So I busted my ankle. (pain control suggestions)

[chadbag]

So, about 2 weeks ago (Sunday 11/28) I busted my left ankle. I was carrying a large and heavy computer down to the basement down carpeted stairs. My left foot slipped and got kind of twisted as I kind of 'sat' down and dropped the computer on it. I knew something bad had happened as my foot was pointed out about 30-35 deg. I was probably too shocked but it did not hurt that much. The wife called the neighbors who came to watch the kids and help me get out to the car. Finally making it the wife drove me to the ER through a snowstorm.

Turns out the foot was dislodged 15-17mm back which in turn broke a large piece off the bottom of the tibia and also a small piece and also caused a fracture half way up the fibula. It did not hurt a lot but was more achey. They wanted to give me some pain Meds but I refused (as the ER doc told me before we left I was the only one who really needed pain Meds that day and the only one who refused). I did take some iv morphine when they reset the foot into it's socket.

The ortho doc on call decided that surgery could wait a few days so they could plan out what to do so they did a CT scan and sent me home all splinted up. I went to the ortho doc on Tuesday 11/30 and he said they would do surgery on the following Friday to put a plate in on the big broken piece to stabilize it. The only pain Meds I took was a single 7.5 lortab each night to take the edge off the pain the splints caused by pressing in so I could sleep.

I had the surgery Friday and they gave me some percocet before I left and I took that through Sunday late night. By then the percocet had constipated me so badly and made it hard to urinate. So I stopped taking it for 24 hours. I then took it for a couple more days and stopped again Wednesday afternoon for the same reason. Thursday I had a follow on check up and the splints etc were removed and I was given one of those big boot things to wear whenever I am out and about. At home I don't wear it much. (thank goodness the splints were banished after he checkup - they were going to start to cause mental problems if I had to keep that on my leg :p )

Not a lot of pain. Some. Mostly achyness but some pain now and then in addition. Nothing really unbearable. Except at night. The effect of gravity on the leg when lying down at night -- on the fractured fibula -- causes a lot of pain and makes it hard to sleep. Thursday night I only dozed off and on all night. Probably laying there causes the brain to focus on it and it is probably feels worse because of that than it really is.

Last night was he first nigh back home ( have been staying at my folks' house since he ER so they could help with the kids and also me when the wife was at work) and around 1am I broke down and took some more percocet. I actually slept comparatively well and am abstaining from the percocet during the day. But I would like to avoid narcotics if possible as the constipation and urination issues really suck and my head is not as clear thinking with them. So I was wondering if there were suggestions on nighttime pain control for my ankle and fibula so that I can sleep ( take the edge off -- not trying to totally eliminate the pain -- percocet does not totally eliminate it either)? I would like to try and get off the narcotics if possible but will take them at night if needed.

Thanks


Ps: people needing eguns stuff it is best to email or pm. I have not been home to answer the phone since the accident and will be back at my folks' hous mon and Tuesday while the wife works.

[Nathan_Bell]

Not an MD, don't play one on TV, and didn't sleep in a Holiday Inn lastnight (for the first time in a week), but I have broken both ankles, one multiple times along with other fractures.
For achyness, I have had good luck with Aleve or its generic versions, as it is a good anti inflammatory. Make certain you have something in your stomach when taking them as they can cause heartburn like side effects.
For sharp, I cannot focus my eyes type of pain, use the heavy shit they gave you. That type of pain will slow down the healing.

[citizensoldier16]

NSAIDS like Tylenol, Motrin or Alieve will work best as far as the non-narcotics go. As said above, take them with food for the best result. If you're having trouble sleeping, might want to look into having your MD prescribe some Tylenol with Codeine (aka Tylenol 3) or something else on the narcotics list.

Be careful with the T3...DO NOT drink alcohol when taking it due to the possibility of liver damage. Obviously use the narcotics sparingly and don't drive or operate heavy machinery :D

As an NC Paramedic, we tell people the best option is Tylenol or Motrin taken per the printed directions on the packaging.

Disclaimer to cover my butt: Advice provided here is simply what I would do. It is unofficial and should not be assumed as medical advice. Anyone reading my post should consult with their personal physician before taking any medications. If anyone needs specific medical advice, please see your doctor.

