BREAKING BONES, FRACTURING FAITH, OVERCOMING OSTEOPOROSIS.

by Mickie Jacobs

Born to be active

It is 1964 in Birmingham, England. Picture a young girl of 11 ½. She has just reached puberty; she is about to start secondary school. She is around 157 cms tall (or 5ft 2ins as this is England) and probably around 50 kg or 8 stone.

This is me we are talking about, all those years ago. I was active and busy. I rode my bike or walked a fair distance to the bus stop to get to school. I played netball and other sports. I did not grow, but I did fill out although I was never fat.

Fulfilling a dream, I got into the University of Bristol to do drama as part of my course. At this point, I also fulfilled another ambition to become vegetarian as I was now looking after myself.

When Andrew and I were married in November 1976, I was now quite slight. Instead of picking up the tall genes, I was what my late Dad called ‘a throwback to the Joel’s’, relatives on his side who were tiny.

My varied working life has always been active, as a UK mummy, I pushed prams loaded with shopping up and down hills and I swam. I lost weight. I swam. We moved from London to Toronto for 2 years. An outdoor life in all weathers and I swam. We moved back to London and then 3 years later to Leeds, where I finally joined a gym at the age of 41. I had watched a programme presented by a well know television presenter who was also a brilliant horsewoman. She had been diagnosed with osteoporosis and for the first time I became vaguely aware that swimming was not a weight bearing exercise. I still swam a lot.

The diagnosis

In 2001, Andrew, Rachel and I moved to Johannesburg. Sian was on a gap year in Israel and looking forward to university in Manchester. A few months in I went for a mammogram and the radiotherapist asked me why I had not booked a bone scan. The NHS in the UK does not offer screening in the same way as those of us fortunate enough to be on medical aid in South Africa and I am not sure I was really aware.

On my 50th birthday, I went for a whole-body check and was asked why I wasn’t on HRT. Due to the complexities of Sian’s birth condition, we have always used homeopathy wherever possible and I wasn’t willing to take conventional HRT.

My first bone scan showed osteopenia in 2005. I found a wonderful bio-kineticist at the gym we belonged to at the time and we have been working together ever since.

First fractures

In January 2005, we climbed Kilimanjaro up a route over the Arrow Glacier that was abandoned soon after. Incredibly gruelling and a huge toll on the body. A few months later, we took up road cycling and I rode my first 100 km race the same weekend I started on Phosomax as I now had osteoporosis. That lasted all of 3 weeks. My body hated it.

Actonel was the next attempt and whilst taking that, in February 2007 I slipped by our pool. Despite intense pain for a few days, I carried on as normal until the Sunday morning. This was a month before what was then called the Cape Argus Cycle Tour. A couple of kilometres into the ride, I gently turned a corner and came off my bike. Now we realised I really had hurt myself. My right hip was broken. While the orthopaedic surgeon was deciding what to do for the best I told him, I am going to Poland and Israel in 8 weeks’ time with my older daughter and a delegation of South African adults to The March of the Living. I need to be able to walk 3 kilometres along the train tracks from Auschwitz to Birkenau. Stunned, he said well we need to pin you then as the recovery is quicker than a hip replacement.

Coming home from hospital, I started trying to find a physiotherapist who would come to the house. We worked together twice a week and in between I diligently did my exercises. There is a tennis court on our property that is rarely used for tennis, but I started to walk round and round to build up stamina and watched curiously by my 3 cats. Sian came out to Jo’burg and we travelled to Poland with the rest of our group. The ground in many places we visited was difficult and uneven, but I coped, and I made those 3 kilometres on a crutch. The next day I abandoned the crutch. Andrew saw me off at ORT in a wheelchair and welcomed me home with no walking support.

That May, 3 months after the fracture, I was back on my bike and soon riding races again. The next medication I took was Protos 2 g for 6 years. During that time, we did lots of hiking, I rode cycle races and in November 2012, we trekked to Everest Base camp. The higher and the colder it gets, the more treacherous the terrain. Probably not recommended for someone with osteoporosis but then one member of our group has multiple sclerosis, so who was I to worry.

Shattered Bones

In February 2016 we were out in the Cradle of Humankind, a month before the Cape Cycle Tour, on a beautiful summer morning. As I came down a hill near the Rhino and Lion Park there was an almighty thump in the back of my little road bike, and I was flying. I landed heavily on my left side and the pain was so excruciating I almost fainted. I had been hit by a young woman on a mountain bike. My left shoulder was shattered but fortunately apart from heavy bruising and a lot of scrapes all down my left side, no other bones were affected. At the hospital I was met by that wonderful rarity – a female orthopaedic surgeon. So, when I say we are going with our girls and Sian’s husband for a special nostalgia trip to Canada in 3 months she looks at me slightly askance and says, well you will not be carrying suitcases….and do not fall. As a lay voluntary counsellor, I recognise that I was deeply traumatised after this accident and it took me some weeks to recover my equilibrium.

