Let's Get Physical

Wow! It’s been quite the ride since my infamous ladder accident on March 12^th.

After having my cast removed by an ISOS doctor here in Accra, I entered into physical therapy for my stiff wrist. Dr. T set me up with two physical therapists from 37 Military Hospital, which is right down the street from our complex. Initially they came to my house to provide me with the PT.

Emmanuel and Richard were very kind, and we had multiple and varied conversations over the next several months.

Emmanuel is a bit older and is a civilian. He seemed to be more knowledgeable about anatomy and injuries. He grew up in the Volta Region, has three grown children, and is devoted to his family.

Richard was born and raised right here in Accra, and has three children; the youngest being around 7. Richard is a member of the Army. He often wanted to discuss the places to which I had travelled, as he was very proud of his opportunity to travel as a result of his military service. Most notable was the time he spent in Liberia and couldn’t believe I had not yet been to that country. Honestly, I’m not sure why he wanted me to go there, as he always complained about hot and miserable it was.

 

When I asked Richard where he had been trained (i.e., University of Ghana, perhaps), I was surprised to hear, “37 Military Hospital.” Uh oh…..

PT was very, very basic and consisted of about three flexibility exercises and Emmanuel massaging my wrist and hand with some concoction that smelled vaguely like Icy Hot. He squeezed the liquid out of a small Johnsons Baby Oil bottle, but it contained some “secret” ingredient. In those first couple of weeks, my home PT appointments lasted approximately 15 minutes a day.

My wrist was slowly, slowly making progress. Although I’ve suffered two other broken arms, they were as a child, and I never underwent any type of PT after the removal of the casts. Unfortunately, I was beginning to experience intense pain in my hands, especially at night when trying to sleep. I would wake up with my fingers numb and a burning sensation running throughout my hand. The only way for me to make the pain subside was to sit or stand up and hang my arm at my side. A couple of weeks after the cast was removed, I also began experiencing pain in my shoulder, and in particular on the outside of my shoulder in the deltoid muscle. I couldn’t recall doing anything in particular to hurt my shoulder. Frankly, I had been favoring that arm so much that I’d hardly even been moving it at all, a move that was going to eventually haunt me!

One day Richard came to the house by himself. When I told he and Emmanuel about the pain in my shoulder at the previous appointment, they decided it was time for some electrical stimulation. If you’ve never experienced physical therapy before, you might be surprised to know that in many cases patients are treated to high voltage pulsed galvanic stimulation to reduce muscle spasm and/or soft tissue swelling, which is what the PTs suspected was the issue with my shoulder. I’ve had electrical stimulation plenty of times in the U.S. as a result of two foot surgeries. However, the equipment here in Ghana leaves much to be desired.

As Richard pulled out the machine from his backpack, I noticed the cord first and foremost. Whereby an average cord would just be plugged into the wall, this piece of equipment had two wires sticking out at the end of the cord. Richard fiddled around  with it for a while, stood up and said, “I’ll be right back.” I watched him through the front window as he sifted through my flower bed on the front porch. He returned with a small stick, which he promptly pushed into the top hole in the outlet and then inserted the two wires into the remaining outlet holes. I was pretty sure I was going to get electrocuted right there in my own house, and yet I said nothing!

Richard proceeded to put the pads on my wrist, elbow and shoulder. It’s really hard to explain how different it all was here in Ghana, but suffice it to say that everything was a bit more primal….meaning the pads were strapped onto my wrist and arm with cellophane tape, rather than having some sticky solution that adheres to the skin. Richard then cranked up the electrical currents so that my head started twitching. I implored him to reduce the current.

Another PT strategy is to use ultrasound and heat to get to the deeper tissues. My shoulder was not getting any better; and in fact, was getting worse so the boys decided to use the heat approach. Again, from within his backpack, Richard pulls out this enormous infrared heat lamp. I wish to hell I would have taken a picture of it, but alas, I did not. Here’s a picture of one I found on the Internet. (picture of a similar one).

