Saturday, 1 December 2012

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.

Wednesday, 21 November 2012

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 :)

Wednesday, 7 November 2012

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.

Wednesday, 22 August 2012

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..

Wednesday, 25 July 2012

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.

Tuesday, 10 July 2012

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 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

Monday, 9 July 2012

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.

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

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


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.

Sunday, 8 July 2012

Pennine Way Day 15 - Mankinholes - Crowden

July 8, 2008


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

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.

Saturday, 7 July 2012

Pennine Way Day 14 - Lothersdale - Mankinholes

July 7, 2008


0837 Lothersdale
Up at last.. rained in the night. But reasonably bright now. Sort out feet, sort out GPS traces, then I'll pack up and move on. Long day ahead :)
Non-National Park footpaths are not always so welcoming looking...
Climbing up onto Ickornshaw Moor - rain, rain more rain.
2050 Top Brink Inn, Mankinholes
Oh my God what a day! Rained about 6 hours solid. Finally made it to Mankinholes. And thank God they a) were open; b) were still a youth hostel and c) had a bed for me.

That was a long way with a lot of climbing compounded by the weather - I wrang my socks out twice - my feet were wet after 2 miles! Once again the book is nonsense for distances.

It did clear up for the last two hours but my shorts wouldn't dry out and now I have painful chapped skin on the insides of my legs... Pray for it to heal overnight and for clear, dry weather tomorrow...

Right now I'm in the Top Brink pub - my God I needed a beer. I can totally see why Dad gave up here. They have about 10 beers on draught!
Walshaw Dean Middle Reservoir.

The PW at Pry Hill - you don't seriously expect me to walk up that do you?
The paths on this walk are occasionally not very good, especially around towns that are not in a national park. There was a bit where I was supposed to walk between 2 walls through all manner of nettles and stuff - luckily there was a nice field parallel to walk up! The people in the house there thought I was lost - I wasn't - I just could bloody believe that that was the path! It's the premier national trail ffs! Lots of up and down today as well. Saw Top Withens - just a ruin. But it's true that some of the signs around Haworth are in Japanese. Weird!

Dropping down into Hebden Bridge.
The fact that is had rained so much of course meant that all becks and rivers were in full force - at Hebble Hole it was so powerful!

Mmmm starter justd arrive - black pudding - v. nice... probably could've eaten the mixed grill I reckon, but anyway, cumberland sausage to come! :)

Isn't cumberland sausage usually a spiral? Maybe I'm wrong but anyway... it was nice too, and God I needed it. Now on 3rd pint of Lomond Gold's Blonde Ale @ 5% - need to go after this and it'll be dark soon... and the door closes at 11 - not that that's a problem - I'll be back at half ten.. then I can check on how all my stuff in the drying room is doing.
You can see Stoodley Pike from miles away.
And then you walk right past it.
Later @ Mankinholes YHA
So back at the YHA - my inner thighs really hurt from the chapped skin. Have put more savlon on them - doubt they'll be painless in the morning though :(
Just before dropping down off the PW to Mankinholes.

Day 14 Statistics

23.6 miles
1403m ascent
452m max elev.
time moving: 8h25m
time stopped: 0h43m
overall average: 2.6mph
average while moving: 2.8mph


You can see I think that I was getting to the point now where I really needed the end to come. I wasn't writing as much in the journal during the day and this day in particular I remember the walking was quite hard because of the weather. My camera lens steamed up so a lot of my pictures came out blurry too.

Of course there was no question now that I wouldn't finish, but I had a conversation with the manager of the Mankinholes YHA who told me that after I finished this walk I wouldn't want to look at my hiking boots for a very long time. As it turned out, he was right!