as I flexed my arm back and forth. This was done while under electrical stimulation to the biceps so it was a bit weird. Ten minutes of this was quite tiring. Then the therapist started on the manipulation which included wrist movement which I still have issues with. I take back what I said about the last session being the most painful. This one takes top spot for now. The therapist was impressed with my extension but the flexion still needs a lot of work.

Physiotherapy, Part 3

The last physiotherapy session for the week was particularly painful. After the usual hot compress and electrical stimulation, the therapist started in on my arm focusing on wrist movement. This really hurt... my arm is still sensitive to twisting so there's considerable pain when twisting to the palm up position. There seems to be no stiffness in the movement, but there's a lot of pain. We also worked on arm extension and I think it improved by about 5 degrees. My arm feels almost straight; I estimate the degree of extension at about 160 degrees.

My arm and shoulder were sore for quite  a while after the session. At least I can rest for a few days before the start of more sessions next week.

Physiotherapy, Part 2

Wheeeeeee..... another physiotherapy session. On the menu today, we have a heat pack for starters, followed by 10 minutes of electrical stimulation. For the main course, we have aggressive massage and stretching and for dessert, we have cold compress with free movement.

The session today was done at the 'Hand Unit', the workshop-esque section. The regular physiotherapist didn't really do anything for me today. Instead, another guy performed the stretching to loosen my stiff elbow. It was very painful of course. I found myself laughing while he was doing it. There's something darkly funny about subjecting yourself to such pain and I guess it's better than crying about it. At the end of it, there was an improvement in the extension by maybe 10 degrees with little improvement in flexion.

My arm is quite sore and there's still another session tomorrow.

Physiotherapy, Part 1

Today I had my first real torture physiotherapy session (after the first 'introductory' session), I left work after lunch to undergo the first of three sessions this week. I got there early, so I started my session half an hour earlier than scheduled. They started with the heat pack for like 15 minutes. This was followed by some minor manipulation and massage by the therapist. This did not hurt all that much. Then came the electrical stimulation. They attached four electrolyte-soaked sponges to strategic muscle sites and pumped in current from 48mA to 62mA over 20 minutes. I was mildly fascinated by the involuntary wrist and finger contractions caused by the higher currents.

Then the real fun began.

The therapist (a big guy who wouldn't look out of place in a rugby team) gradually exercised my arm, focusing on improving the extension movement. It hurt like heck. The scary part is that the therapist said this was a 'gentle' exercise. Thankfully, it wasn't very long.

At the end of it, my arm extension had improved by about 10-15 degrees (I'd say my arm can extend to around 150 degrees now). Contraction didn't improve much, but I guess that's not bad for one session. Until Thursday then...

The Jason-that-was-Broken has been re-forged

This post is a followup to my last post about my broken arm.

After I returned to KL, I started taking cabs to work in the mornings and back home in the evenings. This was fraught with difficulty as my semi-regular cab driver was not always available. More than once, I had to rely on the charity of my colleague to drive me home as cabs drivers did not want to enter my traffic-infested area at peak hours.

On the work front, doing my job with one good hand (my right arm was still in the sling) was quite difficult as typing with only my left hand was slow and error-prone. Still, I think I was still fairly effective all things considered.

My arm grew stronger day by day, feeling more and more like my arm and not some useless limb that refused to obey my commands. I still couldn't straighten or bend it much although the range of motion has grown over two weeks. I was doing exercises but still wore the sling though for support as I did not know if the fracture had healed. That changed yesterday when I went to see another orthopaedic surgeon at Pantai Medical Centre for a consult and x-ray.

Good news: I'm no longer broken.
Bad news: My elbow joint is really stiff and I need aggressive physiotherapy to get the motion back.

So they prescribed three physiotherapy sessions a week for the next two weeks and we'd see how I progressed from there. I had a short 'introductory' session yesterday. Physiotherapy doesn't seem like any medical treatment I've seen. The place was like a workshop and was filled with tools. They started by manipulating my arm to find my range of painless motion. It hurt. Then they applied a hot compress for a while. Next came some exercising coupled with electrical stimulation to my biceps and triceps. My wrist and upper arm were suspended by rubber tubes and I had to extend and retract my arm as far as I could without pain. It was tiring but I did feel better.

The doctor says I shouldn't wear the arm sling any more. I'm a little sorry to see it go. It's been so supportive over the last few weeks :) Bye bye arm slings... thanks for the support!

I'm glad I'm unbroken. Now if only I could get untwisted, I'd be normal again.

Falling Down: A Chronicle of the Broken

On 2nd February 2011, on the eve of the Lunar New Year, I was at my parents' house in Penang looking forward to our reunion dinner and the following festivities. The Universe had a different plan in mind however (if I had a Facebook account, I would so un-friend The Universe). I was going to follow my dad on a walk to a nearby sundry shop to get some stuff. Barely out of the gate, I tripped or slipped and fell forward. My right arm broke the fall and the fall returned the favour. It's been four weeks and the fracture has healed. The after-effects of the fracture and the accompanying sprain are still with me and I'm due to start physiotherapy which I'll cover in another post.

