My Brachial Plexus Injury

My tbpi (traumatic brachial plexus injury) has been diagnosed by a local neurologist as a stretch injury. This conclusion was made three weeks after my accident. My neuro found signal in all muscles, some a strong signal, some weak, and some barely a trickle. This was all figured out after about a 20 mintue EMG. His prognosis was a full recovery in 6 to 12 months. However, when he was telling me this he didn't sound very convincing. I left there with a mixed bag of feelings. A year seemed forever, but a stretch injury is about as mild a form of a bpi as you can get. The next day was my clavicle surgery, so I thought - give me a couple of weeks and then some PT and i'll be on my way to recovery. This turned out to be a very wishful thinking. While there has been some recovery (and believe me, i'll take anything), some muscles just aren't really showing any return.



Over the course of the next few months I have had some recovery. The return is extremely slow. Some of my return has been movement, some has been feeling, and some has been just muscles twitching or flexing. My strength in all of my arm is very very weak. It is almost as if my right arm is just coming out of the embryonic state. According to my physical therapist, my shoulder is supported. There are some muscles still doing their job to keep my shoulder in the socket. Because my grip is still good, I have to be very careful not to lift anything with much weight to protect my shoulder. The main muscles that are not responding are my bicep, brachioradiallis(used in conjunction with bicep for doing a curl), infraspinatus(used for shoulder abduction), and my deltoid. I do have flextion as long as my palm is pronated, once I supinate I can not do a curl even weightless.
It is a very odd feeling to have muscles not work. They feel like dead weight. My shoulder used to feel like it was constantly being pulled on. Now, I don't notice it as much. Either I am getting used to it, some other muscles are compensating, or I am slowly getting some strength in a few of the deinnervated muscles.
In about 4 weeks I will be heading to the Mayo Clinic in Rochester, Minn. This is the king of bpi specialists. I will finally get some answers as to what is my true prognosis. It is very important to see solid improvement within 3 - 6 months post accident. Otherwise if surgery is needed they will want to do it within 6 months of the accident. This allows for the best possible recovery. My understanding is the muscles start to atrophy so far that after a year to a year and a half, even if the muscle is reinnervated, it may not come back. If we need to do surgery to repair the nerve, or clean out scar tissue, doing this prior to 6 months post accident allows for the nerve to heal and reinnervate the muscle before it has atrophied too far.
Well, that's probably enough for now. I will post some pictures soon to show how far I have atrophied, as well as some of the exercises I do at home on a regular basis. Thanks for reading.

Pain pills, guilt, and depression

Wow, that seems pretty extreme, but those of you who have been through this type of injury, or even a surgery, have probably dealt with one or all of these. After my surgery I was left in a fairly strange mental place. I was unable to work, unable to do any real physical therapy, and unable to sleep. Fortunately I was able to get off the pain pills in a matter of days after my surgery. I am one of the very lucky ones with a brachial plexus injury in that I do not have any nerve pain to speak of. I did have some at first, but I was on pain medication for almost a month so it was hard to know unless I didn't take it. Mostly out of fear of pain I took it. I continued to take Tylenol for a period, but I stopped taking that sometime in October.
The lack of sleep was due to two contributing factors. The first being I had this injury that only allowed for sleeping on my back. I hate sleeping on my back, I have always been a side to the belly to the side kind of sleeper. Also when I would go to bed I would take my sling off so my arm would just lay there by my side. I am not a claustrophobic person, but when I would lay down and have this arm that I couldn't move next to me it just freaked me out. Right after I would lay down, I would sit back up in a bit of a panic because I couldn't move my arm. It was never as bad during the day, but when I laid down it just became way more noticable. I really began to dread bedtime. The other contributing factor was I had an 8 month old at the time and I am a light sleeper. Put these two together and talk about a pretty shitty nights sleep.
Due to my inablity to do much I also began to feel very guilty. I felt guilty for several reasons, most of which revolved around two people closest to me, my wife and my work partner. I felt like I had left them high and dry. My wife had just started back at work after six months maternity leave. She is a night nurse in OB, so there was no way I could take care of our small baby all night when I wasn't even able to hold him. Once again she was forced to take more time off, approximatley two more months. After two months we were forced to figure something out as our insurance would not cover me if she missed any more work. Aarin (my wife), has a sister who agreed to stay the nights Aarin worked to help out. While all this was going on I was also still the owner/partner of an electrical business which was very busy. We had no employees, just myself and my partner Miles. I guess you could say each of us were each others insurance, and I was the one cashing in my policy. Well, Miles kept the ship right, but the struggle of depending on someone in that sense just increased my guilt.
All of this landed me in a state of depression which I had never seen before. When you have a brachial plexus injury there are alot of unanswered questions. Nobody (at least around here) can give you a true prognosis. This type of injury is very specialized and very mysterious. I mean how many of you have heard of a brachial plexus injury? Probably nobody, unless you have one. This depression lasted pretty consistently and still is surfacing. Some redeeming factors are the fact that I have been able to ride my bicycle again. About the middle of October I was able to get back on my trainer in my garage. That helped but only temporarily. I then was able to get outdoors on my bike, albiet very carefully and somewhat uncomfortably. You would think this would have done wonders for my psyche, but it almost had the opposite effect. I was really concerned I would never be able to ride like I had in the past. I am very competitve and I love to race my bicycle. I, even to this day, don't know if I will ever road race again. Mostly out of fear of crashing and knowing what may happen. Time will tell, and as anyone knows with this type of an injury, patience is a virtue. Enough for now, thanks for reading.

