Leg lengthening, 0-5mm

I've been to physiotherapy today in Liverpool. I got picked up in a car by East Midlands Ambulance Service by a nice driver who took me to Liverpool. It was very good, I was comfortable in the back. We arrived about 0940. I had my appointment at 10. I showed the physiotherapist the strut that's not behaving properly, seems like the nut is threaded maybe and I've been using pliers to make sure it works. He took one look at it and decided to replace it - I'm still not sure if adjusting this with it threaded matters or not. He put on a temporary strut to keep the tension while the other one was taken off and a new one put on. Then he went and got me clip removers so Rebecca can take the clips out later (the clips from where they cut in to chisel my tibia) and I also asked for and got a big bag of dressings so Rebecca and I can be change them again in about a week from now. It's really great how they trust me so I can just ask for stuff and get on with it myself and with Rebecca's help. That has been a constant throughout my treatment at Preston and here - I really can't speak highly enough of all those NHS professionals that have looked after me.

For actual physiotherapy we did stretches of my knee, my forefoot and my toes. It really makes a difference to the range of movement in my forefoot which has to be maintained so that I can walk properly without an ankle that moves. I must also do the knee stretches to try to stay in the 'honeymoon period' for longest. What is the 'honeymoon period' I hear you ask? Well I asked him about not being sure anything was really happening and them having built this lengthening procedure up as a really tough thing etc. So he explained.

There's always a 'honeymoon period' while the natural stretch in your tissues is used up - it varies for different people, you can check it just by stretching your skin with a finger, but it could easily be 5mm so I'm obviously still in that period now. What happens when the limit is reached is that the soft tissues can no longer keep up with the extension you're making, so then it's like over-stretching a muscle. If you overstretch it for a few seconds and then relax, no problem. If you were to hold the stretch for more than a few minutes, you'll probably feel pain and want to relax. If you hold it for more than an hour, the pain gets worse because you're having to constantly deal with it. Until you relax the stretch. So what's going to happen is that once I get as far as the natural limit of my tissue, it will be like stretching a muscle and never relaxing it. That will be painful. Oh and there's the other stuff I talked about previously about wounds around pin sites. So that's where we're headed - the knee stretches may help increase the length of this period so I'll be keeping on doing them ha ha ;)

Anyway after this enlightening conversation about pain I went for an X-ray and since I can't wait until next Tuesday to see, I asked the radiographer if I could see them. You really can see the gap, it's not my imagination, it might even be 5.25mm ;) Fab! See below, where I have also made some blow ups of the interesting bits!

Here's my photo of the screen in radiography, this is the top view x-ray. Once you orient yourself to
what you're seeing, you can see my fibula, still (and forever) in several pieces, and you can see the gap opening up,
see the blow-up below.

And here on the right is the side view, close up of my knee, you can see the gap opening up.

This is a close up of the side view knee x-ray, you can see the gap and the staples over the wound to the right.

Here you can see the three nails or screws that they put in to hold my ankle together.  One of them is at an angle that I can't really understand, like it went in from the top going downwards, I'll ask about that next week because it doesn't seem to fit with the description before the operation. 

Here's a blow up of the top view x-ray, you can see the staples and underneath the gap opening up in my tibia. It's definitely there, it could even be 5.25mm!

Operation 16 and What Happens Now

The cut through my tibia was made on November 8th in an operation which lasted around 90 minutes. Everyone was happy and I was feeling pretty strong the day after so I was discharged with, as usual, a big bag of meds and dressings. There was the usual wait for pharmacy to deliver the drugs, but they did in the end and we got home about 7pm. The only visible change is a new dressing where they cut in to get at my bone.

After Op 16. Dressing covering incision to break tibia.

Incision with clips. Pretty? :)

What happens now is 10 days waiting for the bone to begin to knit together, then lengthening starts. So this is tomorrow now, Friday November 18th. I have my instructions and spanner. The break is where the incision is, meaning that the ring near my knee will not move, but everything else on the frame will. One quarter turn on the square nuts four times per day, that's one turn per day, which is 1mm extension. We're going for about 20mm give or take, so 20 days of adjustments to come.

