Wednesday, April 3, 2013

Healing Bone Fractures, Part 4

This is the fourth 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 the remainder of the posts I am providing an update on how things are progressing and any modifications that I have made to the protocols that I am using.

Overall, things have been going well, specifically with regard to the healing of my fractures. My leg is strong and I am well ahead of schedule. However, there have been a couple of unexpected complications relating to other aspects of my healing process which I will document below. I will begin with adjustments to the remedies and protocols that I am using.

Systemic Herbal Formulation: In Part 3 of this series I provided the details of the second systemic formulation that I began using about 3 weeks after my surgery. At about the 5 week point the second formulation ran out and once more I decided to make a slight change to the formula. While maintaining the focus on healing my bone fractures, I wanted to increase the emphasis on improving circulation to help further compensate for my lack of movement which was still resulting in a fair amount of blood pooling in my foot. At that time I only made a slight change, substituting rosemary (Rosmarinus officinalis) for wild ginger (Asarum canadense). I made additional changes at the 7 week point when I prepared my fourth formulation, replacing American plantain (Plantago rugelii) with maidenhair tree (Ginkgo biloba) and stinging nettle (Urtica dioica) with wood nettle (Laportea canadensis). The fourth version of the formulation contains wood nettle herb (Laportea canadensis) 20%, boneset herb (Eupatorium perfoliatum) 20%, common comfrey herb (Symphytum officinale) 20%, maidenhair tree leaf (Ginkgo biloba) 18%, turmeric rhizome (Curcuma longa) 10%, rosemary herb (Rosmarinus officinalis) 10%, and 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.

Wood nettle (Laportea canadensis) is rarely mentioned in the herbal literature.
Its properties are similar to stinging nettle (Urtica dioica) but a bit more diverse.

Herbal Sleep Formulation: My sleep has been very good since my last post four weeks ago. Beginning a few days after I posted Part 3, I was able to gradually start shifting slightly onto my right side, which made it easier for me to sleep. For the last two weeks I have been able to sleep completely on my right side without any discomfort. However, I still can't lie on my left side for more than 10-15 minutes before my leg starts to get uncomfortable as there is pressure directly on the plate and screws in my leg. It doesn't hurt, it just doesn't feel good. At this point I am sleeping mostly on my right side and shifting onto my back or left side for short periods a few times per night when my body starts to stiffen up. Because of the importance of getting good sleep to facilitate my healing process, I am still taking 0.75 mg of melatonin and an herbal sleep formulation when I go to bed. Due to the additional changes to my primary systemic formulation, once more 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) 20%, wood nettle herb (Laportea canadensis) 20%, St. Johnswort herb (Hypericum perforatum) 15%, German chamomile flowering top (Matricaria recutita) 15%, common comfrey herb (Symphytum officinale) 10%, hop strobilus (Humulus lupulus) 10%, 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. Among other things, wood nettle is an excellent tranquilizer. I am continuing to take 6 ml immediately before bed and additional 3 ml doses through the night, as required. However, in the last three weeks I haven't had to take an additional dose more than once or twice per week.

Homeopathic Remedies: I am continuing to take the same homeopathic remedies that I indicated in Part 3.

Supplements: I am continuing to take the same supplements that I indicated in  Part 2 except that I no longer need to take the probiotics.

Topical Herbal Preparations: It is with regard to the application of topical preparations that I have had to make a couple of adjustments, partly because of some unforeseen complications.

The first change to the protocols that I implemented was at the suggestion of Monika Ghent. She recommended that I use a scar formulation instead of a generic ointment on my incisions. Since Monika has a lot more experience than I do working with topical herbal preparations for healing and cosmetic uses, as this is one of her areas of specialization, I had her make up the formulation for me (see below). About two weeks ago I started using it on the scars from my incisions twice per day.

