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I met with an accident on 6 November 2016, yes, this day that (last) year . While crossing a road on foot, I was hit by a speeding motor bike, direct impact on my left leg at an approximate speed of 100 KM/H. I broke my Tibia and Fibula bones on the left leg, for the uninitiated, Tibia is the medical term for the shin bone (the bone that sits between the knee and the ankle) and fibula is the medical term for a much thinner bone that exists right behind the Tibia but is not visible from the outside, nor can one feel it by touch. Both bones were broken into two right from the middle and it wasn’t just a crack. But, it wasn’t a compound fracture, as the bones had not pierced all the flesh and skin to protrude out of the body. I was taken to a Government Run Trauma Center nearby and got an Xray done, they also, straightened the bones back into alignment and put on a temporary plaster with a wooden plank for support, since I had to be transferred to a private hospital of my choice, several miles away. I was advised to get an ORIF (open reduction and internal fixation) surgery done. This involved placing a titanium rod inside the Tibia and fastening it with two screws each at either ends. The Fibula is not treated for fractures in this way as it’s a tiny bone in comparison to the Tibia and as per my Physio, it only bears 5% or 10% of the total body weight. The good thing was that my fracture was right in the middle of the long bone and not near either of the joints at either ends. Normally, Tibia fractures Occur very near to the ankle. The legal case for the accident was decided in my favor.
So, on 8th of November 2016, the same day as the demonetization announcement was made, my health insurer approved the surgery and the associated costs and I finally underwent the ORIF surgery. I was given spinal anesthesia wherein only my left leg would be under anesthesia and I would be awake otherwise. The anesthetist asked me if I would like to be sleeping or awake during the surgery and I asked to be put to sleep as I didn’t want to be a daredevil and be awake and then get scared during the surgery as that would then negatively impact the surgery and my health. This was also the very first surgery of my life. Although I didn’t want it But I woke up in the middle of the surgery and saw that the surgeons were grappling with a problem, the primary surgeon appeared to be on the verge of panicking, so I understood that there is something seriously wrong. I didn’t open my eyes so that I don’t let them know that I’m conscious now as that may deter them from talking about the problem openly as they were doing at that time. One of the junior surgeons, who I had seen to be very enthusiastic and energetic, decided to take things into his hands and seemed confident that he can solve the problem. Although I couldn’t understand what the problem was but I think it was solved without any damage, as towards the end, the primary surgeon was heard saying that ‘we got out of this difficult situation very easily’. So, the surgery was done with and I came back to my room. Later that evening, the Prime Minister was making the unprecedented announcement relating to demonetization and I could not even open my eyes to watch it on TV due to the excruciating pain that I was experiencing at that time. I was being administered a narcotic pain killer, which, I believe was Morphine or something of the same kind, through the catheter that was inserted to my spine during the anesthesia administration just before the surgery. But the dosage was kept low and thus the immense pain. I would spend the next several hours asking the nursing staff to increase the dosage, it would really help when they would administer me a secondary pain killer via the IV line along with the constant morphine administration. Those would be the hours when I would be able to sleep peacefully. But, sometimes, the nurse would administer Paracetamol as the secondary pain killer and that would have zero effect. Anyhow, after a few days in the hospital bed, I was finally discharged and came back home. Then, began the never ending recovery process.
Eight weeks is the normal duration in which tibia fractures are expected to somewhat heal and the patient is expected to ditch the walker and start walking with a stick. When I went for the Xray at 8 weeks, very hopeful to see good progress, I was disappointed to see no difference between the post operative xray and the xray at 8 weeks. I met a junior doctor that day, who was more attentive towards his smart phone than to his patients and he advised to start walking with a stick. Such an advise was shocking for me but since they say, doctor knows best, I went to the phsyio department, bought a stick from the hospital store and asked them to teach me how to walk using it, five different Physios tried all their skills but could not make me walk even a single step. It was clear that the junior doctor didn’t care what the xray showed and had given his advise purely based on the fact that 8 weeks had passed since my surgery. Then began the process of visit after visit to see no or very little progress. Dynamization was also done after 16 weeks where they remove one of the four screws to make both pieces of the tibia more mobile which should lead to them getting in contact with each other more often, which in turn is expected to aid in callus formation, which was not happening until then. Around the same time, I also started taking some additional supplements apart from the calcium supplement that I was prescribed. This decision was based on my personal research on bone healing. As time progressed, I made some further enhancements to my supplements intake and that really paid off when I saw complete union in my xray that was taken after 9 months. I have ditched the stick now, although stairs and uneven surfaces are still somewhat a challenge but I’m happy to see my tibia in one piece instead of two. Being able to walk properly is something we all take for granted, but this accident taught me not to take anything for granted in life, everything is precious. So, after the very long background story, we have finally came to the crux of the matter and the reason why I thought about blogging about my accident – Why did it take soooo long to heal ? About a decade back, I had broken my collar bone and that too had taken a very long time to heal. So, what’s going on with me??
