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..

Latest hospital visit - more adjustments?

On Monday I was at the hospital for my now biweekly x-rays. This time the x-ray still shows no shift of the bone position since the struts were unlocked now four weeks ago. That is good. However, I have noticed that I am walking a little on the outside of my left foot again - not much, just a bit, but when I try to walk without crutches, which I have been doing at least around the house - it is noticeable and is making 'walking' a bit odd. So, there is the possibility with this frame to make an adjustment of my bone position to accommodate the loss of range in my ankle, which may or may not return, but certainly won't return fully or quickly.

Yesterday, then, I locked the struts again and put them back in their final positions of four weeks ago. Straight away I can feel a difference, which means that the bone must have shifted a bit, even if it's a very small amount. I have a new prescription now from my consultant to adjust the struts over four days to achieve a 5 degree bend in my tibia. He says it may not move at all, which would suggest that the bone has healed enough to be solid, but I think I already can see that that's not the case, otherwise I wouldn't have noticed a difference when I relocked the struts. I had to change out two of the struts, because the new prescription makes strut 2 go shorter than it can and strut 6 longer than it can. Fortunately, swapping them over works, so I've done my bit with the spanners again :)

The fact that it feels better now raises the question of whether or not I really need the new adjustments. I guess I'll do them anyway, and see what happens. Maybe if I push it out further than it really needs to be, it'll settle back to where I want it?

Last night my ankle was incredibly painful. I don't know why, maybe my soft tissue adjusting to the slight movement I must have given it yesterday? This morning it's not too bad, and I can tell by trying to walk without crutches that this position, whatever it is, is better than what it was with the struts unlocked. If it would heal up solid in this position, I think walking would not be far off.

It's very swollen now too, no doubt because I've been pushing it the last two weeks, trying to do as much one-crutching as possible and even some no-crutching around the house and garden.

Next appointment is in two weeks. I don't think frame removal is too far off now. My consultant said that on my latest x-ray it looks like there are two places where the bone has knitted and two places where it might have. If there was three knitted places normally that would be enough to go with and take the frame off. So in the next month, there might be four such places. I say leave it on until we're sure.. it's not pleasant and it's quite awkward, but it's better than waiting another year and having to start again ;) 

I think he agrees with my theory about why it bent last time and that maybe going in a cast again is not going to be a good idea.

My Pennine Way Book

While I've been writing up the PW adventure for this blog, I've put some time into making a book on photobox.co.uk. Here it is so you can look at it if you like, there are many more photos that I took included in it. The text is broadly speaking what you've seen in the blog posts. Please ignore the fact that photobox wants to sell you a printed copy - just look at the preview. Having said that, I did get a printed copy myself and it's really lovely :)

Pennine Way - Conclusions & Reflections

"Let us have this through route to health and happiness for this and succeeding generations who may thus make acquaintance with some of the finest scenery in the land. Whatever the cost, it would be a worthy and enduring testimony bringing health and pleasure beyond computation, for none could walk the Pennine Way without being improved in mind and body, inspired and invigorated and filled with the desire to explore every corner of this lovely island."

- Tom Stephenson, June 1935, the man whose idea the PW was.

The Pennine Way is without doubt the hardest challenge I've ever done.

Afterwards, Mum and Dad sent me a card in which Dad had written a very touching message basically saying he was proud of me. That meant a lot.

And Roddy, the guy I met in The Border Hotel the night before the start, was true to his word and I got my certificate in the post shortly after emailing him to tell him I'd finished.

Really the crux of the PW is that it is many days of long walks over tough terrain. If you do it like I did, you are carrying a heavy pack too. The difficulty comes in stringing the days together. It seems like a long time since I started this daily blog about it! In hindsight, the things that made it possible for me were that I didn't plan it all out and book ahead, and Compeed. I really couldn't have done it without that stuff on my feet. I don't understand still why the pain in my knee came and then went just as suddenly, but I guess I will thank a few lunchtime pints for that (not!). Meeting Mum and Dad and Ciska along the way was important too as it provided some mental mileposts. When I met Mum and Dad in Keld I really couldn't contemplate the whole remainder of the walk. It was only when I got to Mankinholes that I could do that. Before that I was just looking one day ahead.

Route-wise, the famously horrid boggy bits (Featherbed Moss, Black Hill, etc.) are all paved now so they're actually quite easy and almost tedious - views notwithstanding, but there are a lot of miles of squelch, a lot of them at relatively low level which comes as a bit of a surprise. There is not a great deal of easy enjoyable walking. Probably the best day in that respect was the day over Cross Fell.

On balance I think I was pretty lucky with the weather. If I'd have done it this year on the same days, it would have been a nightmare! I did get rained on quite a bit, but when it really mattered, like on The Cheviot or on Cross Fell, it was nice weather. If every time I'd gone up high I'd gone into cloud and drizzle or worse, morale would have been really bad. The wettest I got was on the day from Horton-in-Ribblesdale to Malham where I didn't see anything over Fountains Fell except rain in my eyes. Second place was probably the day from Lothersdale to Mankinholes.

