Proximal humerus fracture - part 5

If you need to catch up, you can read part 1, part 2, part 3 and part 4 :)

After two weeks spent with the half-cast on, we returned to the clinic for another appointment. It followed the same pattern as the previous one, with x-rays, a meeting with a doctor, and a visit to the Body Shop.

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Instead of meeting with the head orthopedic surgeon, we met with one of the residents, which suggests that they're not considering this case all that worrisome. It was actually nice to get a chance to talk to a resident, because he was eager to explain things to us, and willing to go into more details when we asked questions. He suggested that it's possible or even likely that BR did not damage the periosteum around her bone, which is quite encouraging because it should be quite helpful in reshaping the bone and protect the rest of her arm (nerves etc) from the sharp edges of the bone. I have to say I have learned so much about the human bones and their development in the last month than I ever have in school. I guess I am paying a lot more attention now :)

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The doc told us that we should put the half-cast back on (it was removed for the x-rays), but we should start removing it daily and gave BR some exercises to do without the half-cast to help regain a full range of motion and work on regaining strength and flexibility. And after 3-4 weeks, we would be able to take the half-cast off for good. 

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BR was super happy to hear that we would be able to re-use the existing half-cast, because she was quite worried about having to deal with another cast setting and heating up. She complained a bit about her arm hurting, but couldn't articulate whether it was more of an itch or a pain, so we figured it was just a bit tight and would work itself out.

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Our next appointment was scheduled for two months later. That meant that taking off the cast and working on all the physio would have to be done on our own, and she'd be back in school before we saw the doctors again. It's a good news/bad news situation, good because it gives us confidence that things are proceeding well, and bad because we don't really get a chance to ask questions or check how things are going until September.

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When we took off the half-cast the next day, we discovered that the two parts of the cast had pinched the skin on BRs upper arm. It now had a big bruise and a long cut and was just great for the parental guilt. We covered it up with a bit of ointment and some gauze before putting the half-cast back on. We tried to air it out as much as possible (bandaging up around it), and finally after two weeks it all healed up. It's quite interesting how much slower the skin heals when it's covered up all day and night.

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And so now you're all caught up. It's been two weeks since the last appointment, we've built up to having the half-cast off for the whole evening without pain or discomfort. BR alternates between feeling better and appreciating the progress she's made and being bored and annoyed at not being able to do things and being asked to take it a little easier. She misses spending time with other kids and having some time away from her parents. But she's a trooper and really we can't complain much about how the last 5 weeks have gone.

Proximal humerus fracture - part 4

If you need to catch up, you can read part 1, part 2 and part 3 :)

Our second visit to the hospital was very different from the first one. For one, we were there less than 2 hours, which went by very fast. It's not surprising, as there was a lot to do:

• got registered at the clinic, 
• waited a bit in the waiting room
• received our requisition to go get some new x-rays
• went to get those done
• came back to the waiting room for a while
• got called into a consultation room
• waited a few minutes more
• met up with the orthopedic surgeon
• back to the waiting room for a bit
• to the "Body Shop" to get a half-cast

The consult with surgeon was quick and slightly confusing, as there was a lot to absorb. We tried to prepare questions ahead of time, but even then we felt like we didn't ask enough questions. The x-ray was still showing the bone very much disconnected and displaced, but the surgeon didn't seem all that worried about it, expecting that gravity will continue to work on it and pull things together.

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He recommended that we get a half-cast, which is basically a splint made out of plaster, and tied together with a bandage. 

BR was kind of happy to get the half-cast, as it gave her a certain feeling of legitimacy, like she belonged with all the other broken-armed and broken-legged kids. The big arm is definitely more impressive looking than just seeing her arm in the sling. Even her new collar and cuff sling was much more serious looking than the original.

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The one thing we didn't know or remember about the plaster for the cast was that it gets hot after it gets applied as it sets. I think they don't mention it to the kids to avoid freaking them out in advance. However, in hindsight it might have been a good idea to prepare BR, because she really got quite scared and worried about all the heat. She was ok while the cast was being put on, but afterwards she kept crying and complaining about the heat. I think she was worried it was going to be like that forever. A few minutes later she was visibly relieved as things cooled off.

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We left the clinic with an appointment set for two weeks later. Things were quite a bit easier with the half-cast, especially the nights and sleeping. The only downside was that BR was a lot hotter with the cast, so we ended up installing a ceiling fan in her room. Our instructions were not to remove the splint for the whole two weeks, and we were worried about BR's skin getting sweaty and itchy, but luckily she only complained about it a handful of times and just blowing into the cast helped. I think a half-cast is much easier to handle from that perspective than a full cast.

