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My Back Injury
Written by Chloe on Thursday, October 23, 2008
While skiing in December 2006, I sustained a minor T10-T12 spinal compression injury resulting in some permanent nerve damage. I am happy to have a teaser, but at the same time frustrated not to have much more extensive paralysis and sensory loss.
The Injury
My skiing companion asked me if I was O.K. I knew I had done something rather more serious to my back than previous pulled muscles. It was quite a bit more painful than what I had done before. Still, there was the mid-mountain chairlift just yards away. I thought if I sat down the pain might ease up a bit. I said that I had done something to my back, but that I thought I’d be alright; let’s just get on the chairlift.
As soon as I sat on the chairlift the pain intensified tremendously. It had me gasping for breath and trying in vain to find some position to lessen the pain. Within seconds I told my companion that I needed to get down off the mountain as soon as possible. We took it very slowly, skiing down.
I told my companion that I would wait in the lodge while he continued sking. I still thought the pain was likely to ease up soon. It didn’t. It continued to get worse. By the time my companion had done two more runs, and came back to check up on me, I was begging him to take me to the emergency room immediately.
My cell phone wasn’t getting any reception up at the ski resort. On the way to the hospital I called my partner to meet us there. This was a ride from hell. The pain continued to get worse, and I couldn’t find a position that seemed to make it any better. By the time I saw a physician, I was finding it very hard to formulate coherent sentences. Most of the questions were answered by my skiing companion. We were sent home with prescriptions for pain killers and muscle relaxants.
I remember very little after I made the phone call to my partner, for about the next ten days. I have found that extreme pain seems to blot out the memory function. I only remember two things from those first ten days in fact. I remember that lying in bed was impossible. The only tolerable position (relatively speaking) was to lie on the couch on my side, with pillows and cushions propping me up in strategic locations. I also remember the number of percocet it took for me to get any sleep. It was seven, far more than had been recommended by the emergency physician. The problem with physicians asking how much pain one has is that there comes a point where the pain is simply inexpressible, and they don’t get it. The pain from this back injury was the second worst I have experienced.
Sensory Changes
At about ten days post injury, I started being able to sit up on the couch for more than a few minutes at a time. My partner was sitting to the left of me. In attempt to give me comfort for the obvious pain I was in, she started to stroke my bare left thigh very gently. This sent shockwaves of pain coursing to my brain. I was stunned! I knew I hadn’t injured my leg at all. She figured it out. She said "That’s nerve pain. You have nerve damage". Several times over the next few months she would forget, and gently try to comfort me, making me gasp with pain. At three months post injury the nerve pain gradually began to subside. At six months it was completely gone.
Only after the nerve pain was mostly gone did I realise that a great deal of my left thigh was bereft of sensation. It has taken me a long time to figure out the new sensory map. I am still learning new things. I shall descibe my thigh as if seated. The top and inner surfaces of the thigh are completely devoid of feeling. There is slight sensation on the outer surface. The under surface is maybe 30% sensate. Everything from the knee down is "normal". The entire right leg is "normal".
Heat sensation follows a similar pattern, with the exception that there is partial sensation on the inner surface of the left thigh. Cold sensation is very weird. At every part of my left thigh the cold sensation is translocated to a different part of my thigh. For example a cold stimulus on the upper top surface is translocated down to just above the knee. A cold stimulus on the upper inner thigh is translocated to the lower outer thigh. This is hard to get used to. It is always a surprise. If I scratch hard on parts of the thigh where there is no feeling, there is a translocated tingling sensation that follows the same pattern as cold.
Sensory loss is not limited to my left thigh. An area of partial sensory loss extends up through my genitalia, pubic area, and lower abdomen. It fades into "normality" an inch below my navel. There is a lot more sensory loss in my left labia than my right. Above that, the sensory loss is symmetrical. There is translocation of cold sensation too. A cold stimulus on my (almost hairless) left pubic area is felt in my lower right labia. I thought that a contralateral translocation like this was particularly strange. I didn’t know it was possible. Sean reassured me that I was not alone in this kind of sensory translocation.
