January 10th, 2021 Update - THE HALO REMOVED

Dr. Lynn did me a solid and scheduled my CT scan for December 31st - specifically so I could claim it on my health insurance for 2020 (life pro tip: breaking your neck is a great way to hit your max deductible/out-of-pocket REAL fast). The CT scan was at the hospital in Greer and was a pretty simple in-and-out procedure, with a chance to meet a handful of new hospital employees and explain in enthusiastic detail the specifics of my predicament. 

It was then an INCREDIBLY long weekend, both to ring in the new year and attempt to wait patiently until my appointment the following Monday with Dr. Lynn to parse the results. 

The results - were good! The CT scan shows total healing of the C1 and C7 fractures (the two lesser of the three breaks). The C2 fracture is still in the process of healing. Where the “pin bone” (odontoid) is knitting itself back to the body of the C2 vertebrae, there is fusion across roughly half of the connector point. Naturally I forgot, in the moment, to snap a picture of the scan to post here, so please enjoy instead this rough sketch by Lindsay, my very capable artist-in-residence. 

The C2 pin (odontoid) bone, 
healed partially across

I get the sense that in a perfect world, at this point, we’d see complete fusion along this junction, but I didn’t feel any overt concern from Dr. Lynn. Sometimes there is slower healing on sections of bone like this, he indicated, and said that in time we should still see complete fusion. We’ll just need to keep looking at it, so we go back the first week of February for another set of x-rays to check on the progress. 

But with the amount of bone healing that we do see, said Dr. Lynn - “Yeah let’s get you out of this thing, huh?” Sweeter words I perhaps have never heard, and so we start out the New Year exactly as we hoped - with being freed from the Cage of the Halo Brace!

A slight delay immediately arose, however - we’d have to see Todd the Orthotist for the Halo removal (as only he possessed the magical tools, wrenches, etc required) - and although we called over to his office - Todd had gone home for the day. So the soonest we could get in to see him was Wednesday morning, January 6th. Honestly, this was completely fine with me - After almost four months in the Halo, what was another couple of days? This also gave me the chance on Tuesday to capture some video footage I wanted for a few practical Halo videos I have contemplated making to post to Youtube at some point, as reference videos for other people who might find themselves in my shoes (or brace, in this case) someday. 

It also gave me a chance to mentally prepare myself for this next step. Don’t get me wrong - I was eager to get out of the Halo and move forward to the next stage of healing and progression - but at the same time, I can’t say I wasn’t a little nervous about what would come next. After four months in the Halo, it was (believe it not) comfortable. There was no pain, no discomfort - it was bulky, unwieldy, sure - but I had adapted it into my everyday life and I knew what everything felt like and how everything worked. And for an injury as unstable and mentally nerve-wracking as a neck fracture, well - stability and surety goes a long way, both physiologically and psychologically. 

Look, it’s not that I ACTUALLY thought that, once Halo-less, my head might fall off and roll away, but all I’m saying is that, were you in my shoes, you might also have weird dreams in which that very sort of thing happens. But, this is real life, and we must move forward with all the courage and mental fortitude we can muster to play the hand we are dealt. 

So, Wednesday morning, January 6th, 2021 dawned - Day 119 in the Halo - and to Todd’s office we went. (Per Todd’s advice from several months back, I had saved an oxycodone pill and tipped it back 15 minutes before arriving at his office) The procedure was smooth and simple - here’s a video for those who’d like to watch along. 

First Todd secured around my neck the hard Aspen collar that will become my new best friend for the next several weeks/months at least. Then, the rods connecting the “halo” part of the brace to the “vest” part of the brace were removed, one by one. These rods are really what effectively held my head in place - so as each one was removed, I could feel gravity taking control of my head again and could feel myself “sinking down” into the collar. What a terrifically odd feeling, to suddenly have that weight again - I immediately thought of a book I read recently by Canadian astronaut Chris Hadfield, describing what the “weight” of gravity feels like at first for astronauts returning from spending any length of time on the International Space Station. Thankfully the collar could do all the work for me while my neck muscles, long dormant, were suddenly forced to wake up and (attempt to) kick back into action. 

Once the rods were removed, it was to the halo itself. Todd and his assistant took out two screws at once on opposing sides of my head - the first two created a feeling of “pressure release” - not unlike the pressure I felt when they put the new screws in a couple months back to replace the infected pins in the back. Once those two were removed, they took out the remaining two - the moment when those two pins “released” was by far the most painful part of the process - specifically the screw at the front left side of my head had a distinct moment where it felt as though it were “ripping free” - thankfully a mere handful of moments and this pain began to subside. My head immediately did feel as though it weighed 30 pounds or more, but the Aspen collar provided all the support and stability I needed. We removed the vest portions, bandaged up the pin sites on my forehead, put the Halo remains in a large plastic bag to keep and save for posterity, and home we went. 

What a strange, wonderful, and absolutely bizarre sensation to not have the Halo on. It was jarring - not in a displeasing way - just in a discombobulating way. I felt overall as though I weighed 10 pounds lighter, but my head felt as though it weighed 20 pounds more. I felt both much freer - from the Halo - and yet more constrained - by the Aspen collar snug around my neck. But all in all - a net positive, and an absolute win, I decided. 