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The shirts and dresses I had prepared for BR the previous week really came in handy with the half cast - we were able to put them on and take them off without disturbing her arm at all, and allowed us to change outfits every day and give BR some variety and a chance to make some choices around what she was going to wear every day.

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BR's energy was slowly returning, and with that came new challenges. She felt more secure with her arm bandaged up, but we knew her bone wasn't together yet and needed to move down some more, so we often needed to remind her to let her arm hang down, and not jostle it too much. She was also getting bored with the few activities available to her, and looking forward to any kind of new activity. We downloaded a whole bunch of new games to the tablet, introduced her to a bunch of new card games and generally tried to give her some things to anticipate, like birthday parties and picnic lunches.

Proximal humerus fracture - part 3

So as you may have figured out from the titles of the previous posts, the official diagnosis for BR's broken arm is "proximal humerus fracture" on the left side. It's a broken shoulder, the humerus, or upper arm bone broken right at the top. On top of being broken, the bone also moved sideways, causing a displacement of almost 2 cms. Given that BR's arm is not all that wide, it's a big break. Not surprising that anyone who saw the x-ray of the shoulder had a strong reaction.

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I think all three of us were expecting BR to get a cast before getting discharged from the hospital. We were more than a little surprised to be sent home with just a little sling to support her hand. The idea behind it was to get gravity to pull the arm down and get the bone aligned. A great idea in theory, but quite a hard thing to manage when it comes time to try to sleep. The slightest movement and her arm would start hurting, so the first few nights BR would wake up screaming in pain, and even when she was asleep she would be whimpering and whining in her sleep.

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BR is generally not a big fan of medication. It's always been hard to get her to take any antibiotics or pain killers, no matter how crappy she might be feeling. Luckily she hasn't required much medication in the past. Even at the hospital, she was not keen on taking the medicine provided to her.

Turns out, a broken bone convinced her of the usefulness of pain killers. By Thursday morning, she was counting the hours until she was allowed the next dose of whichever medication was coming up. We made sure she got a dose immediately before bedtime so she'd get some relief during her sleep, and if she woke up in pain in the middle of the night, we offered her some as well (with varying success). A few days in, she was back to her usual distrust of medication, giving us some hope that her state was improving.

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The first few days were pretty rough. BR was so quiet and sad, unable to move much, just sitting there. She was a trooper, not complaining much at all, and she appreciated being able to watch TV most of the day. She could not use her left hand at all, couldn't really move (walking down the hall took 15 minutes), didn't feel like eating much. She enjoyed reading e-books, so I bought a few and let her read them on my tablet - but that didn't last long.Thankfully I figured out a way to borrow those from the library, because at 20 minutes per book, it was becoming an expensive habit (kid books are not that expensive, but they are pretty short).

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When we left the hospital we were asked to book a follow-up appointment at the hospital's orthopedic clinic a week later. Counting down the days to the appointment helped us pass the time, and keep our anxiety in check. DH and I were a little worried about the possible complications in case the bone didn't get aligned (surgery, having to re-break the bone?). We tried not to worry about it too much, but all our googling indicated that this is a fairly rare type of fracture in small kids, and none of the x-ray pictures I found online looked as displaced as BRs. So while we tried to remain positive, we had some nagging worries in the back of our minds. And of course we didn't want to worry BR either.

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As BR started feeling slightly better, her mood changed too. She was getting frustrated, both with the situation and with us. At the same time as she regained some strength and energy she felt ready to move more, and we had to remind her of her broken bone. She was also getting bored with the limited number of activities she was able to do. Add to it the crappy sleep, and it's no surprise it was a rough week.

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The one bright spot that week was all the love sent our way by friends and family. BR's class sent her a full envelope of cards and notes from each student. Her teacher prepared her a wonderful bucket full of surprises. A friend dropped by and chatted with her for a little while and they did some crafts together. BR loved receiving flowers and stuffed animals, and she really enjoyed reading all the messages of encouragement in email and on FB.

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Since moving BR's left arm was out of the question, there was no way for us to remove her t-shirt. Since she was stuck at home all week and barely moving, we decided to keep the t-shirt on, giving her sponge baths from time to time. Finally, on the eve of our appointment at the clinic, we cut open the shirt sleeve and took it off, allowing her to have a full bath. Meanwhile I took a few of her shirts and dresses and opened up their left arm so we could get her dressed and undressed without moving the arm at all.