[Erik 1]

I have had the best results with two Tylenol and two Advil taken together. It was recommended to me when I had a badly broken wrist several years back and I found it worked better than the painkillers I was prescribed, which made me feel funky but didn't knock the pain back all that much. Of course, I'm not a doctor either. This is just what works for me.

[chadbag]

I don't get in front of the real computer much now (not conducive to keeping leg up etc) and usually use the iPhone or iPad now to read M4C so I keep comments short. Sitting in front of my home office desktop for the first time now in 2 weeks...

Thanks for the comments and well wishes (both as replies and PMs).

I am a little leery of taking NSAIDs with broken bones due to this sort of research

http://www.arthritis.org/nsaids-fracture-healing.php

http://blogs.consumerreports.org/health/2009/03/ibuprofen-risky-for-broken-bones.html

http://www.thehealthierlife.co.uk/natural-health-articles/chronic-pain/painkillers-avoided-broken-bone-00050.html

etc. I read the last one in the middle of the night a few nights ago and so ended up buying some Bromelain. It did actually help when taken on an empty stomach but not enough to make it worth continuing with. I am not sure Tylenol (plain Acetaminophen, not T3 or anything) alone would do the job since the percocet is also a reasonable dose of Tylenol in addition to the oxycodone narcotic and together they just bring it down to tolerable. My complaints are the side effects of the narcotics like urination issues, constipation, and funny feeling head etc. (Last night I felt the first buzz from the narcotic in taking it the last week or so -- several slightly euphoric waves came over me while lying in bed -- kind of strange -- certainly not anything I would seek out this sort of thing for)

The pain and ache is not great most of the time. The worst is in the night time when trying to sleep. You tend to concentrate on these things lying in bed which makes it worse. Plus the fibula fracture, when the leg is lying flat or slightly elevated, due to gravity, starts hurting. When sitting up etc that normally does not hurt that much.

Luckily, my bed ("waveless" soft side water bed with 2.5" memory foam on top) supports the leg better than the bed I was on at my folks' house the last 12 days so there is less pain when lying down than there had been, though it is still there.

I have been trying to keep the leg elevated some most of the time. That helps. When sleeping, due to trying to get comfortable and lying on my side, etc, the leg sometimes becomes more flat than elevated though I try and keep it a little elevated with a body pillow. Lying on the couch I keep it up.

I do not recommend breaking your ankle to anyone. What a disruption. Makes me think of all the people who have it worse than me with sickness or injury and be glad that it I am relatively OK and just inconvenienced. I try to be grateful that my problem is only a broken ankle that has been surgically repaired and I am just waiting for healing and not something like cancer, or really screwed up body/injuries, etc. I also try and be grateful for my family for the things they do to help me out. Especially this time of year. Holidays are a sucky time to get sick or injured. Thank goodness for online retailers. I am a bit late in getting something for the wife and daughter (son is taken care of).

Anyway, thanks for all the kind thoughts and suggestions and PMs

Chad

[500grains]

Sorry to hear things went so badly with the ankle. I hope your recovery is a complete success.

Regarding the heavy computer, how long has it been since computers were heavy? Were you carrying a DEC VAX or PDP/11 down the stairs? ;)

Regarding the pain, you can use your energy to fight the pain or you can use your energy to heal and recover. If you can stand it, take the prescription percocet or whatever so that you are not completely worn to a frazzle just by enduring the pain. IMO.

[kmrtnsn]

I recommend you go back to your doc for either better pain meds or upping your dosage. Most docs now will under prescribe pain meds, especially with Vicodin and the like; they don't want you turning into another Rush Limbaugh.

[chadbag]

Sorry to hear things went so badly with the ankle. I hope your recovery is a complete success.


Thanks. It will turn out ok.