Because of how the C2 vertebrae was only partially healed, Dr. Lynn’s instructions are to wear the Aspen collar more or less full-time for the next month until I see him again. I am allowed to remove it for sleeping and showering, but I get the sense he doesn’t want me to work too hard on any “rehab protocol” until we check things with another x-ray in a month to see how that pin bone is doing. These first few days have been pretty slow and cautious. There is a lot of neck soreness and discomfort, but it seems to be getting marginally better each day. As Dr. Lynn put it “soreness is okay, pain is not” - it definitely feels like everything going on in the neck region is just soreness of a variety of different kinds. The collar keeps me secure and stable - it permits a very very tiny bit of neck movement but so far my goal is to keep things as still as possible. (For that matter, I really CAN'T move my neck very much anyway with how weak the muscles are) So far I have only removed the collar once for a few minutes just to let my neck breathe a little bit - it felt alright, but I’m SUPER tentative about accidentally making any kind of quick or sudden movement that would cause pain. I’m back to sleeping in the recliner for now but within a few more days I’m hoping to try lying flat and maybe even taking the collar off overnight. A lot of the soreness and pressure in the neck now reminds me a lot of the first few weeks in the Halo, so I’m optimistic that as my neck muscles get acclimated to even micro-usage, we’ll see definite improvement over the next few weeks. If I get a little stronger and feel a little better everyday, by the time we see Dr. Lynn on February 1st, I’ll be ready for whatever comes next!

Feels great to be Halo-Free!

The (terrifying) moment of truth, 
taking off the Aspen collar
for the first time

Day 111 Update - A Very Halo Christmas

And so we come, almost, to the end of December, the end of 2020.

Whew. What a year, right?

Christmas was great -  naturally I had the idea to get a string of battery powered Christmas lights and we figured how to drape them artfully around my Halo. After not doing anything too wild for Halloween it was a smash hit with the family and I was quite proud of taking advantage of a Christmastime Halo experience to get decorated up beside the tree. 

The last X-ray appointment with Dr. Lynn was back on December 7th - it’s as routine as can be at this point, in and out with ease and alacrity. Everything on the x-rays looks normal, the pinsites look just fine, so it took all of about 5 minutes to get the “all-clear, see you next month”. The next step will be a CT Scan - scheduled for December 31st (claim it on 2020’s insurance, thankyouverymuch) - and then we’ll see Dr. Lynn the following Monday, January 4th for the interpretation of said scan. That will be right at the four month mark, and there’s a chance - if the CT Scan looks good - that we might get the Halo off that first week of January. That would be a TERRIFIC way to ring in the New Year in my opinion. Or if he looks at it and says nah you need to keep cooking for another few weeks, well, that could happen as well. But I’m thinking positively and optimistically as best I can. 

The prospect of waiting another month is not awful, when I do consider it. While my laundry list of “Things To Do Once I’m Out Of the Halo” is being thoughtfully added to on a regular basis, if I’ve gotten good at anything these past 100+ days, it’s being patient. I can be patient a little longer if it means better neck health in the long run. 

100 Days, though - that milestone came on December 18th. What a wild thing to have lived with this brace on for 100 Days. What’s really remarkable at this point is just how normal it feels. I’ve virtually no neck pain or discomfort (unless I sleep oddly and wake up with a crick in my neck or shoulders), so I go about my daily routine and often don’t even think about this odd contraption strapped to my upper body. I take Graham out for walks, I do chores around the house, we go to the grocery store, I do some light loadbearing exercises to attempt to prevent ALL of my muscle mass from withering away - working around the Halo has become part of my routine, part of the normal. The  body - and the mind - can adapt to anything. It will be incredibly strange now when the Halo comes off. I mused on this to some family members over the holidays - right now, I know how the Halo feels, how it works, it’s “comfortable”, it’s “normal” - there are no surprises after this long in it. It’ll be oddly unnerving when it comes off as then I’ll be the proverbial baby deer finding its legs for the first time - having to re-learn back to a non-Halo center of gravity, getting used to new sensations and soreness as my neck protests against having to be used again. I’m looking forward to it, but the strange irony of The Halo becoming The Default is not lost on me. 

Things I’m looking forward to most once I’m out of the Halo - 

1) A Shower - So Many Showers - Lindsay got me a shower cap for Christmas since those pinsites may be pretty tender for a few days once the screws come out, but boy I can’t wait to take a shower

2) Riding My Bike (Indoors) - I picked my bike back up from the bike shop last week. They checked it out thoroughly and - it was fine. Barely a scratch. The chain fell off and had to be put back on, but otherwise, I took pretty much the full force of the crash. I’ve already put the bike back on my indoor trainer (we’ll talk about taking the bike outdoors again...someday way down the line) - but I do the majority of my riding indoors anyway - I should be able to get back to that pretty soon once I’m out of the Halo and boy I can’t wait to get some real cardiovascular activity going again

3) Pushups - I really want to do some pushups. And pullups. 

4) To Lay My Head On My Dog - I haven’t been able to use Graham as a pillow in almost FOUR MONTHS, people. This is a tragedy. 

There are others, but those are a few that spring to mind right away. 

I’ve got a few “Halo How-To” posts/videos/guides I want to make in the coming weeks as well - some resources for future Halo-wearers that might find this blog. Some of those nuts-and-bolts (hah) tips and tricks that I found helpful on other people’s blogs in the early days of my journey deserve to have their space here. 

This time next week I’ll know about the results of the CT Scan as well so - more news incoming. 

