Sunday, March 3, 2013

Healing Bone Fractures, Part 3

This is the third in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In Part 2 I provided a detailed account of the protocols that I implemented when I returned home. In this post I am providing an update on how things are progressing four weeks after my surgery and any modifications that I have made to the protocols that I am using.

Systemic Herbal Formulation: On the fifth day after my surgery I was finally able to make a specific herbal formulation to treat my injury. I made up a 250 bottle, which lasts two weeks at the dose I am taking (for the details see Part 2). This formula ran out during the third week after my surgery. Although I was only taking it for two weeks and I could have just repeated the same formula, I decided to make a slight change to the formula. Since there is no evidence of nerve damage, I eliminated the St. Johnswort (Hypericum perforatum). I also substituted stinging nettle (Urtica dioica) for common horsetail (Equisetum arvense). The second version of the formulation contains turmeric rhizome (Curcuma longa) 18%, stinging nettle herb (Urtica dioica) 20%, boneset herb (Eupatorium perfoliatum) 20%, American plantain herb (Plantago rugelii) 20%, common comfrey herb (Symphytum officinale) 15%, wild ginger rhizome (Asarum canadense) 5%, white pine leaf/twig (Pinus strobus) 2%. I am continuing to take 6 ml three times per day on an empty stomach, 5-10 minutes before each meal.

St. Johnswort (Hypericum perforatum), topically, systemically and in homeopathic potencies,
is a very important herb for healing nerve damage.

Herbal Sleep Formulation: Due to the changes to my primary systemic formulation I made a slight adjustment to the sleep formulation as well so that the two formulations remain well coordinated. It now contains English lavender flowering spike (Lavandula angustifolia) 15%, St. Johnswort herb (Hypericum perforatum) 15%, catnip herb (Nepeta cataria) 15%, American plantain herb (Plantago rugelii) 15%, hop strobilus (Humulus lupulus) 15%, stinging nettle herb (Urtica dioica) 15%, turmeric rhizome (Curcuma longa) 9%, white pine leaf/twig (Pinus strobus) 1%. Once more this formula overlaps with and carries over some of the properties of my daytime formula while still maintaining its effectiveness as a sleep formula. Just as with plantain, it is rare for stinging nettle herb to be acknowledged as a sedative in the herbal literature. In fact, it is a very calming herb, especially when harvested a bit later in its life cycle when a some of the harvested portion includes the immature seeds. These are the most sedating part of the plant. I am continuing to take 6 ml immediately before bed and additional 3 ml doses through the night, as required.

More On Sleep: For reasons that I explained in Part 2, getting sufficient sleep has been a real challenge for me, even with the herbal sleep formula. By day 23 after my surgery I still had experienced only a slight improvement in my sleep, so I decided to go one step further and take melatonin as well. In the past I have found that clients with moderate to severe insomnia for whom an herbal sleep formula does not produce sufficient results usually respond well to the addition of a small amount of melatonin into the mix. Although I am not experiencing typical insomnia, my hope was that this will help me to sleep deeper and I won't wake up as much due to the discomfort and stiffness I have been experiencing as a result of having to lie on my back all night. I have to say, I was appalled at the poor selection of melatonin products even in a very well stocked health food store. Most of them had additional undesirable ingredients such as high doses of individual B vitamins or calcium. In addition, the doses of melatonin were way too high. Melatonin is a hormone and, although it is safe when used correctly, it is important to use only the minimum dose that will produce the desired results. The way I recommend people take it is to begin with a 0.5 mg dose for a few days. If that isn't strong enough I have them increase the dose in 0.5 mg increments (allowing a few days each time the dose is increased to determine its effectiveness) until they hit the ideal dose for them. One of the advantages of using melatonin in combination with a good herbal sedative is that they are mutually synergistic and, when taken concurrently with the herbs, the melatonin will usually produced the desired result at a very low dose. Although I did find a few products that had relatively low (1 mg) dose of melatonin, they all had other things in them that I didn't want to take. As a result, I ended up purchasing a 3 mg sublingual lozenge that I am able to cut into quarters so that each dose is approximately 0.75 mg. I take 0.75 mg of melatonin about 15 minutes before I go to bed and then take a 6 ml dose of my sleep formulation just before bed. When I wake up in the night and have difficulty falling back to sleep, if it seems that I won't have too much difficulty falling asleep I will take an additional 3 ml dose of the tincture. However, if it seems that I am going to have more difficulty, I will allow myself one more 0.75 mg dose of melatonin in addition to 3 ml of the tincture. If I wake up additional times through the night and have difficulty falling asleep I will only take the tincture. As it turns out, the first night I required two doses of melatonin but after that my sleep improved so much I only required one. I have found that I am waking up less often through the night and having less difficulty falling back to sleep when I wake up.