Unlike many of the lamps I found out on the Internet, this one had no stand, so Richard plugged it in (with a REAL electrical cord), and then stood and held the lamp close to my shoulder. Let me tell you, this puppy put out the heat. More than once I had to tell Richard to back off. I don’t know how many times between March 12^th and May 20^th that I said to myself, “I can’t believe this is happening to me,” but I can assure you that many of those times were during PT!

More than once Richard would fall asleep on my couch while Emmanuel was massaging my arm, or affixing the electrical stimulation paraphernalia to my arm. You have to understand Ghanaians. They are the most amazing sleepers. They can sleep anywhere; on the bus, in the restaurant, in the car, on the side of the main road, and evidently on my couch. I swear I was talking to Richard one moment and in the next he was sound asleep.

One day I asked him why he was so tired. He told me that he must get up at 3 a.m. in order to get to work on time. I then asked him what time he went to bed to which he replied, “About midnight.” Why in God’s name would you stay up so late when you have to be up so early, I queried? He told me that in the evenings, after everyone goes to bed, he listens to the radio. In Richard’s defense, I never asked what he listens to, but I’ve heard the radio programs in Ghana, and they are anything but relaxing. They mostly are people yelling about the topic of the day. Regardless, I reminded Richard that if he would get to bed earlier, he would get more sleep, and would, therefore, not fall asleep on client couches. J

Richard also told me that he sings his wife to sleep every night. He informed me that he was a very good singer, and then proceeded to give me a demonstration; leaning down into my ear and softly singing to me. It was very, very weird.

Emmanuel was fairly quiet and only talked if I asked him questions. Richard, on the other hand, was nosy. He noticed a picture of my family on a table and started asking me about them. I explained who everyone in the picture was; my husband, my son, my stepchildren.

Him: “What?”
Me: “What do you mean?”
Him: “You are divorced?”
Me: “No, actually I am married.”
Him: “But, you have been divorced?”
Me: “Yes.”
Him: “Oh, I am so sorry.”
Me: “Oh, don’t be sorry. It all worked out for the best. My ex-husband and I are on friendly terms and I have an awesome son that resulted from that marriage.”
Him: “You are friendly with your ex-husband?”
Me: “Yes. He is one of my Facebook ‘friends.’”
Him: “Do you ever talk to him?”
Me: “Yes. From time to time – like when we are discussing our son; Christmas or birthday presents, his schooling, etc., Are you surprised?”
Him: “Yes. That would never happen in Ghana.”
Me: “Why not?”
Him: “A black man can never be trusted.”
Me: (laughing) “Oh Richard! Give yourself some credit.”
Him: “No madam! I could never sit and have coffee with my ex-girlfriend. I cannot trust myself. Does your husband know you chat with your ex-husband?”
Me: “Well, I don’t mention every single time I ‘chat’ with him, but in general he knows we speak because I’ll relay a conversation we’ve had.”
Him: “You need to tell your husband tonight.”
Me: “OK, Richard. I will.”

That evening I told Dave about our conversation, and he just sort of shook his head asking me if the PT was working. As you can see, this white woman CAN be trusted.

The pain in my shoulder refused to go away and was intensifying. I had noticed that my range of motion was becoming very limited and Emmanuel felt it best for me to come to 37 Military Hospital for more intense PT.

37 Military Hospital is probably one mile from my house, but with the Accra traffic, it took 15-20 minutes to get there. The first day I arrived, Emmanuel met me out front and led me through the open aired hallways to leading to the Physiotherapy Unit. There were many Ghanaians sitting in the lobby, but of course we walked right by them.

PT at the hospital was exactly the same every day. First, I was taken into a private room for the heat treatment. Almost always there was another patient in the room. This day was an exception, which is why I was able to take a picture of the room.

