Targets

Today I went out and made my cycling target for the week, which was 30 miles. This month I'm aiming for 100, which looks possible. What I'm trying to do at the moment is build up a selection of routes which I can come back to in the coming months to monitor progress. I've been looking back over my riding history from 2007 - 2010, and I am quite surprised how infrequently I repeated a route! There are a couple which I can use to see some progress with my fitness, but it would of course be easier if there was at least one route I did regularly with the same equipment.

Likewise there aren't many routes from previously that I can use now to gauge where I am compared to then. On the road bike, many of the routes I did before are too long or go up roads I don't think I could muscle my way up at the moment. On the mountain bike, many of the routes go on trails that I don't feel my ankle would like very much at the moment. Although I could try some of them, I suppose.

Hence why I'm trying to be more systematic now. I guess before I was just riding purely for fun, with no specific target in mind, whereas now I want to get back to being able to do the longer rides, races and cyclosportives I feel I need some kind of programme.



Last week I did however repeat a route that I did once before, on February 15 2009. This was the Chinley Loop, out from the house via Thornsett, left at Birch Vale, right at Hayfield, over Peep O' Day, right into Chinley, through Buxworth, onto the A6 and home. It's 11.7 miles. In 2009, moving time was 50 minutes, last week it was 1h 3m. Most of the difference was in the climb up to Peep O' Day, which isn't that bad really, but I'm quite unfit at the moment! It is quite a long steady climb, good for training. In 2009 my average heart rate for this ride was 168, last week it was 177. I've been doing a bit of investigating into this with my historical data, and it definitely seems that my average heart rate goes down when I've been training. I guess this is all well-known stuff to coaches and so on, but I found it quite fascinating to be looking at that in my own data. The program I use to record my rides, myTourbook, lets you see a histogram of your heart rate with time for each ride, colour-coded by heart rate zone. So I can compare my heart rate in zones between these two rides:

Last week.

Compare with 2009.

On the face of it they look quite similar, but if you look at the distribution through the zones, you see that in 2009 the percentage of the ride I spent in zones 3:4:5 was about 21:43:29. Last week it was 4:49:45. That looks quite significant to me. Hopefully I'll be able to revisit this route over the next few months and compare some more!

Back in the Saddle

So far this week I've ridden 24 miles in two rides. Last week I did one ride of 12 miles. This week my target is to do 30 miles and this month, 100. The weather in December was really awful - lots of rain - so I didn't get out much. But now it feels like the training has started properly. I'm really unfit of course - it feels like there's nothing in my thighs at all, especially the left one. The right one I get a burn in quite quickly, but so far I haven't felt much in the left. I'm swapping between my road bike and my newly modified mountain bike, depending on what route I choose to do. There are some hills around here which I doubt I could get up on my road bike at the moment!

With these leggings on you can barely tell there's been anything wrong!

It's been snowing this week and is trying to lay down a covering right now but hopefully I'll be able to complete my weekly target tomorrow afternoon or Saturday morning with a short-ish ride. I'm trying to establish some routes that I can come back to every month to see any improvements.
My physio thinks I'm crazy because I like measuring and recording everything. But she is very good - I'm seeing her once a week now and she's working mostly on my foot, ankle and calf, trying to get some mobility back in my ankle and loosening up the muscles in my foot and calf, which apparently have been very very knotted up. It is really helping - I always feel much looser and better after my appointment there. I guess I'll be seeing her for the forseeable future!
At the moment I can readily believe that I will get back to where I was before on the bike. There's an issue with my ankle - every time I change gear or go over any kind of bump, it hurts. So I think proper off-road riding is off the cards for the time being. After the rides my ankle is very sore and I am hobbling around worse than usual for the next day, but I hope that will subside and in any case I can tolerate that if it means I can ride properly again. It will take time, but I can see building up the strength in my quads and calves and achieving my target of being able to do a 'proper' ride of 90 miles or so around the Peak District by June/July. Then the plan will be to enter the Bradley Wiggins Sportive on August 18, for my return to 'competition'.



Where I will end up walking-wise though, I really can't say. I knew a long time ago that I'd be cycling again way before I was able to walk, and so it is proving. I can manage a short walk to the shops without crutches, but by the time I'm back my walking pattern has deteriorated a lot because of fatigue. It's going to take a long time and a lot of work before I can go up Kinder Scout again unaided... Right now, weather not-withstanding, I could probably take the Glossop bus up onto the hill and walk across the moor with one stick. I should do that soon because I really miss the moors! Maybe I should look into getting a walking pole - something I swore I'd never ever have, but now maybe it would help. Or I could get a more traditional walking stick - how cool would I look then?!