Now, here is the thing: I have been told often that this is tough, the lengthening process. In fact, I was told at physio this week that they once had a patient who was in the SAS and had been on tours in Afghanistan and Iraq, and this process broke him. Here is why: it's not the bone. You can 'grow' your bone 1mm per day no problem, in fact I've done this before in 2012 with the straightening process. It's not the bone, the pins move with the bone, the issue is with the soft tissue, the skin and flesh. Moving the frame down means I will cut open wounds wherever a pin enters my skin below the cut. There are 12 of these sites. Opening up a 20mm wound in each of these locations. And soft tissue doesn't want to stretch at 1mm per day either, wounds notwithstanding. So I think I understand now why this might get tough. Hopefully though I've so little feeling in my lower leg that I won't feel so much as the pins cutting through. It does sound a bit like self-inflicted torture I guess..

On the plus side, the physiotherapist did say I had already been through a lot (true) and that I looked like an excellent coper (also true, I think). Well we will see won't we, whether I'm tougher than the SAS. I'm ready. Lengthening and cutting starts tomorrow then.

Expect regular updates and measurement photos like last time :)

Bonus free spanner to adjust the frame with!

Operation 15/15b/16

Operation 15, to sort out my heel and ankle, and put the frame on and break my tibia, was a complete success. My ankle and heel are now held together by pins and a big nail going up from the sole of my foot (lovely), or something. And the frame is on ahead of the leg-lengthening. BUT, they didn't actually do the break of my tibia, so that is going to happen this week, on Tuesday 8 November. Apparently when I came around after op 15 I was a bit disappointed about this, this being 'plan B' not 'plan A', but they explained to me that it was best for me and for them, they were tired after 6 hours of operating on me, and they want to get this last bit exactly right. So fair enough. Look, I'm never going to complain am I?! They've all been brilliant.

In fact the level of care at Broadgreen Hospital is pretty amazing. Everybody seems to know exactly what they're doing and just gets on with it. It seems like a good place to work. My 5 day visit was really good in that respect. Even the food is nice! It's a new unit, maybe 18 months old, and it shows at least in the sense of organisation - everything is quite close, like the physiotherapy gym is just at the end of the ward, opposite where you go before your operation. 

There's no A&E at the hospital, and I think that helps to give it a calm feel. Anyway, I'll be spending another night there this week which I don't mind at all.

After (left) and before (right) operation 15.

The way of dressing the pin sites is something I've never seen before - you can barely see the pins afterwards. They use syringe drivers to hold the dressing against the pin site (clever!) and then wrap each group of 2 or 3 pins in a bandage which has them ending up looking like garlics you get in the supermarket, or meringues possibly. It's really clever because none of the pin is exposed. It makes me realise how exposed I've had them in the past - I mean, I was showering and then putting a gauze over and cutting a dressing to slot around the pin, meaning only the bit near my skin was covered. This is much better. They also last 10 days dressed like this so when I come to do it myself, much less work and hassle to maintain them! Excellent.

I can't weight-bear on my left leg for 3 months. I should have realised this, but it did come as a slight eyebrow-raise, not a complete surprise. The other times I've been able to touch weight-bear, so this is different, and will be more of a challenge. I'll end up with an even stronger right leg and upper body! But it adds an extra element of nerves, because I really can't afford a mishap now. It's because the ankle and heel fusion has to heal before I can put weight through it. Fair enough. I like a challenge.

I've spent most of this last week since I was discharged readjusting to life on crutches; how to transport a cup of coffee from the kitchen to the living room; how to have a shower (bin bag over leg, bath board); how to find a comfortable position to sit for extended periods with my leg elevated, etc. A lot of moving involves balancing on my right leg, but I'm pretty good at that. Outside I've only been as far as the supermarket, coming back up the hill was OK but a bit tiring. If I go to work on the train it'll be tough at the moment, so I'll probably have to rely on a lift for a while.

Anyway, back to this week, operation 15b or 16 (let's just call it 16) will be a short one to cut my tibia near my knee (on a healthy bit) and then after a week or so for it to settle down, the lengthening process will begin. I should be in for 24 hours this week. The consultant who spoke to me said they weren't going to "just burn through it with a saw" but rather they'll "use chisels to get a nice controlled cut". Lovely. Glad I'll be asleep.

Operation 15

It's been a long time since I blogged about my leg. Unfortunately that doesn't mean it's been all back to normal, it just means there's been nothing significant to write about, but now, well, there is. On Wednesday October 26th I'll have an operation to break it again, this time in Liverpool (at Broadgreen Hospital). About 18 months ago my consultant in Preston referred me to the Specialist Limb Reconstruction Unit there, and I saw them for the first time in July 2015. They were so positive about what a difference another surgery would make that it felt inevitable that I would go through with it, and so, after a bit of a delay, I am doing.

