Chronicles of Less Urban Living, Fresh from In the Night Farm

Down, But Not Out

If you follow In the Night Farm on Facebook, you’ve heard the grisly tale:

Last Sunday, I decided to take a short ride on my endurance horse, who has been enjoying 2 months of almost complete rest, thanks to icy footing and generally nasty weather conditions in my corner of Idaho.

The ride was short, all right.  Almost as soon as I mounted, my mare took off bucking and leaping.  This uncharacteristic behavior took me quite by surprise, and I went flying.

You know how the world slows down during moments of crisis?  I remember coming off at the top of a buck (adding a few feet to my fall), watching to make sure my left foot came free of the stirrup, and noting miserably that the ground I was about to hit was frozen solid.

Very, very solid.

I landed on my left lower back and hip.  In the resultant explosion of pain, I coiled up and rolled onto my right side thinking something along the lines of, “Oh shit, this is a bad one.”  (Any equestrian knows that if you ride enough, you’re going to fall occasionally.  Most falls are relatively harmless.  Some are serious.  A few are fatal.  It’s part of the game.)

I pulled my cell phone out of my vest pocket.  Who to call?  Ironman was several hours’ drive away.  All my other friends were at least 30 minutes’ drive from here.  Besides, I’d landed on my spine.  And it hurt.  A lot.  Decision made:  beep-boop-boop.

I didn’t move, except to make sure I could wiggle my toes, in the 15 minutes it took the ambulance to arrive.  The hard backboard against my screaming lumbar region made the ride to the hospital an, ahem, adventure, but it was bearable so I declined pain medication.  Repeatedly.

Sidebar:  I wonder why the (very nice) EMTs were so eager to administer drugs.  Wouldn’t it be best for me to be able to assess, with unblunted accuracy, the region and level of my pain? 

X-rays indicated that I was free of dislocations and breaks.  Blood and urine tests confirmed that, bruised kidney notwithstanding, my organs were happily intact.  But when I tried to walk (4 hours post-injury, still sans painkillers), I nearly vomited and passed out.

Due to this unexpectedly high pain reaction given my “stoicism” thus far, the doc ordered a CAT scan to check for hairline pelvic fractures.  None.  Just massive soft tissue damage that was officially labeled “pelvic contusion” but definitely extends to my left hip.

At that point, I finally agreed to some IV and oral painkillers, because there was simply no way I’d get out of bed — let alone out of the hospital — without them.  I also accepted a prescription for Vicodan, which I took for 12 hours and then ditched in favor of ibuprofen.

The first couple days were sheer misery.  I was almost completely immobile, unable to roll over in bed, stand up, get dressed, or do pretty much anything without help.  Don’t even ask about my mental state.  NOT. HAPPY.  Since then, however, I’ve improved dramatically.  I can walk, albeit stiffly and without twisting, and even feed the livestock twice daily.

Sadly, I’m still a long way from being able to resume workouts.  I’m guessing it’ll be weeks — 6 or more? — before I can deadlift, backsquat, or sprint.  If my shoulder (which has recently featured a cranky rotator cuff) cooperates, I may be able to return to pullups and pushups somewhat sooner.

So, what’s a girl to do?  My main goals right now are:

  1. Heal as quickly and thorougly as possible.
  2. Maintain leanness (approx 18% bodyfat) despite inactivity.
  3. Preserve as much muscle mass and strength as possible despite inactivity.

How?

Get extra sleep.  Sleep is difficult when painless positions are hard to come by, but I’m doing my best to get 10 hours nightly.  Extra magnesium supplementation helps.

Take it easy.  This is the hardest one for me.  Inactivity drives me insane.  I hate losing ground on strength gains, and I get terribly bored when unable to simply move.  But, I’m being good and doing everything I safely can, but not more.  (Staying off the painkillers — even Advil — helps with this.  I need the pain as as “cast” to tell me where my limits are.)