Regarding the heavy computer, how long has it been since computers were heavy? Were you carrying a DEC VAX or PDP/11 down the stairs? ;)



Maybe microvax heavy or pdp11/05 or something. (I grew up a DEC brat and worked there a total of about 5 years myself). It is a file server for my home office and is a lian li vp2000 plus case with a dual opteron mb w/ big @ss heatsinks and 10 or more hd and an optical drive etc and lots of empty bays yet to fill. Pretty bulky and heavy though not the 1st line cause of the fall it made it worse and was the reason I was on stairs in the first place.



Regarding the pain, you can use your energy to fight the pain or you can use your energy to heal and recover. If you can stand it, take the prescription percocet or whatever so that you are not completely worn to a frazzle just by enduring the pain. IMO.

I'd rather endure low levels of pain and ache than endure the side effects of constipation, urination difficulties, unclear brain, etc. That is much more wearing. However, I am taking the percocet at night right now when the pain seems to be more than low level. I am not hero, so to speak, trying to overcome pain for the sake of it. I just feel low level pain is less a problem than the side effects are on me but when the pain goes up like at night now the equation changes. I am interested in other options if they exist. Even at night the pain is not so high that it is really a big issue. The issue is that it makes it hard for me to sleep as it occupies the mind and the lack of sleep is what worries me as a tired body doesn't heal well and it is a drag on me during the day to be exhausted. I want it understood that we are not talking 8 or 10 on the 0-10 nurses scale of pain. Probably 1-3 during day going up to 3-5 at night.

Anyway, thanks for all the suggestions. It will be time for bed shortly and time to go to never never land ;)

[NinjaMedic]

DO NOT TAKE NSAIDS FOR THIS INJURY!

NSAID's can and do severely retard bone healing as this is part of the body's inflamatory response. Either 1 - go see your doctor, or 2 - take 1000mg Tylenol PO before bed.

[montanadave]

While I can understand your reluctance to take opioid pain medications, they are pretty much the gold standard for pain control and the previous post by 500grains is right on the money with respect to wasting energy fighting pain which can be better utilized for healing.

Pain is a subjective experience and everyone handles it a differently but there is little doubt it tends to reinforce itself. That's why medical folks harp about "staying on top of the pain" and not letting it get away from you, because playing "catch-up" sucks.

Use the stronger pain meds as needed. Some work better than others for different people. I get very nauseous with oxycodone (Percocet) but do OK with hydrocodone (Lortab or Vicodin). Taking promethazine (Phenergan) with the pain meds can also alleviate some of the nausea while potentiating the pain control of the narcotic (i.e. getting more "bang for the buck" from the opioid and thus having to use less of it). And if you, like many, have a GI system that is sensitive to opioids, don't wait until you get bound up to address it--take a stool softener with the pain meds or, better yet, a combination OTC med like Sennakot-S which has both a stool softener and a mild laxative.

Figuring out a system for keeping the leg elevated at night will also go a long ways towards getting some much needed rest. The more fatigued you are, the more taxing the pain becomes. It's a vicious cycle. I spent several months earlier this year recovering from a severe leg injury and experienced a lot of what you are describing. It sucked but did improve with time and my leg, with plenty of rehab, is almost back to 100 percent.

Hope things heal quickly and you hit upon the right combination of meds and methods to give you some relief. And like several others have said, check out any medication suggestions with your physician prior to taking anything other than what has been prescribed by him/her.

[thopkins22]

Obviously I think Ninjamedic has given the best advice....

But, I nursed quite a few injuries during my football days, and had surprisingly decent results from cayenne pepper capsules taken in the morning. I noticed reduced pain on the days I took it. Do take it in the morning when you'll be standing/sitting up for obvious reasons....

[DTHN2LGS]

What MontanaDave said mirrors my experience with pain control. After my spinal surgery this year, I used Percocet too, but felt that the side effects were much worse than with Hydrocodone (Vicodin). I would ask the Dr. to switch you to Hydrocodone. I especially agree with his comments about "staying on top of the pain." The Dr. gave me a Rx for constipation, but the gas was so violent, I had better results with Over-The-Counter meds.

I broke my ankle in 1981 and had a cast up to my hip with my knee bent and my foot twisted to the opposite direction of the break. Getting my leg elevated to sleep was very important. I used a Bean Bag foot stool, but I don't know if you can find those anymore.

