When I say my orthopedic surgeon just over two weeks ago (Jan. 8th), I brought up the subject of physical therapy with the hope that he would write my a script and send me on my way. He did not fail to deliver! Since coming home from the hospital with my external fixator on December 1st, I have had three visits, all in December, from a home physical therapist. The first time she came she gave me some simple exercises to do, the second I mentioned that I somehow pulled a muscle in my right knee so she told me to take it easy for a bit and the third and last time she told me to continue to do the exercises she originally gave me and that there was nothing more she could do for me at the time. The exercises she gave me included bending my foot up and down, moving my leg outwards/inwards and up/down to keep my hip muscles moving, and bending my knee. The purpose of physical therapy is to keep my muscles working as much as possible and to prevent muscles atrophy. These are real concerns when a limb is immobile and goes unused for months on end. They are even bigger problems when it comes to external fixators. First, fixators hurt, so getting enough motivation to move is already difficult, especially if you feel like you aren't getting anywhere; movement usually causes pain. Second, the pins attaching my fixator to my bone push aside muscles and nerves. For obvious reasons, moving my knee, ankle, or leg in general causes the nerves and muscles to rub against the pins (which in turn prevents the muscles from returning to their normal position). Uncomfortable to say the least! And third, along with an external fixator, I have an IM nail, or intramedullary rod, that was inserted during my latest surgery on Nov. 25th. In order to place an IM nail, which is inserted into the tibia, an incision is made over the knee and the knee cap, along with a tone of muscles and ligaments with it, is pushed completely to the side. As a result of this, there is a lot of scar tissue building up in my knee, preventing my leg from being able to straighten the entire way. Read a lot of stiffness and discomfort. The exercises that the home physical therapist gave me haven't been helping much; I have been noticing a gradual but steady increase in stiffness and loss of range of motion. When I brought this up at my latest appointment with my orthopedic surgeon, he mentioned that some physical therapists do things differently and that someone else might be able to help me more. So my wish was fulfilled and I walk... erm, hopped away with a prescription for physical therapy.
The following week I started doing some research on physiotherapy clinics in the vicinity of where I live. A quick search on Google brought up a sizable list and, after going to numerous websites for individual clinics, several clinics made the short list of places I wanted to consider. Meanwhile, my mum was also doing her own research. She read something online that suggested that my physical therapy appointments might be covered by OHIP. I was skeptical, because everyone I know who has ever hat physical therapy has had to pay out of pocket or through private insurance. Regardless of my doubts, we brought it up with my home nurse on the Thur. 14th. She didn't have any answers to my questions, explaining that home nurses are not instructed about the ins and outs of physical therapy, but she did give me the number for my case manager. I tried calling my case manager that day, with no response, and again at the start of last week. I still have not gotten a call back. On Tuesday I did, however (on my mother's urging), call a different number of the company that provides home nursing and got through to a lovely woman who knew all about what I needed to know. She thought that I would be eligible for OHIP covered PT and gave me the number of the only OHIP funded clinic in the city I live in. That whittled down my list of options pretty fast! Fortunately, the clinic she mentioned was the front runner on my personal list anyways =)
I called the PT clinic right away and explained my situation to the receptionist. She confirmed that because I need physical therapy due to surgery and because I had stayed overnight in the hospital I am eligible for OHIP covered physical therapy. This is wonderful news because my surgeon had already mentioned months earlier that I would require some pretty serious physical therapy, which can add up fast money wise.
My first appointment, for an initial assessment, was last week Thursday at 3:30pm. I arrived early in order to filler out some paper work. While doing do, I heard the receptionist tell someone over the phone that there were no more OHIP covered spots until April. When leaving my appointment and waiting in line to make a new one, I overheard the receptionist tell the gentleman in front of me the same thing. And then there is the realization that hits you - that you probably got one of, if not the last OHIP covered spot for the remainder of the year funding wise (rolls over in April). To think that a matter of a day and a half could make the difference! Not to say that other people don't need physical therapy as well, but given the external fixator and, up to this point alone, not having been able to walk for five months, I definitely need a lot of physical therapy and, therefore, OHIP coverage. If I only needed a few appointments, like many people do post-surgery, I wouldn't mind paying completely out of pocket, but the amount of physio I need equates to some serious cash.
The appointment with the physical therapist went really well; she is super nice and seems very knowledgeable. She, like my home nurses and the home physiotherapist I saw, has never worked with a patient with an external fixator before and is excited to do so. She had me go through my whole health history, twice (because of how complicated and ongoing the issues with my leg have been). I also had to answer a lot of questions about my health in general. After that she did an assessment of my legs (e.g., skin sensation, range of motion, strength). She explained why I couldn't straighten my leg the entire way, which I described above, and mentioned some areas we really need to work on (e.g., straightening my leg, regaining some range of motion in my ankle, moving my toes!). Last week I felt like I could move my toes just fine; this week, not so much. She explained that this is a significant area to work on because toes play a tremendous role in walking and balance. She also said that by the time the fixator comes off and I am given the go ahead to start walking that I will pretty much be learning how to walk again. This scares me more than any words can convey. Walking is so incredibly important; so freeing. To sum it all up, I will require intense physiotherapy, just like my surgeon had said. On top of this, my physical therapist wants to add exercises that focus on building muscles strength to the ones I was given by the home physiotherapist. These exercises will help me hit the ground running (not literally of course) once my fixator is removed and I am allowed to start weight bearing. Range of motion is not the only thing that matters when it comes to walking and there is quite a noticeable amount of muscle atrophy throughout my leg at this point. In addition, the physical therapist wants to give me some exercises for my back. She explained that humans are not meant to either sit on a chair or lay in bed all day, so being unable to walk is problematic. Furthermore, walking with crutches can cause some overcompensation issues for the unaffected side of the body (left hip/leg). It will be great to get some exercises for all this in addition to the ones for my knee and ankle. My mum and I left the appointment on a good note and I am excited to go back next week which is when I will be given exercises to do!
If it wasn't already evident by everything I have said up to this point in this post, I am rather ecstatic about getting physical therapy. During the entire decade that I have been dealing with the aftermaths of my broken leg and the chronic bone infection, this is the first time that physio has been offered to me. I could really have used it in 2006 after my leg had been in a cast and/or walking boot for ten months and I had surgery to re-break my leg, and again in 2008 after hardware removal. It wouldn't really have been necessary in 2012 because the surgery I had that year was relatively minor, although after being as sick as I was in 2011 and 2012 with the chronic bone infection it might have been good to get some physio to help regain some overall strength. But then, I am saying that with hindsight and half a nursing diploma behind me. Obviously I couldn't get physio after surgery in August because I was in a cast. But I am getting it now and that is what matters =) I am much more impressed with my physiotherapist at the PT clinic than I was with the home physiotherapist (not that she wasn't good, but her scope of practice was definitely working with elderly people, who are the most likely to require home physio and are often able to do a lot less, which is the opposite of what I need - hard core physio to get me back to a normal active life). I am really hopeful that physio will play a tremendous role at getting me up and walking and as close to normal as possible after so much surgery.
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