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00:00:05.599Hi there, fellow physiotherapists.
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00:00:14.960I am Elien van Aswechen, your host for Physiotherapy Trauma Talks, where we discuss everything related to trauma care.
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00:00:29.359So if you are passionate to learn more about physiotherapy in the field of trauma to ensure that you provide the best possible care for your patients, then this is the right podcast series for you.
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00:00:42.000Joining me today is Cheryl Haley, a physiotherapist from Johannesburg, who agreed to share some of her personal experiences as a trauma survivor.
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00:00:48.719Cheryl, thank you very much for your willingness to contribute to this conversation today.
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00:01:01.119I hope it will enlighten people on the benefit of physiotherapy in trauma cases as well.
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00:01:03.359Yeah, I know, I'm sure it will.
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00:01:12.319As we start, um, won't you just share a little bit with our audience about your background in the physiotherapy profession?
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00:01:16.719So I've been a physio practicing for 25 years.
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00:01:21.040Um I found it an extremely rewarding profession.
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00:01:30.879Um I do largely outpatient work, but I do do some in-hospital, mostly post-orthopedic surgery work as well.
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00:01:37.920So I don't see a lot of trauma as such, but we do see patients immediately post-surgery.
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00:01:43.040Um, and what I really love about physiotherapy is it's just so rewarding.
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00:01:58.879You empower your patients, you help them with their pain, you help them manage their conditions that they've got, and you give them the confidence to do improvements and return back to their normal sort of way of life.
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00:02:16.080I've also, yeah, just in terms of kind of CV, I've done OMT, I've done a master's in sort of knee rehab, I've done a PhD, and I teach some dry needling to qualified physios.
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00:02:28.000Okay, that's wonderful to hear about your clinical involvement over the years, your involvement in teaching and also in doing research within the profession.
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00:02:29.680That's really lovely.
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00:02:36.879Being a physiotherapist, I know that we all like to be physically active when we're not working.
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00:02:41.199Uh, what type of physical activities do you enjoy doing?
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00:02:47.680I agree, we do love being physically active and we recognize the benefits of it.
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00:02:52.639Um I think I used to enjoy physical activity almost too much.
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00:02:56.800Probably um overdid the exercise.
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00:03:01.840I uh used to compete in triathlon, so did swimming, cycling, and running.
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00:03:04.080I'll also do some yoga and Pilates.
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00:03:12.080But yeah, since the injuries, I have only resumed cycling on the indoor trainer now.
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00:03:18.719So talking about the injuries, it was last year that you were involved in this accident.
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00:03:24.479Would you mind telling our listeners a little bit more about what happened on that day?
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00:03:27.280Yeah, so it was one year ago now.
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00:03:33.280Um, a couple of us were just doing an easy cycle on a Saturday in the cradle of mankind.
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00:03:37.280We often ride out there because it's relatively safe.
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00:03:42.639There are a few kind of motor cars and the roads have quite wide cycling lanes.
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00:03:54.080So I was just chatting to a guy next to me when suddenly he saw a baboon running towards us, and he got a fright and reacted and swerved into me and sent me flying.
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00:03:59.039We were probably going quite fast down a hill, maybe 60 kilometers an hour.
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00:04:04.159And I actually don't remember the accident thereafter.
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00:04:11.680I just remember him bumping me from the left side, and I must have woken up about 45 minutes later in an ambulance.
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00:04:13.120My goodness.
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00:04:21.360Yeah, and if you think about it, going on a bicycle at about 60 kilometers an hour, that is actually quite fast.
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00:04:24.160You know, faster than we would think.
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00:04:29.279So, what type of injuries did you sustain with this accident?
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00:04:38.000So, funny, when I woke up in the ambulance, I could immediately feel that I'd fractured my pelvis and my sacrum.
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00:04:53.600And uh then I had a CT scan, which confirmed two fractures on the left of the pelvis, the superior and inferior pubic ramus, which are two of the bones in the pelvis, and on the right side the inferior pubic ramus, which is also one of the bones in the pulvis.
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00:04:57.439And the right side of my sacrum was fractured all the way down.
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00:05:00.639It was on CT scan, it kind of looked like it was crushed.
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00:05:09.680So there were little bone fragments that had gone through the neural foramen, which are the little holes in the sacrum through which your nerves exit.
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00:05:18.240Um, and I had a bone fragment sitting on one of my nerve roots on the S2, which caused a lot of neural pain down my leg.
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00:05:22.160Um, I had two large hematomas within the pelvis.
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00:05:25.680I'd fractured my fourth and fifth rib on the left.
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00:05:46.079I had quite a severe concussion and a whiplash, and quite a lot of facial wounds on the the left side of my face, left side of my eye and forehead that included a lot of tissue loss and facial nerve injury on the left side of my face and forehead.
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00:05:48.879Yeah, so quite severe injuries.
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00:05:49.439Yeah.
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00:05:55.600Oh, and I had lung contusions, which are important in a traumat talk.
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00:05:58.160Yeah, no, definitely.
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00:06:04.240But um, equally important is the concussion and the pelvic injuries that you had.
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00:06:05.199Yes.
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00:06:09.759So what management did you receive in the hospital?
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00:06:15.279Uh so I was admitted to high care where I spent six days.
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00:06:18.480Um, the fractures were managed conservatively.
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00:06:36.240The both the orthopedic surgeon and the neurosurgeon suggested that trying to reduce the fractures surgically could end up um creating more complications, particularly in the pelvic area, disruption of the bladder and bowel, which thankfully at that stage were okay.
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00:06:38.240So the organs were good.
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00:06:42.240And they said it didn't necessarily accelerate the recovery.
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00:06:45.600So all the fractures managed conservatively.
