With the current spate of very hot weather in Melbourne I have spent some time in the backyard pool. I was messing around having a go at some arm exercises and discovered that I can do a few strokes of backstroke.I can get out about 6 strokes with my left effected arm but it is a struggle as I have that sinking feeling as it lacks power in the water.
I have discussed with Melanie, my arm therapist why this works, and she believes that as my deltoids are activated by my triceps (I had a tricep nerve transfer into my deltoids) the backstroke action is perfect for activating the triceps. Anyway this is exciting and gives me another way to move through the water.
I have about 2 weeks before I see the Surgeon to decide whether an operation is needed to get my external rotation going (see previous blog). Whilst it is stronger when I practice laying down, I am concerned that when upright there seems to be little improvement. At this stage I fear the operation is more likely than not.
Prior to my last meeting with the surgeon he had requested that the arm therapist complete a sensory evaluation test. The test is titled the SWMF (Semmes Weinstein Monofilament Test) and involves the therapist touching you hand with different diameter filaments that are not dissimilar to fishing line. Generally they start with a very fine filament and with your eyes shut you have to indicate when you feel the touch. Needless to say you start imagining things the longer it is between touches. The attached Youtube clip demonstrates the test.
Craig’s Sensory Results
At each touch the therapist records when the touch is noted and if it is in the same spot that was touched. A colour coding system is used to note the level of sensation. The result is the attached diagram of my hands sensory pattern.
green (yellow on this diagram) indicates normal touch
blue – diminished light touch
purple – diminished protective sensation
red – loss of protective sensation
As you can see I have very little normal feeling in my left hand with a few spots of loss of protective feeling.
The worst loss of feeling is in my thumb and the first finger. Interestingly a few weeks back I was cooking and it was not to the next day I noticed a large blister on my first finger that was the result of a burn. I had not and never did feel the pain associated with the burn. It does mean you have to be incredible careful around heat.
The purpose of the sensory test was to establish if I needed a sensory nerve transfer in my hand. This will involve a sensory nerve from my little finger and index finger being moved to my thumb and first finger. The challenge will be that it when I touch things with my thumb and first finger my brain will be telling me it is my little and index finger. The brain will eventually adapt. A decision has yet to be made on whether this operation will be done. If it is it will be done at the same time as the tendon transfer.
The last blog indicated I was off to see my surgeon, Dr Wheel to find to whether I would need more surgery. I have been unable to get external rotation to work in my left arm. It seems no matter how hard I will it to move, not a lot happens.
I can get a little bit of movement in the swimming pool or laying on my back.
As mentioned in an earlier blog I had been reviewed by a team of surgeons at the Alfred Hospital. When I met with Dr Wheel he indicated that they had been in agreement that the external rotation was weak and would most likely need to be enhanced through a tendon transfer. Not the news I wanted! The tendon transfer involves the latissimus dorsi muscle, commonly called “the lat”.
The lat attaches into your upper arm and in this transfer they move it to attach in your shoulder (I think). The effect, hopefully, is to strengthen the external rotation.
I asked Dr Wheel about the chances of success and he indicated that they have had success with children but neither he nor his colleagues have done it on an adult, let alone an ageing 59 year old. Whilst this doesn’t immediately inspire confidence, I have total faith in Dr Wheel to deliver. I admire his enthusiasm and creativity. He is a problem solver – here is the issue how can I get the best outcome for the patient. If he doesn’t fix me it will not be for the want of trying.
The down side to the surgery is that I will be in a cast for the best part of 10 weeks with my arm bent and sticking straight out. Like holding a plate in front of you. More concerning is 10 weeks with little physical exercise. I hope all the fitness I have gained since the accident will not be lost.
The surgery is planned for March and I have another visit to Dr Wheel in February. If he is happy with my improvement by then the surgery can be called off. So needless to say, I am being as rigorous as possible with my exercises to try to get some movement going. It is a few weeks now since I have seen Dr Wheel and I think there is slight improvement when lying down but unfortunately nothing whilst vertical – video attached.
The summer is fast approaching and I am planning to ramp up the participation in some runs, swims and triathlons. Unfortunately Melbourne’s spring has been a shocker with plenty of wind and rain. This has particularly put me off getting on the bike as I am still fairly nervous about traffic. The big difference now is I seem to hear every car, whereas in the past I rode amongst traffic and didn’t notice them.
Our Noosa ResultsConsidering I now only ride in light traffic areas this is a big difference. This means I now do most of my riding indoors – I have purchased a new indoor bike. That will be the topic of the next blog.
Considering I now only ride in light traffic areas this is a big difference. This means I now do most of my riding indoors – I have purchased a new indoor bike. That will be the topic of the next blog.