Good luck and be patient, some things can't be rushed.

[Gutshot John]

Go to your doctor for some pain medications.

I was unaware that NSAIDs retard bone healing but a cursory google search indicated some serious concerns about its use vis-a-vis fractures. If you smoke that's also a huge no-no.

That said I think tylenol also has some serious drawbacks. I'd go to your Doctor and demand (yes demand) some form of -cet. There is no point in fighting through pain when you need to relax and let your body heal. Studies show that when narcotics are taken for actual pain there is significantly less "fuzzy brain" it just makes you normal. When my mom was in a lot of pain during stage 4 cancer, she was taking diluadid and fetanyl constantly and she said it didn't make her "high".

That said there is a time to be a tough guy and there is a time to take your meds.

Eat calcium rich foods, if the swelling hasn't gone down, ice and keep it elevated. Assuming the swelling has mostly gone down, apply warm compresses to get blood flowing to the area to aid in healing.

[SWATcop556]

I've had my fair share of broken bones and I've found I heal faster when I just take what the DR prescribes and rest. I had my orbital bone fractured by a drunk with a paint roller rod and I was 100% better in about a week just from meds and rest. For dull aches and pains I always just cycle advil and Tylenol.

Or just drink lots of good whiskey. That always helped me too. :alcoholic:

[chadbag]

Another pretty restful night. I've been taking the percocet at night when I feel the pain more. During the day it is mostly just a low dull ache from my foot resting in funny positions so not to tweak the fibula fracture or to keep the weight off it like the doctor said to (when not on the couch with it propped up). Not much pain during the day.

My main motivation in asking for ideas on pain control was for night time so I could sleep as it had been difficult. That part is looking up.

Still swollen though a lot less than a few days ago. I practice moving my foot around and stretching the achilles tendon. Some of the ache is due to stiffness as well from the foot not being used.

I think I am going to end up with my good leg being twice as big when I am all done from all the extra work it is doing in supporting me when I hobble around (and I am a little worried about the knee on the good leg having to support more weight -- I am a little on the pudgy side though not a walking blob of fat -- pant size is like 37/38 with a belly hanging over). I do work on moving the leg and foot to try and exercise the bad side as well but it gets no where near the workout. I am sure the doctor will send me to PT/rehab on this.



Even with just taking the percocet 2x (every 4 hours so total 8 hours) out of 24) it jams my system up. I am normally a good bowel movement person (2x a day or so, sometimes more) with a high fiber (both soluble and non-soluble) so being plugged up is really frustrating.

thanks for all the suggestions and kind words. The most frustrating thing is having to keep the leg propped up most of the day and not being able to get much productive work done. My body is a stiff non-limber body (never have been able to touch my toes and have worked on stretching etc to improve it but it does not get much improvement even with coaching) genetically (though not as bad as my dad) so I cannot sit up with the leg propped up. I tend to have to lean back a lot to get the leg propped up which makes it hard to sit and work at a computer. I have been working to transition back to the software business so it is frustrating to not be able to use this time to work on my projects etc very much. I am reading some books but it still is frustrating. I have been able to get some small eguns orders out but am reliant on the wife to help find stuff as I have not gotten down to the basement stockroom yet -- it is somewhat cluttered and hard to get around on crutches I think though I will be trying soon as it needs to get done. So the biggest issues are turning out to be mental -- frustration and not being able to take care of things for my family, using time more productively, not being bored, etc.

I don't tend to watch a lot of movies or stuff normally -- I have a stack of DVDs purchased over the last few years and they are still unopened. A small amount of my free time I am taking to change that. I did manage to watch "The Last Samurai" last night on the iPad. That was a great movie. Not much a TC fan but he did a good job in this movie and the idealized Samurai were an inspiration.

[Mjolnir]

Not for pain but for bone healing:


Bone Meal
Zinc
Boron
Silica and Magnesium (forms Calcium that the body readily processes)
Antioxidants (A, C, E, etc.)


For Pain I always used Meditation and homeopathic remedies such as Symphytum and Hypericum.

Sorry to hear about the injury and I pray that you heal quickly. For the record I used all of the above and it worked admirably.