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00:06:58.399Um I had two surgeries done on my face by the plastic surgeon, including a full thickness skin graft that he took out of my neck and sewed into the side of my face.
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00:06:59.360My goodness.
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00:07:04.480And he he thankfully managed to largely sort of save the facial nerve.
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00:07:10.720So slowly I could start getting some sensation and some feeling back in the side of my face.
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00:07:11.759Thankfully.
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00:07:12.319Yeah.
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00:07:28.000So, Cheryl, I just want to clarify for our listeners, you mentioned at the time of the accident you lost consciousness, but then you woke up 45 minutes later, and after that you had not lost consciousness again.
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00:07:29.120Is that correct?
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00:07:30.160No, yes.
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00:07:32.160I didn't lose consciousness a second time.
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00:07:41.360Okay, so that's why you were managed in high care versus being in ICU, needing ventilation and things like that.
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00:07:41.920Yeah.
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00:07:42.560Okay.
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00:07:48.079Yeah, and the brain scan also didn't reveal any visible brain injury.
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00:07:54.319Um, there was only the hematoma and the tissue loss on the kind of exterior of the skull.
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00:07:59.120So the brain and the spinal cord were okay, thank goodness.
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00:07:59.920Yeah.
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00:08:05.759And I suppose together with all of this, you must have been on strong painkillers.
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00:08:08.800I was on lots of painkillers.
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00:08:19.040And um were there any side effects you think from being on the strong painkillers while you were in the hospital?
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00:08:21.759Anything specific that you noticed?
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00:08:33.679The biggest challenges I found in those first couple of days was that, you know, as kind of an athlete anyway, my heart rate and blood pressure tended to be low on a good day.
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00:08:39.440So the strong painkillers dropped my heart rate and my blood pressure even further.
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00:08:46.000So I was often sitting in the 30s for the heart rate, and my blood pressure didn't really go above 90 over 60.
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00:08:58.960And after a couple of days, I felt that that was my biggest challenge when the Mary Physio came along to try and get me up, is I was so lightheaded that that was holding me back more than the pain was.
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00:09:08.879So I chatted to the doctor and I said, you know, we really need to try and, you know, reduce the pain tablets a bit so that I can have some blood pressure when I stand up.
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00:09:13.519Um so that he did, and that improved quite quickly, which was great.
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00:09:20.159I was also quite concerned about being constipated because that's the last thing you need with numerous fractures in your pelvis.
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00:09:27.759So thankfully they did give me lots of mooty to help get my tummy going, which was good.
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00:09:33.200Um, so I'd say those were the main side effects of the medication itself.
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00:11:20.639Okay.
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00:11:33.920And um, you were back and forth to theater twice for the surgery on your face, meaning that you were under anaesthetic for a few hours at a time, I would assume.
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00:11:37.680So, did that impact your breathing at all?
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00:11:46.800Did you feel that you had any secretions in your chest that you had to try and cough up despite the rib fractures and the contusion?
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00:11:56.000Yes, I must say I didn't recognize whether it was particularly bad after the anesthetic or not, whether the anesthetic um contributed to it.
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00:12:11.759I was also, yeah, I was definitely concussed and I was on all those pain tablets, so I don't remember every detail very clearly, but I do remember being very mindful of my chest, particularly you know, as a physio, watching my sats, making sure they stayed up.
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00:12:22.160I was on a nasal cannula um with oxygen until I, even when I moved into the normal ward, I was still on a nasal cannula getting oxygen.
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00:12:27.600And I would do my breathing exercises religiously a few times a day.
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00:12:36.879Um I don't think I had a nebulizer, and I don't think I thankfully developed a chest infection because of the contusion on the lung.
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00:12:43.280Interestingly, although the rib fractures were on the left, the contusion was worse on the right, the right lung.
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00:12:53.520So I did do my breathing exercises and some of my friends came around with a toy baboon, which they thought was a hilarious joke.
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00:13:04.000But it worked really well to hold under my arm and help brace my ribs when I did need to cough to try and clear my secretions.
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00:13:15.600How did it feel to be a patient suddenly in the hospital when you're really so used to being the professional providing care for patients in the hospital?
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00:13:20.080Yeah, it was a very interesting and enlightening experience.
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00:13:24.160You know, a lot of the information and the do's and don'ts, you know.
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00:13:29.280You know about keeping your sets up, keeping your blood pressure up, side effects of medication.
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00:13:37.520I was very conscious of preventing clots as well, because I could not move either leg other than just moving my foot up and down at the ankle.
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00:13:40.320So I couldn't move either leg independently.
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00:13:44.639So I did lots of um calf pumps to prevent a DVT.
00:13:45.040 -->
00:13:49.759So I kind of feel I just woke up and I thought, right, this is the situation.
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00:13:51.280This is what we've got to do.
00:13:51.440 -->
00:13:54.639You know, just you've just got to go with it now.
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00:13:57.920Here you are, be the best patient you can be.
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00:14:01.759Um so I think that did help.
00:14:01.920 -->
00:14:12.720I also learned a few things about um, you know, pressure under the heels, general pressure areas that you get, the the benefits of those calf pumps.
00:14:12.960 -->
00:14:17.200I definitely remember that it was very important to be nice to your nurse.
00:14:17.600 -->
00:14:23.440So bring them cupcakes and be a good patient.
00:14:24.000 -->
00:14:29.280And then they'll willingly help you when you need help because you need help.
00:14:29.600 -->
00:14:46.800And I think that was certainly one of my biggest challenges is you're so used to being able to not only be independent and do everything you need yourself, but also help other patients all the time and help them to put on their slippers and do whatever they need to do.