This is elective surgery which means that I've chosen to have it. That makes it quite a lot different in principle from my previous operations, which have really been compulsory to regain any sort of function in my leg. You may, or may not, remember that my last operation in 2012 was necessary because my leg healed up with a 17 degree bend in my tibia (shin). That absolutely had to be corrected for me to be able to weight bear again. You'll remember I was in external fixation for 6 months to straighten it out and wait for it to heal up. While that operation allowed me to walk unaided again (as well as bike, etc.) it didn't correct either the length of my left leg, which is 2.5cm shorter than it used to be and than my right leg, and it also didn't correct the angle of my ankle or the relative positions of my knee, ankle and heel. You can kind of see the problem from the photo Rebecca took of me recently from behind after I'd been biking. I'm lop-sided and my foot doesn't hit the ground properly.

Photo of my legs from behind. You can clearly see I hope what the problem is!

Anyway, the length of my leg and the positions of my ankle and heel will be corrected all-at-once by this next operation. Ultimately this will mean walking will be easier, less painful, and I won't be damaging my ankle and back further by trying to behave normally. So it's worth doing, even if it does feel like a massive step backwards. I've been talking myself into it for ages now basically along the lines of the following conversation:

"I don't really need this operation, I can manage just fine now, I've adapted."

"Yes but what about in 10 years' time, will you be able to manage then?"

"I don't know, possibly not if it gets worse."

"Well if you can't, or if it gets much worse, will you regret not having this operation then?"

"Yes I will."

And that is not good, and that is why I'm going through with it, even though I know what it means in terms of mobility, pain, and hassle. I will have a frame bolted to my tibia not unlike the previous one, except this time I will adjust the struts to lengthen my leg out, not straighten it. You can grow your bone 1mm per day, so that will be about 25 days of adjustment, after an initial settling-in period of about 2 weeks if it is like last time. Then you are just waiting for the bone to fill in the gap you've made. That will probably take 4-5 months. At the same time, they're going to break my pretty much completely fused already ankle, and re-fuse it in a better position, more perpendicular to my leg, so I can put it flat on the ground. And, they will break my heel bone and pin it so that it is in better alignment with my ankle and knee. So all these adjustments are to improve my biomechanics, make them more like a normal person would have.

In hassle terms, it means wearing the frame for about 6 months, which is awkward and irritating because it's bulky, you can't wear normal clothes, it looks awful, and mainly because you have to keep the pin sites, the bits where metal enters your body, very clean. In practice it means cleaning and dressing them all probably every other day. This means lots of dressings and stuff, but I remember all that stuff from the two previous times so as long as I can get everything from the pharmacy it should be OK, it just takes time and you have to do it properly because infection would not be good. Really not.

This is what it looked like last time.  This time will be similar, except my leg is now straighter,
and it may be longer this time, going down closer to my ankle.

Obviously it means no driving, no biking, difficult to get around. I now have quite a lot more going on than I did last time, so I'm probably going to get more frustrated than I did last time, and then on top of that there's the knowledge that I chose to have this done and I'm doing it from a position of relative activity, not like last time.

I haven't written this to make you feel sorry for me, not at all, just to explain what's going to happen so that if you see me afterwards you know some of the story. This is operation number 15 in total. It will hopefully be the last. If you want to know the full story, look at my previous post called 'Recover' (https://ajmk-est1974.blogspot.co.uk/2013/08/recover-slide-show.html). Or click on 'The Accident and My Leg' above.

Another thing that's very different from last time is that I have a lovely wife at home who is prepared to suffer me, and a great extended family through our church. This will make a massive difference I'm sure. We started going to Revive Church just before my last frame was removed, in November 2012. I'm really thankful for how my life is now. I thank God every day for it, but the truth is that the good is inseparable from the 'bad'. What happened to me and the resulting changes in my life and faith are completely inseparable, so I thank God for my accident and my dodgy leg. And for the NHS and blood donors. For my wife, my family, our church, my job and my altered perspective.

No doubt I'll feel the need to blog again about this, and post photos, after the op :)

Recover - From Left for Dead to Ride with Brad

I know I'm not fully recovered yet, still on crutches, stress fractures, possibly more treatment on the horizon etc., but this week it feels like a significant enough milestone was passed to warrant the publication of my photo diary to date.