First bike ride for 895 days.

OK, today I had to wait for some Christmas presents to be delivered, but the plan was, weather and light permitting, to get out and ride. Finally.

By two o'clock all my parcels had arrived, so I quickly put my lycra on :) and got myself sorted out, water bottle etc. gps, heart rate monitor, pumped up bike tyres to about 90 psi, basic toolkit in pocket just in case, phone, keys, looked at the roads - a bit damp but looking OK - and, nervously, I went.

After one failed attempt to clip my right foot in (it's been a long time!) I was riding my bike down the road outside the house. It's like riding a bike, you never forget. I had thought carefully about this ride. Going right out of the house means there's a flat bit for a few hundred metres. All other directions are a hill. So I gave myself 30 seconds for something to go wrong and it still be flat. So far so good. Nothing went wrong. Felt very strange after all this time. I was worried something on my bike would snap or the tyre would burst or something else equally unlikely was going to happen. It didn't. After the few hundred metres the road goes down a bit so no pedalling required - again, good. At the bottom it's flat again for a bit, maybe 400m, then there's a hill. A molehill, not worth speaking about.

As soon as I started up it, I knew my plan wasn't going to work for this ride. This hill suddenly felt like a major climb. I never really noticed it much before, sort of a warm up before the ride starts properly after the first few miles. Oh dear. Are my legs really that weak? Is that really the lowest gear on my bike? It used to go lower than that! No, it didn't. Lots of things have changed, but the gear ratios on my bike are still the same.

After that hill, there's another downhill section and then another uphill, perhaps not as steep as the first, and certainly another that I'd never really noticed, but I did today! At the top of that, at Birch Vale, the road meets the Hayfield road, I turned left. This bit is flat until the junction with the Glossop - Chinley road. There I had planned to go right and go over the hill to Chinley. That was the hill I talked about last time. What actually happened was I had a rest. I'd known since the first uphill that this wasn't going to be a good idea. When I stopped and unclipped and put my feet down, my legs were feeling so weak like they might give way :(

I dismounted (also difficult as it happens), and walked back across the road. I decided to go back exactly the way I came. The Chinley loop, for which I have pre-accident data, will have to wait a bit yet. Tijl and everyone was right - it was too much for the first ride. I hate being wrong. I hate failing, not achieving what I set out to do.

I retraced my steps along the Hayfield road - I could've gone straight on and back to New Mills going up Union Road, but that's a climb too, and it's the town's main street so there would be people around to witness my pathetic struggle in the granny gear. So I went back the back way, to avoid being seen as much as possible.

It didn't seem quite as bad on the way back, possibly I had resigned myself to just going slowly and pacing myself up the 'climbs' like I would normally have done on something much more severe. It worked, but when I got to the front door I had to wait a few minutes before I dared swing my left leg over the saddle to get off. Courage needed. You won't fall. But it feels like I might. You won't. Just do it.

What have I learned? It's going to be hard mentally as well as physically. I know what I could do. I just can't do it now. Didn't I know it was going to be hard mentally? Yes I think so, but I honestly thought I'd set a realistic goal today. Now I see I hadn't. I never thought I my legs could feel so weak on a bike as that. 

I was also quite nervous about being clipped in and generally handling the bike. I put this down to physical weakness as well as lack of even a shred of specific fitness. The more I get out on it now, the more that will return I'm sure.

Positives? Absolutely. 2012 will have bike miles! After 895 days, I did 5.6 miles.

Not much mechanical pain, at least not that I could notice next to all the pain from lack of muscle and fitness. Ankle not moving doesn't seem to cause much problem. I didn't try to stand up on the pedals going up the hills - I think that would've finished me off completely, my legs just didn't feel strong enough for that.

Will my strength for this recover. Of course it will. I just needed to get out the first time and set a benchmark for my mind and my body. On the way back I think my body was already starting to remember how to suffer and where to get the extra energy from. Or maybe I just think that because I've relaxed and recovered a bit now...

I also got to post a ride on Strava, which I've been dying to do - and I see there are some segments of even the short ride I did today which other people have times on. Amazingly, I haven't posted the lowest time on any of the three of them that are there! Almost in one case (78th out of 81) but look, I haven't ridden my bike for 29 months. Oh, and did I mention I almost lost my leg?