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00:14:50.240And now you're the one continuously asking for help.
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00:14:51.360Yeah.
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00:15:08.639Now, I think uh many of the physiotherapists listening to this discussion will agree that we are all people that are problem solvers, and it's very difficult for us to sit back and say, now I need help myself.
00:15:08.879 -->
00:15:12.639Um, so I totally understand what you mean.
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00:15:18.879Um, can you maybe just tell us a little bit about your recovery journey in the hospital?
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00:15:26.960You mentioned that you um couldn't really move your legs yourself apart from the fact that you could move your ankles.
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00:15:32.320Um, how did mobilization out of bed happen in your case?
00:15:32.720 -->
00:15:38.879So thankfully, I did have a lovely physio who was very experienced in seeing trauma patients.
00:15:39.280 -->
00:15:46.720And I suppose my knowledge of keeping things closed chain, particularly with you know multiple pelvic fractures, helped.
00:15:46.960 -->
00:15:55.840So we would just do some gentle heel slides, keeping the foot in contact with the bed and ease up and over the side of the bed.
00:15:56.000 -->
00:16:05.520And the physio was really great, although I knew what needed to be done, and I mobilized patients myself when I'm the physio treating patients.
00:16:06.320 -->
00:16:08.560I was really scared.
00:16:08.879 -->
00:16:11.120You know, I was sore.
00:16:11.600 -->
00:16:13.360I could see my blood pressure wasn't great.
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00:16:21.120So I feared standing up and passing out and falling down with a pelvis that already fell black, a bag of bones.
00:16:22.000 -->
00:16:32.240And the physio just really gave me the confidence to do this, to get up and stand up and, you know, wake me through my arms, which were thankfully nice and strong.
00:16:32.480 -->
00:16:49.200And I think it's just so important to have that person that you trust and that is going to hold your hand through this journey, you know, almost more than the knowledge, that experience that they have, that, you know, we can we can do this and get you up and mobilize with a walker.
00:16:49.600 -->
00:17:00.480And also just highlighted how important it is to have good general and physical health and I suppose mental health, so that you can take on these.
00:17:00.639 -->
00:17:08.160And, you know, I could use one of my physio straps and pull my own legs up and help my them out the bed.
00:17:08.240 -->
00:17:21.359I asked my husband to bring it from home and um, you know, then I could use them and pull my my legs up and take one out the bed and then take the other one out the bed, and up we got.
00:17:21.839 -->
00:17:23.599Yeah, you made a plan.
00:17:24.240 -->
00:17:27.039Yes, yes, we did lots of making plans.
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00:17:35.119Um, and Cheryl, the just talk a little bit about your facial injuries.
00:17:35.279 -->
00:17:41.200Um, what was the treatment protocol regarding that after the surgery?
00:17:41.440 -->
00:17:46.960What were you allowed to do and not to do with the graft that was on your face?
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00:17:55.839Yeah, so for five weeks I wasn't allowed to get my face wet, which also made extra challenging, you know, getting into the shower.
00:17:56.160 -->
00:18:00.240And it had to be the skin graft had a special dressing on it.
00:18:00.400 -->
00:18:05.039It was sort of like a spongy dressing that had to be cleaned.
00:18:05.359 -->
00:18:10.879I had that um Cloromax ointment, which was absolutely amazing stuff.
00:18:11.039 -->
00:18:19.519It's usually used for pink eye, but this plastic surgeon just insisted it and put it all over all the facial wounds of my face.
00:18:19.759 -->
00:18:30.240And um, so every morning and every evening I had to clean the wounds with the sterile saline and gauze, and then apply this Cloromax to the wounds.
00:18:30.480 -->
00:18:50.960So my mum thankfully also came round every day to assist me with this because it was also a bit tricky to do yourself, and you're a little bit disorientated in blurred vision, and you just felt like you needed a little TLC almost, a little extra help with those, with the dressing of the facial wound.
00:18:51.119 -->
00:18:58.159And then, you know, I had to just hold some a little plastic shield over my face if we tried to wash my hair.
00:18:58.399 -->
00:19:05.919Then I'd sit on a plastic chair in the shower, and my husband would do his best effort at washing my hair.
00:19:06.480 -->
00:19:16.000So, yeah, face couldn't get washed at all for a number of weeks, and then after five weeks I could start getting it wet, but no soap.
00:19:16.720 -->
00:19:23.839And after about two months, I could start with just a very gentle sort of face cleanser.
00:19:24.319 -->
00:19:24.639Okay.
00:19:25.279 -->
00:19:30.159And what about a stiffness in your face with a soft tissue?
00:19:30.399 -->
00:19:36.079Were you allowed to do some facial exercises and stretches at all?
00:19:37.039 -->
00:19:48.399So I wasn't for I'd say the first two months, I think it was the eight-week checkup with a plastic surgeon that I could only start doing some facial exercises.
00:19:48.559 -->
00:19:56.159It was a little tricky because I can't only raise the one side of my forehead, you know, the one eyebrow.
00:19:56.480 -->
00:20:06.000So it was actually really sore because if I was speaking, I'd often, you know, well, I do often move my eyebrows up and down as as you speak.
00:20:06.159 -->
00:20:08.240You, you know, have these facial expressions.
00:20:08.399 -->
00:20:12.960And then the right side would move and pull on the wounds on the left side.
00:20:13.279 -->
00:20:15.679So that that was quite sore initially.
00:20:15.839 -->
00:20:25.599So after two months, I could start doing some very gentle scar massage and and some some facial exercises.
00:20:25.919 -->
00:20:38.720But the they were so sore that the plastic surgeon actually gave me a little bit of Botox in the right side of my forehead, just so that the right side could relax and calm down and it wasn't continuously pulling on the left side.