As I said before, tibia fractures are expected to heal in 8 weeks, mine took 9 months, the same amount of time as it takes for a baby to form completely and be delivered. While there are some minor reasons as well like there being a lot of soft tissue damage around the fracture site etc. The major reason (as I found out) was my diet for the last 15 years or so, before the accident. I was following the ‘Western Diet’, which consists of very large quantities of meat – Chicken/Lamb and very little quantities or often, none at all, of vegetables and fruits. I used to drink milk every day too. Apart from this, I was addicted to soft drinks and used to drink, at least, half a liter of it every single day. The enormous amount of sugar intake, that went on for decades, resulting from my soft drink addiction, created a lot many issues for me. While, the negative effects of soft drink addiction are still being researched in the world, the early results show brittle bones and teeth to be the most obvious problems. One lady in Australia, who used to drink about 10 liters of soft drinks every day, had multiple babies without any enamel on their teeth. I have already broken two of my teeth while chewing food, this doesn’t happen to normal people, nobody’s teeth are so fragile, but mine are. The science behind how and why exactly such excessive intake of soft drinks causes such serious problems is still being researched but one thing that can be said very confidently is that soft drinks are not good for health AT ALL. In my personal opinion, liquor causes less damage than soft drinks do. So, as you would have guessed, I stopped having soft drinks altogether. Now coming back to the food part of my faulty diet. Eating a lot of meat gave me a lot of protein, which I thought was great for me and this belief stemmed from the serious scientific backing that protein has got these days. But what it also did was to make me deficient in almost all other vitamins and minerals. Because those don’t come from meat, they only come from veggies and fruits and I was not having them, at least, not in enough quantities and often enough. I also found out that even protein is not needed by humans in as much quantities as we seem to assume. Even if you just stick to a completely vegetarian diet, you will get more than enough protein that your body needs. So, while I was getting very good amount of protein by following the western diet, my body didn’t need that much of it. And what it needed in very good quantities – Vitamins and Minerals, I wasn’t getting enough. So, let’s now get to the specifics of it.
We all know that, Bone healing requires good amounts of calcium, as bones are made up of it. But when I understood how that calcium reaches the bones or in my case, how is it expected to join my broken bones, is when I understood that I need good supplementation of some other minerals and vitamins apart from calcium. When humans take calcium via food or supplements, it needs Vitamin D to be absorbed in the stomach. If you lack sufficient amounts of vitamin D, no matter how much calcium you take, none of it is ever going to be absorbed by your body and resultantly, all of it is going to go to waste. Sunlight is the best and free source of Vitamin D, but in the modern lifestyle, where we get out of the house and sit in the car, reach office, get out of the car and immediately walk into the office building, we are not getting exposed to the sun for our bodies to be able to get any vitamin D. So, I was obviously deficient in Vitamin D, like most other urban dwellers. But, so far nothing was new for me. I knew that by the virtue of drinking milk every day, I should already have enough calcium in my body and after every fracture, the doctors prescribe a calcium supplement, which nowadays contain vitamin D as well, And I was taking all of it from day one. So, where was the problem? After all, the two things required for bone healing were there in the supplements, right?. That’s when I found out that there are many other minerals and vitamins needed for fracture healing. Most important of them is Vitamin K, this is a relatively recent discovery that Vitamain K’s sole purpose is not to make blood clot but it also helps in taking the calcium in your blood stream to get deposited in to the bones. So, let’s paint the full picture, when you take calcium,your body needs a substance called calcitriol to absorb it and take that calcium to the blood stream. Calcitriol is made when the Liver and Kidney work in tandem by using another substance called Cholecalciferol, this is the name given to the form of vitamin D that you absorb from the Sun or other sources. If you are taking a vitamin D supplement, the chances are that it contains cholecalciferol (some supplements also have it in the calcitriol form, calspen is one such supplement), so cholecalciferol is converted to its usable form of calcitriol by the liver and the kidney and then its ready to absorb calcium in your stomach and take it to the blood stream. Now, Vitamin K enters the picture and takes that calcium from your blood stream, and deposits it to your bones. When this happens, your fracture starts healing. On a side note here, if someone has liver and/or kidney problems then instead of taking cholecalciferol based supplements for vitamin D, they should take calcitriol