Over the last month I have completed a few competitive runs. Firstly it was off to Noosa to do the run leg of the Noosa Triathlon. It is the largest triathlon in the Southern Hemisphere and a spectacular occasion. If you are in to triathlon you must do this one at least once. Our team, The Hacks, consists of me doing the run leg, a close mate, Phil doing the bike and a local ring-in doing the swim. Phil has a bung knee but rides exceptionally well for his 66 years and our swimmer was very competitive. I exceeded my expectations running the 10km in 53:43 minutes whilst running in my sling. We finished 44/80 in the Masters category. The Hacks were pretty happy with this.
City to Sea 2013
On 11 November I ran the City to Sea 14 km fun run in Melbourne. It is a flat, fast and subsequently pretty boring course. I had a great race doing it in 72:40. Getting very close to the 5 minute km mark which is the ultimate target. I was on track early but faded in the last 4km. Interestingly my arm therapist. Anna ran third in the female open. She is a gun and has represented Australia many times. In the lead up to the race she was approached for media stories and referred them to me. This led to two radio interviews about my brachial plexus injury and the challenge to get back to fitness. it was good fun doing the interviews.
Last weekend I was meant to do the first of the season’s triathlons but I pulled the plug as the wind and subsequent swell would have been too big a challenge for my one arm swimming technique. Can’t say I enjoyed pulling out!!!
I now need to plan the triathlons I compete in around the likelihood of rough water. Luckily there are a few where it is more than likely the water will be flat.
Tomorrow it is off to the surgeon. It is 2 years since the accident and I will find out if I need more surgery. Fingers crossed that I don’t.
Last week I was called to a case review at the Alfred Hospital where I originally went after the accident. It seems the case review was a regular meeting the brachial plexus surgeons have with the therapists. The start time was 6:30am which was a bit demanding but once there it was an interesting meeting.
Before the meeting I was assessed by one of the resident doctors who seemed to be in training to be a surgeon. In the meeting the resident doctor presented my case to the doctors who quizzed her about my injuries. She was clearly nervous and rushed and after calling my shoulder my elbow twice was told to slow down. Once she had finished her analysis the surgeons quickly got down to analysing my symptoms and recovery. My surgeon, Dr Wheel was present and was able to give his view. It was good to be part of the process, but I didn’t learn a lot as they talked in their own language. What I did come away feeling is that unless the external rotation of my arm happens soon more surgery seems inevitable – can’t say I am keen on that idea as it will mean my arm and all my sporting activities are stopped for a significant period of time. The meeting closed with Dr Wheel saying the other surgeons had pretty much agreed with his analysis.
From there it was off to the arm therapist. It seems lately I have a different person every time I go there. today It was Anthony, who I have had before and he brings a different approach and is good fun. It was a great session as we seemed to get some external rotation with me lying down. It did give me some hope that with time it may happen. The amazing thing was the difficulty I had switching off the internal rotation which was so strong that it was overpowering any chance of external rotation. I left the session with something to practice and more hope of avoiding surgery. The attached video shows the movement.
I recently had a question about the pain associated with my brachial plexus injury. It is wasn’t the best time to ask as the last few weeks have been really bad. I remember when I was first diagnosed in hospital the specialist trauma doctor immediately referred me to the Caulfield Pain Clinic in Melbourne and indicated that this was a painful injury and sufferers often experienced chronic pain. He was correct!!!
My pain has been different over the journey. Immediately after the accident it was only shooting and sharp pains in my hand. As time has gone by it has become more constant with occasional bolts of pain. The pain may have increased as I have gradually reduced the pain killers so that I could operate more effectively at work. Interestingly the therapy I receive also triggers greater pain. It seems doing he exercises stirs up the nerves.
I have discussed the pain with a number of specialists and there doesn’t seem to be a shared view. My surgeon is of the view that as the movement improves there will be a point where the pain subsides. The Caulfield Pain Clinic doctor said “this could go on for decades”, which I found depressing. And I am seeing another doctor who is an anaesthetist and he has me trying alternative therapies as he believes there is no medical solution. He has encourage me to try anything that has some credibility.
Some of the solutions that have given relief are:
- The Mirror Box – a box with mirrors where you stick your bad arm in the box and watch the movement of your good arm in the mirrors as if it is your bad arm.
Homemade Mirror Box
Hopefully fooling your brain into thinking the good arm is moving.
- The App Recognise which gets you to look at hands in various positions to get your brain again to be see your injured hand moving. I found this one really hard to do initially which really shocked me.
- Keep busy. There is no doubt you feel the pain less when you are distracted. When I hop in the car after work the pain always arrives. I am sure it has been there during the day but I have been distracted and not noticed it.
