Monday, March 17, 2008
Usually the stories come from the playing field, but this time the injury happened outside the ropes when golf announcer David Feherty was hit by a car as he was riding his bicycle. It’s not often when broken ribs and a collapsed lung can be called lucky, but bicycles don’t have air bags and there is no crumple zone built in.
Broken ribs are difficult injuries because the healing takes weeks and the patient is reminded with every breath, 10 or more times a minute, how much pain there is. Normally, we breathe like a bellows; the ribs swing out, the diaphragm pushes down and air is sucked into the lung. When there is rib damage, the instinct is to take shallow breaths to avoid moving the hurt area. That may work for sprained ankles or wrists but the lungs are special. Every time the patient takes a breath, the bones move and healing is delayed just a little bit longer.
The problem with immobilizing ribs is that the lung underneath doesn’t expand with a deep breath. It’s dark and warm in the recesses of the lung. Stagnant air and fluid hang out and is a breeding ground for infection; think pneumonia, an infection of the lung and the reason rib fractures aren’t taped or wrapped anymore.
The treatment for rib fractures is simple. Use whatever means necessary to take deep breaths. The recommendations are the same as if the patient had abdominal or chest surgery. Pain control with ibuprofen and narcotics, ice the sore spots and use incentive spirometry, a fancy toy to show how much air is being breathed in.
Aside from breathing, the other bad news is that rib fractures make it hard to move. The chest and back muscles go into spasm to protect the injury. Just as the patient gets comfortable, the decision to move becomes a mind over matter issue. The brain knows that the initial move to sit up or twist will be met with significant pain and the brain isn’t stupid; it doesn’t want any pain signals. Some bodily needs, like a full bladder, trump the brain and sometimes, you just have to get out of bed. It’s the first move that hurts so bad.
Eventually al thing heal, including ribs. Weeks after the injury, the patient wakes up one day, doesn’t hurt as much and may get out of bed a little easier. It’s also when compassion is born for the football player who is sidelined for a few weeks because of cracked ribs (remember that cracked, fractured and broken all mean the same thing). It’s hard to yell at the guy to rush the quarterback when you know it takes all his effort to sit up and breathe.
Best wishes to Mr. Feherty. How unfair for an Irish ex-pat to be hurting on St. Patrick’s Day. We hope to see him blitzing outside the ropes at The Masters.