Blackbeard’s Death Ocracoke 1718/ My Elbow Day 34

Wednesday, August 17th, 2011 At 11:14 pm

On November 17th 1718, Lieutenant Robert Maynard, of the Royal Navy,  set sail from the James River with a crew of 30 men on the hired sloop Ranger, to find the notorious pirate Blackbeard (AKA Edward Teach) somewhere off the coast of the Outer Banks of North Carolina.  Alongside another sloop named Jane with an additional 25 men, Maynard found the pirates anchored on the inner side of Ocracoke Island on November 21st 1718.

On that same night aboard the pirate ship Adventure, Blackbeard and his crew of only 19 were drinking in his cabin, anticipating what Maynard’s first move would be.  Reportedly, one of the crew asked Blackbeard, ” If ye die on the morrow, does your wife, Mary, know where ye buried the treasure?”  Blackbeard replied,” Damn ye, my friend, nobody but me and the Devil knows where it is hid and the longest liver will get it all.”

Maynard decided to attack on the morning of the 22nd in anticipation of a more favorable tide.  As the two sloops approached Blackbeard’s Adventure, Blackbeard’s superior knowledge of the waters and devastating attack disabled the Jane killing the Captain, midshipman Hyde, along with six others, and wounding 10.  Badly hit, but still in pursuit the Ranger, captained by Maynard, was able to disable the rigging of the Adventure forcing it ashore. Seeing only a few crew members standing on Deck alongside Maynard, Blackbeard decided to board the ship with ten men to end the battle, as he has done many times before.  To Blackbeard’s surprise, the crafty Maynard had ordered most of the crew below deck, and as they emerged, the pirate crew were engaged by a superior force.  The following account of the  ensuing battle was reported on the colonies only newspaper the “Boston News Letter”

“Maynard and Teach themselves begun the fight with their swords, Maynard making a thrust, the point of his sword against Teach’s cartridge box, and bent it to the hilt. Teach broke the guard of it, and wounded Maynard’s fingers but did not disable him, whereupon he jumped back and threw away his sword and fired his pistol which wounded Teach. Demelt struck in between them with his sword and cut Teach’s face pretty much; in the interim both companies engaged in Maynard’s sloop, one of Maynard’s men being a Highlander, engaged Teach with his broad sword, who gave Teach a cut on the neck, Teach saying well done lad; the Highlander replied, If it be not well done, I’ll do it better. With that he gave him a second stroke, which cut off his head, laying it flat on his shoulder”.

Blackbeard was killed, and the battle ended.  The most feared and respected Pirate, was reportedly shot five times and stabbed more than twenty before he was decapitated and died. Legends of Blackbeard spread after his death like wildfire.  There was even a report that after he was thrown overboard, his headless body swam 3 times around the ship.

This is part of the most accepted version of the death of Blackbeard.  There is some debate over who Blackbeard really was,  his relationship with the British government and Governors of Virginia and North Carolina, and his status as a pirate upon his death.  But all accounts confirm a formidable man and adversary. 

As I pondered this story on my recent trip to the outer banks of North Carolina and Ocracoke Island, a few things struck me.  First, it took them a full five days to sail down the James River and the coast of North Carolina to reach Ocracoke.  Perhaps it was due to the need for investigation along their quest to find the elusive Blackbeard, or they were in no rush to be killed and decided to stop for some of the amazing seafood along the Outer Banks.  But I will no longer complain about the beach traffic we have to deal with every time we head up route 12.  Instead I will imagine the fearful anticipation Maynard and his crew had to endure for those five days knowing they were about to face certain death.

Secondly, by most accounts, Blackbeard was shot 5 times and stabbed over 20 times, yet still fought Maynard to his death.  Now, maybe in the heat of battle I would find some inner strength to fight on for the greater good.  Just as in the case of the 120 lb mother who, with superhuman strength, was able to lift a 3500 lb car off of her trapped son,  I could put aside my pain and with the strength of Achilles in the Iliad of Homer, battle on.  But sitting around, as I watched my wife pack and unpack the RV as others looked on, made me feel a little inept and a little guilty.  If  Blackbeard can endure being mortally wounded, yet still swim around the ship in a defiant victory lap, I could chip in a little.  But due to my dedication to my patients, the need to heal my broken elbow so I could return to work, and following Doctors orders, I popped open a Stella and continued to read about the history of Ocracoke Island.