BIG UPDATE - HALO REMOVAL POST

Day 82 Update - No(vember) News Is Good News

 I almost put this update off til tomorrow but then realized that would mean I wouldn’t have posted anything during the entire month of November and well, that just won’t do. In truth, I’ve been sitting on this update for several weeks now, since my last x-ray appointment back on, uh, November 3rd. 

Not a lot of terribly interesting things have happened in the month of November.

And yet, that’s good news at this stage. We’re now solidly into the “no news is good news” part of the process, patiently waiting on time to pass and the bones to knit themselves back together. 

Update on the new back pins installed at the end of last month -  things are looking pretty well. The new pinsites are not nearly as “open-woundish” as the original ones were. There have been some small amounts of discharge at times, but not nearly the giant-globules-of-dried-pus levels we were seeing consistently over those first weeks. Daily pin site cleanings continue, at times we are using both hydrogen peroxide AND neosporin to really deliver the ol’ one-two punch to keep them in line. The front pinsites continue to be virtually no issue whatsoever. 

The first week or so after the new pins were put in was pretty wretched, to be honest. Having, at that point, gotten very used to how everything felt and to a basically “pain-free” level of living, to suddenly go back to having constant spikes of pain through my skull everytime I moved was more than a little discouraging. Thankfully - as we hoped - after several days of chewing ibuprofen and gritting my teeth (but not too tightly, lest it cause even more skull pain) - the aching started to subside and eventually evened out to merely the background level of “discomfort” that has become the quite-liveable norm these days. 

This also provided an opportunity to see how the wound sites where the old pins were taken out will heal. As I’ll be dealing with four of those at such time as the Halo comes off, it was a nice preview. No stitches or anything required - once the pins came out, the skin in the area just kind of slapped itself back together, and Dr. Lynn’s only instruction was to “pack those suckers full of Neosporin for a week”. So we did, and Lindsay reports they are healing nicely. It seemed like all the pain was from the new sites - not so much the old - which gives hope for not too much localized pain when the screws come out when the Halo comes off. 

The last x-ray appointment back on Nov 3rd was all smooth sailing. Virtually nothing has changed on the x-rays - everything is still aligned properly. Dr. Lynn was able to point out how you can see, faintly, where the bones are stitching themselves back together, pinpointing some progress. The plan from here out is thus: in early December, we’ll do another set of x-rays (at the three month mark) - expecting here to see virtually the same as these previous ones. Then, in January - at the four month mark - we’ll do a CT scan. Dr. Lynn explained that while x-rays let us see that everything is aligned and hint at the bone growth happening, only CT scans can adequately show just how strong the bones are/have grown back together. So the CT scan will really provide the gold standard for when it’s time to take the Halo off. We COULD do CT scans at three months - sometimes bones grow back fast, and it’s theoretically possible we could be in a good-enough spot to remove the Halo then. But - CT scans hit the body with about 1500x the radiation that x-rays do, and Dr. Lynn said he doesn’t like “over-ordering” them - he’d rather wait another month and do the CT scan in January. If the bones don’t look quite ready at that point, we can wait another few weeks or a month and then check again. But he said - and I agree - I’m fine with wearing the Halo for a few extra weeks if it promotes better bone growth in the long run. While I’m eager to get out of this cage, in the grand scheme of things, a few more weeks or a month won’t make that much difference. Patience is a virtue, and all that. 

The rest of life continues to be pretty normal. Work keeps me busy, I walk several miles daily on my treadmill, and Graham demands nigh-constant attention when he’s not napping on the sofa. I’ve started venturing out of the house more often than just for the doctor’s visits now - after two months I decided I really wanted to get back to going about one of my favorite errands - grocery shopping - so we’ve resumed our weekly trips to Walmart. I figured it would be a shame to not go out in public when possible with the Halo on to see what kind of public reaction it gets. So far - not a ton, at least that I’ve noticed. I’ve had a couple Walmart cashiers engage me in friendly dialogue about it, and one kindly old lady shook her head as she passed and remarked “my goodness, and I thought having to wear a mask was bad!” The Walmart cashier tonight did seem hesitant at first, then finally broached the topic with an “Alright, so - I’m sorry - I just - I have to ask, and you don’t have to answer if you don’t want, but….” - which gave Lindsay and I the idea that we need to create a sign I can wear on my back that says something to the effect of “Feel Free To Ask, I Don’t Mind”. It’s not that I’m trying to set myself up as the Halo Ambassador, but I certainly have not gotten tired of talking about it, so hey, why not invite conversation?

Next appointment is on December 7th, only a week away. More updates to come (with hopefully less of a delay before the next post!)

Next Update - A Very Halo Christmas

Graham, the ever-faithful guard dog

This is a highly normal x-ray

Day 51 Update - The (New) Holes In My Head

 Today, we will talk about the holes in my head.

I was going to tell you about pinsites anyway, but thanks to a last minute doctor’s appointment yesterday, the story just got exponentially better.

So as a quick reminder, the Halo brace is screwed into my head at four points. The bolts, or “pins”, that are used are screwed directly into my skull to a depth of just a few millimeters and tightened to 8 lbs of torque. After the first couple weeks of a somewhat-annoying constant tension headache, they honestly have not been terribly uncomfortable. As with anything, the body adapts and you just get used to the sensation of wearing a slightly-too-small hat 24/7. It always feels more like a band of pressure around the head as opposed to four distinct insertion points, and once I got used to it, it really has been hardly noticeable the last few weeks. I mean, as “hardly noticeable” as a Halo brace can be. 