Look for yourself. The mechanical bone/tissue rebuild may be over, the rebuild of everything else starts here.

This Week's X-rays etc.

This week has been a bit major to say the least. I had three appointments: one with the consultant at Preston on Wednesday, one with a specialist in Sheffield on Thursday, and my physio appointment on Friday. One of the things that's kind of annoying is all the time something like this can take out of your life - I mean, each of those appointments took at least half a working day out. This is time I won't get back....

Anyway, on Wednesday I went to see my consultant in Preston - it's actually a paediatric clinic but he said I could pretend to be a child for the day.. This is to fit in with my lecturing, normally I'd go on Monday to the fracture clinic, but they've always been quite nice and flexible with me to let me have it affect my job as little as possible. The nurse in the clinic said she wanted no tantrums from me when I said I was going to pretend to be a child! Pretend! As if - I am a child. Mostly. 

So over the last few weeks I've been convincing myself alternately that my leg wasn't bending again, and that it was. This x-ray would provide the proof one way or the other. Thankfully, it shows that my tibia is straight as an arrow! This is good! I've been fully weight-bearing as much as possible on it for 3 weeks since the frame was removed. Of course the struts were unlocked for something like 6 weeks already, so really it's more like 9 weeks when it could've bent. But this shows it hasn't.

Top view. No bend in tibia.Yippee!

Side view - the angle in this plane is not as important, but it's still pretty straight anyway.

OK, so, it looks like it worked :) What a relief! Now I can push as much as I want / can. I don't have to go back to see my consultant now for 3 months - until March 4 2013. This is a bit like a semi-discharge compared to what I've been used to for the last 29 months!

You can see from the top view that there is an illusion now of it being bent - there is much more of a taper of the soft tissue on the outside than the inside. It looks bent. It isn't.

I asked about driving. No problem, he said, if I feel like I can do an emergency stop, everything's OK. I do. So I will have a little practice in Mum's car next weekend, and then we're all good for renting a car at Christmas. This will make Rebecca's life then much more enjoyable - and mine too :) Freedom!

When I wake up, it looks a lot less swollen :)
Possibly it's shorter too, but hey. You can't have it all (so I'm told).

I also got some tubi-grip to put around it so that maybe the swelling will go down quicker. That's good too. When my consultant said 3 months, I think I knew that deep down, but still, it meant saying thank you for the time being and that is a bit hard because thank you just doesn't seem to cover it. He said he thought it was good that in the end they had fixed it so that I hadn't lost my leg, and that it looked like from that point of view it was a success. I know it's their jobs, but really, how can you repay something like that?

Next, Sheffield on Thursday. There is a whole side of this accident that I haven't spoken about in my blog - the claim against the insurance company. For obvious reasons I don't want to go too much into it yet because it's ongoing, but my visit to the specialist in Sheffield was at the behest of the insurance company. It passed off without incident - the guy was nice, possibly a (retired?) orthopaedic consultant. He asked a lot of the usual questions which I don't really like going over again but I've been over it so many times now with so many people I could practically do it in my sleep. He measured up all of my scars, asked about pain etc. and how it's affected my life. My file is massive! No doubt that's copies of all my medical records. One day I will write up my thoughts on all this side of it.

On Friday I had physiotherapy at Stepping Hill. My physio was pleased to see me amble in almost without crutch. I explained I was showing off because I was there, but he said you have to be able to do it to show off. I guess that's right. We went through my stretches and step exercises, which have got easier over the last fortnight to be fair, especially stepping up backwards leading with my left leg. Now I have sideways step ups to do, and heel dips and raises over the edge of the step. They are hard on my calves.

We talked about the motion in my ankle. He said realistically it was unlikely I'll recover much more than I've got at the moment. I have no fibula anymore (you can see the wreckage of it in my first x-ray above) so he thinks it is possible that my ankle has fused to compensate for the lack of stability that brings. I do have some plantar flexion, but hardly any dorsi flexion. Cycling wise it shouldn't matter too much - I am mildly concerned about balance on the mountain bike since some of that comes from dropping your heels a bit, but we'll see about that later on. Of course, I can keep working on it to see if it will loosen up a bit, but I guess he was telling me not to be too hopeful. Maybe I knew that deep down already, it wasn't a surprise but still a disappointment. He said (as have others) that I have to look at it as a leg saved. But I suppose I want to believe it'll be back to normal eventually, mechanically. What matters I guess is what I can do with it. I intend for that to surpass what was normal before, eventually. Walking barefoot is never going to be easy now though. You don't walk around outside with no shoes on was his reply. :)

I told him that I was intending to go out on my bike on Saturday - there hadn't yet been the right combination of light, dry roads and time.

