Take a deep breath

Monday, July 21, 2008

265 pounds and almost 7 feet tall, Dwight Howard is a basketball superstar brought to his knees by a crack in his breastbone. A few weeks ago, Howard was diagnosed with a sternal stress fracture, a chest wall injury that made it tough to move and take a deep breath. How much did it hurt? There was no guarantee that he could play for the US Olympic team, even after recuperating since the middle of May, eight weeks ago. Fortunately, he did make it to training camp and is getting ready for Beijing.

What can the mere mortal, non-superstar learn from Dwight Howard.

The fall took a split second and the edge of the table caught the patient in the ribs, knocking the breath out of him. Another split second to make sure all was well and a sigh of relief that nothing bad happened until the next split second and the first deep breath. It was like a knife being stabbed into his side. Who knew that it could hurt so bad to breathe?

A quick visit to the doctor, a feel here, another one there, a listen to the lungs with a stethoscope, then off for a chest x-ray.

“Good news, bad news. The good news is that the x-ray shows no collapse or bruising of the lung. The bad news is that you’re going to hurt for a month.”

“Do I have a broken rib?”

“Don’t know and it really doesn’t matter if the rob is broken or not. The x=ray was meant to look at the lung and regardless, the treatment’s the same whether the rib is broken or not and it’s going to hurt for just as long.”

It seems that we breathe like a bellows. The ribs swing out and the diaphragm moves down allowing air to be sucked into the lungs. When ribs are bruised or broken, it’s hard for them to move and suck air in. Instead, it’s easier to take short, shallow breaths and protect the injured area. While resting other parts of the body that are injured seems to work, it isn’t such a good plan for chest wall injuries. Lung tissue that doesn’t expand with air is at risk for infection. Fever, chills, cough, shortness of breath are all signs of pneumonia, the ugly complication of a chest wall injury.

The treatment for rib injuries is ice, anti-inflammatory medication like ibuprofen, pain medication, deep breaths and time. It doesn’t matter if they are broken or bruised. Each time you take a deep breath, you move the injured area and delay healing. Hurt your arm and the doc puts you in a sling to rest it. Hurt your leg and you get crutch. Hurt your ribs…you can’t stop breathing.

Once upon a time, injured ribs would be wrapped or taped for pain control, but it seems that many people developed pneumonia because the lung that was underneath the damaged ribs couldn’t air out and expand.

Chest wall pain is tough. The ribs form the structure of the trunk and all the muscles that less us do things like sit up, twist, reach down to put on socks and all the other routine things that we take for granted. Sleep is difficult since there is no comfortable position. After experimenting, it’s often least painful to sleep sitting up. That first move out of bed in the morning is an eye opener, since the muscles surrounding the injury have had a few hours to stiffen. After a few days, you get used to the pain, except when you breathe, cough or move. One day you wake up with those same painful expectations but you’re pleasantly surprised .It doesn’t hurt quite as much and a few weeks later, you’re as good as new.

It takes an injured athlete to remind us how much things hurt. Even with their ability to train and play through pain, it’s hard to play if you can’t breathe. Dwight Howard reminds us that patience is a virtue, even when it is thrust upon us uninvited. And it is especially good to see him reaching for his Olympic dream.

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