So here it is, from dying on a dark road in 2010 to finishing the Ride with Brad in 2013. Some of the photos are not for the faint-hearted, but I didn't really want to leave anything out. And I still haven't managed to secure the 'best' photo, but I will try and get it. There are a few other photos that I can't really show until after everything is over insurance-wise. So you'll have to be patient for them. For now, this should be enough!

It works best if you put it in full screen mode and if you press Show Info then you can see the captions for each picture giving the date and some commentary. You can slow it down under Options.

Frame removed!

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

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

No frame, no cast! November 7, 2012.

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

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

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

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

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

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

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

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

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

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

SAFE: The squeamish come back now :)

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

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

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

Leg update, new X-rays.

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

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

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

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

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

X-ray from this week, August 20.

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

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

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

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

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

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

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

In summary, progress. Slow, but no doubt.

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

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

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

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

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

Until next time..

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.

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.

Hospital visit - leg update - struts loosened

Yesterday I was at the hospital again, for my routine x-rays and check-up. I didn't take a photo of my x-ray this time, but suffice to say that there has been more improvement! Looking at the cross section, two-thirds of the bone seems to be healed now. There's still a gap on the inside of my leg, but it doesn't look as big now.

So, the struts have been loosened. This means that they're still there (see photo), but are now not under tension. I was a bit nervous at first because basically this means that the two sets of rings are not firmly connected together anymore so in principle my leg could shift if the break hasn't healed enough. If I notice it shifting at all now I have to reapply the strut tension and set them back to how they were before yesterday.

But after 24 hours it now feels almost the same strength-wise as it did before - I think that's a really good sign. What's odd now is that it rattles a lot which is a bit disconcerting! Also, the rings at the bottom can move if you press on them, which is also very strange because they are bolted to my bone so it must be moving too. I guess this means that the bone hasn't calcified yet, but that would be normal - I saw this last time when they took the frame off.

What's next? I'm going to be like this for 2 weeks - enough time to see on a new x-ray whether the bone has shifted. If it has, I think the tension will be put back on and the struts put back in position. But on the last 24 hours' evidence, I don't think it will shift, so then I think the struts will be removed completely. That will be another adjustment mentally for me but it might be better because at least there won't be the rattling! Two weeks after that, assuming no shift of the bone, will be the earliest the frame can be removed. That would be early August I think.

The consultant said he'd like to see a bit more growth into the remaining gap before he removes the frame completely. I agree. In fact I'd be in favour of erring completely on the side of caution this time - I don't want to end up needing another corrective operation, and it's been so long now that another month or two is insignificant. Of course, the frame is awkward and uncomfortable and causes some pain at the pin sites, but leave it on as long as possible I say.

And I like it that I'm going back in 2 weeks - these visits are the milestones which I have to pace myself against - the more frequent the better.

Some good news at last :)

On Monday this week I had my (seemingly monthly now) X-rays. I wasn't expecting to be able to see anything or for there to have been any progress, it being 6 weeks since I stopped the adjustments, but... there was visible growth in the gap! There was quite a crowd in my consultant's office, which I guess is what happens when there's some good news to dish out (maybe). One of the nurses commented that it was about time I had some good news!

Monday's top-view X-ray.

It looks like a big gap still, but comparing with last month's, you can clearly see some more cloudiness in the gap, and that the gap is less defined. These are both signs of new bone growth. Even when it's fully healed, I think it will still look broken on the X-ray.

The consultant did a bit of a comparison of the lengths of my legs and we decided that probably no further adjustment in terms of length was necessary. Looks like I won't be in the NBA after all ;)

The plan now is that I will go back in 4 weeks on June 25, and depending on the result of the X-rays that day, maybe some of the struts will get loosened. If that comes to pass it will mean the healing is going faster than I expected. My consultant explained to me that eventually the struts will be removed and then 2 weeks with no support will be enough to determine if the healing is complete. Then I can get the frame removed. This is one of the advantages of this kind of frame - you can see if it's worked before you take the step to remove it. Awesome.

Here's what it looks like in the flesh now.

I've been told now to try to do as much as possible within pain limits in terms of weight-bearing and trying to leave the crutches behind. The more I can do, the more it will promote the healing of the bone. So today I left the house for the first time with only one crutch since the operation, to get my hair cut. Only a little way down the hill and back up again, but I'm paying for it now. Man it hurts now! I've guzzled down some paracetomol and ibuprofen so hopefully that will help.

