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 :)

4 years on, KiloToGo Flat Out in the Fens pre-race thoughts

It's a special weekend this coming one. I'm off to the Fens, east from Peterborough, to ride the Wiggle KiloToGo Flat Out in the Fens sportive. I'm doing the 152 mile option, which will make this by some stretch the furthest I've ever ridden in a day, assuming I complete it of course :)

But it's special because it marks the 4th anniversary of my appointment with destiny, June 21, 2010. The World Cup has been reminding me of it too - I know I watched some of the last one from a hospital bed in Preston but I can't say I remember a right lot of it. Although as an England fan that may be a good thing ;) 

4 years on

Over the 4 years since several factors have returned me to the point where I can consider doing the kinds of rides I used to do, and even go beyond. In the first place there's the NHS, who saved me and put me back together, rebuilt my leg and followed up with me until just recently, to make sure I was as good as they could get me, for free. I suspect that most people in this country have no idea how lucky they are that we have the healthcare system we do. Long may it continue to be so. 

The encouragement of friends and family has been important. None of them have ever 'managed my expectations' which would have been a valid thing for them to try to do, but I guess they know me well enough to know it's not what I wanted. If I haven't already, I'd like to thank them all again for their support - knowing when not to speak as well as when to - and also to apologise again for putting them all through this in the first place.

Finally, and in a rare departure from my usual modest self, I know my attitude has been one of the most important factors. I have tried to stay as positive as I could throughout the whole episode, and for the most part I've succeeded. Last week some people who really didn't have to paid me a massive compliment by describing me as 'amazingly positive' and 'a shining light'. These were the guys from the insurance company, a matter which I'm pleased to say, 4 years on, is now behind me.

It's unlikely I'll ever run again, which crosses off all sorts of things as possible, but I can live with that, and you never know, right? I'll never go a day again without pain in my leg and ankle, but it's the price of being alive. I will probably have another operation in the next couple of years, to break my ankle a few times and hopefully make this pain more manageable, and walking a bit easier. I might have a few more operations to make my leg look nicer, but there's probably not a lot of point is there? The days of me being a leg model are over ;)

There have been moments where I've been really sad and have struggled - I still have flashes of it and there are some persistent and annoying symptoms of post-traumatic stress, but it was worst was when I couldn't ride. In the 895 days I couldn't ride my bike, sometimes it looked a long way off, but the truth is I never genuinely doubted - I knew I'd turn the pedals again eventually and I knew I wouldn't just turn them, I'd push.

And here we are.

Flat Out in the Fens

The furthest I've ever ridden in a day before was 108 miles in 2009 in Wales. Since then I've ridden 100 miles a bunch of times. What are the issues with this ride then? OK well it's flat. I did more climbing within 4 miles of my house the other day than I will do in the whole ride on Sunday. So that makes this one different. Flat brings two potential problems to my mind: first, you have to pedal pretty much the whole time. On a more normal ride you at least get to freewheel down hills if you want a rest, etc. Second, wind. There will be no protection from potentially strong winds. There may be many, many miles riding into a headwind. I don't like that at the best of times, but after 100+ miles that could be a killer.

Got my number and timing chip, and some new OTE bottles and smart bottle cages for the occasion.

Anything else? Well, yes. Eating and drinking. Of course there's the well-stocked feed stations as usual with KiloToGo rides, but availability of food is never my problem - it's eating it. This time I will have to be really disciplined and eat regularly. This is too far to push through I think. Sometimes by 90 miles I'm thinking - I'm hungry and aching a bit but only 10 miles to go... this time it will be 60. Yikes. It's a long way. I will aim to carry enough food with me for the whole ride as usual, and only use the feed stations as top up and to get water. I'll probably adopt my usual strategy of missing the first one altogether. If it's super hot I will need water, but that should be quick.

What else? Fundraising. This time I'm going to ride for the North West Air Ambulance. I didn't need them, but people involved in similar accidents to mine regularly do and regularly get saved by them. I think they're an extremely worthy cause and will for sure help people like me, so they count. I hope to raise a significant amount this time, even though I know people may be getting tired of sponsoring me now - I have to think about that for the future. As usual, you can donate by clicking the JustGiving link on the right hand side of this page.