Finally, he gave me a target - off crutches completely by New Year. Now that seems ambitious to me, but what is certainly true is that I could do a lot more without. Just carry the one and use it when necessary - in two weeks when I go back, I have to be at 50% crutch usage.

First weeks of Phase 4

OK I don't know why I numbered the phases the way I did, but Phase 4 is now, leg unsupported and in principle able to recover without further intervention.

To recap, the other phases have been: Phase 1 - external fixation post discharge (August - December 2010); Phase 2 - leg in cast post frame removal (December 2010 - March 2012); Phase 3 - leg rebroken and in external fixation again (March - November 2012). So I guess Phase 0 was June - August 2010 when I was in hospital in the beginning.

Deep breath - Anyway, the frame was removed, and honestly, I couldn't have hoped for it to feel this good this quickly. Of course, there's still a way to go until I can use it without thinking, until I'm completely off crutches etc., but it does feel pretty good! I realise now how much pain I've been in the last couple of months, because it's relatively painless now - I still get sharp twinges, especially if I'm putting weight through it, but it doesn't hurt hardly at all now when I bend my leg - so that pain was definitely due to the frame. I should've remembered this from December 2010 when they removed the first fixator, because it was similar with my knee back then, but I think you don't dare hope it'll not hurt, so, when it doesn't, it's a nice surprise.

I also thought there would be much more of a psychological issue about putting weight through it without the frame - even though I knew for the last few months the frame wasn't supporting my leg (struts unlocked) I thought there would be some effect. Well, apart from the first day or half-day, I've not had a problem with that! Maybe I'm just too sick of hobbling around and I don't care anymore? In any case I've been fine with it, just one-crutching around like before. It really just feels the same without the frame as with, stability-wise. I think this completely vindicates erring on the side of caution re. taking the frame off. I think it probably would have been OK to remove it two months ago, but this is much better - worth the extra months of difficulty to not have to go in a cast for an undetermined amount of time. I feel good about not begging for it to be removed as soon as possible. 10 points to me :)

A few days after frame removal, looks a bit less swollen? 

The itching bandage too much, I took it off, here's what was underneath.

The pin sites healed quickly - the small ones where the wires were had healed up the first time I took the bandages off. The bigger pin sites took a few more days before they dried up but it didn't take long. What a difference compared to last time! No infection in bone, no MRSA (I guess). Big difference. So I could have a bath again :) Crikey I missed having a bath. I've had one every other day since I could - still not had enough. I've not been able to wash my left leg properly since March, so there was a lot of dead skin and mank to soak off of it (nice if you're eating your tea, I know). Most of that has gone now and it looks clean again, kind of.

The first close look, the pin sites mostly healed up.

Swelling, yes, still quite a lot. Last time, being in the cast no doubt helped to reduce the swelling because of the pressure. I think I'll ask my consultant if there's some kind of strapping I can get to speed it up this time. It definitely looks different in the morning when I wake up to when I go to bed at night. It's still a bit unsightly, and of course it'll never look normal, but it seems to work. That was always supposed to be the deal.

A few days, and a few baths later, looking much better :)

Clothes - I had all my jeans and trousers out which I haven't worn for 29 months. The intersection of the set of trousers I can get over my leg with the set I can fasten around my (now much bigger) waist contains but one member, and even that pair is on the tight side. So, I either need some bigger, looser pairs or I need to slim and get the swelling down quickly.

These, the only pair of jeans I can get over my leg and around my waist!