I haven’t tried yoga yet, but I am sure it has something to offer as I believe the solution lies in mind control rather than drugs.
For those interested I still take Lyrica 75mg night and morning and 10mg of Endep in the evenings. The Endep allows me to get a good nights sleep on most occasions.
If you have a Brachial Plexus injury don’t underestimate the pain you will have to manage and get the best support you can as it can be very demanding.
The next psychological hurdle was to get back on the bike. It was bad enough for me but even worse for Kerry (my wife) who had to witness all that went on at the hospital during the weeks after the bike crash. I initially decided to venture out on the recreational bike with Kerry on the quiet roads of Apollo Bay in January 2013. I went okay but nice and slowly. Eventually I got the road bike out and went to the local bike track. I couldn’t believe how wobbly I was to start, but I gradually built up some confidence. Getting back on the roads was scary, but I found a couple of spots where there are almost no cars.
Over the recovery journey I had set myself the target of doing a triathlon before the end of the 2012/13 triathlon season. The last race of the Gatorade series was in April and fast approaching. My swimming and running were good enough for the 700m swim and 5km run and I figured the bike would be okay as there would be no cars and no drafting. Kerry had agreed I could have a go and she was able to be my “handler” in transition. I have to say it was great to be competing again – but also very nerve racking.
The swim was tougher than I thought as I had to battle the other swimmers whilst swimming on my side and not really being able to see where I was going. I took a wide path to keep out of trouble. The bike went smoothly with no problems – I did take it very cautiously!!!! The run was good although I had been struggling a little with an achilles injury. All up it was a great day and if it hadn’t been for a very slow swim I would have been well inside the top 10 in my age group. It was great for me that Kerry was able to help on the day as she has, and continues to do so much to help me recover. It has given me confidence for more racing in the upcoming season.
It is September 2013 and you would not believe my ability to injury myself. I suspect I am a bit clumsy after this latest incident. I was running last Saturday on a glorious sunny last day of winter. I had intended to run 15kms and was really happy with the way I was running especially given I was wearing the sling. I was running along Beach Road on Melbourne’s Port Phillip Bay and was heading back to where I had left my car.
About 3km from the end I was cruising along when whack, I hit my head on a piece of bush hanging over the path. I am not sure I had seen it but hidden amongst the leaves was some branches that had been pruned and left jagged edges. In shock I reached for my head to be greeted with a lot of blood. It seems heads bleed rather profusely. Luckily I had some tissues in my shorts pocket which I could hold to me head to stop the bleeding.
I had been listening to music on my iPhone so I could ring home. I was worried about alarming them, but my daughter answered who didn’t know I had been running and when I said I had split my head she assumed I had been riding and was ready to tell me off. She came and picked me up before my wife then took me to casualty.
The Split Head
In casualty I was advised to have some staples put in to hold the wound together. I was told a local anesthetic would be ineffective so the staples proceeded. I have to tell you – it hurt. Luckily I was not warned.
The reaction of friends has been to shake their heads in amazement at my stupidity and to suggest perhaps I should give it away. The reality is they don’t really mean it – or do they??
The task of getting my arm to bend proved long and frustrating. It seemed that I could bend it in water quite easily but out of the water gravity was proving a great challenge. The main tool I used to help was a long timber rod that I held in both hands to do arm curls. I had one at home, one in my regular office and one that traveled in the car with me for when I was not in the regular office.
In early November 2012 nearly one year after the accident I entered as the run leg in a team at the Noosa Triathlon. Noosa is the biggest triathlon in the southern hemisphere. I had completed the last two as an individual, so it was nice to be able to be part of a team and compete again. It was to be my first competition since the crash. I had a great run although it was very warm.
Finish of 2012 Noosa Triathlon
The highlight of the day was yet to come. Back in the hotel room in doing my exercises we finally got the arm to do a curl of sorts. And I emphasis “of sorts”. Have a look at the video attached to see my first arm curl in a year.
The progress with my arm continued as the year progressed. It was hard and slow work.
After a few months of my own method of swimming Dan Aldrich (mentioned in my other blogs) sent me a video of a swimming technique developed by Challenged Athletes (USA). This video gave another method that I have embraced and is working well. The technique involves swimming on your side and swimming freestyle using your arm like an oar. The video is attached.
This technique meant I had to learn to kick which I had never done well in the past. With a little practice I saw my time for 100 m improve to about 2:50.
Just recently I have begun working with a professional swim coach to assist me to develop my technique. In a short time this has proven very beneficial with some obvious faults in my technique identified and some significant improvements in my time. This week I was swimming 2:15 for 100m. The coach used an iPad to video my technique. It was amazing to see how different the reality was from what I thought I was doing. Even without using a coach I would recommend using video to analyse your technique.