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..

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