Homeopathics: On day 23 after my surgery, when I added the melatonin, I also diverged from the homeopathic protocols that I had intended to follow (as indicated in Part 2). I am continuing to take Symphytum 200C three times per day to support the healing of my bone. Since I was past the stage of the initial tissue trauma, I dropped the Arnica. As there seemed to be no major nerve damage, but there is a little bit of numbness of my skin along the major incision, I dropped the Hypericum 200C to one dose per day. To address the mild numbness I also kept Hypericum (St. Johnswort) in my sleep formulation even though I eliminated it from my daytime formulation. I also added Rhus 200C two doses per day. Rhus is for injuries or strains that stiffen up and feel worse when they are rested for periods of time, but feel better when we move around. These symptoms are typical for me whenever I have injuries or stiffness. I always feel better when I can move around and limber up. My hope was that the Rhus will help reduce the stiffness I am experiencing from lying on my back all night, since this stiffness is one of the things interfering with my sleep. It has helped somewhat and I have experienced a significant improvement in my sleep since adding the Rhus and melatonin to my protocols. It is my intention to continue taking these three homeopathic remedies in these doses for the next few weeks.

Eastern poison oak (Toxicodendron pubescens) was formerly classified as Rhus toxicodendron.
The names of homeopathic remedies are often based on obsolete botanical names
so as to maintain the continuity of the name with older homeopathic texts.

Topical Herbal Preparations: I have two incisions in my leg. A smaller one just below my knee and a larger one that runs down to my ankle which is the area where the plate was put in. On day 13 after my surgery all of the stitches in the smaller incision were removed, but the surgeon decided to remove only half of the stitches in my larger incision because the inflammation and edema were putting a lot of pressure on that area. He wanted me to come back in two more weeks to have the remainder of the stitches removed. On day 16 we began applying a poultice to the smaller incision from which all of the stitches had been removed (for more details about the poultice, see Part 2). We decided to use it as an opportunity to demonstrate how to apply a poultice during our Making Herbal Tinctures workshop. By day 18 it was apparent that the healing of the smaller incision was already much further along than the larger incision to which I was not yet able to apply a poultice because of the remaining stitches. I tried to get an appointment that week to see the surgeon and have the remaining stitches removed so that I could begin working on the longer incision, but there were no appointments available. As a result, I decided it was best if I removed the stitches before my appointment the following week. On day 23, herbalist (and my partner) Monika Ghent removed them for me in the morning. We allowed the holes to seal during the next few hours and began applying a poultice to the larger incision as well that night.

This photograph was taken of my leg just before we removed the remaining stitches from the larger incision.
Notice how much further along the healing is on the smaller incision which at this point I had been
poulticing for a week. The redness is in areas that were formerly covered by scabs.

Since then the protocol that I have been using is as follows:
  • When I wake up I apply the liniment I am using (see Part 2) to my whole lower leg up to and including my knee, but not to the area of the incisions themselves. I apply an ointment to the incisions. The ointment is made from the same infused oil that I used as the base for my liniment (see Part 2) with a little bit of English lavender (Lavandula angustifolia) essential oil added to it (probably about 2 drops in each 25 ml jar). Both the infused oil and the ointment were made during our Herbal Field Studies field workshops.
  • In the mid afternoon I apply a poultice to both incisions (for details see Part 2). I leave them on for 30-45 minutes and then remove them and allow the plant juices to dry on my leg. I do not apply anything else at that time.
  • In the evening I apply a second poultice to both incisions. However, after I remove them and the plant juices dry on my leg I apply a comfrey (Symphytum officinale) ointment to my whole lower leg below the knee including the incisions. I had not prepared any comfrey ointment but fortunately my friend and fellow herbalist Rick DeSylva provided me with an jar of his excellent comfrey ointment.

This is what the protocols I am using look like at about 4 weeks after my surgery. There is no pain in my leg even when I touch the area where the incisions and fractures are. The surgeon was quite surprised at that. My leg feels strong and I am doing my best to stretch the tendons and ligaments in my ankle and knee so they don't tighten up too much while I'm not walking. There is some edema in my foot because I am spending a fair bit of time upright, which allows the blood and lymph to pool in my foot. This is has gone down somewhat but is still significant except when I wake up in the morning after I've been horizontal through the night. It is something I'm going to have to put up with until I start walking unless I want to spend the whole day sitting or lying with my leg raised, which is not an option.

I will continue provide updates on how things are progressing and any changes to my protocols in Part 4.

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