Physicians
The emergency room physician did not say anything at all about a possible spinal cord injury. He said nothing about the potential for nerve damage. Actually I have no memory of anything he said. I am relying on my partner to fill in some gaps. Since then I have read some accounts of people with spinal cord injuries. It is not that uncommon for someone with an incomplete injury to be dismissed from the emergency room with no hint that there could be an SCI. Nerve damage can become evident more than a week after the injury. Apparently this is what happened to me.
Eventually I saw another three physicians in connection with my back injury. They said that I have a minor T10-T12 compression injury. I interpret this to mean that there was (is?) compression between T10 and T11, and also between T11 and T12. I am assuming that there was neither a fracture nor a dislocation of any vertebrae. One of my interactions with a physician was sufficiently entertaining that I shall repeat it verbatim (to the best of my recollection) here:
Physician: You have a T10-T12 spinal compression.
Me: Uh huh.
Physician: You came very close to being paraplegic.
Me: Oh!
Physician: You really need to get a metal rod put in your back.
Me: No, I don’t think I’m going to do that.
Physician: Well, you can’t ever ski again. There’s a high risk that a reinjury would result in complete paraplegia.
Me: I’m going to keep on skiing. I see lots of paraplegics skiing.
Physician: You don’t want to be paraplegic! Paraplegia is absolutely horrible! (He is visibly agitated at this point)
Me: I can handle it. (After this comment, he is giving me a look of utter disgust)
Physician: I’ll take you round the paraplegic ward. Then you’ll see.
Me: O.K. (At this point we are both silent for some seconds, recognising the stalemate)
Physician: At the very least, you’ll have to wear a back brace every time you ski. It will help prevent a reinjury.
Me: Alright.
Paralysis
I last saw my GP for a check up in early March (2008). After examining my back and my leg she said "The nerve damage could get worse even without a reinjury. It will most likely manifest as increasing weakness, paralysis, and atrophy of the (left) quadriceps". (I tried my very best not to smile as she said this).
At the beginning of the hiking seaon (May 2008) I noticed right away that my left thigh would start hurting about 40 minutes into a hike. Then it would feel weak, and I would start limping ("for real" that is). I told my (paralysed) friend about this, and she said that those symptoms would be typical of a minor paralysis.
My last physician visit in connection with the back injury was at the beginning of August (2008). He confirmed that I do in fact have minor paralysis of the left quadriceps. This makes me happy! If nothing else, it enables me to say truthfully that I have some paralysis, in response to questions about the wheelchair, etc.
In addition to the quadriceps, hiking causes the muscle(s) on the underside of the thigh to become painful. That muscle(s) is also clearly more floppy and flabby than on the right side. I suspect that there might be some paralysis there too. It could be wishful thinking though. Since it has not (yet) been confirmed by a physician, I am not going to say that there is paralysis.
During the 2007 hiking season I experienced similar pain and weakness in the left thigh muscles. However, the start of the hiking season overlapped with the time that I was still experiencing touch registering as pain. So I attributed the pain to that. Clearly it is not so. I have experienced a greater amount of thigh pain during the 2008 hiking season.
Muscle Spasms
I have muscle spasms in the left quadriceps where there is some paralysis, and also on the inner part of the thigh. They are minor. I would describe them more as "twitches". However, the physician described them as "spasms". He said it was normal under the circumstances. They are not strong enough to cause an involuntary movement of the leg. They are clearly visible. It can be entertaining to watch! The spasms are strong enough to wake me up sometimes. They usually occur in somewhat regular pulses, with short breaks between a sequence of pulses. The whole episode will usually last somewhere between one minute and ten minutes.
Bladder Issues
Since my back injury, I have peed myself by accident four times. This hadn’t happened since I was a kid. The first three times were within months of the injury. In each instance I was naked, and I had just got up in order to go pee. I felt it as it reached my left knee. My genitalia and left inner thigh did not have enough feeling to register anything, so I didn’t know I was peeing. On the fourth occasion, much more recently, I was at a party with good friends. I peed as I was laughing hard. As soon as I figured out I was peeing it made me laugh some more, which made me pee some more. I wasn’t wearing any incontinence protection. It was not embarrassing for me, being among those friends.