Which brings me on to exercise. Last Friday I had my first physiotherapy appointment since the frame removal, and I was looking forwards to it because I've known for some time that physio would only start properly when my leg was unsupported - which it hasn't been at any point since the accident - until now. So, I expected to be able to do a few more exercises than before. I wasn't disappointed! Of course I have a lot of stretching to do to try to free my ankle a bit because it still doesn't move very much. I probably have just about enough dorsiflexion (that's moving your foot towards you) to walk, but obviously more would make it easier and more natural. I have more plantar flexion (moving foot away from you). I've got some exercises to do with a step - stepping up and wdown in all possible combinations of which leg first forwards and backwards - and also lowering (well, trying to) my ankles over the edge of the step. The hardest is stepping up onto the step backwards leading with my left leg. At the moment I can do it if I first do it a few times holding on to something. I think that must just be a case of trusting my leg. I also can't walk downstairs without holding on to something - that is going to take a long time I think! Stretching is also tough because my ankle is really really stiff. I'm supposed to bend my knee towards a wall from a stretch position with my foot flat on the floor. Of course I can bend my knee freely, but seemingly not at all with my foot flat on the ground. Hmmm. Work needed, patience too I suspect.

Next, I have to try to drop down to only using one crutch, all the time, because using two now will hold me back - I think I was expecting this, so my physio confiscated one of my crutches and I left the appointment with just one. That will be a struggle for a while, but the idea is I will walk again without crutches, so my strength and stamina for that has to be built up. My crutches have become crutches, it seems :) Of course I do have more crutches at home in case I really need two at any time.

BUT by far the best news since they told me they could reconstruct my leg and not have to amputate it, is that I have now been given the green light to go swimming and, wait for it, to ride my bike outside. I wasn't really expecting to be allowed that yet, but my physio said "why not?" when I asked him meekly. "You need to reclaim your life." Yes I do. That was last Friday, today is Wednesday. So far I haven't been outside on my bike. Hold on, hold on, I hear you cry - you've been waiting for this for two and a half years, what's wrong with you! Yes that's right, I say, but I also say, I've waited 29 months, so I can wait a few more days until I get my head around the idea and feel comfortable about doing it.

Rebecca grabbed this cheeky picture of me suffering.
First time on a bike for 29 months.

On Sunday I rode my road bike on the trainer properly for the first time. I set a target of 10 minutes. 2 minutes in, I was knackered, thighs burning, heart rate at maximum. Maybe I should have just turned the pedals for 10 minutes, but that's not really my style, so I pushed it, and pushed through the 10 minutes. It was so hard, but it felt so good to be able to feel the burn again. It was a bit tricky for my left foot to stay in position on the pedal, so I have reattached my clipless pedals to fix that little niggle. I posted my 'ride' on the Strava site - something I've been dying to use. The trainer is not a good measure really for a number of reasons but mainly (I feel) because you can't really have a rest and free-wheel like you would on a descent on the road. And you don't have fresh air and scenery to keep you happy. But it is good for pushing you :) Needless to say, however much I try to convince anyone otherwise, or however much they try to convince me, I am hopelessly unfit. But, I have a data point now, for the progression back to where I was. Joy of joys, that process can start.

Yesterday I sorted out my road bike so I can take it outside. This wasn't the original plan - that was to use my old mountain bike, but I found to my dismay that the fork has rusted :( Maybe if I take it out and batter it a bit it will come loose again, but I don't really want to 'batter' it at the moment in case I batter my leg in the process. So, road bike it is. It took me a little while to check and clean and everything but I think it's good to go now. I'd have gone yesterday afternoon if the weather had been better, but it's November now and rainy season appears to have started in High Peak. But it's ready, when time and weather permit.

I have, however, decided on a route to do first of all, to put down a proper marker. I looked back in my ride log from before the accident, and found a loop I did once around here, which is not very long (11.7 miles) and which contains a long, reasonably hard climb about halfway round. I think this is perfect. Of course, the first time, I will be horrified at how hard it is and how slow I am (won't I?), but it will mean I can see exactly where I am with respect to where I was, with the added bonus that it was in February 2009, fully a year before I reached my 'peak' in Spring 2010. Naturally I have other rides I can compare with later on, but they're all further and harder and I want (need) to start small. I probably need another 10 mile route, 2 x 5-mile routes and a 25 mile route too, to break up the training a bit more properly. I am so pleased to discover that my enthusiasm for training and testing and riding has not diminished. I didn't seriously think it would have, if anything, it would get stronger, but you never know. This experience could have killed it completely. It hasn't.

Last night I spent some time on the internet looking for a new helmet, the only thing I really need before I can go out. I will also replace my nutrition products which I had to bin because they went out of date in 2011 :( And I found some new overshoes for the weather and probably I need a second pair of long-legged bib shorts too. Ah, you see how it goes! I love this stuff :)

The best thing: 2012 will not be 0 bike miles :)

Frame removed!