As far as my status, I am now 5 weeks into what will most likely be a 7 to 8 week healing process.  I have been a compliant patient, except for my 2-week hiatus from therapy learning the lore of Blackbeard the Pirate.  I now have a first hand appreciation for what it is that we do at Capitol Rehab, and the importance applying the correct therapy at the correct time.  The well-rounded, balanced approach is of paramount importance.  From acute care, to the final stages of healing (called the remodeling phase) there are things you must demand from your Doctor and Therapist.  On Monday, I will break down the importance of the following from my experince as a practitioner and now as a patient:

• Manual Therapy- What is it and why is it so important.
• Modalities such as IFC (estim), ultrasound, and the often unused Russian Stim- When they should be applied and why.
• Exercise- When is it bad and when is it good.

So, check back next Monday!

My Epiphany- The Making of a Pearl-Days 8-11

Monday, July 25th, 2011 At 9:29 pm

Did you know, before the time of cultured pearls, natural pearls, also known as “the Queen of Gems”,  were so rare, they were reserved for only the very rich and powerful.  It has been reported that the value of just one natural pearl earring was enough to finance a Roman military campaign.  Even today, with the abundance of pearls from farming or “cultured” pearls, a natural pearl necklace can fetch hundreds of thousands of dollars.  This information alone was not an epiphany, nor was it at all new.  But thanks to Father Dobbins’ sermon this weekend, I learned a little more about what it takes to make a pearl.  This information changed my outlook on my injury, and to some degree, my life.

The creation of a pearl is actually an immune response from a mollusk.  These particular species of oyster, mussel, or clam secrete a fluid around an irritant, such as a piece of sand.  This defense mechanism of secretion forms layer upon layer around the irritant until a lustrous pearl is formed.  This irritant, or wound, is similar to my fractured elbow and torn ligaments; and the secretion, is similar to the inflammation.  A beautiful and rare pearl is formed from an irratant.

This simple story, told by a man I greatly respect, had particular meaning for me that day.  The wound I received, and the difficulty it has caused, has turned into a blessing.  Things that I took for granted, such as being able to brush my teeth, eat my food, and play with my children, have been either taken away or made more difficult.  I realize how lucky I am and how much I loved doing those things.

I also had a re-affirmation of what I do for a living.  I love being a Chiropractor and helping people recover from their injuries.  It is easy to get caught up in the day-to-day monotony of paperwork, insurance companies, and other mundane tasks.  At that moment I realized that the mundane tasks are a small price to pay for all the things I enjoy, but have taken for granted.  I look forward to my return.

So what has transpired since last Thursday?  I received three more treatments.  Dr. Ricci adjusted my neck and mid-back to reduce the restriction I had been experiencing.  The adjustments have helped my neck pain and that rib pain tremendously.  My neck pain is currently at a 0/10.  My range of motion in my neck and mid-back is back to normal.  I still have some stiffness around the rib-cage but the sharp pains are gone.  I also had a 1 hour massage on my neck, back and arm.  The combination of better spinal mobility, along with the benefits of massage for circulation and muscle function, have directly improved my elbow.  To see this relationship you must understand what the adjustment of the spine is and what it does for extremity injuries.

According to the World Chiropractic Alliance,

The Goal of the Adjustment:

The goal of a chiropractic adjustment is to correct the spinal subluxations detected during the examination. To do that, the doctor applies pressure to the bone and “unlocks” it from its improper position. The bone will then be free to align itself correctly.

Unfortunately, the muscles connected to subluxated vertebrae get used to their positions and have a tendency to pull the bone back out of place. It may take several adjustments before the adjustment “holds,” and the bone settles into its proper alignment.

So when my neck and mid back were adjusted, it allows for normal range of motion.  This allows for better posture and movement for all the muscles that travel from my back to my shoulder.  This in turn allows for better movement of my shoulder and arm, thus taking stress off of the healing bones, muscles and tendons.

In my career I have seen neck and back adjustment relieve pain in the arms, wrists, knees and ankles of my patients due to this direct relationship.  My bone and soft tissue still have to heal.  But I am allowing them to heal at maximum capacity because I am treating the whole body rather than just the injury itself. I have also increased my vitamin C and water intake.