Summary of each day's numbers and totals.

As I said, not booking ahead was crucial for me. If I hadn't carried my tent and camping stuff I would only have really come unstuck at Lothersdale and Crowden. At Lothersdale I could conceivably have pushed on to Cowling and tried to find a B&B there. At Crowden I'm not sure what the alternatives are. The YHA there is one of the ones where it's been converted into an outdoor pursuits centre and I don't think you can just stay there as a member. Having said that I haven't actually checked now so it would be worth phoning them if you're reading this and planning the walk.

Anyway, the conclusion is that I'm so, so glad I did the Pennine Way, especially now with the accident and everything. It taught me a lot about myself and helped me remember some other things that maybe I'd forgotten. It made me remember that I can push my body a long way and it will go with me; that your mind is actually very important in that respect too. It spurred me on to other challenges, especially in cycling and mountain biking. Ultimately it is probably the reason why I know that I'll recover from what's happening to me right now.

And Tom Stephenson was right.

We will meet again one day, PW.

"Nothing in the world can take the place of persistence. Talent will not. Genius will not. Education will not. Persistence and determination alone are omnipotent. The slogan 'Press On' has solved and always will solve the problems of the human race."

- Calvin Coolidge

Hospital visit. Latest X-ray.

Today I was back at the hospital. The purpose was to get an x-ray and see if, in the two weeks since the struts on my frame were loosened, the bone has bent at all. 

If it had, then the tension would have to be put back in the struts and the position adjusted back to what it was after the final adjustment. I wasn't sure whether or not it had shifted. I could convince myself it had, but from looking at photographs I had taken before the struts were loosened and since, it seems as though the frame has definitely moved but my leg hasn't. So I knew if it had bent at all, it must be a small amount. I figured I would also feel it on the floor with my foot if it had bent much.

X-ray from 9 July 2012. Front view.

As it turned out, it hasn't moved. My knee and ankle are still in the correct alignment, so that's a good thing! I think that maybe my consultant was a bit worried that I would take this as a sign that the frame should come off, but I'm more sensible than that (I know!). I think we should leave the frame on until the break is almost completely healed. Last time, when the ex-fix came off and I went into plaster, my leg gradually bent over until it was in the state it was in. So this time, let's be ultra-cautious.

There is definitely some healing on the outside of my leg (right side on the x-ray), even though on the x-ray it does kind of look like the bone's in two pieces still with a big gap. It's clear when zoomed in that there is cloudiness across about a half to two thirds of it. The metric we're going to use now is 'whiteness', meaning very cloudy and probably healed up (yes, quite vague). It is probably about 20% white now on the cross section, and when it is 60-70% white the frame will come off. But I know from past experience that bone healing is non-linear, so it could take another two months to get there, or another six months. Either way, the frame stays on until we're sure it's two-thirds knitted.

In two weeks, I will go back again for another x-ray. I will go back now every two weeks to monitor if the bone is bending at all. If at some point the x-ray shows that healing has slowed down or stopped, there are some things we can do using the frame. We can compress the bone a bit to promote the healing, then stretch it out again afterwards. Another advantage of the Taylor Spatial frame I guess :)

Comparing back with my x-ray from October 2010, when I had the previous external fixator fitted, it's amazing how my tibia has changed. It seems to be a lot thicker now and the area where the main break is is quite a mess now compared to then. But, if it heals up, fine, and being thicker is better because now I've got no fibula. I don't have a picture of the October 2010 x-ray, I'll get one next time so you can see the difference.

Since the struts were loosened, my leg and ankle have been more swollen and more painful. The frame rattles a lot and moves if I knock it on something, which hurts. I'm not really sleeping properly at the moment, I keep waking up with a sore ankle :( The swelling is very variable - the other day it looked less swollen than ever before, then a day later it was more swollen than ever before!

So it's not particularly pleasant having the frame still on - clearly I'd much rather it was off - but I get why it has to stay on and I agree with that. If my consultant had said he wanted to take it off now, I would have objected! I really don't want to run the risk of it bending again and then needing another operation later on. What's an extra few months now, after more than two years?!

I also feel like I've got a good relationship with my consultant. I think he trusts me to look after it and my pin sites etc. (which are still all quite clean and dry), and I trust him to tell me the truth about what's going on and make the right decisions.

I'm very tired now after having gone to Preston and back today, but I will get a rest day tomorrow where I don't do much except tap on my computer and get some work done.

Pennine Way Day 16 - Crowden - Edale

July 9, 2008

0600 Crowden
A miserable night - cold mainly, not much sleep. Am making coffee and breakfast and will then pack up and leave. Tired and cold.

0735
Departed midge-land.

Torside Reservoir.

On Clough Edge, Torside Clough.

Wain Stones, or "kissing stones" - a curious natural rock formation.

1450 Nag's Head, Edale
Arrived Nag's Head, Edale. I was almost in tears on the little path down into Edale. This is a fucking hard walk. Make no bones about it.