My other thoughts at the moment to do with the ride are slight worries about pain in my ankle, my contact points (hands and bottom) and lower back. I'm not sure what state I will finish this one in! I'll probably take some Ibuprofen and Paracetamol with me and hope not to need it. Also we can hope that the weather will play ball again - no rain and no wind would be best!  Finally, I have no idea what time to expect or to aim for on this one. As I said, it'll be pedalling pretty much all the time which is not what I'm used to. I was thinking if I finish in 9 hours I'll be happy, but really I don't know if that's realistic or not. I guess we'll find out won't we!

My itinerary for the weekend is to leave on Friday lunchtime - on Friday night I'm staying with friends in Cambridge, who I haven't seen for a long time so that should be fun! Saturday and Sunday night I'm booked into The Bell Inn in Stilton - as in the cheese - that will be lovely I'm sure. On Saturday during the day I will go and find some pretty village to look around or something equally relaxing. When I get to the hotel I might ride for half an hour if the weather is appropriate. It's an early start on Sunday morning - I'm aiming for 7am on the start line - so I decided to stay Sunday night too, didn't fancy driving for 3 hours after this one! So I'll come back on Monday.

I'm sure it'll be a great weekend whatever happens on the ride. I will see another part of the country I've never really seen before and I hope that I can raise some money for a good cause at the same time. I will try my best to write a proper ride report as soon as possible afterwards. I know I'm not always very good at that!

Endura Trek Lionheart 2014 results as spreadsheet

Here is a link to an Excel spreadsheet (.xlsx) of the results from the 2014 edition of the Endura Trek Lionheart ride, which took place on March 23. I made this mainly because I wanted to see the times in order of the hill climb up King Alfred's Tower, so I could figure out that I was 479th fastest (!) and I make the sheet available for others who may want to play with the data in a way that the racetimingsystems site doesn't cater for.

All I did was cut and paste the data from the pages on their web site and reformat it. Not difficult, but saves you some time. The column 'E/B' is the ratio of the time the rider started the King Alfred's Tower climb to their total time for the ride. In principle this number lets you filter out those riders on 100 mile or km route independently of what route they entered (column 'Entered'), e.g. < 0.4 = 100 miles, > 0.4 = 100 km. Dirty, but should work in most cases.

The link: https://www.dropbox.com/s/jy95yptcoynxwyr/Lionheart2014.xlsx

While you're here, you may want to consider donating money to the NHS, who saved my life and rebuilt my left leg after I was left for dead on a road in 2010. Read the condensed version on the page The Accident & My Leg. Donate by clicking on the justgiving link to the right.

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.

Ride with Brad 2013

OK, the short version is, mission accomplished :)

Yesterday was the second (annual?) Ride with Brad sportive out of Barnoldswick in Lancashire. Some of you will know that I volunteered at the first one last year while my leg was in external fixation after the rebreak, and it did occur to me at the time that if they ran it this year I might be able to take part. It was a good target.

I plumped for the 100km route option, mainly as a nod to common sense and realism that I probably wasn't ready yet for 100 miles with nearly 3000m of climbing. There were a lot of people on the ride again, and I would guess more on the 100km than on the 100 miles, so maybe word had got around from last year how hard this route is!

Rebecca and I camped at Lower Greenhill Camp site where I stayed last year, a lovely camp site with friendly people, recommended. On Saturday I picked Rebecca up from work in the hire car, and we arrived at Barnoldswick, OK Salterforth actually, just before 4pm. We pitched and then went to registration at Victory Park, the event centre. The queue for the 100km was only a few people, which is why I wanted to register on the Saturday, no queuing for ages on the Sunday morning! I was on my crutches of course, which brought a few comments, and required my usual explanation of "I know it seems very strange, but walking is much harder than riding at the moment!". Anyway I got my rider number and timing chip label - the numbers and labels have your name printed on them this year! I've never been to an event where that was so - a nice touch!

Numbers with names on. Cool!

Next we went to The Craven Heifer in Kelbrook for a beer and some dinner. I had a massive gammon steak which pretty much covered the whole plate - not exactly carbo-loading but it filled me up anyway. 