00:20:38.960 -->
00:20:46.639Because I'd find if somebody came to visit and I was talking a lot, I really had a lot of pain then in my forehead and eye.
00:20:46.879 -->
00:20:50.799Uh fortunately, my Yeah, my eye could close and open.
00:20:50.960 -->
00:20:58.000Okay, so it was just squinting, frowning, and the forehead, the the real muscles of facial expression that were affected.
00:20:58.319 -->
00:21:05.839Yeah, it's it's interesting how movement on the opposite side actually caused so much discomfort.
00:21:05.919 -->
00:21:22.960And I would think that um the muscles on the opposite side, the uninjured side, were in some sense trying to overcompensate while you were talking and trying to express yourself because on the affected side there was not as much movement.
00:21:23.119 -->
00:21:30.240So one can think about that um or just imagine that imbalance in muscle activity.
00:21:30.399 -->
00:21:36.240So thank goodness the doctor had a solution in the sense of Botox injections.
00:21:36.319 -->
00:21:38.159Um, and that that helped a lot.
00:21:38.319 -->
00:21:39.119That's great.
00:21:39.439 -->
00:21:42.159Yes, it did just help through that recovery time.
00:21:42.480 -->
00:21:43.119Yeah.
00:21:43.679 -->
00:21:49.519Cheryl, I want to come back a little bit to your inpatient um journey.
00:21:49.679 -->
00:21:56.480You mentioned with your pelvic fracture when you started getting up out of bed, you were using a walking frame.
00:21:56.720 -->
00:22:00.319How long were you on that walking frame for?
00:22:00.639 -->
00:22:03.279And were you discharged home with it?
00:22:03.439 -->
00:22:07.119Um, if you can maybe just paint the picture there a little bit more.
00:22:07.679 -->
00:22:10.960Yes, I was discharged with the walking frame.
00:22:11.199 -->
00:22:14.720Fortunately, so I was discharged after eight days.
00:22:14.879 -->
00:22:25.599I only spent two days in the normal ward, and then I the the surgeon wanted to send me to step down for two weeks, and I convinced him that I'd be fine because I'm a physio.
00:22:26.399 -->
00:22:31.759Um so I came home, and thankfully, we don't have stairs at home, otherwise, it I would have had to go to step down.
00:22:31.919 -->
00:22:35.279So we have a flat house and our shower is quite easy.
00:22:35.359 -->
00:22:36.960I can walk straight into it.
00:22:37.199 -->
00:22:43.279So thankfully, our house is very practical, which I specifically made that way.
00:22:43.759 -->
00:22:44.879And so that helped.
00:22:44.960 -->
00:22:49.599Um, but I was on the walking frame for five weeks, actually.
00:22:49.919 -->
00:22:53.439Because I couldn't really put full weight on either leg.
00:22:53.919 -->
00:23:00.639After about three weeks, I ambitiously tried some crutches and I was in absolute agony after that day.
00:23:00.799 -->
00:23:02.720So had to go back to the walker.
00:23:02.879 -->
00:23:05.759So yeah, walker full time for five weeks.
00:23:06.079 -->
00:23:13.679Thereafter, I got onto two crutches, which I used up until 11, the 11-week mark.
00:23:13.839 -->
00:23:19.679But I would still use my walker if I got up at night and I would walk it all the way into the shower.
00:23:19.919 -->
00:23:23.199So nighttime and shower time, I still used the walker.
00:23:23.359 -->
00:23:28.159And every now and then, if I got tired and I was a bit sore, I would still use the walker.
00:23:28.559 -->
00:23:32.639So I I really advocate for a walking frame.
00:23:32.799 -->
00:23:47.599You know, after myself being quite a strong, physically active person, and I still found a walking frame to be so valuable because the crutches, you know, when you've got so many fractures, are tricky.
00:23:47.759 -->
00:23:52.639Plus, you've got the rib fractures, so weight bearing through the left side was difficult.
00:23:53.039 -->
00:23:54.399Yeah, I can imagine.
00:23:54.879 -->
00:24:12.720We are sometimes very quick to wean patients off a walking frame onto crutches, but there are times clearly that being on the walking frame a little bit longer is actually more convenient and comfortable for for the patient recovering from your type of injuries.
00:24:13.119 -->
00:24:14.639Yes, I agree.
00:24:14.960 -->
00:24:15.599Yeah.
00:24:15.919 -->
00:24:18.159I was wondering about sitting.
00:24:18.399 -->
00:24:25.679How long did it take for you to be able to sit comfortably again with those pelvic ring fractures?
00:24:26.319 -->
00:24:29.279So interestingly, I could sit straight up.
00:24:29.359 -->
00:24:39.039So if I was sitting on like my office chair or a dining room chair, that was comfortable, even although I was weight-bearing on those initial tuberosities.
00:24:39.199 -->
00:24:49.119I think that my sacrum was so painful that I could not sit on the couch for a couple of months, actually.
00:24:50.000 -->
00:24:55.919Even the dog would look at me as if to say, Why are you sitting on the office chair in the lounge?
00:24:56.559 -->
00:24:59.679Why don't you come and sit on the couch like everybody else?
00:24:59.919 -->
00:25:05.359So any sort of sacral sitting or relaxed sitting would really hurt for a long time.
00:25:05.439 -->
00:25:13.439And in fact, even now, one year down the line, I can't do a sort of relaxed sacral sit for a long time.
00:25:13.599 -->
00:25:16.319I the sacrum just gets way too uncomfortable.
00:25:16.559 -->
00:25:22.639So thankfully, sitting was okay because lying down was also not that comfortable.