With four pins screwing directly into your skull though, the Number One home maintenance practice required while in a Halo is what L and I affectionately refer to as “PinCare” - every night before bed we use q-tips and a syringe to clean around the pinsites with hydrogen peroxide or an antibacterial cleaner. Risk of infection at those pinsites is one of the only major “complications” of the brace, so we’ve been religious about cleaning and care on our daily schedule. 

Of course, the best laid plans of mice and men, etc, etc. 

A couple weeks into this whole debacle, Lindsay noted that she was still seeing a lot of active discharge from around the back pinsites. The front ones (in my forehead) - no problem at all, clean as a whistle with no issues. But the back ones were still, well, just oozing pus from what appeared to be still some active wound trauma right around/below where the pin inserted. (Did I mention this post might not be for the faint of heart of you out there? Read on at your own risk). At no point did the back pinsites ever HURT - which is still my primary metric for “is there an infection / is something seriously wrong” - for all their weeping and oozing they never got red or inflamed or started being painful. We dithered for a while on if this was normal vs severe enough to call the doctors about - we finally did make a few calls and I was given an antibiotic prescription. At my first xray follow up a few weeks ago the PA checked out the sites and said to keep taking the antibiotic and let them know if it got any worse. 

It never got much worse, but it really didn’t get much better, either. We continued to clean and pull a multitude of crumb-sized chunks of dried discharge out of my hair every night. Lindsay could show me pictures of the sites but of course I couldn’t see them - and still there was no discomfort or pain. I was scheduled to go in on Nov 3rd for my next x-ray shots, so we figured we were just holding on til then for the next in-person look. However, to my surprise, a couple days ago I got a call saying “Dr. Lynn has decided he’d like to see those pinsites in person so why don’t you come in this Thursday”. So into the car I was loaded (getting much better at that every time, for sure) and off we went. 

I was delighted to see Todd the Orthotist again in the doctor's office. He checked out the sites and hemmed and hawed, then Dr. Lynn came in and took a look as well. He said it was a good sign that I was not having any pain or tenderness - that would be the sign of a more serious infection - but he did say that based on how “open-wound” the back sites were looking, it would be a good idea to go ahead and put in new pins in an adjacent spot and remove those current back two.

Oh, well, okay, today just got more interesting. 

Dr. Lynn said it would be possible to schedule the procedure at the hospital and put me under general anesthesia, but in a moment of bravado (real or imagined, who can say), I suggested we go ahead and just do it right there in the office. No sense waiting, let’s just make it happen. So off they went to get the supplies they needed and I sat in a chair in the room wondering exactly what I had just agreed to. 

In a way, it wasn’t unlike a dental procedure (if you’ve ever had that done). Dr. Lynn came in and injected local anesthetic into the sides of my head (very much when they inject the like into your gums - that sharp needle and then that flooding/burning sensation as the agent spreads through the area). After about 10 minutes it had gotten nice and numb and so Todd brought forth his Special Magical Halo Brace Pin Screwdrivers and the new pins. The whole thing took only between five and ten minutes - it was like having my own personal pit crew working on me. There are numerous holes in the halo part of the brace, so Dr. Lynn started on the right side and screwed in a new pin in the slot adjacent to the current one. There was a mild stinging pain that the anesthesia didn’t quite cover, but the primary sensation was just pressure - a ton of pressure. As the bolt enters your skull, the best way to describe the feeling is as if your head was in a vise being slowly squeezed tighter and tighter...and tighter...and tighter. For about ten seconds I did in fact begin to wonder if my skull was just going shatter- the pressure started at the site and then just slowly radiated across my entire skull in slow moving waves. Once the pin was “set” though, it seemed to stabilize and lessen slightly. The pin on the left side actually went in a little easier - it seemed to sort of “balance out” the pressure waves from the right side - and once they were torqued to the proper amount, they simply unscrewed the first set of pins. I didn’t even feel them coming out at all (probably thanks to the fun new sensations going on with the new ones). 

And that was pretty much that. New pins in the back, two holes in my head where the old pins had come out. The skin there has enough elasticity to work to close itself over the old pin sites it seems, as no stitches or anything of that sort were required - Dr. Lynn said to just slap on the neosporin a couple times a day for a week and keep an eye on it. We’ll return back today (Friday) to have Todd check the back pins to make sure they are still at the proper torque (standard procedure after 24 hours with new pins). And then I go back for x-rays next Tuesday so that will be another chance to make sure all is well with the (new) holes in my head. 

I wasn’t feeling too bad for the first few hours after the new pin installation, but into the later afternoon the local anesthetic wore off and I started having flashbacks to those hospital-pain-levels from The Early Days. Back to chewing ibuprofen on schedule for a few days at least, it seems. Thankfully I slept just fine last night. Seems like moving around actually starts triggering more pain, but Lindsay says everything looks as good as it can for now. 

Oh and of course I have to share the two highest compliments received of the day. Both Todd and Dr. Lynn were MASSIVELY impressed with the shirt that Lindsay has custom cut for me to fit around the Halo that I wear when out in public. They both said in all their years of seeing people in similar circumstances, they've never seen something that cleverly constructed. All credit to Lindsay on that one - I'll show some more details in a future post on what exactly she's done to my shirts to make them wearable, but have to give her a shout out for that compliment. 

Oh and they both also said that I smelled remarkably better then most people they see in Halo braces. So, uh...good to know that my current personal hygiene levels are above the mean. 