Back at the campsite I got everything ready for the ride, put the number on my bike and checked the pressure in the tyres etc. I had decided to take a non-standard pedal configuration, on account of my nerves at making it up some of the steepest gradients. I took off my SPD-SL pedals, and put a flat one on the right and an XTR SPD on the left. That way, I could wear my Shimano shoes which have the cleats flush with the soles. This served two purposes: first I could bail easily without having to unclip on a steep bit of road, and second, if I did bail I would be able to 'walk' - walking is nearly impossible for me in the riding shoes with the SL cleats on, well, without really hurting my foot anyway. I don't like this set up because it looks crazy on the bike, but in this case I think practicality has to take precedence.

Camp.

It was an early start yesterday morning - I was up at about 0545 getting excited. Got everything together, had some breakfast - tuna pasta I brought with me, made Rebecca and I a coffee and Rebecca a bacon sandwich, then packed some stuff up and headed out. Got parked and bike out of the car about 0720. Now I was happy, I'm always a bit nervous about getting to the start line on time. The start for the 100km route was 0800-0830 so everything was good. When we got to Victory Park there was a massive queue for registration, like I remember from last year, but I already had my number so I could just line up. Had a quick toilet visit, then into the line. And a long wait! I don't know why they seemed to only be letting a few people go every couple of minutes. But more likely there was a lot of people in front of me. The 160km guys had all already gone, so all these people were doing the 100km.

Event Centre, Victory Park, Barnoldswick.

While I was waiting Rebecca was alongside over the barrier taking pictures and chatting. Then there was some commotion up front and apparently Sir Bradley Wiggins was in attendance! He gave a typically verbose interview: "Are you looking forwards to it?" "Yeah, should be a good ride." Then he and the Wiggle-Honda girls were on the start line and after a half-hearted countdown, they were off. After that, they let the rest of us all go off quite quickly. That was the closest I came to Sir Brad all day!

Waiting to get going.

And ready for the rain!

The route, which I had studied on the map of course several times, starts off easy. About 15 miles of easy actually, until Waddington where the fun begins. Waddington Fell was the first proper climb of the day and it's quite long, and has a sharp pull near the top, but it was the first of the day so no real problem, legs quite fresh and all. I sent a tweet from the top, had a minute's rest and then started down the other side. Rain! No, wait, hail? Stinging the face anyway. I had set off with my Berghaus Paclite jacket on in anticipation of some rain and that helped I'm sure. It was quite an exciting descent on a wide fairly smooth road so no danger to worry about even in the wet. At the bottom of Waddington Fell at Newton there's the split point, 100km to the left. The 160km riders had gone off here for a 40 mile loop through the Trough of Bowland, which I've ridden some years ago and it's pretty spectacular. Then they rejoin us at Dunsop Bridge, so for them it's 40 miles but for us it's about 3 or so.

After that we're heading south, nice easy miles for a bit until a sharp pull up to the first Feed Station at Wildboar Forest. I stopped here at the junction for a rest and to take stock, but decided not to go into the feed stop and instead to push on. Mainly I was aware that the next climb was the one I was not looking forwards to the most, and I wanted it over. Longridge Fell, Jeffrey Hill. Now that's a ramp. It was here that I realised my pedal and shoe choice had been very wise indeed. I think I got about 5/6 of the way up the first really steep bit before I cracked. It's a shame because I knew that at the bend it eases off a bit, but there really wasn't enough strength in my thighs. It's not all about endurance - I've got loads of that (modesty) - I just need more strength for those really steep prolonged bits where I'm out of the saddle. Anyway, I wasn't the only one beaten by this short stretch of tarmac! So I walked around the bend and stopped for a little rest to compose myself. Then back on and OK until the top. But something was wrong! A strange feeling like the road got very bumpy all of a sudden. A rear-wheel puncture!

I wasn't the only one walking this little stretch! Jeffrey Hill, Longridge Fell. Hard.