00:25:22.799 -->
00:25:26.639I couldn't lie on either side, so I could only lie on my back.
00:25:26.960 -->
00:25:37.279And trying to get into lying and sitting back up again, I could hardly use my abdominals because as you use your abdominals, they pull on the you know the pubic ramus.
00:25:37.599 -->
00:25:40.000So that was very painful.
00:25:40.319 -->
00:25:43.439So lying down was not a pleasure.
00:25:44.960 -->
00:25:49.599So I would actually sit up mostly in the office chair most of the day.
00:25:50.000 -->
00:25:55.839Yeah, no, and those are things that you don't know unless you've gone through them.
00:25:56.079 -->
00:25:56.480Yeah.
00:25:56.960 -->
00:26:10.319Quite a long recovery period that you've had, and up to a year now after the injury, you still have some consequences that are causing you discomfort around the sacral area.
00:26:10.559 -->
00:26:10.879Yeah.
00:26:11.119 -->
00:26:22.079So it's good to know about these things, and um, you know, it will help all of us to be a little bit more empathetic with patients with pelvic fractures that are recovering.
00:26:22.480 -->
00:26:31.839So chronic pain, I assume there has been a bit of chronic pain in the pelvis and the sacral area, as you've uh mentioned.
00:26:32.399 -->
00:26:38.240Any other places where you've had discomfort even now, one year down the line?
00:26:38.960 -->
00:26:46.879I have managed to resume some running, but that does cause a bit of pain if I run too fast or too far.
00:26:47.119 -->
00:26:58.480And particularly running downhill, I almost feel as if my kind of lumbar sacral junction has it feels like it's changed shape, which I know it sounds like a very patient thing to say.
00:26:58.960 -->
00:27:05.839But um my my running stride just doesn't feel the same as it used to.
00:27:06.000 -->
00:27:12.480So running uphill is completely comfortable, but running downhill really does hurt in the sacrum.
00:27:12.799 -->
00:27:18.559And then my my back muscles and my periformis, particularly, go into a bit of a spasm.
00:27:18.799 -->
00:27:23.039And I'm assuming it's just the periformis then that sometimes catches the sciatic nerve.
00:27:23.119 -->
00:27:27.359And occasionally I'll get some sciatic nerve pain down my one leg still.
00:27:27.679 -->
00:27:31.439And how do you manage your pain at this stage?
00:27:32.159 -->
00:27:41.519Mostly I so swimming really helps, particularly swimming with the pool boy, um, which is that little foam thing that you put between your thighs.
00:27:41.679 -->
00:27:48.079I think that just gives you that forced closure and then to help stabilize the pelvis.
00:27:48.240 -->
00:27:50.079I also have worn an SI belt.
00:27:50.159 -->
00:27:57.439The Physio in hospital gave me an SIJ belt, so that I wore continuously in the first couple of months.
00:27:57.599 -->
00:28:01.519And now, if I am, so I still go and put my SIJ belt back on.
00:28:01.679 -->
00:28:18.079And I do still go for physio from time to time to one of my colleagues, and they'll work a little bit on the periformis and my lumbosacral junction, the lumbospine, just releasing some of those tight muscles that go into spasm and a lot of protective spasm.
00:28:18.399 -->
00:28:18.799Yeah.
00:28:19.119 -->
00:28:19.439Okay.
00:28:20.319 -->
00:28:34.720So I wanted to ask a little bit about your mental well-being and your cognitive function after the injury and how that has changed to this point after the accident.
00:28:35.039 -->
00:28:46.159Did you experience any difficulties in memory or remembering things, not just from the accident, but on a day-to-day basis because of the concussion?
00:28:46.799 -->
00:28:47.279Yes.
00:28:47.519 -->
00:28:51.119So that was definitely one of my major concerns.
00:28:51.599 -->
00:29:04.720Initially, I suppose I was a bit dazed and confused, and I'd had anesthetic and I'd had medication, and I almost wasn't sure, you know, what was contributing to my kind of brain fog feeling.
00:29:05.759 -->
00:29:14.720And after about two weeks, I'd sent my family to the shop with my bank card and I told them what the pin was.
00:29:14.960 -->
00:29:18.559And they phoned me from the shop and said that pin's not working.
00:29:18.720 -->
00:29:20.879And I absolutely could not remember my pin.
00:29:21.039 -->
00:29:22.639It's been the same pin for years.
00:29:22.879 -->
00:29:24.240I'm good with numbers.
00:29:24.960 -->
00:29:30.639And then I realized, okay, all is not, all is not back to normal.
00:29:31.359 -->
00:29:34.480So yeah, memory definitely took a toll.
00:29:34.799 -->
00:29:43.119I was, you know, I couldn't remember people's names, even people I knew quite well, which was sometimes a bit embarrassing.
00:29:43.279 -->
00:29:45.679And just little things I would just miss.
00:29:45.759 -->
00:29:58.319And I didn't really notice, but my husband had said in hindsight, you know, he I would definitely forget things, and he would say something, and I'd completely forgotten that it had happened, and it was just sort of the day before.
00:29:58.720 -->
00:30:00.799Yeah, the accident I still don't remember.
00:30:01.519 -->
00:30:06.799I found I'm still yeah, I still need to write something down.
00:30:06.960 -->
00:30:10.399If I don't write something down, I forget to do it.
00:30:10.960 -->
00:30:14.799So that's just has to become my new routine.
00:30:15.119 -->
00:30:19.279My eyesight is still not where it was before the accident.
00:30:20.000 -->
00:30:23.839Um so yeah, the concussion, the concussion was a concern.
00:30:24.559 -->
00:30:33.279I think the biggest disappointment, and I know you yeah, you might allude to this later, but the concussion I feel wasn't diagnosed properly in hospital.