based supplements as their body might not be able to efficiently convert cholecalciferol into calcitriol. This is only the high level overview, bones need various other minerals as well and fracture healing process is not just limited to bone healing, we will talk about all that in just a bit. So, as you might have again guessed, I was deficient in Vitamin K as well, now this is well established because, before every surgery, a blood clotting test is conducted, although the results of my test were not shared with me but I was administered Vitamin K via IV line the night before my surgery, so it was proof enough on what the report would have said about my Vitamin K levels. Vitamin K is found in green leafy veggies and I was not having them at all. Also, my doctor didn’t prescribe any Vitamin K supplements to me either. On the contrary, he was laughing when I spoke to him about what I found about Vitamin K and this time, it wasn’t that smartphone addict junior doctor, it was the director of the orthopedics department. There could be two reasons to his ignorance, its possible that when he studied medicine, Vitamin K’s role in bone healing was not discovered and he didn’t keep himself upto date about such research. The other reason was more worrysome, I found out that doctors are not taught about nutrition when they are studying to be doctors, and this is the case around the world, in no country are doctors taught about the role of nutrition in healing. So, I was taking a lot of calcium and Vitamin D, so my calcium was being absorbed and reaching the blood stream but it was staying there due to vitamin k deficiency. This was not only limiting my fracture healing process but could have caused other issues like calcification of the arteries, this happens when a lot of calcium reaches the blood stream but doesn’t get deposited to the bones, the body starts depositing the extra calcium in the blood to the arteries and it starts to narrow down the arteries just like plaque caused by cholesterol does. If this goes on for very long durations, it can even cause a heart attack just like cholesterol based plaques. This is when I decided to take a Vitamin K supplement. Vitamin B6, B9 and B12 are also known to help in bone healing, so a good Vitamin B complex supplement should have the adequate amount of this vitamin family and I also started taking that.
Now, lets talk about the other minerals needed for fracture healing and the right dosage and efficient ways to consume them. Starting with calcium yet again, it is not recommended to have more than 2000 mg/day via food and supplements combined. The recommendation is to keep it at 1000 mg/day for supplements only. If you take it in very large quantities for a substantial period of time, like an year or so, it can cause kidney stones. It is also recommended to take calcium in smaller amounts per meal, that leads to better absorption of calcium. But some calcium supplement tablets contain very high amounts in a single tablet, I was taking one such tablet which had 1000 mg of calcium in a single tablet, so what I did was to break each tablet into two and take it right after two different meals. Its also important to take your supplements right after your meal for better absorption. It should be a proper meal and not just a light breakfast. Its also recommended to take different forms of calcium supplements, like calcium carbonate, calcium citrate malate etc. So, you can choose a 500 mg tablet of calcium carbonate to have after lunch and have a calcium citrate malate tablet of the same strength after dinner. If you think you need lesser amounts of calcium as per the stage of your fracture healing then you can go for lesser strength tablets as well. Next would be Vitamin D, which is available as cholecalciferol and calcitriol, the former being more common by a very big margin. You can take Cholecalciferol from 1000 IU (International Units) to 2000 IU per day right after meals. Its also available in the form of sachets of strengths as high as 60000 IU which is recommended to be taken once a week with milk. I prefer the 1000 IU tablets that you can take after each meal, instead of stuffing your body with vitamin D once a week. Vitamin K supplements normally contain Vitamin K2, the daily recommended dosage is 120 mcg (Micrograms). Do not take Vitamin K3 based supplements as that is known to cause some major side effects, but you may not be able to find supplements containing Vitamin K3 due to the same reason. Certain trace minerals, while only needed in the body in tiny amounts, play a major role in bone healing. Zinc, Copper, Phosphorous, magnesium, chromium, manganese, Potassium, Strontium, silicon and boron are such minerals. So, you can choose a multivitamin and multimineral supplement that has all these vitamins and minerals in adequate quantities to help your bones heal faster. The role of silicon and boron in bone healing was discovered not too long ago, so most bone healing supplements don’t have them yet. It’s not necessary that your supplements should have all these minerals but it would be beneficial to have supplements that cover most of these minerals. As I stated initially, that making some enhancements to my supplement intake helped me immensely, that was because I appeared to be extremely deficient in most of these vitamins and minerals, so I doubled my intake for about three months, while it was double than the recommended dosage it seemed to accelerate my bone healing by a great deal. So, while it may not be safe for everyone to do it but if you are not getting good results with regular amounts of these supplements, you can try doubling them for a couple of months and see if it makes any difference. Be very careful with calcium supplements and raise it to only till 1700 mg/day due to the risk of kidney stones.