Proximal humerus fracture - part 2

So part 1 ended with us in the waiting area of the ER, slightly dazed and confused. By that point BR had found a reasonably comfortable position in the wheelchair, and she looked more shocked than in pain. A nurse came out to triage us, she poked and prodded BR's arm, concluding that she didn't feel anything broken under the temporary splint. She was also surprised that BR wasn't screaming or yelling and seemed to be too quiet for someone severely injured. Unfortunately when she got to the elbow and started moving it around, BR cried out and started complaining about sharp pain (in the elbow). We didn't realize it at the time, but the nurse simply put in BR's file that her injury was to the elbow - despite the fact that I kept telling her how scarily angled her upper arm looked before it got wrapped up. She also told us to hold off on getting an x-ray until we've been seen by the doctor, to make sure the proper part of the arm gets checked.

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Once the nurse left, the elbow pain only got worse. BR was whimpering and complaining about the constant pain, unable to get comfortable and just totally miserable. By that point we'd been at the hospital for a few hours, so we asked for some more pain relief, and she received a dose of acetaminophen. Didn't seem to help at all. 

Seeing her in so much pain and not seeing any progress in our situation, we decided to ask to have the x-ray done as soon as possible, so that we'd have it in hand when the doctor saw us. We got sent to the imaging department pretty much immediately, and the wait there was very short. It was quite nice to be out of the waiting room and feeling like something was finally happening.

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The x-ray tech was not happy about BR being protective of her arm. She needed the elbow positioned just right on the table, and was quite curt telling her not to tense up, and that we wouldn't get any useful images if she didn't cooperate right-this-moment. BR was in fact not cooperating, she was quite scared and in pain and did not want to move her arm at all. Luckily for all of us, another technician came in, clearly experienced and with excellent kid bedside manners. She got BR positioned properly and they took the pictures.

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At that point, it was back to the waiting room for us. Luckily the positioning of the arm for the x-ray seemed to help with the elbow pain, and BR was back to her calmer self. We managed to take her to the bathroom, and she was in much better spirits.

We were seen by the resident and doctor very quickly afterwards. The elbow x-rays showed nothing, so they got her arm fully unwrapped and the splint removed, at which point the odd angle was quite plainly visible. Unfortunately that part of the arm was not visible in the picture, so we were sent back to the imaging department for more x-rays, this time of the shoulder.

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The x-ray techs were not very happy to see us returning. After the giant kerfuffle of our earlier visit, it was quite understandable. Luckily, the shoulder x-ray is a much easier procedure, no positioning required, everything is done just standing in front of a screen.

For some unknown reason, I looked directly at the tech's face the moment she took the picture (this was the same tech who was giving BR such a hard time for being uncooperative earlier). When she saw the picture, her jaw dropped and she had a quick moment of shock. She quickly regained composure, likely realizing I was looking at her. This is when I knew we had a bad break on our hands.

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This time, when we came back to the waiting room, we weren't seen right away. In fact, we ended up waiting to be seen for a few more hours. By 8:30, BR was super tired and falling asleep from exhaustion. The wheelchair did not recline, so I had to support her head for it not to topple over. I got a lot of sympathetic looks from the other parents in the room. Neither BR nor I had eaten anything since lunch, and it was getting quite late at this point, but she wasn't allowed to eat or drink "just in case", and I couldn't even think about eating. We just wanted to see the doctor and find out what showed up in the x-ray.

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Finally, almost 6 hours after arriving to the ER, we got called back to see the doctor. She was very nice to us, and she was apologetic for the long wait. She told us we had to take a look at the x-ray ourselves. I am glad we got a chance to take a look, but it was definitely not a pleasant experience. I don't have a copy of the image itself, but here's an image that should give you a basic idea of what it looked like:

She fashioned a simple "collar and cuff" sling for BR's arm and sent us on our way. Shell-shocked and bleary-eyed, we headed home.

Broken bones: Proximal humerus fracture

If you're following BR's blog, you already know that BR broke her arm a month ago. She's doing much better now, and is on her way to recovery, so we've been able to breath a sigh of relief. But I still feel the need to document the whole story from the parent's perspective, so I've decided to dust off this old blog and do some posting here. I suspect this will take more than one entry, as it's been a long journey. So grab a chair and join me as I recall the unfolding of the events.