About a week and a half ago (7.5 weeks since my surgery) is when things got a bit complicated. Firstly, I started to get a rash on my leg around the area of my incisions. At first I wasn't sure what was causing it. Since I hadn't been using the scar ointment for very long and it contains a number of ingredients that I have never used before, I considered the possibility that I was allergic to one of the ingredients in that formulation. I stopped using it for a few days but the rash got worse. That's when I realized what was going on. I had over-astringed my leg from poulticing too much!

Pot marigold (Calendula officinalis) is a very potent healing and antimicrobial herb. It is also very astringent.
I increased the proportion of this herb to boost the antimicrobial element of my poultice formulation
which may have contributed to the more rapid astringing of my skin.

Contrary to what you are likely to read in the herbal literature, all herbs are astringent. This is because the most common astringent constituents, such as organic acids and polyphenols, are found in all plants. Whenever we apply herbs in concentration to a localized area there is a danger of astringing the tissues too deeply so that the affect penetrates down into the deeper living tissue layers. It is even more of a concern for mucus membranes, but it can happen to our skin as well. This is one of several reasons why it is very important that a poultice is very mucilaginous, because this reduces the affect somewhat. I had been applying a poultice to my leg for about 5 weeks at that point, twice per day for 30 minutes to an hour. I knew that the astringency would be a concern eventually. However, my poultices were very mucilaginous. I was applying oil-based preparations such as liniments and ointments to my leg twice per day as well. The moisturizing action of the oil also helps to counteract the affects of the astringency to some degree. In addition, because my fractures were healing well and also to reduce the potential for excessive astringency, in the last two weeks that I was applying poultices I only did the afternoon poultice a couple of times per week. So, I was taken off guard when I got the rash. I didn't expect it to happen that quickly given everything that I was doing. That being said, once I realized what was going on I stopped applying the poultices.

The second complication was that there were two spots, one at the top of each incision, where very thick scabs had formed. Scabs have an important protective function and are often an important element of the healing process. However, scabs can actually interfere with healing and lead to the formation of more scar tissue if they persist for too long. If they are relatively thick, they also interfere with the ability of the herbal constituents to penetrate to the underlying tissues where they are needed. Finally, by trapping too much moisture, they can also lead to infection. That's what happened in my case. I got a mild infection under the scabs. As a result, I stopped using the ointments on the scabs because the oil base can also contribute to trapping moisture under the scabs. Instead, I began applying essential oils directly to the scabs. I am using marjoram (Origanum majorana) because it is very antimicrobial. I combine it 50/50 with English lavender (Lavandula angustifolia) essential oil. Although the lavender is not as antimicrobial as the marjoram, it is a good combination because lavender essential oil is very healing and not as harsh. It is one of the few essential oils that can be used neat (undiluted). Combining them reduces the harshness of the marjoram essential oil. Essential oils are appropriate for this application because they are very penetrating and they don't contain any water or fixed oil (lipid), so they won't add to or trap moisture under the scab. I have been using them for a bit more than a week now and the infection is gone from one of the spots and almost gone from the other.

English lavender (Lavandula angustifolia) has been part of many of my systemic and local formulations.

Now that I've explained the complications I've had to deal with, here is what the topical protocols I am using currently look like:
  • 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 a 50/50 mixture of neat lavender and marjoram essential oils to the two areas where there was a bit of infection under the scabs. Then I apply Monika's scar ointment to the rest of the area of the incisions, and any remaining areas immediately adjacent where there is still a bit of the astringency rash to help heal and moisturize those tissues. Monika was kind enough to provide the ingredients of her scar formulation. It contains cocoa butter (Theobroma cacao), shea butter (Vitellaria paradoxa), castor oil (Ricinus communis), camellia oil (Camellia sinensis), argan oil (Argania spinosa), rosehip oil (Rosa rubiginosa), infused oil [St. Johnswort herb (Hypericum perforatum), pot marigold flower (Calendula officinalis), purple loosestrife herb (Lythrum salicaria), yarrow herb (Achillea millefolium) and American plantain herb (Plantago rugelii) in a base of olive oil (Olea europaea) and coconut oil (Cocos nucifera)], vitamin E (mixed tocopherols), vitamin D, English lavender (Lavandula angustifolia) essential oil, patchouli (Pogostemon cablin) essential oil, carrot (Daucus carota) essential oil, and Bach flower remedies [cherry plum (Prunus cerasifera), clematis (Clematis vitalba), impatiens (Impatiens glandulifera), rock rose (Helianthemum nummularium), star of Bethlehem (Ornithogalum umbellatum), crab apple (Malus sylvestris) and walnut (Juglans regia)].
  • In the evening before I go to bed I more or less repeat the morning protocol except that I use the comfrey ointment instead of the liniment.