No pain, no gain! But boy it hurts now!

Hospital: New X-rays: Gap in tibia.

Today I was back at the hospital for X-rays. It's now a month since the operation to fit the frame, and all 12 adjustments of the frame are complete. I was expecting therefore to be able to see the big gap that's opened up in my tibia. I wasn't disappointed!

Today's X-rays. Top view (left), side view (right). Note gap :)

I knew my consultant wasn't going to be there today, but he will see these X-rays on Wednesday and tell me whether or not the bones are in the right positions now. If not there'll be some more tweaking to do.

Here's a comparison between the last X-ray (after 3 adjustments; left) and the current one (after 12 adjustments; right).

My leg is getting quite swollen when I spend too much time with it vertical, so I think what I'm doing on days like today is the limit at the moment. I imagine that now that the adjustments have stopped, it will have a chance to settle down - after all, I've been moving my broken bones around so there was bound to be some swelling. Sometimes at one point it's almost touching the frame, so I'll have to keep my eye on that.

#12 - The 'Final' Adjustment

OK so today I made the 'final' adjustment. Whether or not it really is the final one or not depends on the results of my X-rays on April 30. We might be able to get a bit more length out of it, I think the consultant said, so we'll see. Needless to say it looks a lot more of a normal shape now than it did before!

Day 0 (left) - Day 12 (right).

Day 0 (top) - Day 12 (bottom).

Adjustment 11

Here's today's pictures, plus one I tried to do showing both pictures on the same image... which was more difficult to do than I expected... I guess it's more difficult than it sounds to always take a picture from the same position!

Day 0 - 11.

Day 0 (left) - Day 11 (right).

Day 0 (top) - Day 11 (bottom).

Adjustment 10/12

Just done adjustment 10 as well as my pin site cleaning / dressings etc. I feel like I made a bit of a dog's dinner out of my dressings today.. oh well.

Day 0 (left) - Day 10 (right).

Day 0 (top) - Day 10 (bottom).

Adjustment 9/12

We're at 75% now :) When I looked at today's picture, I was struck by exactly how bent it was at the beginning! When I move about now my left foot feels a lot flatter on the floor too. And I don't know if it's my imagination but I think I can move my ankle a bit more now than last week...

Today it has been a bit swollen and sore though. Have I done anything strenuous? Well, I went down to the shop to get a chicken and some bread and stuff, and then I was standing in the kitchen a little bit today - nothing major, maybe for half an hour, but clearly that was still a bit too much for it at the moment.

Day 0 (left) - Day 9 (right).

Day 0 (top) - Day 9 (bottom).

In other news, Boro managed to win today despite being typically useless and conceding a goal in the first minute of the game! Honestly, today was a must-win if we want to have a chance still of reaching the playoffs, so you'd think they'd have gone out steeled with at least keep it tight for the first 15 minutes. It's hard work being a Boro fan sometimes. Now we have to rely on Cardiff losing at Crystal Palace next Saturday lunchtime, while we have to beat Watford on their ground. So it's not likely we'll get there, but it's not impossible either.

Adjustment 8/12

Today's adjustment and dressings change completed. Two-thirds of the way there now... It's still quite painful in my ankle on the left side. It's going to take some serious work to get my ankle working again I think...

Day 0 (left) - Day 8 (right).

Day 0 (top) - Day 8 (bottom).

Adjustment 7/12

Here are today's pics - day 7/12. No problems or issues. Didn't see it move so much today, although on the top view picture today I did notice how much strut 2 (on the left with the orange badge) has contracted by.

Day 0 (left) - Day 7 (right).

Day 0 (top) - Day 7 (bottom).

Adjustment 6 - half-way there.. with spanners!

Today I have made the 6th adjustment to my frame. In so doing I had to replace strut 5 which had reached its limit of 120mm. This was not difficult - fortunately I didn't need bolt-cutters - it came off easily enough. The new one goes out to 150mm, which is where it will be after adjustment 12. Today it went to 124mm.

Step 1: the strut comes off...

Step 2: the new (longer) strut goes on...

Step 3: attach it at the bottom.

New strut 5 - by the end this will be at 150mm!

Day 0 (left) - Day 6 (right).

Day 0 (top) - Day 6 (bottom).

Adjustment 5 - You can really see it now!

Just done today's adjustment. You can really see it straightening out now.

Day 0 (left) - Day 5 (top).

Day 0 (top) - Day 5 (bottom).