00:30:33.439 -->
00:30:40.240And at the six-week follow-up with the neurosurgeon, he kind of asked me if I'd had any headaches, which surprisingly I hadn't.
00:30:40.399 -->
00:30:46.960I don't know if that was just because I was still taking, you know, something for pain and that then knocked out the headache for the day.
00:30:47.039 -->
00:30:48.960But surprisingly, I didn't get headaches.
00:30:49.119 -->
00:30:52.079And he said to me, Oh, so you didn't have a concussion, did you?
00:30:52.720 -->
00:30:56.399I kind of thought, well, I was unconscious for 45 minutes, you know.
00:30:56.720 -->
00:30:58.720Yes, I had a concussion.
00:30:59.039 -->
00:31:03.919And then he said, Oh, well, we better, you know, send you for another concussion assessment.
00:31:04.399 -->
00:31:13.599So then I thought, okay, let me go to uh, you know, Megan Robinson, who I know is a concussion physio and an expert in the field.
00:31:13.839 -->
00:31:20.319And when she did the assessment, I found we found a whole lot of symptoms that I was still experiencing.
00:31:20.639 -->
00:31:25.839And it's really so much more than just headaches because I still hadn't been getting headaches.
00:31:26.000 -->
00:31:36.399And I actually learned a fortune about concussion, which I think you know is a well, when I qualified, concussion wasn't really part of the syllabus, and it's not something I knew a lot about.
00:31:36.639 -->
00:31:45.839And now finding out all the symptoms from memory to eyesight to hearing sensitivity, you know, poor sleep, anxiety, which is not something.
00:31:46.159 -->
00:31:48.000Something I used to struggle with.
00:31:48.240 -->
00:31:54.079But definitely screen time and you know the ability to scroll on a screen.
00:31:54.399 -->
00:32:01.679And I was even struggling to control my body temperature, which I've learned is all symptoms of concussion.
00:32:01.919 -->
00:32:04.879So just having that knowledge helped a lot.
00:32:05.119 -->
00:32:12.079I then went to a neurooptometrist who assessed my eyesight and saw that my eyes weren't converging.
00:32:12.240 -->
00:32:15.199So I was struggling to focus on a point in front of me.
00:32:15.279 -->
00:32:17.599Um and hence my eyesight was blurry.
00:32:17.919 -->
00:32:22.559So I had special prism lenses made for my glasses.
00:32:22.720 -->
00:32:25.519And I can see that it's still not perfect.
00:32:25.839 -->
00:32:42.159Um, she did give me lots of eye exercises to do thereafter, but unfortunately, this was already eight weeks post the accident, and she gave me lots of advice and about scrolling on your phone and not watching a screen in a dark room.
00:32:42.319 -->
00:32:52.960And I just wished that I'd been given that sort of advice immediately after the injury because I did actually spend a fair bit of time in front of a screen because it was one of the few things you could do.
00:32:53.279 -->
00:32:59.119Sit and look at your screen and possibly delay my brain recovery.
00:32:59.599 -->
00:32:59.919Okay.
00:33:00.639 -->
00:33:04.480So how do you manage this on a day-to-day basis?
00:33:04.639 -->
00:33:10.000Is it uh continuing with the exercises and writing things down?
00:33:10.240 -->
00:33:23.519Do you find that you're able to cope with the fact that your cognitive function as a result of the concussion is not optimal yet, or does it cause you more frustration than anything else?
00:33:24.079 -->
00:33:36.879I suppose I've just largely had to accept, well, this is where we're at, optimistically hoping things will still improve because they are improving by the day, but I do write everything down.
00:33:37.199 -->
00:33:39.919I do still do most of my exercises.
00:33:40.079 -->
00:33:49.279I was given quite nice exercises to do actually while I'm exercising, because that was one of the it's it's the multitasking as well that's tricky.
00:33:49.519 -->
00:34:02.079So not just sitting still and doing your eye exercises, but you know, riding on an indoor bike or running and doing your eye exercises while you're busy with that and eye hand coordination exercises.
00:34:02.319 -->
00:34:07.919Yeah, I had to pass a couple of the eye hand coordination exercises before I was cleared to drive.
00:34:08.159 -->
00:34:19.920So driving was not just up to my physical ability and the status of the pelvis, but I actually had to, my reactions had to be sharp again before I could drive.
00:34:20.240 -->
00:34:24.400So yeah, on a day-to-day basis, now I just write things down.
00:34:24.480 -->
00:34:31.119I still do my exercises, I still wear my glasses, and I don't scroll on my phone excessively.
00:34:32.880 -->
00:34:43.760Um, okay, no, so it shows that you've been able to adapt and um that you are consciously trying to still move towards as much recovery as possible.
00:34:44.079 -->
00:34:46.079How about return to work?
00:34:46.240 -->
00:34:49.119When were you able to return to work?
00:34:49.840 -->
00:34:52.720I could return to work after four months.
00:34:52.880 -->
00:35:08.480Uh I was optimistically hoping to return after three months, but the physio that I went to with that for the concussion actually explained even the impact on the concussion on your work, that the fatigue is so much greater.
00:35:08.720 -->
00:35:19.920It's quite interestingly that the concussion symptoms are strongly correlated with long COVID symptoms, that is sort of the brain fog and fatigue.
00:35:20.159 -->
00:35:30.400And she said, if you go back too soon and you get fatigued, the patients aren't necessarily going to understand that you're not sore, you're just not coping.
00:35:30.559 -->
00:35:38.159And the anxiety might come to play and you might have a complete meltdown and burnout so much easier.
00:35:38.240 -->
00:35:44.159So she advised, you know, to give it four months and progressively increase your patient load.