Previously, I also talked about fracture healing not being the same as just bone healing. Bone healing is the biggest part of fracture healing but still not all of it. When any kind of fracture occurs, there is some associated tissue or muscle damage as well, this results in inflammation and pain. As we learned earlier, calcium travels to the bones via the blood stream, so the blood has to reach the fracture site inorder to deliver calcium, but if all the muscles and tissues around the fracture are damaged, it becomes more difficult for blood to deposit adequate amounts of calcium to the broken bones. The more the damage, the more difficult it becomes for blood to reach on site. So, the tissue healing has to happen to make calcium delivery faster, this requires some other vitamins like Vitamin C, omega-3 fatty acids etc.
Now, lets get back to protein, from what we have discussed so far it would appear that protein has no role in bone healing, but on the contrary, it has a very important role, protein is also needed for bone healing but as I said before, we get good amount of protein even without bingeing on poultry or protein supplements, it’s the other vitamins and minerals that we generally lack in our diet and need to make up for. If you have 10 blue shirts already, you would not be looking to buy more blue shirts on your next shopping trip. Same is the case with Protein.
As you might have noticed, there are many vitamins and minerals, whose role in fracture healing was not known till not too long ago. So, I believe it would be a safe assumption that there could be more such vitamins and minerals that assist in bone healing but we don’t know about them yet. So, in my opinion, having a very well balanced diet is the key to optimal bone healing. Also, no supplement is recommended to be taken life long, while they are good to deal with a specific problem that you might have, like a fracture for instance, but it’s never a long term solution for your nutrition needs. Also, nutrients derived from supplements are no match for the nutrients derived from your diet. I Personally recommend having a lot of plant based food and ditching processed food altogether, especially, processed meat, which has been classified as a Class 1 Carcinogen by WHO. Carcinogens are cancer causing substances and they are divided into classes based on how likely are they to cause that disease. Some other class 1 carcinogens are asbestos and plutonium, so you can imagine what you are consuming when you order that next bucket of chicken. Non vegetarian food does not add much value other than protein, so it can be consumed as a special occasion food, instead of being consumed as the daily staple. Having non veg food daily, pushes out the plant based food out of our plates and makes us deficient in vitamins and minerals. As we can have only so much food, if we just gorge on non veg food, there’s no place left for the nutritious plant based food. One should try to consume as many varied vegetables as one can so that you get all the different nutrients that each of them contain. Various Pulses and seeds not only add variety to our food, they are also great sources of much needed nutrients. Having fixed schedules for your meals is another good habit. A fruit bowl without any added salt or other spices is the best snack one can have. So, snacking is still good if its done with salads and fruits. Dry Fruits in general are very rich in minerals, especially, walnuts and almonds are very good substitutes for chips and biscuits, which are commonly used for snacking. Dates can be termed as a superfood for bone healing as it contains a lot of the nutrients required for the same. Apart from eating the good food, we should avoid some bad foods as well, We should regulate the consumption of sugar and salt even if we are not suffering from High/Low blood pressure and/or diabetes. Its not only the soft drinks that are the sugar kings, Tomato Sauces and Packed Yogurt also have a high amount of sugar, so those foods are to be avoided as well. White flour or cake flour is another one of the villains that we should try to avoid, so pizzas and burgers go out of the window. In the beginning, it would seem like one can’t live without having such bad food in today’s day and age, but if you commit yourself to the same, then it’s not all that difficult like I’m finding out myself. Having preached all that, it’s also ok to cut loose every once in a while, you don’t need to be a social outcast to stay healthy. If there is a pizza party at office, have pizza by all means, don’t say no. If you are traveling somewhere and you think having a burger is the only option for lunch today, go and get it. You don’t need to be too particular about your food choices, every second of your life. As the great Oscar Wilde said – “Everything in Moderation, Including Moderation”.