I have never had a puncture on this bike before. Most likely it was all the pot-holes - some of the roads had had quite bad surfaces already. Anyway I knew I could fix it it was just a surprise and very inconvenient on top of Longridge Fell in the rain! Took me a while to get the tyre off the rim, took me a while to get the new tube to inflate, especially after I bent the valve, oops. There was a point where I was worried it wouldn't go up, but a bit of care and fiddling around and I got enough pressure in it, I hoped. Because now I couldn't afford another one! Oh, how bad would it be to fail this ride because of a mechanical? Something I had never considered - always thinking about me and my body, never worried about the bike which had never given me any problem in the past? I guess I spend about 20 minutes fixing the puncture. I knew the second Feed Station wasn't that far away so I could get there and get some mechanical assistance if I needed it, I hoped.

After Longridge Fell I protected the rear wheel a lot on the descents, afraid of going over a pot-hole and puncturing again, but I tried to convince myself that I must have done about 2000 miles on this bike without a puncture so it wasn't likely to happen. There's a lot of downhill on the next section, down into the Ribble Valley. Time for a bit of recovery. The second feed stop, near Billington, was a must for me. I could already feel the tiredness in my legs and with still 20 miles and some climbs to go, I admit I was a bit worried. But the best I could do was stop, rest, and take on board some food and drink. I refilled my bottles, took a few gels in my pocket, ate my banana and had a chocolate cookie. There was really a lot of stuff, I could have had muffins or sandwiches or fruit. Well catered. I had a bit of a chat with some lads who had seen my leg and were curious. They were impressed, I think. That gave me a boost.

I knew the next climb was the Nick O' Pendle which is pretty nasty about 2/3 of the way up. At the base of it I finally took off my waterproof jacket and stuffed it in my jersey - instantly I felt better - it was like being released from a sweaty bin liner! That helped too. I got most of the way up in lowest gear until, again, about 3/4 of the way up the steepest bit I had to stop. This time I only walked probably 50m over a little lip before I could get back on and then was fine all the way to the top. This is telling me something about my level of fitness / strength. What? I'll have to think about that!

I paused at the summit to take a picture. The rest of the ride from here is undulating almost until the finish. I knew there was a couple more pulls that would probably cause me problems and the rest probably wouldn't. Descending into Sabden I thought I'd punctured again :( But at the bottom I stopped and no, it was just a strange sound coming from somewhere. The climb out of Sabden is nasty. Three single chevrons on the OS map over about 3/4 mile. I didn't walk at all on this one, but I did have to stop halfway for a rest, "to admire the view". I was now passing and being passed by a nice guy on a mountain bike so we were having a bit of a chat.

Summit of Nick O' Pendle.

After Sabden there's a nice easy miles stretch then it goes down and up near Newchurch. Here, again, on the steepest bit, I had to walk. Coming up to a house where people were watching riders go past, a nice lady came down the hill a bit clearly concerned about me (probably saw my leg!). She asked if I was OK, "yes". She asked if I had any support riders, "no". She asked if I was going to continue, "yes". Did I need her to phone anyone? "no". It is nice when people care! But really, I explained to her and her family what I already knew - I just can't get up the steepest bits, probably because of the strength, or lack thereof, in my legs still. I knew there was 10 miles to go, there was no way now I wasn't finishing, major mechanical or body-bag notwithstanding. But her Dad told me I deserved a medal. That was enough to get me to the end.

In Barley I stopped to take a gel and eat my Go bar. Because I knew Barley Fell was a climb, but no chevrons so slow and steady should win the race! It did. After that, there's a descent and a right turn, then undulating until 3 miles from Barnoldswick. This section has some nasty pulls on it, but they're all quite short, so I didn't have a problem. As usual on these rides, the legs start to come back a bit as they sense the proximity of the finish! By the time I got to the main road, and knew it was all downhill for 3 miles to the finish, I felt like I could've done the 160km route. No wait, actually I know I probably couldn't have done that yesterday. But I will next year ;)

Crossing the finish line.