So, the reason for the lack of updates since August is simply that not much has happened! Until this week on Wednesday, when the metal frame was taken off my leg. Basically the last 2 months we've been reasonably sure the bone was healed enough but erring well on the side of caution.

Last time I posted, I had just relocked the struts because after they were unlocked I started to notice a bit of a bend again in my leg using the position of my foot on the ground. In September I got a badly sprained ankle after one of my friends picked me up and dropped me on it! We had just won a game of pool by 7 balls, but still! So I had to take the weight off my left leg for a little while after that. However, I used that as the opportunity to unlock the struts again, and gradually ease back to weight-bearing as my swollen ankle got better.

No frame, no cast! November 7, 2012.

After a while my ankle returned to 'normal' and that's been the situation for the last 2 months. Last month my consultant sent me for a CT scan, and if the results of that looked OK, he would book me in for the frame removal. I had the CT scan on October 26, and sure enough, it looked healed enough now to take the frame off. We had a bit of an email conversation about dates and about anaesthetic. I think the default must be to have a general anaesthetic for this sort of thing, but I was a bit surprised because last time (December 2010) he just unscrewed it out of my leg while I was awake and with no anaesthetic. I asked him about it and he said that if I wanted to I could have it without the GA, so I said that was what I wanted because firstly the GA makes you (me, at least) feel awful for a day after, and secondly because I wanted to see what was going on! I also had a 9am lecture on the Thursday morning and a pretty busy day at work, so I didn't want to be groggy or feeling unwell for that. He said it was no problem.

Wednesday November 7 is therefore one of the red letter days in the story of my leg. I went in at 11am and was gowned up and pre-opped as usual for an operation. At about 1330 I saw the consultant and he asked me if I still wanted to do it without the anaesthetic. I said yes and he said they'd give me something to bite down on. I asked if that was a joke and he said no it wasn't :) OK, I thought, a bit of pain never hurt anyone!

In hindsight I probably could've got away with taking my phone in and getting some pictures, but I didn't know beforehand exactly where I was going or what was going to happen, so I left my phone in the locker room. So I'm afraid there are no pictures, but for some of you that will probably be a good thing! It is a shame, but then I guess it's only me who knows exactly what happened and it is my leg after all. I will however try to describe the procedure now - the squeamish scroll down a few paragraphs, until SAFE!

The procedure took place in the kind of ante-room where usually you get anaesthetised. I suspect this was because they were about to do a bigger more serious op in the theatre, and mine would only take 10 minutes, but I don't know for sure. Anyway, I got hooked up to the blood pressure and pulse monitor while the consultant sorted out his tools - he asked the theatre nurse to bring him pliers, wire-cutters, spanners and the T-handle, which is basically an adjustable spanner with a handle for turning the pins. Cool! Everything was ready, gloves on, begin. First, a good clean of everything, makes sense - don't want to get an infection in a hole that goes right through my bone. Next on to the frame removal proper.

Frame, for reference. 10 points where metal enters my leg.

Referring to a picture of my leg with the frame on, here goes. There are 4 bigger pins which are right through the tibia - two near my knee and two near my ankle. Then there are 3 wires which stabilise the frame - these run right through my leg and out the other side. There are 2 near my knee and one near my ankle. He began by unscrewing the pins from the frame. Of course these guys have done this loads of times, and in hindsight it makes sense, but at the time I thought that was a strange place to begin. Anyway, once those pins were disconnected from the frame, he  unscrewed the top nuts that fix the wires in place. Until this point I didn't know for sure that these wires went right through my leg, but you could twizzle one end and the other end moved! Of course, the ends are bent up and bolted to the frame, so when they put these on they must be straight and bent afterwards. How to get them off then? Wire-cutters. Carefully cut the wire on one side, then pull through from the other. That felt very odd, sort of a feeling you've not felt before, maybe as if a wire was pulled right through your leg quite quickly! So far so good. Same procedure for the next wire down. OK that's 4 out of 10 holes with no real problem. The work so far was being done by another consultant I've met before but who is not 'my' consultant, but now my consultant came in and joined the fun. That made me a bit happier because I've grown to like and trust him. He looked after the wire near my ankle. Strangely I didn't feel anything at all when that one was pulled through, says something about my nerves down there I suppose.