In all of these cases I had a very full bladder. There is a reason that I have a full bladder more often these days. Post injury it is much more difficult for me to go pee. I have to focus very hard to affect the right muscles in order to start peeing. Sometimes the stream will just stop moments after starting, and I have to try again. This can happen several times in one sitting. Sometimes I just give up and try again later. It can easily take twenty minutes or more to go pee. My partner and I joke about this when I have to go pee. She says she’ll read "War and Peace" in the meantime. I have done a self catheterisation on occasion, but it’s a bit of a performance. The solution that I have found works for me best is to wait until my bladder is really full. Then it is easier to start peeing.
Having a very full bladder is a lot less uncomfortable for me than it used to be. I’m guessing that since I have sensory loss on my lower abdomen, the sensory nerves from my bladder might also be affected. I’m not sure.
Incontinence protection seems like a really good idea. Moreover it is consistent with my BIID needs.
Nasty Stuff
If you are squeamish you might want to skip this part. I don’t really want to write about this. It is embarrassing. However, I think it is more important that I keep this real and not sanitise things. It is about pooping my panties.
I had not pooped my panties since I was a kid. I have fabulous bowels! Any time I have had diarrhea, there has been sufficient warning and I have been able to hold it until convenient. I had been thinking how nice it was that my injury had no deleterious effect at all on my bowels. Yes, I know we have been criticised for "choosing" what we want. Alright I admit it. I want to be paralysed, but I don’t want to poop my panties!
This happened recently. I was sitting in my wheelchair, at work on a Saturday afternoon. I was in the middle of writing an e-mail to Claire. Very suddenly there was an urge to poop. Within seconds it was done, and I couldn’t control it. This has never happened to me before. It felt completely different from any previous bowel experience. I wheeled down the corridor to the bathrooms and cleaned myself up. Fortunately the mess was confined to my panties. I was not wearing any incontinence protection. I’m not quite so nonchalant now.
After I got back to my desk, there was that half written e-mail to Claire. I felt like I needed to get this off my chest, so I told Claire about it. Thank you, Claire, for being so gracious. And thank you for your compassionate response, which made me feel a lot better about things. I thank Sean too, for his very eloquent and helpful comment that "Shit happens!".
How do I know this has anything at all to do with my SCI? I don’t. It’s all circumstantial. It has only happened once. Though I do know enough about incomplete SCIs to realise that odd things can happen in terms of nerves temporarily "shorting out".
I interpret my back injury as a message from the universe saying "Here, you can have a teaser". I interpret this incident as a message from the universe saying "Are you sure you can handle this part?". This freaked me out, but yes, I can handle it. I accept everything that a complete SCI will bring.
The Reinjury
It was very exciting to be told by a physician that skiing would give me a good chance of a reinjury resulting in complete paraplegia. After this I became more daring in my skiing. At the top of every run I would pause for a few seconds to ponder if this would be the one.
In late March 2008, I was skiing at the same resort that I’d had my back injury. Contrary to physician advice, I did not have a metal rod in my back and I was not wearing a back brace. I was having lunch at a mid-mountain restaurant. I chose a table by a window that had a good view of what seemed to be the most difficult expert run at the resort. I had never done this run before. It is a long steep chute with rock obstacles, starting at what appeared to be a cliff. I decided that today was the day for this run.
After lunch I did a warm up run and headed up the appropriate lift to my objective. Getting to the top of the cliff required a short hike and then an ascending traverse. There was someone standing at the top when I got there. This is the kind of run that you stand at the top of and contemplate the meaning of life before you launch yourself off into space. This is a run that takes experience, skill, nerve, and self confidence. I have these. The other skier launched. About a third of the way down he chickened out and traversed through some trees to an easier area. Sissy!