Never a dull moment in this life, it seems. Dr. Lynn mentioned he had taken a look at the x-rays from a few weeks ago and he was very pleased, so hopefully we’ll get more of that good news next week. I also had a good chance to talk to Todd about the actual procedure of when they put the Halo Brace on, so I might unpack that a little more in a future post. 

New update will come next week after the next x-ray report! 

Next Update - Day 82

BONUS - For the Real Strong of Heart - Here's video of them screwing in the new pins as well as a link for pictures of the before and after of the infected pin sites

And here is a link to some very mildly graphic photos

Day 37 Update - Let's Talk About Neck Bones

If you want a career with a nice predictable schedule that never changes, neurosurgery might not be for you.

My first post-op appointment with Dr. Lynn was originally scheduled for September 29th, but a couple days prior I received a call from his office that unfortunately the appointment would have to be moved a whole week and a half later to October 8th. This was, at first, disheartening - this first post-op appointment would include x-rays to ensure all the bones in my neck were still aligned properly and we were on the right track, and I was anxious to get that (hopefully) good news report. Then, the day before the October 8th appointment, I got ANOTHER call that Dr. Lynn had been called into an emergency surgery the morning of my appointment but that I should still come in and see his PA who I’d met at some point during my hospital stay. While unfortunate to not get to see Dr. Lynn himself, I realize this sort of thing must happen somewhat regularly. Whose regular appointment did I bump when I had to have my Halo procedure? Must be a constant scheduling nightmare, since it’s not like emergency spinal surgeries and procedures happen on a nice predictable schedule, after all.

The appointment with the PA was great. After a month of parsing the written (no visual) reports from several of my initial CT scans at the time of the accident, combined with a hefty amount of research on the cervical spine by way of Google and free-access medical journals, I finally came to a full understanding of exactly how the bones in my neck had broken. For those of you who are not, as of yet, experts on the cervical spine, please sit back and enjoy

BREAKNECK BEAN’S HIGHLY SCIENTIFIC LECTURE ON THE NECK BONE AREA

Okay, so, you have 7 vertebrae in your cervical spine, labeled C1-C7, that connect your skull to the top of your thoracic spine (your “back” spine, as opposed to the “neck” spine)

C1 and C2 - where the worst of my damage was located - are at the top, and they are a little different from all the rest - they have a unique mechanism that controls the rotation of your head from left to right. C1, at the very top, is “The Donut”. No kidding, that’s not my term, Dr. Lynn used that at one point describing things to me in the hospital, so that’s as scientifically accurate as it gets. C1 is a circular ring (hence, donut) that sits right beneath your skull - in fact your skull actually sits on two little “pad” areas right on the top. C2 sits right beneath it, and it is also semi-ring-like in shape, but with a really unique feature - a “Pin” that extends upwards from C2 into the ring of C1. The Donut rotates around this Pin as a pivot point, and that’s the entire reason we can indicate “No” to someone without having to use words. Left and right rotational movement - The Donut (carrying your skull) swiveling around this pivot point - got it? Yes, there will be a quiz at the end of this.

So when I crashed headfirst into the ground, a couple things happened.

First off, imagine taking a donut (in my head, for some reason, it’s always a sour cream donut - something about the shape of those makes me think of the bony ridges and processes of the cervical spine vertebrae) and dropping it on the kitchen floor from about chest height or so. Incredibly sad. Donut on the floor, probably split into multiple pieces. (Quick, 5 second rule, it’s still edible if you move fast!) That’s what happened to my Donut. It effectively cracked in three places - two sections along the back of the ring and one diagonal fracture towards the front and side. Unfortunately this did not qualify me for the very cool-sounding diagnosis of a “Jefferson Fracture” (named for Sir Geoffrey Jefferson of medical fame, not the 3rd POTUS, I don’t think HE was ever cool enough to break his neck) - this requires a “burst fracture” in four separate locations, and mine was only nice enough to break in three. So close!

Moving down the cervical spine, we find out what happens when force is rapidly applied to The Pin of C2 as The Donut around it gets thrown violently around. In this case, it decides to snap right off. This is naturally a serious - but also the most common - type of injury to C2, since that pin is sitting there like a turkey wishbone just waiting to be snapped. This is why I immediately couldn’t turn or move my head at all right after the injury - with that connection broken between C1 and C2, suddenly that whole pivot joint mechanism is very much non-functional. Some of my reading over the last month determined that one of the decisions between Halo brace natural healing vs surgery is based on how far this pin moves once it is snapped. There’s about a 5mm threshold, it seems - where if the pin bone moves out of place by more than that about there’s a much lower chance of being able to get it to reattach and grow back to where it should be on the base of C2. Mine moved approximately 4mm - any more and surgery might have been the only option.

C3-C7 are much simpler bones, they are sort of like building blocks that just go down the rest of your neck spine. My C7 had a bit of a compression fracture but nothing nearly as serious as what was going on up near the skull (had it been only the C7 fracture I suffered, Dr. Lynn said they would have put me in a hard neck brace for a few weeks and called it a day). As it was, in comparison to what was going on up in C1-C2, C7 was almost an afterthought by comparison.

I also learned - from one of the doctors in the emergency room - that your spinal cord controls more and more vital functions the further up it goes. So if you damage your spinal cord at C6-C7, you might suffer loss of function and control of your legs or lower body. Getting up towards C4-5 you’re talking much higher risks of becoming quadriplegic. The C1-C3 area is where autonomous breathing functions are located (this is the area that actor Christopher Reeve of “Superman” fame damaged in his horseback riding injury) - the doctor pointed out very kindly that had C1 or C2 been jolted enough to cause any spinal injury in that area, I very probably would have just suffocated to death in that ditch. Fun!

