Continuing pain @ 4.5 weeks and coronoid fracture

[leebie3]

Hi all..

Surgery was May 30th. 

During 9mm forward BSSO the surgeon had to cut quite high because my nerve bundle is higher than usual and as a result the coronoid on the left side broke off.  It wasn't fixated but left to heal being kept in place by the temporalis muscle (common treatment), I also had a segment split off on the left buccal plane...  see xrays from 6/6/14. 

Approx 10 days post-op I couldn't stifle a yawn although was able to keep my mouth closed.  I heard a crack and had LOTS of pain in the cheek and it turns out I had separated the coronoid fracture again.  I am still needing panadeine forte and nurofen to get by.. the pain isn't disabling but it sure hurts!  It's a deep ache.   sometimes having oxycodone in the evening to help the pain if it's been a bad day.

Should I STILL be THIS sore?  admittedly I do have a low pain threshhold..   I just see others off pain killers at 2 weeks..

I'm still on a purely liquid diet because of the coronoid fracture.

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[LoveofScotch]

Ouch, sorry.

If surgery was May 30th, then you irritated the fracture again on June 10th that puts you at the 3 week mark. Just speaking about general bone health and healing, in general, they like to see a solid improvement in pain at the 3 week mark. With that said it doesn't sound like what you're experiencing is unusual. I would 100% get a recent picture done, if you haven't already, to make sure everything looks good. I would also make sure your diet is really good. When a bone is trying to heal, from a break, it requires a tremendous amount of energy (calories) from your body. I know you're on a limited diet, but a few little dietary adjustments may help speed things along.

Hope you feel better soon!

[leebie3]

thanks

Hoping the surgeon orders more xrays when I see them next week.. 

diet wise?  I'm on a high fat, low carb eating plan for other issues.. I have increased my protein shakes though to above what I usually would have (normally 60grams per day but upped to 90)   also taking multi vite, vitamin c with bioflavs, mct oil, mega b high potency, immune support tabs, selenium and zinc (yes, I'm rattling LOL)    Anything else you'd suggest?

[LoveofScotch]

Yes, please demand additional pictures from your surgeon if you're concerned! It's your body and you know it far better then your doctor.

Personally, I believe a calorie surplus can be highly beneficial for acute bone healing. You may be at a slight disadvantage because of the low carb diet, solely being that it can be difficult to acquire enough calories when carbs are reduced. Besides making sure you're eating enough to support your body, bones love all sorts of other things...

For that, I would google Susan Brown, PhD. She provides a wealth of knowledge, and will be able to articulate everything far better then myself. (I'm in NO way advocating everything she recommends, I just think her website is an amazing resource.)

Just briefly looking at what you wrote, here are a few other things to consider. In addition to ample calories, assuming you're already eating really well, I would consider maximizing your vitamin D and K(2) status. Also, maybe something as simple as a calcium/magnesium supplement (if male, there are potential issues with long-term calcium supplementation, but we're just talking temporary). You said you already increased your protein intake and take a vitamin C supplement, so that's great! The only other thing I can think of, off the top of my head, is potentially making yourself some yummy bone broth.

Good luck!

[leebie3]

bone broth already done!   Will check out calcium & magnesium.. ps:  female.

[LoveofScotch]

Oh, the other thing I forgot to mention is potassium. I would NOT recommend taking potassium supplements, but I would maybe consider looking at increasing via food sources. I'm sure you can find a list online, but, in general, produce is a great bet (fruits and veggies). Some dairy products are also a good source of potassium, but often fruits and veggies provide the most bang for your buck.

[leebie3]

 

checked and they (mega b, zinc complete and immune support)  have heaps of calcium and also have magnesium in them..  how much K would you recommend?  I have 2 tablespoons peanut butter per day (so 210mg K) ..

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[LoveofScotch]

You took a picture of your supplements. That's funny. Just a friendly reminder that I'm a nobody on the internet, so please talk to your doctor and do your own research to determine what's best for you.

First, regarding your supplement that contains calcium. I would make sure the amount listed on the label is the elemental amount of calcium (this is the amount that's available to your body), NOT the total amount of calcium by weight. Unfortunately, at least in the U.S., this isn't regulated, but you can figure it out by going on the company website or by calling the company. Some companies (Metagenics, Thorne Research, Biotics Research, etc.) will only and always list the elemental amount, but other companies (TUMS, etc.) list the amount by weight. They're not the same!

About vitamin K...First, it's a fat soluble vitamin, and you can obviously acquire it through diet and/or supplements. There are two main groups of vitamin K that occur naturally (vitamin K1 and vitamin K2). Very dark, leafy greens are often a good source of K1, where K2 can be found in foods like natto (very salty and a little funky tasting) and other fermented foods. To break it down further, K2 comes as either MK-7 or MK-4. However you get your K, it needs to be taken with fat to be absorbed (so important!), and also remember, being that it's a fat soluble vitamin it takes awhile to build up in the body to a point where it's available for use. It's not like taking vitamin C which is available to your body pretty much immediately after you swallow it.

The recommendations for vitamin K are all over the board, and are continuing to evolve as more research becomes available. I personally believe (remember I'm just a nobody on the internet) that for optimum bone health 1000 mcg/daily is a solid and safe recommendation. Peanut butter is actually not even what's considered a good source of vitamin K. I mean it's delicious, but if you're eating it only with the hopes of increasing your K status, it's not really going to do anything for you. Also, note that vitamin K is looked at in micrograms (mcg).

(If you take any medications to thin your blood (Warfarin, etc.) OR have any blood disorders, clotting issues, etc. DO NOT take vitamin K supplements or even increase your dietary intake without talking to your doctor first!!! Seriously, that's a big deal and really important.)

Cheers!