As for the elbow, it still hurts, and is still very weak.  The swelling is almost completely gone, and my range of motion is still slightly restricted.  All things considered, it has only been 11 days out of the 6-8 weeks it generally takes for these things.  My aggressive therapy seems to be paying off.  I have done Ultrasound, Electrical Stimulation, and both passive and active exercise on the injured side.  I have also increased my exercise on my uninjured arm as there is a small neurological stimulation to the affected side.

Pain: 2/10 spikes 7/10

Swelling: Mild

Prognosis: Good

Next time I will discuss how a good therapist must address more than just exercise and the benefits of myofascial therapy.

Days 5 through 7- My Aching Back

Thursday, July 21st, 2011 At 3:08 pm

Sleeping is the one thing I am innately good at.  Older brothers and sisters (6 of them) who are uninterested in nap-time; bus rides to the early morning high school football games packed with donut-eating sugar crazed teammates; alcohol induced college all-nighters; and crying newborns at 2 AM, wanting something that was impossible to figure out; none of it mattered.  I can sleep through anything.  My wife would be irately jealous of my ability to be thousands of miles away in dreamland within moment of my head hitting the pillow.  But this elbow!!!  It is waking me every few hours.  If I didn’t know better, I would think the amazing wife is accidentally hitting my arm as payback for those nights I slept through the screaming child.  Coincidentally, I did painfully awake a few more times the night after my wife mowed the lawn.  But, I digress.

I saw the orthopedist again on Tuesday.  He still feels confident that no intervention is necessary and to continue as planned.  He warned me to be careful and not overdo it, so as not to re-injure the already mangled ligaments and tendons.  I injured both collateral ligaments.  The medial (closest to the body) better known as “Tommy John Injury” is very tender and bruised.  I guess my childhood dream of playing third base for the New York Yankees, and diving for that game saving catch in a Craig Nettles’ fashion, is finally over.

The orthopedist’s advice is very important at this point.  Since I do not have the elbow braced, it is very easy to over-do it.  I also have to move like an NFL halfback to avoid all those who unknowingly bump into the injured wing.  Not an easy task at my son’s swim meet.  Any injury is very weak and painful in those first 2 to 3 weeks.  Remember, the body is laying down new collagen that is disorganized, weak and tender to the touch.

I was so concerned about my elbow, that I was able to forget the fact my neck and back were impacted.  Remember that “tuck and roll”?  Well the tuck went well, but I seemed to have rolled heavy over my mid back injuring an attachment of one of my ribs and jamming a few of my thoracic vertebra.  Essentially, where the rib attaches to the vertebra there is a cartiliginous attachment that is sprained and subluxed.  It causes muscle spasm and makes it difficult to breathe.  When I try to inhale I get a sharp pain between my ribs that is very uncomfortable.

I have seen a lot of patients with this problem and I now have a better appreciation for their pain.  The Chiropractic adjustment is an extremely effective treatment for this condition, followed by effective exercise to keep it mobile and stabilized for the long run.  This is a good example of the synergy between Chiropractic and Physical Therapy and why the multi-discipline approach, such as we have at Capitol Rehab, is so effective.

So what is my plan for the next week?

I will seek care every other day.  So Tuesday, Thursday, Saturday of this week, and Monday, Wednesday, Friday of next week.  Care will consist of adjustments by Dr. Ricci on the sore Cervical and Thoracic spine as well as that subluxed rib head.  Followed by Electrical Stimulation and Ultrasound on the elbow, and myofascial release (light massage).  Finishing with some pain-free passive and active exercise.

I had my first adjustment on Tuesday and feel much better.  The rib is still an issue and will most likely take a few weeks to stabilize with the adjustments.  I will take each one of the therapies and explain what it is and  why each one is important.  Tomorrow I will discuss the adjustment.  Fridays Topic will be the benefits of soft tissue work such as Massage and Myofascial Release.

Days 5-7

Pain:  4/10 Spikes 7/10

Swelling:  Moderate

Prognosis:  Guarded

Tomorrow’s Topic: Forget what you have heard.  What is a Chiropractic Adjustment and how can it help in your recovery.

The First 96 Hours.. One Word Ouch!!!

Wednesday, July 20th, 2011 At 6:31 pm

Day One:

Immediately I jump to my feet and do a quick scan of my body.  Everything was where it should be.  I thought to myself, “Hey, I am OK.  I should be able to work tonight, because I have a full schedule.  Heck, I should be able to do anther lap.”  This time the voice of denial, which is a close cousin of optimism, was overshadowed by the voice of reason and his brother reality.   The right shoulder and elbow began to ache.  I picked up my bike and began the long walk of shame home.