00:35:44.400 -->
00:35:52.000I have found that I still can't quite take on masses, like a huge patient load day after day.
00:35:52.320 -->
00:35:54.880I just get quite burnt out and quite fatigued.
00:35:54.960 -->
00:35:59.119And then you just feel that you're not giving your patients the best, which nobody wants that.
00:35:59.360 -->
00:36:05.199So I've had to just moderate my days and some days have a lower patient load than other days.
00:36:05.759 -->
00:36:11.519Um yeah, and I also found I had to be, yeah, especially working in the hospital.
00:36:11.759 -->
00:36:28.079I take extra time, just allocate myself extra time to ask a nurse to help me if I needed to, you know, lift something heavy, push the the bed all the way up, you know, because I'm quite tall, so I could reach the patient nicely without bending over and compromising my own well-being.
00:36:28.239 -->
00:36:40.719So I've just definitely spent a little extra time, you know, doing things slowly and carefully and not hurting my own back and my own pelvis when trying to help the patients, particularly in hospital.
00:36:41.119 -->
00:36:49.119Yeah, so pacing yourself and really knowing where your limits are and not exceeding those to your own detriment.
00:36:49.440 -->
00:36:50.079Yes.
00:36:50.400 -->
00:36:53.519That's a very good management approach.
00:36:53.840 -->
00:37:03.440Um, so how has this experience of being a patient influenced your management of your patients now?
00:37:04.239 -->
00:37:18.400I think one of the things is realistic goals for the patients because I was under the impression that after six weeks, the magic bone healing fairy flew over and your bones were fixed.
00:37:19.199 -->
00:37:32.159And uh and I realized after six weeks there was no way I was getting on to one crutch, definitely not no crutches, and that this takes a lot of a long time.
00:37:32.239 -->
00:37:45.440And even if you've been the best patient and you've done your homework and you don't smoke and you don't have comorbidities, and you fit these injuries take time, and it's not from one day to the next, particularly at that six-week mark.
00:37:45.599 -->
00:37:53.920I did have a bit of a meltdown at that six-week mark when I had my follow-up x-rays and those fracture lines were as clear as they had been on the first day.
00:37:54.239 -->
00:38:03.119I felt like no healing had occurred, and they just explained this is going to take some time, especially when there's more than one fracture in the same pelvic ring.
00:38:03.440 -->
00:38:10.559And also I've understood now the disappointments, particularly in a trauma situation where this was an accident.
00:38:10.799 -->
00:38:17.440One day I was planning on, um, so two weeks after the accident, I was planning on flying to Cape Town.
00:38:17.519 -->
00:38:26.880I was going to present my PhD research at the SASMA, which is the South African Sports Medicine Association Congress in Stalinbosch.
00:38:27.039 -->
00:38:28.400That was on the Friday.
00:38:28.639 -->
00:38:32.079And on the Sunday, I was planning to race Cape Town Marathon.
00:38:32.159 -->
00:38:33.599I was going for a personal best.
00:38:33.759 -->
00:38:35.840I'd been training exceptionally hard.
00:38:36.079 -->
00:38:39.279And all these dreams were just crushed.
00:38:39.840 -->
00:38:48.000So I just had immense disappointments, and I just felt like I'd been handed such a raw deal.
00:38:48.400 -->
00:38:59.759So mentally, that's a huge thing that you now have to not only deal with the physical nature of these injuries, but the disappointment on where you wanted to be and where you are now.
00:38:59.920 -->
00:39:02.559And I've now started recognizing that in my patients.
00:39:02.639 -->
00:39:05.199And it's not always that they were going for physical goals.
00:39:05.360 -->
00:39:10.239You might have had somebody, an elderly person, was going to go overseas and visit their grandchildren.
00:39:10.400 -->
00:39:14.639They had a fall, they fractured their hip, they had to cancel their trip.
00:39:14.799 -->
00:39:16.719And it's devastating for them.
00:39:16.880 -->
00:39:20.480You know, they don't know when they're going to see their grandkids next.
00:39:20.719 -->
00:39:32.960And that's not about the physical pain and the surgeries and the rehabilitation, but just that emotional journey that you have to accept that this is where you're at.
00:39:33.199 -->
00:39:35.840You need help, you have to ask for help.
00:39:36.000 -->
00:39:38.559You know, you're not used to asking for help.
00:39:38.960 -->
00:39:44.319And you say, and and people will gladly help you, but you have to express what you need.
00:39:44.480 -->
00:39:49.759They're not psychic, they're not telepathic, they can't just know what you need.
00:39:49.840 -->
00:39:54.960You have to ask them nicely, say thank you, and and so you go.
00:39:55.199 -->
00:40:01.440So this is definitely something I've learned through this experience that I can chat to my patients about.
00:40:01.519 -->
00:40:16.719And I think they're so grateful that somebody understands their frustration and that they can express their frustration, that sometimes that you get frustrated with your family, but they're actually trying their best and they don't know what you're going through.
00:40:16.799 -->
00:40:18.319You have to tell them.
00:40:18.719 -->
00:40:26.559So I almost feel that their mental and emotional journey has enriched me as a physio being a patient.
00:40:26.880 -->
00:40:29.039But also back to the walking frame.
00:40:29.279 -->
00:40:33.199Now I strongly advocate for the walking frame with most of my patients.
00:40:33.279 -->
00:40:46.079And I tell them I've walked with a walking frame because I can see some of them look at me as if, you know, no walking frames are for old people, even if they're, you know, over 70 and have had a hip or knee replacement.
00:40:46.480 -->
00:40:55.840And then when I released, tell them that, you know, safety first, function first, and it doesn't matter what you look like, the walking frame is not forever.