At the finish, in my dreams, Sir Brad was there to congratulate me, and there was an announcement by the commentator saying how great it was that I'd made it to here after 3 years of recovery. Of course, those things didn't happen. But it wasn't really about that was it? It was about my leg, my journey, my ride, my race, my life. I'm very happy I was able to set myself this goal a year ago and realise it. I would have liked to have done the 160km route, but that wasn't realistic. I would have preferred not to have had to walk 3 times on the steepest bits, but that gives me some information about where I am and some more space to improve into. I would like to have at least laid eyes on Sir Brad, but for the second year running, I didn't. Rebecca on the other hand met him at the finish line, exchanged a few words and got a picture! I think Rebecca was a bit bored while I was out riding, but I hope that experience made up for it a bit, and it was really good to have her there as support. I liked texting her a few times on the route. And I had a text from my friend Julia too saying that everyone at church was thinking about me. That meant a lot.

After the finish, there was the goody bag - nice T-shirt this year! - and some rider food, pasta. Then I went and found Sophie (and Leah) from Pennine Events, the organisers, who I'd been exchanging emails with in the run up to this event - to thank them and to say hi.

Then we were away, to pack up the camp and go and get a drink before heading home. I was already thinking about the next ride.

After the finish. I like my new jersey :)

If you want to you can look at my data on strava. Under the circumstances, I'm quite happy with my 5h9m moving time for this ride! Again, I find it very amusing that "there are no achievements on this ride!"

Ride with Brad nerves

Well, I just looked over the 100km route again on the map, I think I know where the worst bits will be. Then I made the mistake of reading a few blog posts from last year's event and now I have to say I'm nervous. "Brutally hard" stands out. Even my friend John 'irontwit' Sutton found it tough and he knows those roads! The blog posts reminded me that it did rain a lot last year so that probably didn't help. Pray for clear dry weather this year.

I used to know for sure that I could muscle my way up anything. I don't know that for sure right now. On the ride I did on Saturday, there was one hill which in April I had to get off on, but on Saturday couldn't understand why as even though it was steep, it was so short. I know I'm stronger. However I also know there are still some roads round here which I haven't dared attempt on my road bike yet. It's Tuesday today, and the ride's not until Sunday, so I could still go and test myself on those roads. But do I want to know? Obviously if I get up them it'll be a big boost, but what if I don't? This attitude is annoying. I keep telling myself it'll be OK if I just relax. I often find on a climb that I get a bit too excited sometimes and then it becomes very hard. If I can force myself to relax and concentrate on one pedal after the other, one at a time, it's usually fine. I know from my elevation vs time plot on Saturday that I'm still limited on the hills. Oh if I could swap my compact chainset for a triple just for one day!

Of course there is also the comforting knowledge that in spite of my leg, I am sure I will not be the least fit person on this ride.

Jeffrey Hill, Longridge Fell. I expect to suffer. 

I also realised that I have ridden some of these roads before. I knew I'd been to Waddington and Chipping on my Slaidburn weekend adventure in 2010. I've actually been across Longridge Fell on the road out of Waddington through Higher Hodder. It was up there somewhere where a deer was in the road! And I remember turning left at the Newdrop Inn before descending into Ribchester. Also that weekend I rode between Dunsop Bridge and Newton which I will do on Sunday in the opposite direction. Small stretches in common, but in common none-the-less. And it is a beautiful part of the country, that's for sure.

The Comeback - August 11 2013 - Ride with Brad

OK so I've kept this a bit under wraps because things are so uncertain with my foot at the moment: I'm doing my comeback sportive on Sunday. It'll be the Ride with Brad starting and finishing in Barnoldswick, see www.ridewithbrad.com

You may remember that last year I was so sick of not going to races that I volunteered at this one, external fixation, camping, crutching, registering riders and all. Last year when I was there it did cross my mind that this year's one might be around the right time for me to enter it as my first sportive in my second cycling 'career'. Anyway, a few weeks ago I got an email from the organisers, Pennine Events, asking me if I wanted to volunteer again, so I reminded them of my situation and they said it would be fantastic if I entered even though they would have also liked me as a volunteer.