But with no spinal injuries, it was just a matter of determining how the bones could be put back together. Screws and pins would do it, a la the surgery option - but since C1-C2 control your neck rotation, that’s why you lose some of that functionality after such a procedure. Metal screws and bolts are great for holding things together, but not for allowing everything in your neck to work precisely the way it was designed. So, the Halo brace immobilizes everything while the bones grow back together, and here we are.

Anyway, yeah, thanks for coming to my TED Talk about neck bones.

So the report on the first post-op x-rays was very good. Fractures can still be seen in several areas, naturally, but everything is lined up where it should be and that’s exactly what we want after one month. Amanda, the PA, said we usually don’t start seeing actual “fusion” of the neck bones until 8-12 weeks, so hopefully we’ll get an even better report at my next check-up in early November (assuming Dr. Lynn doesn’t have to reschedule on me 4 more times). Mostly I’m really curious to get his opinion on my injury as a whole and ask him some specific questions (especially about the procedure when he “set” the neck bones and they put on the brace) so look for more reporting on that subject down the road.

Otherwise, life is good and I’m really feeling fine. It seemed to take about 4 weeks for my body to really “get used” to the Halo - it’s still awkward and cumbersome, but MUCH less so than it was those first couple of weeks. The human body is remarkably adaptable. As odd as it sounds, the screws in my skull aren’t even uncomfortable now, I just register their presence but there’s no pain at all, just a slight pressure. And most days, the neck itself feels pretty good. I’m still mostly sleeping sitting propped up in a chair - it just seems to be the most comfortable position overall - and I’ll wake up most mornings with a lot of stiffness or a sore spot in my neck, but it almost always works out pretty quickly after I get up and move around. Work keeps me busy, Graham keeps me entertained, and Lindsay keeps me from doing anything stupid that I shouldn’t, so all-in-all - the prognosis is good!

Oh and just wait, the next post is gonna be about “pin care” on the screw sites in my skull and that’s gonna be REAL fun. Stay tuned!

Edit - The Next Post - Pinsite Fun

First post-op Xray after a month - 
Pin bone aligned and beginning
to reattach

CT Scan day of the injury -
"The Pin" of the C2 circled

Day 22 Update - A Visit to Todd and Other Miscellaneous

For as bad as everyone complains about the road conditions and potholes here in South Carolina, I’ve honestly never really been bothered by them that much. Well, that is, until I rode in the backseat of a car in a Halo brace where every slight bump and jolt seems to resonate into the bars of my cage. But, on Day 14, it was time to venture back into the outside world for the first follow up appointment with Todd the Orthotist.

I had met Todd in the hospital a couple times - he came by before the Halo installation to take some basic measurements for the procedure, and then afterwards for a post-op screw tightening. This would be just a basic check up to make sure everything with the brace was still behaving exactly as it should. My first follow up with Dr. Lynne the neurosurgeon wouldn’t be for another couple weeks still, at which time we’d actually see how the neck healing was progressing.

Oh, here’s a good spot to talk about a quick CLOTHING update - the vest part of the Halo sits right on your skin and never comes off, but as usual, Lindsay had gotten clever. We took a couple of my sleeveless t shirts and cut the shoulder sections apart, which allowed me to step into a shirt and then slide the front and back now-separated halves up through and underneath the vest and secured under the shoulder sections. There’s just enough wiggle room to get a shirt threaded underneath, which not only allowed a layer of fabric to protect my skin from any irritation, but also allowed me to not feel like I was half naked all the time. This was fine for getting around the house, but further creativity was needed for going outside the house. We made some creative cuts into the back of a large zip up fleece jacket for it to fit around the bars of the Halo in the back. Not perfect, but pretty good for a first attempt. We’ll have plenty of time to keep experimenting with a couple of other extra large hoodies and shirts I picked up as well. One may be in a Halo, but that doesn’t mean one can’t attempt to be as fly as possible at all times.

Snug in my jury-rigged jacket and folded into the car again (much easier than when coming home from the hospital, great strides in mobility over the last week and a half!), we trundled on down to Todd’s office. It was a pretty simple visit all things considered. Todd checked everything out to make sure it all looked good and showed us that the foam pads lining the inside of the vest are actually removable without having to take off the vest itself! With creative use of trash-bag liners to separate the foam from the velcro lining of the vest, it can be removed and swapped out for alternate foam pads should we desire to wash or air out the pads from time to time. It was - while not exactly painful - a rather jostling experience, so I doubt we’ll be doing it every day or two, but it’s good to have the option ready for whenever we need it.

Todd answered a few of our questions and said - barring any unforeseen circumstances - the next time we would see him would be to remove the Halo in however many months down the road Dr. Lynne decided it was time. Optimistically, nothing with the Halo will need adjustment throughout the process - he said to give him a call if any head pain worsened, as that could be a sign that one of the skull screws was loosening and needed to be tightened. He was able to provide the trivia tidbit I had been wondering about - that the entire Halo contraption weighs about 12 lbs total - and also provided us with the wrench set that I must carry with me at all times in case of some catastrophic event in which the vest would need to be removed. Literally, I can’t take this thing off without three separate wrenches for the various bolts and screws that hold it together. That done we returned home and back to our normal routine.

