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Andrew Mangan C5

Andrew Mangan C5

Name: Andrew Mangan      Injury: C5 fracture, presenting as a C7      

Date of Injury: December 11, 2016      Asia Level Initial: C Recent: D

Number: 716-265-1765         Email:          Age: 17

Attitude is a small thing that makes a big difference
— Winston Churchill


Post Accident: Immediately following the accident I had no movement below my chest or in my hands, however I could move my biceps, and wrist extensors and flexors. I retained sensation and could feel deep pressure.

Progress: I first was able to move my knees, initially only a twitch, started about 4 days post injury. I moved my toes on Christmas day, 13 days post injury. From there muscles began returning.

Legs: Quads came back first, adductors far stronger than abductors, hamstrings slowly came  back. I stood in a harness (%75 body weight), 20 days post injury. Walking in harness with manual movement of legs by day 30, transitioned to walker for 2 weeks. Moved to crutches about day 60, I believe I could've transitioned far earlier, found the crutches easier than walker, as I had more lateral balance issues.

Exercises: I moved as much as I could, kicking my legs, doing exercises my entire 70 days at rehab hospital and beyond. Once I was able to stand, I stood in my room as much as possible. I wasn't "cleared" to do this of course but I was spotted by two family members, and each time I stood my hypotension wasn't as bad. By day 80, I was walking with hand crutches, but could walk independently . Started using elliptical for my glutes, super helpful and minimal balance needed. Swimming was paramount, allowing me to walk in water and on underwater treadmill.

Hands: Very slow initial progress, feeding myself painfully slow by day 5. slowly became better, was able to write by day 40, using pens with gel ink. Right hand progressed faster at this point, because I am right handed. My left thumb had significant trouble opposing persisted. By Day 90, my right hand was moving at about 90% efficiency left hand 60%. Right grip strength was about double that of left hand but both are improving.

Exercises: I used hand machine and a lot of e-stim. I also tried to do as much as I could by myself, started feeding myself as soon as I could, although it was extremely tiring and took forever. Played cards and board games requiring fine motor skills. Began using my computer again to type. Wrote a lot as soon as I could hold a pen.

Core: My core was the last major muscle group to come back, slowly strengthened, no real turn on moment. noticed I could move around my bed easier as time went on. By day 70 I could sit upright. Lower back also very weak, slowly strengthened with a lot of targeted PT (Supermans!).

Exercises: Initially my core was too weak to do many exercises but as I gained strength, I did a lot of leg raises, clams, bridges, and work with the Swiss ball. I had a lot of trouble initially flexing my lower back and one of the ways I was able to was inverted sit-ups off of a stretching mat, with someone sitting on my feet. Shallow sit-ups and resisting gravity from the top of a sit-up helped me work my way up to an assisted sit-up. 

Voiding: Immediately post-injury I was given a foley and put on the program. After one month I had the foley removed due to discomfort and I was given the chance to void and I was able to. Shortly after I began going to the bathroom by myself as well. Urgency was a huge issue at first, but I slowly was able to expand my bladder and control it better.

Tone/Spasms: Since the injury, I had both tone and spasms. My spasms mostly occurred either during stretching or while doing physically strenuous activities, in which my muscles where contracting hard. I went on a small dose of bacalifin (anti-muscle spasm,) and my spasms didn't really get better. When I came off of it my spasms actually slightly improved. As time went on, and I got stronger my spasms decreased. I still get them when I am stretching and in the morning after sleeping. I have significant tone in my back, calfs, hands, and ankles. Through stretching I have reduced my tone significantly.

Drugs: Drug use is very dependant on the specific person, but some of the drugs I used and was offered I wish I had more info on. The most notable one was bacalifin. Bacalifin is an anti spasm medication that works by depressing the electric signals in your nerves. I was offered this when I was having bad spasms stretching, but they were never painful. I was reluctant to try bacalifin, because in my mind when trying to reconnect the nerves, reducing the signals didn't seem like a great idea. However, I went on a small dose and it had little effect, I actually think my spasms may have gotten worse (but that could be the placebo effect.) When I came off of bacalifin my spasms actually got better. My outlook from the start was to try to get off of the drugs as soon as I could. My first week in the hospital, my nurse weaned me off of my pain-meds. I was, however in a rare case as I had received no other injuries in my accident. I think this as well as never going on anti-depressants was important, because instead of being tired from the drugs I was moving around and always doing things.

Suggestions/Comments: I have three main suggestions. 1.) Stay positive. What we have to go through is one of the hardest things someone can go through. Having everything taken away and having to learn life anew, yet we persevere, because we are resilient. When we stay positive and have a good attitude it makes even the hardest days better. 2.) Don't always follow the status quo. This may sound cavalier or preposterous, but you know your body the best and if you think you can handle more, whether that's more PT or more time out of bed, then do it. In your PT and OT and all of your therapies, push yourself, the harder you work, the faster your recovery, however small or big, will occur. Unfortunately there are no guarantees with SCI, that's what makes this such a tough obstacle, but if you give it your all, you will get the best possible outcome you can. 3.) Make sure you question during your recovery. For example, immediately after my accident I was put on neurotin, and while I had nerve pain then, it was never revisited in my 70 days at Craig. Not until I asked about it and my doctor realized I didn't need it, was I taken off. The same went with crutches, I had been walking with a walker in PT, but I tried walking with ski poles, at my sister's ski race and noticed it was far easier than the walker, so I asked to use crutches and I was very competent with them and as a result walked out of the hospital with them two weeks later. 

Intensity drives recovery
— Eric

I hope you found my story helpful, whether you are a fellow SCI survivor or a family member or friend. Please feel free to comment or reach out to me with any questions you might have.

C5 Quad to walking
Walking out of Craig Hospital after 70 days
The Six Month Milestone from a C5 fracture.

Mike Shaw C4/5