Today, 6 miles from home, was the first time I got lost on the whole walk, on Bleaklow. I mean it! Properly lost. Without GPS and map I might have either ended up somewhere completely wrong or been wandering around up there for hours :( Still, eventually I got myself back on track.

On Bleaklow. Very strange terrain.

Then got lost in this sort of thing...

... because it all looks the same up there.

Featherbed Moss was totally boring - 2.5 miles of slabs - already in agony.

2.5 miles of this - Featherbed Moss.

Kinder Scout - too long.

On Kinder Scout.

Jacob's Ladder - too steep.

Descending Jacob's Ladder.

Path to Edale from there too long and last little hill, you don't even normally notice, 50m ascent, brutally cruel, just like Wainwright's last hill before Kirk Yetholm.

Field path into Edale. Got a bit tearful here.

Still, I DID IT :)

Now I'm drinking 5.5% beer :) :)

In the Nag's Head, at the end.

I think I'm going to cry later.

Day 16 Statistics

CRO - EDL
18.5 miles (276 miles from KY; 100%)
995m ascent
647m max elev.
time moving: 6h44m
time stopped: 0h29m
overall average: 2.6mph
average while moving: 2.7mph

Comments

Wow! I didn't think of much else on this day except getting to the end. On the tramp across Featherbed Moss I started counting steps to get myself through it. Now, looking back from 4 years away, the pain is a distant memory and it seems amazing that I can have been struggling so much. But reading my journal makes me remember that I was! Today and yesterday would normally have been great walking days, but at the end of the PW they were very very hard.

You can see on the masthead picture for today how wrong I went on Bleaklow. It all looks the same up there! I had to take a bearing towards Higher Shelf Stones and go in a straight line over all the haggs and groughs to intersect the PW path. At the time I couldn't understand what had happened, but afterwards from looking at the GPS trace I realised I had come to the Wain Stones and Bleaklow Head in the wrong order, because I was following the path on the ground rather than the line of the PW. So that set me in completely the wrong direction because I knew it was straight on at Bleaklow Head! Very confusing.

I really did cry a bit coming down the path into Edale. I didn't cry later, just had a rest :)

What I looked like at the end.

What I felt like.

Pennine Way Day 15 - Mankinholes - Crowden

July 8, 2008

Journal

Leaving Mankinholes YHA.

0815 Mankinholes YHA
Awake. Looks dry today thank God. We'll see how my body is etc when I stand up! This is the penultimate day!! Just one long moorland march and I'll be within 6 hours walk of the end. Edale, I'll never look on you the same. The highlight of today may well be crossing the M62 on that bridge - or Black Hill, don't know. Let's get on with it!

Looking back to Stoodley Pike.

Warland Reservoir.

The Aiggin Stone, a medieval waymarker on Blackstone Edge.

1946 Crowden
Arrived Crowden 1850 - no one in reception on the camp site here so I just pitched - just met the guy now he says everything OK. Shop opening again in 10 minutes - will get milk and stuff. Should cook but the place is crawling with midges. And it keeps on raining a bit.

Blackstone Edge (472m).

Approaching the M62 crossing. Seen this bridge many times from the road...

Anyway, how was today? Good. Long, but good. It didn't rain on me much, otherwise it would've been the proverbial. It was a long way though, about 24.5 miles door to door. Crossing the M62 was interesting - a little bit scary actually - and there were lots of trig points today - 4 I think; Blackstone Edge; White Hill; Standedge and Black Hill - which really would be impossible without slabs - God knows how they used to do this walk. There was also a lot more climbing today than I thought by looking at the map last night. Amazingly this has been the second most climbing day after Day 1. No wonder I'm knackered :)

Cotton grass and stone slabs. Just like on Day 1.

Wessenden Reservoir.

At Wessenden Head looking ahead to the path over Black Hill.

Still, I am now on home turf - only 16 miles over Kinder to go. There's a monster climb tomorrow morning but once up there it's a moorland trudge on slabs. Forecast says light rain.
Oh, today I lost a glove. Dope! Now my left hand has to go in the pocket. I think I may have lost it when I went to the toilet! And I had some trouble fording some streams coming across Round Hill Moss - a couple of times my foot was right in the stream! And today was the first time a bog tried to suck me into it. Not so bad, but weird feeling.

Black Hill (582m). Scene of many previous PW nightmares.

Imagine what this would be like without the slabs!

2110 Crowden
Just had my dinner - that Uncle Ben's stuff I've been carrying since KY! Actually it wasn't bad - and I had a bowl of coffee to wake me up a bit. Bought some bacon for the morning. Aim to leave about 9 means up and functioning at 8. Going to read "Into the Wild" a bit now, until it gets too dark.

Danger Deep Bogs! Please keep to path!!

Day 15 Statistics

MAN - CRO
24.5 miles (258 miles from KY; 93%)
1657m ascent
582m max elev.
time moving: 8h24m
time stopped: 0h29m
overall average: 2.8mph
average while moving: 2.9mph

My feet didn't look so good after 15 days hard walking.