My adrenalin was going; heart pounding; shaking. I needed to calm down first. There’s a lot of psychology in pulling off this kind of run. I launched. Once you are in a run like this, thoughts vanish. You are in the moment, one with the mountain. I was vaguely aware that my body was taking a beating. Tight twisting bouncing turns on terrain this steep will pound on your spine. At the bottom I briefly glanced to see how many people had been watching my performance, and then I did a tight 180 degree turn to see my tracks and check out where I had just been. Argh!!!!!
My back hurt like hell. I stood there for about ten minutes wondering how bad it was. I could tell that the pain was in exactly the same place as it had been for my first injury. It didn’t seem quite as bad though. I skied gently down to a chairlift and decided to get on. More argh! I can’t believe I did that again. I skied to the base and drove home. I decided that I didn’t need an emergency room this time.
It was pretty bad for the first week, and then it started to ease up. After the first injury, most of the back pain was gone after six months. It has now been more than six months since the reinjury and there is no sign that the chronic continuous back pain is going to let up any time soon.
The pain in my left thigh from hiking this Summer has been more than it was last year. I interpret that as meaning there could be a little more paralysis than a year ago. I am aware of a little more sensory loss than I had a year ago, nothing dramatic. I have no way of telling if this is related to the reinjury, or if it would have happened anyway as suggested by my GP.
The Back Brace
Wearing a back brace makes a huge difference in being able to deal with my back pain. In the early months post injury I simply would not have been able to get around without it. After the first six months or so, the back pain was minimal and I weaned myself off the brace. I wore it on occasion after that when there was a flare up of pain.
After the reinjury, the back pain has been continuous. I can handle it much better if I wear the back brace 24/7. It can get uncomfortably hot in Summer. I also have issues of vanity and self consciousness about it. If I leave off the back brace for more than a couple of days, the pain invariably gets nasty. With the coming cooler weather, 24/7 should not be a problem.
The Psychological Impact
Were it not for BIID, the psychological impact of my back injury would have been very minimal. Probably the biggest issue would have been the back brace. But hey, you gotta wear a back brace. Deal with it.
Maybe some people would have had a problem with sensory loss in the genitalia. Although I have chosen not to have orgasms since the back injury, it is not because I am unable to. Judging by the amount of sensory loss I would assume that it is still possible, so no big deal.
I suppose that the idea of becoming paraplegic through reinjury is likely to freak people out. But then, they would have gone for the metal rod option in that case.
On the other hand, the impact on the development of my BIID has been HUGE.
From age thirteen until my back injury in 2006, my BIID had been more or less stable with a few ups and downs. I managed it O.K. with splints and bandages whenever the urge became great. It was always in my mind that someday I would be wearing leg braces, that I would need to wear them in fact. It was as much a matter of believing it to be my destiny as it was a matter of desire.
Within a few months of my back injury I was finding that I thought about leg braces incessantly. Somehow I knew that the time had come, and that I needed to get leg braces right away. I didn’t immediately make the psychological connection. Gradually I began to understand that I was interpreting the back injury as the start of my destiny of becoming paraplegic. I had not previously given thought to what level of injury I was "supposed" to have. Here it was, handed to me on a plate. I’m going to be T10 - T12. The universe was telling me what I’m going to get.
The next momentous event was being told that I could become a complete paraplegic with a reinjury from skiing. How about that for an invitation! I started skiing like a demon from hell.
After my reinjury, BIID feelings started getting extremely intense. The universe was telling me "Yes, you can do this; you can have this. BUT, you will have to endure pain. Are you sure?".
Yes, I am sure. It is my destiny…
Tags: Back Brace, Back Injury, BIID, Catheterisation, Claire, Incontinence, Leg Braces, Muscle Spasms, Nerve Damage, Pain, Paralysis, Paraplegia, SCI, Sean, Spinal Cord Injury, Wheelchair
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1 On 18 January, 2009, Jeff said:
Chloe,
Best to ya on your path with hopes you get where you want. I have had many injuries that have only fell short of the “Someday” wish of my own set of HKAFO and a need for them.