A few days in, as a distraction from the pain, I started writing a little journal of the first two weeks or so of my little misadventure on my phone (it's much easier to type on a tiny keyboard when one arm can't move). I present for your reading pleasure, my writings (with little editing), so that I may remember how I felt back then and to share my tale of misery with the world. The writing may seem a little abrupt and choppy (I'm cranky when I'm uncomfortable). Tenses and such may also be a bit jumbled as I wrote in spurts at different times of the day (usually at night).

Day 1
CNY eve. Accompanied Dad to the minimart. Made mistake of running. Just outside the gate - tripped or slipped... Can't remember which. Next I'm on the ground. Saw my right forearm twist far beyond what nature intended. The pain was... bad... very bad. Family brought me inside. Ice assuaged the pain slightly.

Debated going to the hospital. Family thought I should go. Pain was intense so I did not object. Fashioned a makeshift sling from a bolster case. Got to Gleneagles Medical Centre Accidents and Emergencies. They put my arm in a sling and took x-rays. The machine was big and scary. Felt like I was in a starship sickbay. It hurt to straighten my arm for the machine. Photos were mercifully quick while the radiologist took refuge in a little room.

Was surprised to hear the doctor say there was a small fracture of the radius at the elbow joint. I never felt any pain in the bone and I thought it was only a bad twist. Seems my arm was straight and my radius and humerus collided and the latter proved victorious in the battle.

Prognosis : 3 weeks in a half cast. Healing would be natural, thankfully.

They fitted my arm from my wrist to a few inches beyond my elbow with what they called a back slab. It was this weird slab that they applied water to, put in place and let harden with the sling to keep the shape in the meantime.

Got a week's supply of Panadeine as a painkiller. Decided in advance not to take it if at all possible. Still confident pain would pass.

Reunion dinner that night was mediocre. My condition also put a big damper on things.

Only lasted the rest of the day. Come bedtime the pain was pretty bad from the twisting. I took the painkilers and went to bed.

Day 2
Chinese New Year's day. Should be a happy day, but I was far from happy. Couldn't get comfortable with the cast and sling last night, so my sleep wasn't great.

Simple lunch at home then dinner at an uncle's house. My arm feels like it's on fire and weighs a ton. Simple things like brushing my teeth and putting on pants are big productions. I did manage to shave although getting the cap off the foam bottle and getting the foam out were quite challenging. Weird to have to ask for help to open bottles and jars.

Trying to be as cheerful as possible although it's uncomfortable. I couldn't wear the expensive long-sleeved Dockers shirt I bought because it would be weird with my right arm so fat. Had to make do with one of my dad's old 'new' short-sleeved shirts. Getting the shirt on was quite the production as well but it was successful with help from my sisters.

The cast is really uncomfortable and starting to itch. Still can't get comfortable in bed. Using a pillow on my right to rest my elbow and provide some buffer against turning on my side in the night.

Day 3
Woke up at around 3am. Pain in the shoulder from the awkward positioning and the heavy cast is getting really bad. I've had shoulder pain for ages but this is a whole new level.

We're having people over today. I managed to get into the new T-shirt my sister got me. Took some figuring out to find the correct way to get the shirt on. Still have pain from the twisted arm as well as my shoulder. Strangely no pain from the fracture. Reluctantly took some painkillers. They seem to dull the pain somewhat.

A friend I haven't seen in a long time came to the house and gave me a nifty Star Trek insignia badge he got while he was in Canada since ThinkGeek doesn't ship to Malaysia. On a side note: Why do you hate us, ThinkGeek?

On a positive note, the curry and satay we had catered were pretty good; especially the fat-free satay.

The itchiness is getting to me. I swear this cast was sent by unholy demons to vex me. Started using a chopstick to scratch but afraid to scratch too hard lest I injure my skin unknowingly.

After the guests leave, another fitful night. My mood is deteriorating in inverse proportion to my rising shoulder pain. The arm itself doesn't hurt much.


Day 4
Woke up in the middle of the night to more pain. Slept without the sling attached without meaning to. Marginal improvement. Stopped taking painkiller last night.

Lunch at my uncle's place. Discomfort the whole time. Went to Gurney Plaza to buy Mom a new phone. Car ride was so hot. I long for a shower. Got the SE Cedar... cute phone.

Pain in the shoulder is driving me nuts.

Dinner of leftover curry and satay. Got a sharp pain in the muscles? Tendons? Can't prove causality but I had just drunk some iced Coke. Could be the acidity or the cold. No more cold / soft drinks for me.

Shoulder pain getting really bad. Took painkiller again.

Decided to start writing this. Keeps my mind off the pain.

Painkillers seem to work on the shoulder pain. Think I'll sleep with the sling off tonight.