We’ve stabilized into a pretty normal routine at this point. I’m still sleeping in my recliner each night and have graduated to reclining slightly (still more comfortable to sleep mostly sitting up vs lying down - I think this has to do with how the weight of my head is distributed between the four skull pins), and this allows me to keep my feet propped up to avoid any swollen ankles. I’m able to get around the house more and more normally, if still at half-speed or so. Turning or rotating is the most deliberate action - I’m getting better at a smoooooth turn where my entire body rotates at once (I mean my head has to move with the torso, it’s locked into place) - but the smoother the action is the less strain I feel on the neck as I turn. Weekdays I make the climb up the stairs to my office where I’ve found that one thing the Halo is good for is curbing my low-grade physical ADD - whereas before I would often get up from my chair every 20 minutes while working to go do something I had just thought of or been distracted by, now it’s easier to sit and work for at least a couple hours at a time without moving, as it’s when I’m stillest for long periods of time that I am most prone to (almost) forget about my portable, wearable metal cage.

“Pincare” is a new part of our nightly routine as well. One of primary things you have to take care of while in a Halo is maintenance of the four sites where the pins screw into my skull. The four sites have to be cleaned daily to ensure no infection sets in. Using Q-tips and and an antimicrobial/bacterial cleanser (off-brand Hibiclens), Lindsay swabs around the sites to ensure they’re staying as clean and germ-free as possible. Currently, the back two pin sites are causing a bit of consternation. They didn’t shave or trim my hair at all when they put the screws in back there, so for one they are a little hard to see and get to, but for two those two sites are showing some signs of a yellowish discharge (sorry people, no filter here when it comes to the gory details). This is not necessarily abnormal or a huge warning sign as redness, irritation/inflammation, or pain at the sites would be (really the sites don’t hurt at all), but we’ve upgraded (on Todd’s instructions) to using hydrogen peroxide on those sites for a few days for some added cleansing benefit. I’m really not concerned as long as there is no pain or redness - Lindsay is a bit more cautious - but between the two of us I’m confident we would catch any true problems in the early stages and head them off then.

Still plenty of things to do, so thankfully I have never been bored. It is a little astounding how much extra time I feel as though I have some days. In my “previous” life between cycling, running, and working out I was often being physically active for 15-20 hours per week, so to have that much extra time now to sit and get extra sleep, extra reading/gaming/watching done, etc is really a shift in “how I spend my time”. It’s all pretty productive though, so I’m happy.

The higher amount of neck pain I was experiencing last week seems to have subsided a bit. I’m usually only taking a few ibuprofen at night when the fatigue of the day allows more soreness and tenderness to creep in, and to help alleviate any pain that might keep me from sleeping. I’m sleeping pretty well actually, usually in chunks of at least 3-4 hours at a time and sleeping soundly while I’m out. Rest is when the body heals the most, so I’m trying to keep doing as much of that as possible.

I’m constantly reminded - and humbled - by how many good people surround me in my life. Daily reports of people thinking, wishing-well, and praying, as well as dozens of friends stepping up to help provide meals, help around the house, and offers of assistance for anything that we might need over the next few months while I’m facing some of these physical limitations provide daily encouragement and a level of support for which I can never express enough gratitude in return. This recovery may be a tough journey, but I’m very fortunate to not have to walk it alone.

Next Entry - A Discussion of Neck Bones

Graham the Occasional Lapdog 
provides regular emotional support

Adjusting To The Halo - The First Two Weeks At Home (Days 3-18)

I’m writing this blog for two primary reasons - one, to capture the story and share it as it happens (while I take great delight in sharing my condition on any given day in great detail to whomever might ask, this might provide updates for those a little further outside my QuarantineSphere whom I’m not interacting with on a regular basis) - but also because the minute it was decided I was going to start a Halo Journey, frenetic Googling turned up a small handful of blogs by other people documenting their experiences in similar circumstances. Those blogs provided invaluable insight and advice to this terrifically strange and unique phase of life I’m now entering for the next few months.

Because it is my wont (and because I have more than a little extra free time on my hands these days) I may get rather granular at times with the details, or I may just provide semi-regular updates on how things are going - hard to say at this point. I don’t have a lot of planning going into this blog, I’m just here for the ride and to jot down a few thoughts and collect a few memories for the future. And if someone who I have never and may never meet finds this blog, years from now, and finds it in any way resourceful or helpful as they or someone they know gets outfitted with their very own Halo, well, then my time here will be very well spent indeed.

But for now, let’s have a recap of the first couple of weeks of Living With A Halo.

After consideration, I decided to peg the day the Halo was installed (not sure what other verb to use there, really), Wednesday September 9th, 2020 as Day 0. So Thursday 9/10/20 became Day 1, and so on from there. I came home from the hospital on Day 3. Dr. Lynne said that the “listed protocol time” for wearing a Halo brace is 6 months - however it seems that can vary somewhat based on the severity of the break, how quickly the bones heal, etc - many people report a Halo time of three to four months. So in my mind, I’m already “counting up” to Day 180 - and if I’m able to get released early for Good Behavior, well fantastic.

But that’s a long way off. For now, it’s just a matter of Getting Through Today.

As I recap the first two weeks, it might work best to break out some topics individually.