Eat real food.  Low-carb paleo.  Paleo for optimum nutrition and low-carb for leanness.  Basically, I’m eating meat, veggies, and natural fats while avoiding inflammatory foods like grain and sugar, as usual.  However, I’ve adjusted my macronutrient ratios as follows:

  • Maintain high protein consumption (1g/lb of total bodyweight daily),
  • Reduce fat consumption from high to moderate (to decrease energy intake due to lowered activity level, while still getting plenty of essential fats), and
  • Reduce carb intake from low to very low (down from 80g to 50g or less daily).

So far, so good.  I’m at least as lean as I was a week ago.

Supplement.  I’ve made the following modifications to enhance tissue repair:

  • Increase fish oil (Carlson’s lemon flavor) to combat inflammation.
  • Increase magnesium to aid sleep and calm mental agitation.
  • Add MSM to increase blood flow and reduce inflammation.
  • Increase whole food multis (Juice Plus+ Orchard Blend and Innate Response Formulas Maximum Food) for additional antioxident and micronutrient intake, including Vitamin C, which enhances collagen repair.
  • Maintain Vitamin D, E, and B complex intake.
  • I’d use homeopathic arnica both internally and extrenally, if I had any, but I don’t.  Arnica is believed to speed healing of damaged soft tissue.
  • I’m looking into a recent recommendation for some Chinese formulas, Dit Dat Jow and Yunnan Biao (brand name) to aid soft tissue healing.

Ice and Heat.  Ice only for 72+ hours, alternating heat and ice thereafter.  This is a nuisance, but I’m spending 4+ hours daily on it.  It’s worth the trouble.

Sidebar:  Why on earth didn’t the ER nurses get me an ice pack or three?  It’s well known that icing is one of the best ways to minimize inflammation and promote healing, and that the sooner ice is applied, the better.  Ice is cheap and easy.  So why did I spend my first 8 hours post-injury without it? 

Exercise.  Very gentle exercise.  Right now, that means walking and a bit of stretching, plus some “weightless weight lifting” (i.e. bicep curls and delt raises in which I use my own, opposing muscles to add resistance to the movement).

Staying busy.  Have I mentioned that I hate hate HATE sitting around?  I’m trying to keep myself busy reading and researching, and I’ll also be dedicating some time to dramatic expansion of the Nightlife Library.  Keep on eye on it, and feel free to suggest your favorite resource links in the comments.

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23 responses

  1. Sorry to hear about your mishap, and damn glad there’s no serious damage. That must have been scary as hell, especially being isolated.

    “Sidebar: I wonder why the (very nice) EMTs were so eager to administer drugs. Wouldn’t it be best for me to be able to assess, with unblunted accuracy, the region and level of my pain?”

    —For the most part, patient comfort takes precedence, and it’s fairly easy to assess traumatic injury even with analgesics onboard; visual and hands on-palpation show more than subjective symptoms. And I’m assuming the medics would have done all that prior to administering anything. Plus, as a general rule, always accept narcotics from paramedics. I guarantee you’ll never find a higher quality “high” like that again. 😉

    “Sidebar: Why on earth didn’t the ER nurses get me an ice pack or three? It’s well known that icing is one of the best ways to minimize inflammation and promote healing, and that the sooner ice is applied, the better. Ice is cheap and easy. So why did I spend my first 8 hours post-injury without it?”

    —I see this happen all the time: we roll into the ER with a traumatic injury, splinted, elevated, analgesics onboard, and ice packs in place. 15 minutes later when my paperwork is finished, I pop back in to see the patient, and the splint is off, ice packs in the garbage, and the extremity isn’t elevated anymore. All I can say is that sometimes, the basics are forgotten and underestimated. I try and ingrain that in the paramedic students I precept.

    Your gameplan looks solid; my only comments would be:
    —Careful with the ibuprofen, as it’s metabolized renally versus hepatically, and with a bruised kidney, you may be putting more strain on it. Perhaps opt for Tylenol (acetaminophen).
    —On the same note, careful with the fish oil, NSAIDs (like ibuprofen), and Vit E; all affect coagulation, and can have synergistic effects on how fact your blood clots.
    —While your energy output is lower due to lowered activity, your metabolism will be higher due to energy demands for healing; this is more prevalent the more serious an injury. Regardless, don’t put yourself into a un-intentional hypocaloric state.
    —Vit C for soft tissue repair: Excellent idea, and I’d even go to a dose of 1000mg at night; oxidative stress will be high, tissue damage has been done, and, as a bonus, Vit C in doses of 100mg has been shown to alter the testosterone:cortisol ratio by attenuating cortisol.

