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.