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That Wednesday I was trying to finish working on a document at work, so to minimize all distractions I took my laptop to someone else's desk (they were on vacation), so I could focus quietly. All of a sudden I received an email from DH simply saying: "BR fell down at school, unless I hear from you I'm leaving to pick her up in 5 minutes". I picked up all my stuff, sent a quick email to my coworkers (saying "I'm picking up my daughter and will be back online within the hour" - how optimistic of me), and headed to the school.

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When I got to the school, BR was sitting propped up on some blankets and pillows, calm but very pale, and her left arm was sticking out on a very odd angle. She looked scared and very freaked out, and didn't want anyone to come near, worried about being hurt more. There wasn't much I could do to make her more comfortable, but I tried to distract her a bit from the pain. She wasn't talking much, so I couldn't get much information about what happened, other than the fact that she fell on the bouncy castle that all the kids were playing on to celebrate the end of the school year.

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I was a little a lot over my head trying to figure out what to do. BR was refusing to move and did not want to be touched. The vice principal asked me whether I was ok with them calling an ambulance, and I was quite glad for the suggestion. We called an ambulance and waited. In an odd coincidence, earlier that day there was an accident in our neighbourhood where first responders were hurt in a training exercise, so there were fewer ambulances available, but we didn't have to wait very long.

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The paramedics were amazing. There was a young man who has little children, and it certainly showed in his interactions with BR. He quickly assessed her, asked a few questions and even made her smile once or twice. He created a quick splint and wrapped her arm and effortlessly lifted her onto the gurney without jostling her or causing her any pain. Once in the ambulance, BR visibly relaxed, she wasn't in so much pain anymore and she was able to talk a little and interact. In fact, about halfway to the hospital, she looked like she might even fall asleep, I guess as the adrenaline was wearing off.

Hooked up to the monitors, ready to go

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We got to the hospital, and DH was already there waiting for us (I'd called him once we'd called for the ambulance). We got admitted, BR was put in a wheelchair and given a dose of ibuprofen. Then we headed to the waiting room, joining many other families with sick and injured kids. We still didn't know what was wrong with BRs arm. The paramedic was not able to detect anything when he felt her arm, and with the splint on you couldn't really see the crazy angle of her upper arm.

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To be continued...

A message to me, to you, to all of us

Life is tough. It's messy and it's complicated and it's unpredictable and at the core of it, it's very lonely. So why bother? Because there is a world out there that is so amazing it will take your breath away, and there are people out there who will move you and surprise you and inspire you. So whether it's the next great human invention, or the next gorgeous landscape, there's something out there just waiting for you to see. So do what you need to do so you can get there.

A day in the Life

After reading a bunch of these this week, I've decided this is a meme I can really do, so here it is. It got a little long, sorry for that (and I did edit a bunch of boring work stuff out). I was hoping to have some pictures to include, but unfortunately discovered too late that there was no memory card in the camera :(

6:47: Wake up, realize I can still sleep for w bit, doze off

6:58: DH stumbles out of bed, up for the day

7:00: I can hear BR get out of bed, expecting her to come wake me up as she usually does. But instead she heads to the kitchen with Daddy. I quickly contemplate staying in bed for a while longer, but decide to just get up and join everyone in the kitchen.

7:05: Breakfast time in the kitchen. As usual, it's just cereal with milk. Each one of us has a different kind of milk (cow's milk, soy milk and almond milk). From time to time I get up to get a head start on lunch making, which usually happens the night before but last night I skipped it.

7:25: Breakfast is over, time to finish preparing lunches for BR and myself. DH is working from home today, so he can take care of his own lunch at noon.

7:30: Head back to my room to get dressed. I'm usually competing with BR as to who can be dressed first, but she's only missing her socks while I'm still gathering my outfit. She wins hands down, and goes to pack her lunch in her lunchbox.

7:38: Dressed and ready to go, I gather my stuff (laptop and lunch) into my bag. Head to the bathroom for hairdos.

7:43: My hair is done, we're actually running early (huh?) so decide on a fancy hairdo for BR. Two french braids both sides joining together at the back. Inspired by the closing ceremonies of the Olympics we watched the night before :)

7:49: Time for jackets boots, mitts, hats etc. It snowed last night, and the driveway pure ice covered with a fresh coat of snow. Gotta be careful out there!

7:52: Head out to the garage to get in the car. DH is sweet enough to accompany us to the garage, helping to carry the myriad of bags we're bringing (can't forget the piano class this afternoon). Just as we approach the garage I slide on the ice, flailing, slipping, twisting and sliding, but amazingly I manage to remain upright, if terribly ungraceful.