    Speedy healing, girl!

    January 15, 2011 at 1:24 pm

    • Thanks, Mike!

      I’m glad to hear that the narcotics offer (regular pushers, those guys were! ;)) was valid. I’m still glad I didn’t accept, though — when I eventually did, they made me feel like crap. Nauseated crap.

      Don’t worry! I scrapped even the ibuprofin after day 2 post injury. It’s my understanding that NSAIDS slow healing, if only slightly, and affect the organs as you warned, so they should be avoided if possible. Besides, the unmuted pain keeps my activity level in check. 🙂

      Good point about the fish oil. I’m taking about 3 Tbs daily per Robb Wolf’s “all banged up” recommendation, though I understand he may be revising his long-term recs in the near future due to new research.

      No worries about going hypocaloric. I’m eating plenty — just not as much as I would during my usual, intense workout schedule. What’s your opinion on IF during injury rehab? I’ve read 2 sides of that issue!

      Interesting comment about the icing. Glad to hear you at least try — and I can’t believe the ER staff doesn’t follow through! Argh.

      January 15, 2011 at 1:43 pm

  2. That should read “how FAST your blood clots” and “Vit C in doses of 1000mg (1g)”.

    January 15, 2011 at 1:26 pm

  3. Emily

    Sorry to hear this but glad you are feeling better. I will keep you in my prayers.

    January 15, 2011 at 3:03 pm

    • Thanks, Emily. Much appreciated!

      January 15, 2011 at 3:38 pm

  4. What an ordeal for you. I am glad your on the mend. I work in healthcare and am always amazed at how quick doc’s are at giving a pill. So, since no one else has asked, what happened to Cons as you were being wisked away to the hospital and have you and her sorted out what exactly happened to cause her to react as such?

    January 15, 2011 at 4:18 pm

    • I’m not sure what caused Consolation to act so uncharacteristically, Jonna. I suspect it was a combination of being keyed up because some loose dogs had been on the property right before I saddled up (I caught them and shipped them off with Animal Control), excessive energy from cold weather and a long break, and a minor spook that she took advantage of.

      She had settled to grazing (I could tell by the sounds, though I couldn’t see her) by the time the EMTs arrived. One of the guys caught her and had her unsaddled just as I was being loaded into the ambulance. There were also nice enough to let my greyhounds inside, thank goodness, because grays can’t be out too long in cold weather.

      January 15, 2011 at 5:05 pm

  5. I’m constantly amazed at how similar our “girls” tend to be. Just when you think you have it all worked out, then BLAM! Phebes is pretty hyped up right now too after her two month lay off. I too wondered about Consolation as I knew you went to the hospital. Glad your EMT’s were thoughtful about all the animals. Mend well…then back to the round pen for a session or two I say! Take care. ~E.G.

    January 15, 2011 at 6:11 pm

    • Thanks, Jacke. I often think of you and Phebes when working with Consolation!

      As an aside, I think this episode was behavioral, but it’s also possible that her back was sore from rolling on frozen ground or somesuch. I’ll double-check before I get on her next time, just in case.

      January 15, 2011 at 6:27 pm

  6. Tom

    Glad to hear that someone helps take care of Consolation. I was worried about her being loose with a saddle and bridle on.

    I’ll be pulling for you. You Type A’s suffer so much when faced with this sort of situation. And if there was a Type higher than A, such as A+++, that would be you.

    I mostly avoided vicodin when it was prescribed to me too (although it worked very nicely). However, my wife and I have since decided that it’s better to take the meds and that dependency (my concern) really isn’t likely.

    Wishing you rapid healing.

    January 15, 2011 at 6:15 pm

    • Thanks, Tom. 🙂 My mental state is (slowly) improving as I’m able to move around a little more.

      Glad the Vicodin worked for you — it made me terribly nauseated. I don’t worry much about the addicition factor, but I have plenty of concerns about messing with any drugs (even OTC ones like ibuprofen) because you just can’t tweak one thing in the body and expect everything else to remain the same. Why throw your chemistry out of whack if you don’t have to?