The Accident

On August 31, 2008 I embarked on an epic bike ride with 4 of my favorite cycling buddies. How was I to know this ride may have changed my life forever. It was a beautiful summer day and we were in for a big ride on some of the best forest service roads in Humboldt county. I was already in Willow Creek, so I met the other guys at a coffee shop early and we were off. The ride went pretty much as usual, lots of climbing, lots of heckling, and tons of fun. Until about hour number 4, all the climbing was done and it was time to descend back to the creek and some well deserved frosty beverages. The descent was a tricky one, if you are a local you may know it well, Titlow Hill rd. About 3/4 of the way back to highway 299 I was coming around an S turn when my front tire popped. Normally a cyclist will carefully slow down and come to a stop, well this time was not normal. I was going approximately 30mph, which is nothing out of the normal for a descent, actually I was probably even holding back just a bit. I hit the rear brakes and was coming on a left hand turn when I unclipped my left foot, locked the rear brake and slid straight off the side of the road. That side of the road consisted of a small drainage ditch and a large bank of shale rock. Well my front wheel hit the ditch, pointed me in a downward position, and BAM!, I was on my head. The pain was intense in my neck and I wasn't sure if I could move or not. I wiggled around in a panic and immediately wanted to get up, only my right arm was completely limp. This is when my riding buddies were on me. They wanted me to stay on the ground, but I needed to get up for some reason. I sat up and tried to stand up, but I had to kind of swing my limp right arm under me to push up, when I pushed up it shot terrible pain into my clavicle area. This is when I realized I had broken my right clavicle.

I remember Geoff taking this picture of me after I got up. I don't know what made me smile, other than the fact I had no idea how serious this injury was. Believe me, that smile was brief. I quickly laid back down, we made a cell phone call, and in about 15 minutes my wife was there to take me to the hospital. I was very concerned about my flail arm, but I was just thinking(hoping) that this was normal for a broken clavicle.

We drive down Titlow hill and get to highway 299 when we realize, shit! we're about out of gas and the nearest gas in the direction of the hospital is about 20 miles away. Go for it, we decide. We make it and arrive at the hospital in Eureka about 1 1/2 hours post accident. Once in the ER, this is where it began to sink in the severity of my inury. My flail arm concerned and confused these doctors. They told me it should be fine in about a month, and the clavicle would heal on its own. You tell me, would you just let that heal?

Well, I went home, let all this soak in and started making calls to doctors to start to get some answers. About a week after the accident I was finally able to see an orthopedic surgeon. My arm was still pretty much flail and very numb. The one positive was that my hand had always worked. My thumb was numb, but I could use it. So about 3 weeks post accident I ended up having an EMG, which is a nerve conduction test to see what muscles are still firing in my arm. This test showed, in fact, that many muscles were receiving very little, if any, signal. My nuerologist did conclude that the nerves were still in continuity and in about a year I should have a full recovery. HOLY SHIT! A year?!?

Once my orthopod saw the results of the EMG we decided to do surgery on the clavicle. I would receive a stainless steel plate and 7 screws to hold it all together. The surgery was the day after my EMG. All went well and I was out of the hospital late the night of the surgery.

So that gives you an idea of the beginning of this journey, stay tuned for more about my mental struggles, physical struggles, and more. Thanks for reading.

Making Sense of it All

Well, some of you may know what has happened to me, some may not, and some could probably care less. If you are on this blog you probably are at least interested, and that is the purpose of this. I would like to inform my family, friends, and other people who have been blessed with this strange injury what I am doing about it both mentally and physically. I will start from the beginning and cover the last few months and then move into the present fairly quickly. I also hope to post some pictures and videos to help better understand how this particular injury works and how I am dealing with it. So thanks for checking in and be sure to check back.