On March 20, which was one day short of 7 weeks since my surgery, I had an appointment to have the first x-rays done since they were last taken immediately after my surgery. My leg felt strong and, as I suspected, the healing of my fractures looked very good. I also didn't have any pain when the surgeon put pressure on my leg from various angles. As a result, I was given the OK to begin carrying some weight with my leg. The original prognosis was that I wouldn't be able to do so for 12-16 weeks. So, this is in about half the time originally expected.

Fortunately I have been working hard to maintain as much strength and flexibility in my leg by doing various exercises and stretches. Stretching the tendons and ligaments, especially in my foot, ankle and knee, is actually the most difficult part of the rehabilitation process. At that time I had managed to get about 80% of the movement in my knee and 60-70% in my ankle. It has been steadily improving since.

During the first week I put about half of my weight on my leg when standing still (therefore 1/4 of my total body weight) and 10-20% of my weight on my leg while walking. I have also spent much more time walking around. For instance over the last 2 weeks I have been walking my dogs in the back field and woods where I live every day.

During the second week, which is ending today, I have been standing normally (therefore carrying 1/2 of my full body weight) and have worked up to carrying about 40-50% of weight while walking. I don't want to put too much stress on my bones too fast, so I will continue to increase the weight gradually and work towards being off the crutches in another 2-3 weeks.

As you can see, much of the scar looks like it is many months or even years old. The scabs near the top
of each incision are the areas that got infected. The dry areas from the astringency
of the poultices are slightly visible, especially below the lower incision.

Except for a couple of minor issues that I mentioned above, my fracture is healing very well. However, when I saw the surgeon a couple of weeks ago, there was some potentially bad news as well. There was a shadow in the x-ray at the bottom of my tibia below the lowest part of the plate that could be an indication of an infection in my bone. The surgeon wasn't completely sure, especially since there were no other indicators: no pain, no abscessing. He will reassess it when I see him in 2 weeks for another x-ray. In the mean time, I am focusing my treatment on my bone fractures and incisions. At this point I don't know to what degree I should be concerned about the possibility of infection. It is still inconclusive. So far all I've done is ramp up the essential oil content of my liniment when I apply it around my ankle by adding a couple of drops of marjoram essential oil to the liniment that I apply to that area. My current systemic formulation is going to run out in a couple of days and I will probably add an antimicrobial herb to the next version. I hope that it was just an anomaly in my x-ray because infections in bone are difficult to treat, even with a combination of herbs and antibiotics. If there is an infection, it would have been introduced during the surgery, possibly when the screws were put into my bone in that area. According to standard procedure, all of the materials they used would have been disinfected and I was given intravenous antibiotics during the remaining time (about 16 hours) that I was in the hospital following my surgery. Unfortunately, there is always a risk of acquiring an infection when in a hospital and the risks are greater when we must undergo surgery. Infections acquired in hospitals are often the multiple antibiotic resistant kind. In truth, I held out until the last minute on approving the surgery, partly for this reason. However, it was clear that my fracture was too severe and the likelihood of it healing properly with just a cast was very low.

If it turns out that there is an infection, this will require another aggressive protocol. I'll know in a couple of weeks. In the mean time, my fractures are healing amazingly well and I hope to be walking without crutches very soon. For this I am very grateful! I will continue the updates in Part 5.

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