7:54: Off we go. It was a cold night, so the car is freezing, so I am again thankful for seat heaters :)

7:59: We've arrived at BR's daycare. Quick dropoff, say hi to the other kids and teachers, and I am out the door.

8:04: Time for the second part of my commute, daycare to work. Car is now a lot warmer, and I can set my radio to CBC. It's a quick commute, only two traffic lights.

8:14: I'm at work, and it's early, so I get a choice parking spot. Chilly walk through the parking lot and walkway to the building, once inside it's one floor up the stairs and to the end of the floor to my cubicle.

8:20: At my desk, They're still working on the roof, so I get to see all kinds of activity through the window, workers and machinery. Since it snowed, they have to do some snow removal (again!). For the umpteenth time I wonder why they're doing roof work in the winter, always seems like every time they make any progress there's another snow fall and they need to haul snowblowers onto the roof!

8:35: A friend drops by and we head to the coffee room. I just grab a cupful of hot water for my daily mint tea.

8:45: Head back to my desk, to attack the stack of emails that have accumulated since I last checked them at 10:30 last night. Will have no time to prep for my meetings of the morning.

9:30: First meeting.

10:00: Time for the next meeting - luckily in the same room. We have 5 people in the room and 4 on the line from India. I didn't prepare much to talk about, so I'm hoping we can have a quick one. But as usual we get onto some interesting topic and fill the hour.

11:00: Need to have a discussion about a different issue. There's 4 of us in different locations, and it takes us almost a half hour to figure out how to get a phone conversation going. Finally we get a teleconference setup. The meeting is slow and boring, and I am getting hungry.

12:00: Time for lunch, but a few more issues popped up that I want to address first.

12:20: Ok, I'm getting too hungry, going to warm up my lunch the coffee room. Bring it back to my desk and continue working on the myriad of things on the go.

1:00: and 2:00: Two more meetings. Need I say more

3:00: Time to make some progress on my actual work. Need to hurry, as I need to leave early today to make it to BR's piano practice. Aiming for 4:15.

4:15: Someone drops by my desk to alert me to a brand new issue that is coming my way. I should be heading out, but decide to take a quick look to see what is going on (curiosity something something?)

4:36: Get up from my desk in a hurry. Need to run down the hallway, trying to make it to the car as fast as I can.

4:41: Made it to the car, I'm on my way. Meet a deer at the edge of the parking lot, what a cutie!

4:52: Picking up BR. She's dragging her feet, doesn't want to leave her drawing and her friends. Finally get her to put on her jacket and boots, and we get to the car.

4:57: Heading to the piano lesson, there's no way we can make it there for 5, but no need to panic (right?).

5:04: We arrive to the piano lesson, run in and profusely apologize for the lateness.

5:05: I sit down and start writing the summary of my day. In 30 minutes, I've only made it to 10am?

5:35: Lesson over, time to head home. Trying to hurry BR along, but she's still ornery and annoyed at being told what to do. I brainstom with her alternative modes of transportation home...

5:51: We're home. I am exhausted. Luckily we have some leftovers for supper. Spinach, avocado, tomato salad, and coleslaw, as well as egg salad for the grownups. Pancakes for the kid who will not touch salad.

6:01: The doorbell rings. Our neighbour is canvassing for the Heart and Stroke Foundation. We only see her a handful of times during the year, so we have a chat to catch up on things. Her youngest is going to university this year - eek!

6:25: Our neighbour is heading home to prepare dinner for her family. We can finally resume eating and catching up on the days events.

6:45: BR asks whether we still have some Olympics competitions recorded, and since we do, we plop ourselves on the couch to watch some figure skating. I take out my laptop to work on that new issue that popped up before I left work. DH is cleaning up in the kitchen.

7:15: Time's up. BR has a quick cereal snack with Daddy, while I try to wrap up the work stuff.

7:30: Bedtime routine starts: tooth brushing, hair brushing, putting cream on little hands that are getting full of eczema. Quick bedtime story, three songs, and she's asleep by 8.

8:00: I'm back to the couch with the work laptop. Worky, worky, worky...

9:10: Call my Mum for a quick chat. It's a quick one today, we'll be taking a quick trip to Montreal tomorrow and we'll see her then, so we'll get a chance for a longer conversation :)

9:25: Time to finish this blog entry. It's getting so long! I also need to write an entry for BRs blog :)

10:05: Bedtime for the grownups. Another day just flew by.