After some amount of thought and a discussion with my physiotherapist, I decided to enter. But, alas, not the 100 mile route which would have been the ideal :( Common sense and reason have prevailed so I'm going to do the 100 km route, which still goes over most of the climbs - it just misses out a 40 mile loop through the Trough of Bowland. It will be 62 miles with about 1750m of ascent. The main climbs I think are Waddington Fell, Longridge Fell and the Nick O' Pendle, but there are a couple of others too. In any case it promises to be hard, especially if the weather is poor like it is today, but it will be fun and will of course be a massive landmark in my recovery. The last sportive I rode was the 3 Shires Sportive on 18 April 2010, on Sunday that'll be 1,211 days ago. I think the organisers may be going to do a bit of publicity about me because of my story but we'll see. It doesn't really matter but it would be nice to get a thank you in for the NHS and all the people that have helped me get to here. Hopefully this year I will at least lay eyes on Bradley Wiggins, unlike last year where I was so busy registering people in the tent that I never saw him!

What about my foot? Stress fracture and so on. Well, yes, it's a bit of a concern but I went out and did 28.5 miles round here on Saturday, with about 1000m of ascent, and I could feel it but it wasn't too bad. I will chew down some Cocodamol before the ride on Sunday ;)

I am quite nervous but once I set off on it and get up the first hill it will be fine I'm sure. I've ordered some new kit for the occasion - a garish yellow and red Northwave jersey and some new (black) bib shorts. It will be an early start as I'm not camping this year, probably we will need to set off about 5.30am. Rebecca is going with me - I hope she won't be too bored while I'm riding - and the set off time for the 100 km route is 8-8.30. I will tweet (@andrewmarkwick) from the start, finish and some intermediate points (probably the top of the climbs!). Exciting!

After this, the next one is the Autumn Epic, 95 miles in the Elan Valley, October 6. Instead of Bradley Wiggins, on that one I'll have my friend John Sutton (irontwit.creativeblogs.net) for company :)

Stress fractures

The source of my recent and previous foot pains? Stress fractures. Not nerve damage. An X-ray this morning at the hospital, an addition to my routine check-up X-ray set, shows that I currently have a stress fracture on the outside of my foot, but also that I've had previous ones (at least one) that have now healed up. In a way I'm relieved. I was worried it was a nerve problem and that may never have healed, or took a very long time. At least I know a fracture will heal.  There's nothing to be done about the current one, must just take the weight off it more and wait for it to heal. But my consultant is concerned (as am I of course!) that I will keep on getting them. They are happening because I can't walk properly, the weight distribution through my foot is off, so eventually a bone is fracturing, and then ouch! 

So what I can do is go and see the orthotics department, appointment requested, who might be able to fashion some kind of support or insole for my shoe to even up the way weight goes through my foot. If that doesn't work, then it's going to be more surgery.

But crucially I'm still OK to ride my bike as much as I like. I just can't walk far without crutches. Strange situation to be in!

Left foot: left most bone, little crack on left side = stress fracture. Next bone to right, lumpy bit near top of image = healed up stress fracture.

Today I am 3. And in Rio de Janeiro.

It's June 21 which means it's my other birthday. Three years ago I was newly bashed-up in Lancaster hospital.

But today, three years on, I am in Rio de Janeiro! We are visiting Rebecca's parents who now live here on account of her Dad's job. Today is our first day here, and we went to Copacabana to see the beach. It's midwinter here of course with it being the southern hemisphere, but midwinter here is about 28 degrees so it's better than our summer! The beach is so long and the sand so lovely. People come along all the time trying to sell you their wares which is, for the moment, quite entertaining. I know about 50 words of Portuguese which I learned on the plane here thanks to a cool little word learning game on KLM's in-flight entertainment system.

My foot is very sore still, since the ankle manipulating episode from a few weeks ago. Something has changed, because it really hurts at the moment! But I'm sure it will go away eventually and hopefully it'll be the better for it. Walking bare-foot on the sand will, I think, have been good for it. No doubt I'll get a few more opportunities for that while I'm here.

There have been some riots here in Rio over the last few days, but happily they are not right outside where we are staying. These people probably do have something to demonstrate about, but I still don't want to get caught up in it, and I'm sure Mum doesn't want me to either!

I miss the sea, I think where we live at the moment, while lovely, is too far from the coast. Rebecca asked if Copacabana was like Blackpool for the Brazilians :) I read in my Lonely Planet book the five page condensed history of Rio which is quite colourful making me want to learn more about the colonial past of the city and country. It is certainly reflected in the architecture, there are some beautiful buildings here, sandwiched in between the much more modern concrete.