Day 5
Woke at 0330 in a fair amount of shoulder pain. Even my bicep aches when squeezed. Didn't think that was possible. Should have taken painkiller at a later hour before bed. Eventually got back to sleep.

Spent most of the day wallowing in pain and discomfort. I'm not usually one to wallow in self-pity, but I'm perfectly open to wallowing in pain. A bit of TV broke the monotony. Had dinner out. Was in a fair bit of discomfort the whole time. Food was better than the reunion dinner although it's the same restaurant. Cheaper too. Took painkillers after dinner about 2030. Hope it lasts through the night.

Slept with the sling off. Still hard to get comfortable. Arm flat across the abdomen with elbow resting on a pillow to my right seems a far compromise between comfort and security. Painkillers doing their work to dull the shoulder ache.

Day 6
Woke at 0436 but pain was not that bad. Went back to sleep and woke at 0900. Didn't have the intense shoulder pain. To maintain the balance of the Universe, I got a headache instead. Hopefully coffee will help. Took painkillers after breakfast of eggs and baked beans.

My sister returns to KL this afternoon - without me. Sent her to the airport. Strange to say, but I'm sad about not being able to go back to work.

Sent SMS notifications to some close colleagues to tell them I'm off for the week. Received some well wishes. Some people working today. Got some enquiries by phone, so I feel slightly useful. I'm not much use without my laptop though.

Rest of the day spent doing nothing much. Painkillers dulling any pain but still can't shake the feeling that there should be pain though I can't feel it.

I have an appointment with the doctor tomorrow afternoon.

Day 7
Woke up at 7am. Finally, a full night of sleep. Plenty of discomfort but no real pain. Friend of my father visited. She had a broken wrist from a fall. Plenty of that going around. Another member of the broken tribe joining my great aunt and my cousin who also broke sections of their arms recently.

Waited about two hours to see the doctor. Saw a few other broken people there. Oddly comforting to know I'm not the only accident-prone one. When I finally saw the doctor, they removed the bandages and the back-slab. It's hard to describe how I felt, but let me just say that having air on my skin after 168 hours wrapped in a hot itchy bandage is a most luxurious feeling. The doctor looked over my arm and said it would heal and I didn't need the cast any more. I would have leapt for joy if it wouldn't have made me look like a complete idiot. I had almost given up on feeling comfortable again for weeks to come.

I was advised to do minor exercises within the pain threshold. I still can't lift my forearm under its own power or turn my wrist much. I was prescribed an anti-swelling drug (Danzen) and more Panadeine. Still need the sling for support.

My skin has a rash from the bandage but being able to scratch itches that have been building up for a week is positively sublime.

My sling is itchy from the fibres of the bandage. Pro tip: Get a new sling if your bandaged arm has been in it for a week. I lined it with an old pillowcase for now.

The rash on my skin is subsiding.

My mood has improved several orders of magnitude. I feel almost normal. Took the anti-swelling pill but skipping the painkillers. Leaving the sling on tonight. Should be ok without the cast.

2am... Better sleep.

Day 8
Note to self: Don't sleep with sling on. Woke at at 4am with bad pain in the shoulder. Guess the painkillers were masking the pain quite well since I used almost the same position last night.

Tried to move my arm a bit. Still weak but the pain-free range is increasing when assisted by my left hand. Without the painkiller and the overwhelming discomfort of the cast, I can feel the dull ache of the twisted muscles in my forearm and elbow.

No real pain all day. Went to the market with my parents. Bought a new sling - feels much better than that old itchy thing. Only took the painkiller at night.

Tried to move my arm again later. Managed to move under my own power a teeny bit. Quite pleased with that.

Day 9
Woke up at 7-ish without pain. Thanks Panadeine.

Took my first shower in a week. Soooooooooo nice. Did it with the new sling on and let it get totally soaked. Managed to put on a new t-shirt and my freshly washed old sling without help.

An aunt is coming to visit today. Going out for dinner.

Food was fairly good. There was air batu campur for dessert but I dared not eat it for fear of a repeat of the Coke Incident.

Days 10-12
Uneventful days. I still wake up with pain in the shoulder muscles. I still wear the sling at night to limit my movement. I'm taking Panadeine only at night. Its efficacy seems reduced with only one dose a day.

I continue to gain more moblity in my arm. Doing the minor exercises as the doc recommended. I can now hold my arm at 90 degrees without the sling. I still cannot extend or contract my arm much without pain. I'm holding off on more rigorous exercise until the x-ray confirms the fracture has healed. There is still no pain from the fracture but there is a faint dull ache in the muscles.

I return to KL tomorrow. Probably returning to work on Wednesday. Gonna have to take a cab for a while. I'm still debating coming back to Penang for the x-ray next week. Seems wasteful but I would prefer to see the same doctor. Still have a while to decide although I'm leaning towards it.

*********

That's where I stopped writing regularly. In the end, I decided to do the checkup at KL, but that's a tale for another post. Looking back, it sure was sucky being broken. I hope this serves as a cautionary tale. Moral of the story: Walk safe!