 

I’m not sure which heat lamp was worse – the hand-held one or this one. Take a look.

 

I call it the Foreman Grill. Heat did radiate pretty intensely out of this contraption, but the lever system was broken; meaning, the machine was sitting on my sore shoulder. After about 3-4 minutes, I could no longer handle the weight and had to have it removed.

I was also quite concerned about the frayed (and I do mean FRAYED) cords. Check these pictures out. There were signs on the wall indicating that no cell phone pictures were allowed, but I tempted fate.

 

 

Next, I was moved across the hall to the room in which I was to receive the electrical stimulation treatment. Not what I would call a "tidy" room.

 

There was no cellophane tape used here, but rather these very long straps that were wrapped around my arm to keep the pads in place. The pads used in the U.S. feel like rubber - the best way I can describe them – and they are a bit sticky, which ensures they stay in place. When the pads are removed, they are immediately cleaned and sterilized. The pads at 37 Military Hospital are made of fabric. I can only imagine how many people they have been adhered to prior to me. And trust me….they were not what you would call clean or sterile.

Another disturbing item in the room was this air conditioner.

 

 Well, let me be a bit more specific. It wasn’t so much the air conditioner, but rather the large blue bowl sitting on the floor collecting the water dripping from the air conditioner. Notice all of the cords on the ground? As a reminder, I was hooked up to an electrical machine. Yes, many, many things crossed my mind.

 

After I took the picture, Richard implored me to take it back to the U.S. and show everyone. I said, “Why?” He said, “Tell them that this is how our hospitals are over here and that they need to help us.” I very quickly responded, asking, “Why doesn’t maintenance just fix the leak? Why do the Americans have to fix it?” He had no response to that one.

My final treatment was in the paraffin wax room. I had no idea what I was in for; this was one procedure I had not been exposed to previously. The paraffin wax vat is about 24” x 12”. It looked as if there was dirt lying at the bottom of the container.

 

Emmanuel told me to just dip my fingers into the wax, which I did. “Holy crap!” I yelled. It was unbelievably hot. “And you want me to dip my entire hand into that?” I asked. Yep, he said. I shook my head, took a very, very deep breath, as Emmanuel took hold of my arm and dipped my hand into the paraffin wax past my wrist. Not once. Not twice. Not even three times. EIGHT times he dipped my hand into that scalding vat of wax. He then placed a plastic bag over my hand and wrapped it in a towel for the next three minutes at which time he peeled off the wax.

 

Unbelievably, my skin was intact. I was sure I would have multiple burn marks. Did I mention how hot the wax was??

I turned to Emmanuel and asked if that was it, to which he replied, “No. We will do it again.” “WHAT?” I shouted. Every day Emmanuel would submerge my hand into the paraffin wax as I would count to eight.

One day he said, “Why do you count?”

“It is a mental thing. It is so painful for me to put my hand in the wax, it’s my coping mechanism.”

Emmanuel laughed, shook his head and said, “Only a white woman.”

After six weeks of “therapy,” I was not progressing as expected (at least as I expected) and discerned it was time for an intervention! I had already scheduled a trip back to Colorado in late May for my niece’s graduation, and had two medical appointments arranged with orthopedic surgeons in Loveland and Ft. Collins for evaluations of my elbow, wrist, shoulder, and knee. Dave and I agreed that it would be in my best interest to move up those appointments.

Richard asked me if he could come with me….he would just hide in my suitcase. He just wants to visit America for two weeks. I asked him what he would do when we landed and he informed me that he would work; doing what he does in Ghana. I asked him what he would eat and he said he didn’t need to eat. He would just enjoy America.

I met with my elbow doctor first. Dr. Chamberlin’s nurse had obviously relayed my story to him, because when he walked into the examination room he said, “Wow! You have had an interesting couple of months since I last saw you.” I laughed and agreed telling him that my elbow had been the least of my worries.