We have a whole bunch of other sights to see while we're here, I will blog about some of them as we go along.

The Non-linear Path of Physical Recovery

Wow it's been a long time since I wrote here! Nearly 6 months! Time flies.

Since then I've done some biking, though not as much as I would have liked, or as I had planned to in fact. I've been back for a couple of X-rays, which showed little change really - you can see a bit of the gap filling in, but only if you squint at it. The bone hasn't moved though, so it's probably fair to say that the tibia is stable now.

There's still some frustrating setbacks happening though, mostly with my ankle and foot. It seems like you slowly go some way forward and then quickly come a way back again. The other week I manipulated my ankle joint again - manipulated is what they call it where you move a joint that hasn't moved for a long time basically further than you've moved it before. It takes a lot of force, like a stumble or something. Well, it takes more force the more often it happens, if you see what I mean. In the long term these manipulations are good because you are increasing the range of movement of your joints, but in the short term they are incredibly painful :(

Thus is was that in May I was very happy that I had managed to be off crutches for 6 weeks - I had even uttered the fate-tempting phrase "I'm off crutches now" - I did wait 6 whole weeks before saying that, and then a week later I was back on two crutches again! Last week I couldn't really walk, and depressing though it was I stayed at home all week - I can work at home but it's not really the same. Cabin fever sets in. Now I can just about manage hobbling around the house and down to the shop, but it's really frustrating because 2 weeks ago I was even starting to walk without really thinking about it. That's something that I now know you really take for granted, not having to think about every step and how much it's going to hurt or what angle the pavement is at or being careful to put your heel down first etc etc. 

Anyway I know it'll come back, and I know it'll come back better than it was before, but you have to go through these miserable steps backward to go forward again. I've done this to my ankle once before, it swelled up in exactly the same way, hurt exactly as much, and came back better. I did it to my foot too, a massive 'crack!' when I was hobbling up a steep street - hurt like anything for a month, then got better and my foot was springier, all good.

Biking: managed to do 50 miles on the road bike in early May, mostly flat but with a really hilly bit about three quarters of the way through to test the thighs. Hard work but managed it. The other day I went and did 3 miles on my mountain bike and found it very difficult. Non-linear. My physio says biking will be good for my ankle at the moment, might help it loosen up and the swelling go down. I have realised that I have to be more serious about my exercises, because they will make it harder for me to hurt myself! Didn't think of that before, but I have now, so at least I'm learning.

I'm supposed to figure out and write down my goals (short, mid and long-term) for my physical recovery this week, before my next appointment on Thursday. When I've done that I'll post them on here! I'd like to start swimming again too - now I think I could make it to the pool without needing help or crutches, I should go and try it - I'm sure that would help.

When I can step back from the fact that it's my leg and ankle and foot and I'm connected to them 24/7, I can see that things are getting better, and that the non-linear nature of the recovery is actually quite interesting in it's own way. However sometimes it is not easy to be so detached and then you're thinking the usual "why me?" or "what did I do to deserve this?". I need to stay in control of that because it makes it worse. Before this latest setback I was starting to believe that hiking might be possible again, in fact I was almost ready to try it, and the biking, while not as frequent as I had imagined it would be, was going in the right direction. I'll get back there, I know. But it is hard to construct a plan or put times to goals when you don't know and can't predict these manipulations, setbacks. It feels a bit like a process where on a given day there's an x% chance that there will be a setback. That starts me thinking whether that's not actually always the case - you could hurt yourself any day, which would set you back. I guess when you're in the middle of a recovery like I am that chance must be greater, or you have to do less to encounter one. So making a plan like "I'm going to do a 100 mile ride by July" is, I think, a good thing, but it almost certainly has to be tempered by the knowledge that July might have to change to be August or September.

People were saying to me the other week that I'd "overdone it" - that's my Mum's favourite way of putting it. Well, if going on my mountain bike and having to put my foot down, or walking up a street or going to the shop is overdoing it - guilty! But there isn't another way, I don't hurt myself on purpose. 

It'll be 3 years soon.

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.

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 :)