Now for the big pins. Of course, I knew these would be worse. The bottom two near my ankle were unscrewed by my consultant by hand, not much resistance, maybe they were quite loose after 7 months - that would explain why the bottom of the frame moved about so much in the last few months. A bit of  a strange sensation but not much feeling in that part of my leg anyway. The top two pins, near my knee: completely different story. I could tell when he was fastening on the T-handle that this was not going to be pleasant. The first one to go was the one closest to my knee. Wow that hurt! But it came out quite easily once the handle was attached. Quite strange to think that a hand on that handle is connected directly to the inside of my tibia, twisting a piece of metal out of my bone. The last pin was far and away the worst. Maybe they knew this and saved it until last. Serious breath control needed, was offered gas and air but I don't like that either - it's like being completely and utterly out of control of your body - awful - so I gritted my teeth for the two minutes or so it took to twist it out. Tried to think about what I'd be doing at work tomorrow, didn't work - what was that thing on the ceiling - almost worked. In truth, it was very difficult to disconnect it, something I've become pretty good at. Just too much I guess. Again it was a kind of indescribable pain, something you're not supposed to feel. The sight of this guy doing it too made me think that this was what it must be like being tortured, but it wasn't torture, it was a necessary thing to get through to get the frame off so I could ride my bike again. Focus. The nurse tried to distract me a bit by asking a question about something - I can't even remember - and then someone said something about tea and toast afterwards which I just managed to reply to - that I'd be getting a beer instead. My consultant agreed that would be better. I told you I liked him.

Then it was done. A big sigh of relief. a bit of a giggle (endorphins). "Easy."

The frame itself wouldn't come off my leg until all the pins were removed - they tried to get it over the two top pins but it wouldn't go, even after a bit of wrenching. This raises questions about how they fit it in the first place. I think that they must put the pins in after the frame is slid up your leg - otherwise I can't see how they could do it. I must remember to ask next time about that. It'd be amazing if they had a video of my op from March, but I guess they're fairly common (~3/year I think for my consultant) so they probably wouldn't have bothered. After it was removed, and during the removal in fact, it was clear that my leg was not moving at all (in a way that it shouldn't) and that the bone had completely calcified, as the CT scan probably showed. I was happy to see that, though.

Dressings were applied - little Mepores to the pin sites (now holes), a soft bandage then a crepe bandage to hold it all together. 

SAFE: The squeamish come back now :)

I have to leave it covered up in the bandages for two days, then inspect. Hopefully that's enough time for the wounds to have scabbed over, then I can just leave them open to the air. Otherwise, I might have to dress them up again, or if any are weeping I might need to go to the doctor and get some antibiotics. Still, been through all that before so no problem.

I was shown back to the bay where I had a sit down. I quickly got up and crutched to the locker to get my clothes back on, and pick up my bag. Back at the bay I did some texting (Mum, Rebecca, Alison) and the nurse made me a cup of coffee. I didn't see my consultant again, no doubt he was busy starting another procedure in another theatre, but later on I sent him an email saying thank you. I have to go back on November 28 for an X-ray and check up. What a life the orthopaedic surgeons have - any surgeon for that matter. Before this accident I could never have considered becoming one - too squeamish or something - now, I can totally imagine being able to do it.

I thought it would be difficult psychologically to put weight back through it, after the frame had gone. Actually though it was easy. I guess you just know somehow when things are fixed. By the evening I was back one crutching around the house, going up and down stairs etc.. Maybe I was right a couple of months ago, the corner has been turned. Fingers crossed.

Leg update, new X-rays.

It's been 4 weeks now since I updated you on the progress of my leg. I left you with the news that there would be some further adjustments because my foot was starting to feel a bit angled again on the floor. 4 weeks ago then I locked the struts up and returned them to their final positions - straight away I could notice a difference in the position of my foot, so clearly my leg had moved ever so slightly with the struts unlocked.

Since then the struts have remained in their locked positions. I was given some further adjustments by my consultant to add an extra 5 degree bend in my tibia to compensate for my lack of ankle motion. However, after making the first of these 4 adjustments, I decided that was enough, because my foot feels flat on the floor now. So I left the struts in that position which is where they've stayed until now.

On Monday this week I had another set of X-rays, and here I will show you this week's, the last one (August 6) and the one from July 23, so you can see if you can see the progress that the bone is making.

The right X-ray is from July 23 and the left from August 6.