His nurse had gotten a fresh set of xrays of my elbow, shoulder, and wrist, and he quickly went to work studying the scans. He asked me if anyone had told me that in addition to breaking my arm, I had also broken the scaphoid bone in my wrist. Of course not. The scaphoid is located between the hand and forearm on the thumb side of the wrist, and is one of the most common bones to be broken in a hand, particularly in a fall.

Dr. Chamberlin told me that all of the post-injury problems I’d been having (pain and numbness in my hand) were typical of a scaphoid break. He did, fortunately, tell me that the bone was healing nicely, but that if the previous doctor(s) would have seen the break, they would have likely kept me in the cast longer as it takes a while for that particular bone to heal. He told me that it is oftentimes difficult to see a scaphoid break in the first two weeks of the injury. As luck would have it, I just happened to have the very first xray taken of my injured limb. Dr. Chamberlin quickly pointed out the injury, and was surprised that the other three doctors had not spotted the break.

Because I was having difficulty using my hand after the cast was removed, I was not using my shoulder. This resulted in a what is termed “frozen shoulder” (medical term – adhesive capsulitis). According to Wikipedia, this is a “disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.” In researching the condition, I was experiencing the classic signs. Very restrictive movement of my shoulder, pain was constant, and exacerbated at night as I tried to find a comfortable position. The most excruciating pain would come when either my shoulder was bumped unexpectedly, or when I would trip or stumble and I would reach my arm to regain my stability. These actions would almost cause me to fall to my knees in agony. I would just hold my breath and wait for the pain to subside.

Dr. Chamberlin explained that frozen shoulders often take months to heal. He offered three options:

1)      Old lady approach. Do nothing. Eventually (1-3 years) the pain would subside and the motion in my shoulder would return.

2)      Physical therapy. He would start me on a fairly aggressive regiment of physical therapy. Recovery is still slow (9 months – 1 year).

3)      Surgery. He would put me on a table, knock me out, and manually manipulate the shoulder; basically breaking up the tissue. This would be followed by a very aggressive round of physical therapy.

I chose option #2. I wanted to avoid surgery at all costs for several reasons. First, and foremost, if I underwent surgery I was pretty sure Dave wouldn’t be with me, and that did not appeal to me at all. I would have to remain in the U.S. that much longer for the therapy. And of course, anytime one undergoes the knife, there are potential complications and my history with surgeries has not been necessarily kind.

I began therapy just days later with Julie and then later with Nick, an Australian, who took over my case when Julie went on vacation in Italy. I have been dedicated to my physical therapy, only skipping a 3-4 days in the last nine weeks. Several times, while on a Caribbean cruise, my sister would come to our cabin looking for us….and there I would be….doing my PT.

A few days later I was seen by Dr. Rocci Trumper, another ortho doctor in the same practice specializing in knee injuries. I absolutely loved this doctor. He was so personable and completely engaged in the appointment. After quickly scanning the MRI and conducting an examination of my knee, he ascertained that I had probably ruptured my ACL back in 2005 when I suffered a basketball injury. He said that based on my description of what happened in the fall and the subsequent level of pain I endured (which was nothing compared to the 2005 injury), he strongly suspected I had merely dislocated my knee in the fall due to the lack of an ACL. He told me that if I had been happy with the way my knee had been performing up to the day of the injury, he would not recommend surgery. I wanted to hug this man! He had just made my day. Dr. Trumper only had one bad quality – he serves as the athletic doctor for the Colorado State University Rams. I guess everyone has their Achilles heel. J

I am happy to report that although I’m not at 100%, I have regained about 75%-80% of movement in both my wrist and shoulder. Both are a bit painful, but I now have the tools needed to move towards 100% recovery. Every day I work on strengthening the muscles around my knee, and am back to doing low impact cardio. My goal is to get back to my boot camp class in September.

As I very often say when I return to America, “I love the United States of America.” This has never been so true as now.