As part of my fitness recovery from the shoulder, I started to do the Delta Park Run in earnest and discovered that for a woman my age, I am quite nippy. As I wasn’t cycling, I decided to take up running and joined a local running club. On my 3rd or 4th run, I tripped, fell heavily and now to add to a dodgy left shoulder I had a broken knee. This was a mere 6 months after the shoulder fracture. I made sure I was operated on by the same surgeon. However, this was Tuesday night and, on the Friday, a weekend conference that I had been working hard on for more than 6 months as a volunteer, was due to start. Both the surgeon and the anaesthetist, who was attending the conference, told me I should not go, knowing full well I would. My concession was a wheelchair for the weekend, so I didn’t risk being knocked off the crutches. I also told her that 3 months later we would be hiking the whale trail. Her response was ‘Mrs Jacobs, you are a very unusual woman’. To the shoulder physiotherapy was added the knee and it was back to walking round and round the tennis court again and again watched by three cats. Sadly, only one of whom had overseen my hip fracture recovery. Hike the whale trail I did, in a knee brace that ceremonially was abandoned at the end of the 5 days.

I took a pragmatic but sad decision to give up cycling as it now felt too risky. I think I rode approaching 100 cycle races of on average 100 kms each over 12 years. My lovely little road bike was donated to Afrika Tikkun. I still have my hybrid should I want to ride.

Osteoporosis and my meds

At the beginning of 2018, a  friend who is a gynaecologist with an interest in osteoporosis asked to see me and after much consultation, put me back on to Actonel on a monthly dosage. All was well until Actonel was suddenly withdrawn and the accepted substitute was Boniva. I started to experience pains in my legs, and no one could understand why. In the meantime, in February 2019 I slipped at the gym. As one does, I put out my left hand to save myself and fractured my wrist. I have to say I felt extremely fortunate given how hard I came down on my backside that I did not damage to my lower spine or hips. The orthopaedic surgeon asked why I didn’t just arrange to have coffee with her rather than take such dramatic action to see her! The incentive for quick recovery this time was a forthcoming trip to the UK for my mum’s 90th followed by a trip to Germany with our daughters and their partners. The surgeon recommended me to a young endocrinologist working at the same hospital and in fact sharing rooms with a close doctor friend of ours. By this time, the pain in my legs is so excruciating at the start of the day that it takes me all my effort to get up, feed my cats and perhaps 2 hours of pacing around until I get going properly. My usual modus operandi is to be up around 5 a.m., feed my cats, meditate, exercise, and then get on with my working day. The physical pain was matched with sheer frustration at feeling so incapacitated. Finally, I realised that this has been going on since I started Boniva.

Google told me bone pain is a recognised side effect of Boniva when given as an injection but not usually when taken orally. Welcome to my world. I do not do normal or usual. When we saw the endocrinologist, I insisted I could not carry on with Boniva. Well, you fractured so it is not working anyway is the response. For the last 18 months I have been injecting myself nightly with Forteo and will do so for another 6 months.

Beyond the fractures

I run, walk, do my biokinetics programmes, yoga and Pilates. We hike when we have the opportunity. We are incredibly fortunate where we live, so although for pragmatic reasons we have cancelled our gym membership due to Covid 19, we have space at home, in our garden and live on the Braamfontein Spruit close to Delta Park. In the summer I swim as well. Being British, even after 20 years, to have a pool in the garden is an immense privilege.

One of the most important aspects of coping with multiple fractures is maintaining a normal life. I have continued with all or most of my voluntary activities each time. Yes, I have been dependant on others to take me to where I need to be especially as a facilitator for the LifeLine Johannesburg Counselling course. I did not have the confidence to use Uber until the wrist fracture. I felt too vulnerable with my shoulder and knee breaks. Some of my work is home based anyway and I also volunteer at the Johannesburg Holocaust and Genocide centre.

On faith and family

One cannot underestimate the impact traumatic accidents have on the family. Living so close, Rachel has literally picked me up twice when Andrew was unavailable and even after leaving home has had on one occasion to move back for a weekend to help me. Sian has had the anxiety of not really knowing what was going on and for helping me on the March of the Living. On trips to the UK to visit my mother and other family members, she has kept a close eye on me. Andrew has been my chief carer and chauffer. I am extremely blessed in him and my daughters.

Multiple traumas test one’s faith as well. I am a practising non-orthodox Jew. I believe passionately in egalitarian religion and that women should be able to occupy whatever role they wish in their chosen faith. For me, the ability to participate in services adds a whole dimension that being a ‘congregant’ lacks. But of course, when I have fallen and broken myself, inevitably I have asked ‘why me? Why again?’ The answer is to regain my sense of spirituality. Sometimes that does come in a formal service, more often a sublime piece of music, but most often being out in this wonderful creation we call Earth. Running, walking, hiking in magnificent scenery in many parts of the world. Not being afraid to test and push my body. Watching the butterflies in the garden, seeing Wild Dog, tracking a cheetah Mum and her 3 cubs on foot only a few days ago. It is when a client says thank you. I feel so much better, you have listened to me and understood me. It’s when counselling and words come out of my mouth that are so appropriate, I wonder where they come from!

I am blessed with a positive personality and have always been determined to be my best under whatever the circumstances.

My firm belief is that osteoporosis is not a life sentence. It is an opportunity, a door to be opened to new ways of living and coping. To adapt my own words about Sian and her condition,  “the osteoporosis lives with me. I do not live with it”!