It really is amazing how the human brain and body works.  That seemingly limitless energy I had only minutes ago, is now gone,  and I was working on the reserve tank.  My son, Johnny, will tell you when the gas gauge says empty, you still have at least one more gallon left. (This knowledge will come in handy when he is a teenager driving home from school.)  As I walked the mile or so home, I considered all the things I must do to prepare the business and family for an injured Dr. John Doepper/Dad.  I wish I could remember everything I considered.  (I think I solved the federal debt crisis, I just cannot remember the plan!).  I went from a brief moment of despair and the old “Why did this have to happen”, to a moment of “I am extremely lucky, I could have really been badly hurt”.  I am awake, coherent, and walking with my bike home.  I have an amazing work environment with talented professionals who will easily take over my responsibilities to insure the quality of care we strive for at Capitol Rehab for our patients.

And, my amazing wife will not only take care of the daily responsibilities, but is also not afraid to mow the lawn.  So I made it home and called Michelle.  My only fear was to break the  news to my children.  Nicole, my daughter, answered the phone.  ” Nicole, I am sorry, but I have some bad news.  You and Johnny have to come home, you cannot go to Chuck E. Cheeses today.”  Surprisingly they handled it well.  “Oh, and by the way, Daddy fell off his bike…but is OK”.

Now I have to take care of the injury.  I decided I did not have to go to Urgent Care or the Emergency Room.  I am not bleeding to death, do not require emergency surgery, and do not have any head trauma. The limited time these life saving doctors have should be reserved for those in need of their expertise.  Besides, I knew I would wait 4 hours to have them X-ray my arm and tell me I need to see an orthopedist.  I waited until the next day to be referred for the X-ray and consulted with an orthopedic surgeon to review said X-ray.

So I applied Basic Orthopedic Rehab Procedures 101, also known as RICE.  Rest, Ice, Compress, and Elevate.  This mnemonic is extremely important in the acute phase of treatment and is based on the basic understanding of the phases of healing.  Chiropractic and Physical Therapy is applied to help promote these phases and is important to understand.  So I will break them down.

Phases of Healing

Acute Phase:

This is what happens immediately after the injury to about 72 hours later:  An inflammatory response that causes swelling, redness and warmth around the injured area.  This is your body’s way of protecting itself.  The swelling causes stabilization in the area and brings healing properties to the injured area.  This is why my arm started to stiffen up quickly and why it would not move.   The area gets warmer because blood is being pooled in the area.  This blood brings those healing properties that kill any bacteria and remove any debris that is building up.  So swelling is very important.  But equally important is to help swelling move in and out.  Thus, the Ice and Elevation.  Ice causes a vasoconstriction that slows excessive swelling, followed by a vasodilation that then increases the flow.  But this flow is more controlled.  Swelling is like water, it is essential for life.  But as any resident of Sioux City, Iowa that has had to sit back and watch the Missouri River engulf their town will attest, too much water is not always a good thing.  Excessive swelling, and stagnant swelling, can actually break down healthy tissue. During the acute phase I recommend RICE.  Ice in 15 minute increments, 3-6 times per day, immobilize the area, rest, and elevate when possible.  I did all this and used a sling for the first 48-72 hours.

After 48 hours, I removed the sling and switched to a compression sleeve.  I generally recommend my patients keep it in a sling for up to 2-4 weeks, but I am being aggressive.  Old school would immobilize for 6 weeks.  This is a safe way to eliminate re-injury or exasperate the current injury.  But, realize, by immobilizing, you are slowing down the movement of swelling in the joint and, just as the rising Missouri River, increase the time it will take to recover.  There is a fine line between too much movement and not enough after 72 hours.  So for patients I recommend the bracing for a week up to 4 weeks, based on the severity of the injury.  However, I do recommend they start therapy after 72 hours to help the transition from the acute phase to Phase 2: Regeneration Phase.  There is tons of literature showing early passive motion is one of the best therapeutic interventions that can be taken early after the injury.  It is essential your Doctor refer you for Therapy.