I also thought about how can I reverse the ill effects of the years or decades of taking a highly faulty diet ? The best answer I could think of was that just having a good diet, avoiding bad food and maintaining a good lifestyle should heal my body and turn it back to normal. The human body has the amazing ability to heal itself, most of the physical problems we have are treated by our bodies themselves, medicines mostly act as a defense mechanism against external factors only. For instance, if you get a cut, the doctor will bandage it and give you antibiotics, all that the bandage does is to keep the wound from getting infected, it does not do anything to heal that wound. The antibiotics also do the same thing, they also, don’t heal the wound, that part is handled by our body itself, it does not need external help for that. So, all the good food habits that we discussed above, coupled with some kind of daily exercises and stress free lifestyle is the way to lead a healthy and happy life. Exercises are important not only to build a good physique or to be fighting fit, they are important since our lifestyle does not involve any physical activity, we all do sedentary jobs but if we take out the last 100 or 200 years, humans never did only sedentary jobs and thus our physiology is not built for that, human body needs a lot of physical activity to stay healthy and our current lifestyle is depriving it of the same. Even if you are eating healthy and have a good and evolving exercise regimen, stress is one single factor which can make them null and void and make you as unhealthy as one can ever get. So, avoiding stress is the real key, a happy person is more likely to enjoy better health than a fitness freak. Everyone goes through bad patches, but hard times, just like good times, don’t stay forever, although it might look like a never ending nightmare but it’s never, never ending. You can look back at your own life and see for yourself that hard times might have continued for a very long time but it was eventually replaced by good times and good times also get replaced with hard times, this cycle goes on forever, so there is no point stressing about it. Everybody knows all this but hardly anyone acts on it to make their life better, I hope you do, just like I’m trying to!!
So, while I talked about how I detoxified my body by ditching my faulty diet and adopting a more nutritious plant based diet, I should also mention how I detoxified my personal life by ditching some toxic people from my life. I went through some very hard times in the last one year and I could see people turn from good to super bad in no time. These are the people on whom I have showered innumerable favors in the past, in a very consistent fashion, to the extent that if they have any houses or cars it’s all because of me. But they still didn’t take more than a day (in one case at least) to turn on me. I was amazed to see how bad people can be, the very people I cherished turned out be opportunistic parasites. The biggest amazement was that they didn’t even have one single good enough reason to turn on me but they still did that, may be that’s why opportunistic people are called so. Its no wonder that god has punished these people with innumerable family problems, that’s what they deserve. While I was watching these parasites turn their ugly heads (one of them even looks like a snake), I also saw my true friends stand up and fight with me. That, coupled with tremendous family support helped me wade through that rough patch. That was truly heartening to say the least. So, I could see another thing, that I already knew, being proven to be very right – hard times, show true friends. So, in a way, this entire episode of the accident, seriously delayed healing and the rough patch in my personal life taught me a lot of stuff, a whole lot of stuff. That has helped me adopt better lifestyle, food habits and friends, all of which helped and will continue to help me detoxify my body and life as a whole.