      January 15, 2011 at 6:31 pm

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  8. great service by the EMT’s.I am sure you weren’t exactly in the frame of mind to worry a whole lot about it at the time but it’s nice they were capable of dealing with it.

    January 16, 2011 at 9:41 am

    • Yes, they were fantastic. 🙂 Fortunately, I was quite lucid (and even in good humor), so I was able to give directions about where to put my horse and tack. I distinctly recall being afraid that someone who didn’t know better would leave my saddle on the fence, where curious horses could chew it. Ack!

      January 16, 2011 at 9:48 am

  9. Rosanne

    Yikes! I just stumbled upon this while perusing through your other site. I am not on facebook, so it seems I miss a lot of personal news from people. Smart move on your part to forgo the dreaded pain medications that mess with body and mind. I believe you escaped further injury because of your fitness/health level. Hopefully, Consolation will behave herself better on your next ride. I too, was concerned about who would catch and untack your mare after your mishap. I hope you are feeling better!

    January 17, 2011 at 11:31 am

    • Thanks Rosanne — I am certainly much better than I was at this time last week! You make an interesting point about the possiblity that my high level of fitness may have limited the extent of the damage, as well as contributed to surprisingy speedy healing. Ironman and I have been speculating on that as well. Might have to do a little research to satisfy my curiosity…

      January 17, 2011 at 11:40 am

  10. ouch freakin ouch. I know how you felt, from the top of your fall to hitting the ground. and the thought: oh shit. and the throwing-up pain. and the disgust, the impatience, yadda yadda.
    just try to be patient! and heal fast!

    January 30, 2011 at 9:49 am

    • Yeah, you ride enough and it’s gonna happen sometimes…but that doesn’t mean we have to like it!

      January 30, 2011 at 10:14 am

  11. Pain management is a fairly important role for paramedics. One of the reasons for this, other than just patient comfort, is that several studies have shown that patients that have their pain mitigated recover and leave the hospital much faster than the patients that do not receive pain management. Most regions tend to emphasize pain meds largely for that reason.

    Ibuprofen actually metabolizes largely in the liver, with most of the excretion happening in the biliary tract and the urine. The anti-platelet function of ibuprofen, while present is also significantly lower than that of Aspirin.

    Ice… Ice is good for immediate relief of swelling and discomfort. However, more recent studies indicate that it may not actually promote healing.
    http://www.themedguru.com/20101027/newsfeature/ice-prevents-healing-case-injury-study-86141266.html

    Hope you’re feeling better!

    February 10, 2011 at 11:20 pm

    • Thanks for the links, Ian and RB!

      February 20, 2011 at 8:32 am

  12. Kat Webb

    So sorry about your accident! I had almost identical injuries from a horse fall in the middle of November. I came off my very green new arab the first time I rode her at the indoor arena with 8 other riders. I landed on my left hip/back under a mare who was tied to the railing–of course she didn’t like that and scrambled to get out of the way, pulling back on the lead rope and going over the top of me in the process.

    My sacrum/pelvis area hurt so bad (although xrays showed no actual breaks), I didn’t realize for five days that I also had two broken ribs! (The tied mare’s fault, no doubt!)That may very well be because I did accept morphine as soon as it was offered and Percocet a few hours later. It was only after I quit the narcotics a couple of days later that I knew I had additional injuries. Maybe it’s better to be more stoic?

    In any case, I am back to riding both my horses. My new girl seems to be making progress although I can easily say that I do not yet trust her and it may be awhile before my full confidence is restored!

    Good luck with your recovery! Being laid up is the pits so I hope it won’t last too long for you!

    February 28, 2011 at 6:10 pm

    • Yikes! Your accident does sound eerily similar, Kat — though at least I didn’t land under another horse! I just got back on Consolation on Sunday. My hip didn’t mind that too much, though I’m still not sure it’s sufficiently repaired that I could stick a hard spook. Getting there…

      Hope you and your new mare have a good year together. Lots of time. 🙂

      March 1, 2011 at 8:47 am

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