Today we celebrate my not-quite-dead-yet day. 3 years ago we somersaulted with a local boat in a pass in Fiji and got rolled over the reef. Christian managed to climb on the stuck, semi-submerged boat, but the skipper and I were swept into the pass by a strong current. Nobody had witnessed the accident, nobody could help. He drowned, but I managed to swim back into the breaking swell and made it over the reef and to the boat, despite 5 broken ribs and a pneumo-thorax.
My body miraculously recovered, the lung healed itself without surgery and the bones of the broken ribs on my back also mended nicely. The doctors had told me to keep moving, take deep breaths, cough and try everything to keep the rib cage flexible. They said I could do anything that didn’t hurt as long as I didn’t take another fall, so I happily started gentle exercises and physio therapy just weeks after the accident.
Their advice was wrong. What didn’t show up on the X-rays, CT scans (done in Fiji) and even on an MRI I had taken later on, was the fact that my ribs hadn’t just broken at the back, the cartilage at the front was also ripped loose. I kept feeling movement, strange pain in my side, on the front of my chest and even in my sternum. Never the classic stabbing pain that is usually associated with broken ribs, just burning, dragging, radiating pain that didn’t come up suddenly, but intensified over days and weeks. If I had limited myself to bed rest, avoided all exercise, the cartilage might have mended at that point. Instead I went to more doctors and physio therapists, who all insisted that I needed to exercise, so I did.
Half a year after the accident, having done lots of reading I self-diagnosed a slipping rib syndrome (that’s when a loose rib gets stuck underneath a neighbour) and prescribed myself rest: no lifting, no pushing, no pulling, but also no bending and no stretching–every activity below knee level (picking up things, putting on shoes) and above shoulder level (hanging up laundry, reaching for something on an upper board) aggravated the problem. I started to get better, but each time I managed to do something stupid (once I slipped on a muddy road, another time I fell into the companion way when the ladder was removed, etc.), and even subtle movements (trying to stretch my neck or rounded shoulders, aching from a constant protective posture) could sometimes trigger a relapse followed by weeks of recovery.
Almost a year after the accident I followed a good friend’s advice to have my ribs looked at in Australia, but there I was treated like a hypochondriac: a doctor told me he “highly doubted I had ever broken my ribs” and recommended having nerves cauterised, a physio therapists told me that the movement in my side was just “popping joints” and suggested I might be menopausal and having an altered pain perception.
I read that most people with slipping ribs get that kind of treatment from medical professionals as “everyone knows that ribs heal by themselves” and therefore noyone specialises in ribs. Most patients are only diagnosed after years of seeking help, many are probably never diagnosed, but end up as pain patients, apparently the number of suicides or at least attempts among slipping rib patients is high.
I’m stubborn, so I never doubted myself, despite all negative feedback from doctors, well-meaning strangers, fed up friends (move on, get yourself together). One and a half years after the accident, I finally got a full diagnosis at the “rib clinic” in the UK. A dynamic ultrasound clearly showed damaged that was much more extensive than I had thought: the costal cartilage had been broken up to the sternum (there an inflammation remained), some of the junctions had healed, but two remained mobile (therefore the strange pains in different places triggered by different movements) and rib 9 got stuck under 8 whenever I bent forward. Unfortunately the surgeon could not recommend the usual procedure done at the rib clinic (just shortening the slipping rib), but advised to do a more complicated procedure with an implanted plate in addition to the excision and only gave me a 60 % chance that the surgery would actually improve my situation.
Disappointed and depressed I decided against surgery. Interestingly enough I had been at an almost symptom-free point before the dynamic ultra-sound that had badly offended my ribbies with forced movement and pressure and figured I could get back to that stage with patience. I was kind of glad I had certainty now and could no longer be accused of being a hypochondriac, but it also took me more than a year to recover to the state I’m in now: I have phases where I’m painfree, but I’m always careful about every movement and still haven’t had a phase where I feel stable enough to actually do exercise to strengthen the muscles around my chest for long-term stability. I have learned the hard way to listen to my body. 3 years after the accident the good phases are getting longer and the relapses less drastic, so I have still hope that I might at some point be able to have a normal life again.
For now it’s still no lifting, no pulling, no pushing, no bending. Difficult in any kind of situation, but even more so on a sailing boat. And it’s not necessarily easy to explain to strangers why Christian carries all the shopping bags, why I turn away when someone tries to hand me something heavy, why I move as cautiously as a frail, old woman. My body doesn’t show any scars, on the outside I look okay, only inside I’m smashed. What has changed is my face, lots of new lines from worrying, crying, raging. Sometimes I have the helpless feeling that I’m still being swept out on the Pacific to a certain death, but I try to keep swimming.
Here’s my advice to everybody who breaks several ribs in an accident. Be very careful not to start activity and exercises too early. You might be lucky and “just” have broken bones, but if the cartilage got damaged, it will very likely go undiagnosed. If you keep having pain, a feeling of movement, unstability, consider a slipping rib and get help from qualified doctors. As far as my extensive research goes, there are only two clinics in the world that actually specialise in ribs: “The Rib Injury Clinic” in London and “Penn Medicine” in the US.