This image shows the X-ray from July 23 on the right, which was after 4 weeks of leaving the struts unlocked. The left X-ray is from August 6. Between those dates, I had relocked the struts and returned them to the original positions plus one extra adjustment. I think you can see that the bone has straightened out, the gap on the left (inside leg) is wider on the left image. Also I think it is clear that the right of the gap has filled in a bit in that two week period. At this point, my consultant was saying that it looks like the right side of the bone is good, but the left side is not yet. He said that usually if there are three sites where the bone has united, it will be enough to support weight by itself and therefore the frame could be removed. At this point he thought I had two definite yes sites (on the right of the bone -outside leg) and two question mark sites on the left of the bone (inside leg). So, there is doubt and therefore the frame stays on. I agree :)

X-ray from this week, August 20.

This X-ray is from this week, August 20. Now the struts have been relocked for 4 weeks. I am sure it looks altogether cloudier in the gap than the previous image. Checking back over the X-rays from the last months, it looks to me like previously the gap in the right side of the bone looked like the one in the left side does now, so I can hand-wavingly calculate the time for the left side to look like the right side does now to be about 3 months.

My consultant was wondering this week whether or not the united right side could support my weight by itself while the left side finishes filling in. I am probably repeating myself here, but I don't see the point risking it. My pin sites are all clean, there's no sign of infection, so leave it on. I don't like having the frame on, it's painful (more later) and awkward, but I want it finishing off right with the minimum chance of needing another operation. So I am going to forecast November as the month when it comes off. We will see later how close I am to being correct.

Pain. Yes, it's got worse. Since I relocked the struts actually, the last 4 weeks, it has been more painful than before. I am not sure why, although I do remember that when I had the previous external fixator on, from August - December 2010,  it did get more and more painful as time went by. Whether this is my nerves reconnecting or the bone reuniting or what, I don't know. I remember that when the previous frame was removed, a lot of the pain, especially in my knee, disappeared almost immediately. I hope that's the case this time too. It is also possible that a lot of the pain is muscular I suppose.

It gets very swollen still, but seems to reach a point quite quickly and then go no further. Fortunately this point is just slightly shy of pressing on the frame in one place. I guess that's just lucky.

I suspect (hope) that now, a lot of the pain and swelling is due to the frame being there. After all, I've got ten pieces of metal screwed all the way into (in some cases through) my bone. 

I asked my consultant this week if I could do my leg any harm by overdoing crutching around or trying to put weight through it. He told me that was "highly unlikely" and that actually the worst I could do would be to break one of the pins, which doesn't happen very often but is possible nonetheless.

What now then? I'm due back in 4 weeks, and now I have been put in charge of the struts! Meaning, I can unlock them, see if over a few days / weeks my leg starts bending (judged by my foot position as before) and relock them if necessary. It's up to me. What I have decided to do therefore is leave them locked up for two weeks more, so that'll be six weeks locked in total, then unlock them, which leaves two weeks unlocked before my next X-ray which will be enough time to feel any movement, I think.

In summary, progress. Slow, but no doubt.

That's the positive bit. Physically I seem to be improving. Mentally, the last 4 weeks have been a struggle. The mental component is not to be underestimated I think. Usually, I am about 90% sure that I will walk properly and ride etc. again. Recently, the percentage has been lower. 

Why? I think it's a combination of feeling like it's another summer lost - it's three now - plus watching the Olympics, which, while awesome and so good, has also been a bit frustrating. I don't need inspiring or motivating - I just need my leg to work! It is very inspiring to see all the athletes who work and train hard succeeding in fulfilling their dreams. I want to fulfil my much less grandiose dream. I am motivated to do it, but I need to get to the start first! I honestly can't wait to begin the climb back to full fitness. 

I also tried to help Dave with redecorating my bathroom, but wasn't able to do as much as I thought I would be. I did do some grouting and tiling, painting, washing the tiles, bagging up rubbish, filling in holes, putting up a mirror. I even climbed on a chair a few times to do the painting near the ceiling (ignore that mum!) - but I still felt useless not being able to help more. Poor Dave and Lindsey did most of it, which was not what I intended to happen but for which I am very grateful.

Anyway, after a lot of moping around and feeling sorry for myself I decided that I needed to do something about it which is why I volunteered to help out at the Ride with Brad Sportive this last weekend. I miss my little adventures to races a lot, so I managed to have one without actually doing the race.

Since then, I have been feeling much better, back to 90% I think, maybe even 95% (wow!). In any case, I didn't want this post to end on a low :)

Until next time..