*On a side note.  I did have an Orthopedist review my X-ray and inform me it was stable.  He further advised that I did not need a cast or surgery.  This is an important note because immobilization is essential to allow an unstable fracture to heal.  So, just as I did, check with an orthopedist to make sure you are stable, do not require surgery, and do not have the type of fracture that will require long term immobilization.  Once the facts are established, then that is when your Physical Therapist, like we have here at Capitol Rehab, comes in.

Repair Phase (Regeneration) (72 hours to 6 weeks)

This is when the inflammation has gone down and your body begins to repair the injured area.  Your body will begin to lay down collagen to replace the damaged tissue structure.  Oxygen and vitamin C are necessary to aide in the collagen formation.  I provide my patients with Electrical Stimulation and Ultrasound, which will help promote the circulation.  I also apply light myofascial release (specific massage) to help this collagen formation and improve Lymph drainage.  Easy pain free movement, perhaps only passive during this period, is essential.  I visited Mike Gerometta, Garrett Sanders, DPT and Dr. Ricci, at my clinic at 48, 72 and 96 hours for this care.  The structure of the collagen is unorganized at this point.  Or as I tell people, clumped up. The myofascial work and supervised, almost pain free exercise,  promotes better formation.  I see patients 3 times per week for the first 3 weeks.

Remodeling Phase (3 weeks up to one year)

Once the collagen has been regenerated in the second phase of healing, it is weak and disorganized.  The collagen is similar to sticky glue at first.  It needs to be molded in certain alignments so it is able to perform the functional capabilities of the tissue it is replacing.  During this phase you may feel pretty good and perhaps be virtually pain free.  Don’t be fooled!  Do not let pain be your only guide.  This phase is largely one of an improvement in the quality, orientation and tensile strength of the collagen. It is during this phase we increase the amount of very specific exercise to help create strong and functional tissue.  This is essential to prevent weakness, chronicity and compensatory injuries.  Generally care is reduced to twice a week and more home exercises are incorporated.

First 96 Hours

Pain: 4/10 with spikes of 9/10

Swelling: Severe at 24-48 hours moderate at 72 hours

Prognosis: Guarded

Days 5-7:  Tomorrow’s Topic: A visit to the orthopedist and my aching back!

My Broken Arm

Tuesday, July 19th, 2011 At 12:52 pm

I was feeling so good that I decided to extend my normal bike workout form 2-3 laps to 5. My energy was so good I  decided to extend my course to also include a yet uncharted trail. Do you know when you are about to do something, and you hear that little voice whispering in your ear? This little voice was screaming at the top of its lungs, STOP!!!! But my energy and ego completely ignored the little guy who seemed to say to himself, “OK don’t listen to me, I am only omniscient”.

So instead, I increased my speed. I turned a sharp corner to see the trail as it takes a 90 degree turn. Essentially, I was running out of road but had plenty of speed. So reality hits. The svelte 25-year old triathlete, with cat-like reflexes I envisioned, transforms back to a 43-year old with the reflexes of a speedy snail.  My choice was to take a header into a tree or brake hard and do an awkward flip over the handlebars. I choose the latter. So here I am flying through the air like Wile E. Coyote after the Road Runner has removed the ACME rocket from beneath his legs. I land on my extended right arm and attempt a “graceful” tuck and roll. (Let’s just go with it for now).

I stood up and said to myself, I think I am alright. The only difference now is that little voice is now loud and clear. I have been treating orthopedic injuries for 15 years and I know what I probably did. You cannot catapult 210 lbs up into the air, and come down stiff-armed without some injury. I also felt the compression in my elbow and shoulder. I just hoped the damage was not a displaced fracture that would require a long term cast. I also know I should not try to diagnose myself.

So, to jump ahead a day, it turns out I have a compression fracture of my radial head (elbow) as well as excessive swelling in the elbow joint.  And a lot of soft tissue damage.  I also have a mild whiplash and a subluxed rib head. So much for the graceful tuck and roll.

I have decided to blog this event for the benefit of my patients. To share my experiences.  I want to document how I manage my injury and the benefits of rehabilitation through the stages of recovery. I will try to cover the most frequently asked questions such as; when to ice and when to heat, do I need an MRI? How long should I expect recovery to take? When do I start exercise? Should I brace or cast or not at all?

I welcome any questions you may have, and will keep you informed on a daily basis. Tomorrow, I will break down the first week from what I did immediately after the wreck, to my visit to the orthopedist today. I hope you find it interesting and I look forward to getting back to 100%.

John Doepper DC