00:40:56.159 -->
00:40:57.519Yes, exactly.
00:40:58.079 -->
00:41:04.400Cheryl, it's very clear that you've been through quite an ordeal after this accident.
00:41:04.480 -->
00:41:07.599And as you said earlier, it was an accident.
00:41:07.679 -->
00:41:11.119It's not something that you could foresee happening.
00:41:11.519 -->
00:41:38.159And it is really heartwarming to hear how you have coped in your recovery up to this point, which is one year after the accident, and how you are a lot more empathetic and sympathetic as a physiotherapist towards your patients now, and that you can actually share some of your personal experiences and advice with your patients.
00:41:38.639 -->
00:41:44.719So thank you so much for being willing to talk about all of this today.
00:41:45.119 -->
00:41:55.039As we wrap up the discussion, are there any last thoughts or reflections that you would like to share with our audience?
00:41:55.759 -->
00:42:10.079I think it's so important to be able to have a different goal that if you were going in one direction and life changes substantially, that you just have something to tie you through over this time.
00:42:10.319 -->
00:42:19.360And I was fortunately busy with my PhD at the time, and I had my last chapter, which was my concluding chapter, to still write.
00:42:19.599 -->
00:42:35.679And this was the biggest blessing through this time because I could get up in the day, I could comfortably sit in my office chair, I could work on my computer, which probably I overdid, not knowing that I should have limited my screen time because of the concussion.
00:42:35.840 -->
00:42:44.400But it gave me a sense of purpose and just a bit of an escape from you know all the physical limitations I had.
00:42:44.639 -->
00:42:49.599So that was really valuable to have something else constructive to do.
00:42:49.840 -->
00:43:07.039And I think if if patients have there's so many kind of online little courses that you can do these days, that if a patient is physically impaired, that they can put that time to constructive use really helps with getting, you know, through.
00:43:07.279 -->
00:43:17.360And while I am also very empathetic with my patients now, I'm also quite strict because I know I've been through this and I've did my exercises diligently every day.
00:43:17.519 -->
00:43:18.799There's no excuse.
00:43:18.960 -->
00:43:21.920You do what you can comfortably manage, but you do it.
00:43:22.079 -->
00:43:31.199You know, you it's breathing exercises, whatever you can manage, you've got to do these exercises to get you through this time.
00:43:31.440 -->
00:43:45.119And also, yeah, just from a medical practitioner and physio perspective, the concussion awareness, I think, is starting to become much more prevalent these days, but it's still highlighted to kind of rugby injuries.
00:43:45.279 -->
00:44:01.279And I think while as physios, we're not going to be experts in every field, but if we can just recognize the little signs and symptoms that this person's had a concussion or this person's, you know, another thing I didn't mention is my bladder wasn't that great.
00:44:01.360 -->
00:44:06.960So I was struggling with urinary incontinence just to add insult to injury in the beginning.
00:44:07.679 -->
00:44:18.960And, you know, just the little tips that the physio gave me to manage that was invaluable because as it is, it takes you so long to get out the bed and head towards the toilet.
00:44:19.039 -->
00:44:25.039And, you know, if the water starts running down your leg before you get there, it's quite soul-destroying.
00:44:25.360 -->
00:44:31.119So, you know, she helped me manage the incontinence as well, which was so helpful.
00:44:31.360 -->
00:44:42.559And, you know, just picking up these little things, and if you can't manage it as the physio, if that's not your field, referring to somebody who does know about this will be really helpful.
00:44:42.719 -->
00:44:47.039And I've probably seen four different physios in my journey, and that's okay.
00:44:47.199 -->
00:44:50.400You know, then you see the expert in this and the expert in that.
00:44:50.719 -->
00:44:54.159And so many people have such valuable knowledge to add.
00:44:54.719 -->
00:44:55.119Yeah.
00:44:55.360 -->
00:44:57.119And you're quite correct.
00:44:57.279 -->
00:45:13.519You know, it doesn't matter how many professionals you see, the important thing is that your quality of life becomes as optimal as possible, despite these lingering symptoms that you still have and that you've learned to cope with.
00:45:13.759 -->
00:45:36.799And I think that just highlights to me again how important it is that the patient communicates to the healthcare professional about their needs, but that we, as the healthcare professionals, also know when to refer on and who to refer to and to do that as quickly as possible so that there's not a delay in the patient's healing.
00:45:37.119 -->
00:45:39.679Yeah, that's absolutely important.
00:45:40.319 -->
00:45:40.960Yeah.
00:45:41.199 -->
00:45:43.199Um, Cheryl, thank you so much.
00:45:43.440 -->
00:45:48.880I could sit and chat here for another three hours, but I think we need to wrap it up.
00:45:49.119 -->
00:45:53.199It was a wonderful discussion, and thank you so much for sharing.
00:45:53.360 -->
00:45:54.880I really appreciate it.
00:45:55.199 -->
00:45:56.239Thank you, Hillian.
00:45:56.319 -->
00:46:01.039It was also good that hopefully something good can come out of this ordeal.
00:46:01.279 -->
00:46:10.639And um, if you know, enlightening other physios and other practitioners is one thing that came out of this that is good, then I'm very happy.
00:46:10.960 -->
00:46:11.119Good.
00:46:11.199 -->
00:46:17.599Yeah, I've learned a lot from you today just by listening to your experience, and I'm sure the listeners will as well.
00:46:17.840 -->
00:46:18.960Thank you, Cheryl.
00:46:19.360 -->
00:46:20.000Okay, good.
00:46:20.079 -->
00:46:20.319Thank you.
00:46:20.400 -->
00:46:21.599Thanks, Hillian.