Mobility / Activity - For the first couple of days, every single movement was slow, difficult, and (often) painful. I was still weak and adjusting to my new center of gravity as provided by the Halo, and even simple movements like getting out of a chair or turning around while standing had to be done at about 10% speed. While nothing else on my body really hurt, everything in your upper body connects to your neck somehow - so using my arms to lift or brace myself and many minor upper body adjustments or movements if not done at the absolute easiest intensity and speed would cause bolts of pain to shoot through the neck. The Halo keeps your neck and spine immobilized, but I still had a lot of damaged nerves and muscles that would fire off warnings anytime they felt movement from elsewhere. On Day 5 I managed to get out of a chair by myself without any assistance, which felt like a huge win. Every day after that for the first two weeks seemed to bring a measurable increase in strength and ability. My lower body was more or less unscathed, so once I was standing I was able to do some knee raises and other light lower body activity and stretches just to try to keep the blood flowing and the body moving as much as possible.

The one lower body side effect I did experience was a good bit of swelling in my legs and feet - turns out sitting for 22 hours a day isn't the most conducive to good circulation. Propping my feet up seemed to help the most, so as much as possible especially while sleeping I continue to try to elevate my legs to keep the blood flowing. 

I waited until Week Two at home (Day 11) to climb the stairs at home up to the second floor, but by then my stability and balance had progressed to the point where - as long as I moved slowly and deliberately - I felt like I could move in just about any way I needed to (within the locked in confines of the Halo, or course). As long as my torso and head stay locked in the same plane, I can get around pretty well. Easy, slow movement is the key, especially while everything that's damaged and inflamed in the neck heals here in the early stages.

Pain - Overall I feel remarkably fortunate to have as little ongoing, acute pain as I do. I think I expected more, honestly, but - as long as I’m remaining still, or moving at a glacial pace - it’s more levels of discomfort, if anything. I was prescribed oxycontin as needed coming out of the hospital, but by Day 6 or so was mostly just taking ibuprofen as they actually seemed to give better relief for what negative effects I was feeling. Week One at home was mostly dominated by head pain from getting used to the screws of the Halo brace in my skull. I don’t feel the individual “pin” sites, as they’re called - rather, the four of them surrounding my head result in more a feeling of a tight band encircling my head at that level. This ongoing tension headache would come and go throughout the day, but slowly lessened into Week Two, I think mostly as my body became accustomed to the sensation. Week Two actually started bringing more neck pain - likely because as I was able to move around more and more, the Halo has to prevent me from moving in any way I shouldn’t - and every time it limits me, it stops me right as my neck starts to protest whatever action I was about to try to do. This builds up through the day and tends to get worse in the evening as my fatigue also increases. Overall, very manageable though, and for that I am very grateful.

Sleeping - The most consistently painful action I felt the first few days having the Halo were trying to move from lying on my back and getting onto my feet, and vice versa. I never really slept very well in the hospital, and the first night at home, trying to get comfortable in any position was almost impossible at first. Eventually I decided to just try sleeping while in the most discomfort-less position possible, sitting straight up in a recliner. It actually worked pretty well. I would stay up as late as possible into the night to get as tired as possible, and then would be able to fall asleep for at least a few hours at a time. It’s an odd sensation - when you fall asleep while sitting, usually your head starts to fall to one side or in front (sometimes jerking you back away, right?) - but in a Halo, my head is perfectly suspended and locked in place. Waking up was a trip sometimes, trying to figure out why it felt like my head was floating in space before my senses caught up and remembered the contraption into which I was now built. I established a pretty good routine of sleeping in at least 2-3 decent chunks throughout the night - often I would wake up for a while and it would take me a while to get back to sleep, but I would keep my phone and books close at hand and just tried to embrace a multi-phasic sleep schedule for the time being.

Activity - So what AM I doing? Getting really good at sitting in a chair, that’s for sure. Thankfully I had plenty of accumulated vacation time at work, and Lindsay was doing almost all her adjunct teaching from home, so we were able to really just spend a lot of time sitting in the living room together, reading, watching movies and TV shows, gaming, etc. We have a phrase we use for those days that happen a couple of times per year, often a Saturday with no obligations, where we just make it a lazy day, forget about the concept of time and the calendar and adult responsibilities and do nothing but sit on the couch for the entirety of a day and and eat snacks and just hang out together - we call them “The Days That Don’t Exist”. Well - that first week from home was “The Week That Didn’t Exist” - and it was honestly pretty great just to focus on rest and recovery. While it feels really strange to be at home and not be able to be as active as I normally am, I also have no shortage of books to read, video games to play, and movies to watch, so I’m certainly not going to get bored anytime soon! I’m very fortunate in that I am able to work entirely remotely, so on Day 12 I went “back to work” from my home office. It was actually really nice to achieve another step in the feeling of a normal routine, and gave me another (seated) activity to pour my time and returning energy into.

Overall - life is good. Yes, the Halo is requiring some significant adjustments to life right now and forcing me to be a lot more deliberate than I usually am with every single action - but when I consider how much worse my accident could have been, I feel extraordinarily fortunate. When I consider just how much harder all this would be a broken leg, or wrist, or cracked ribs, etc - it makes me realize that my injury and limitations are not nearly as bad as many people who might be in a similar situation. All any of us can ever do is to respond in the most positive, beneficial way to the circumstances we find ourselves in - I remind myself constantly that mindset is half the battle on a journey such as this one.

Next Entry: Day Twenty Two

Graham is a willing and attentive HHCP 
(Home Health Care Pupper)
and mostly just demands payment in food