On the mend

It's Over

2011-10-02T11:58:00.003+01:00

Well, it's over.

The training and the anticipation finally gave way to the event last weekend.

I've very pleased to say that, along with my colleagues on the team I completed the Princes Trust Wild UK Challenge 2011 - I've even got a medal to prove it. The kayaking was a breeze, the cycling enjoyable (although the hills are a bit steep in Devon) and the walking very tough on my sore feet, but it was well worth the discomfort. Thanks to all who sponsored me.

I've lost weight, I feel fitter than I have done for a while and I can look back on a rehabilitation that now feels complete. True, I still have aches and pains and will probably never regain the lost mobility in my left ankle, but overall I have to be very pleased indeed with my situation.

Once more I would like to thank everyone who has helped and supported me. All the staff at the Sheffield NGH Limb Reconstruction Team, friends and family and Maggie (of course!).

That's it now; no more need for the blog (unless I can find something really stupid to do next!).

I really do wish all the best to anyone who stumbles over these ramblings whilst contemplating a period of injury or disability and trust that you can find some hope in what others have achieved.

Wild Challenge 2011 - Am I mad?

2011-03-01T21:00:00.004Z

It's been a long time since my last post and things generally continue to improve. If it weren't for my inherent laziness I'm sure I'd be fitter by now, but I'm doing more walking now including a nice little trip to the French Alps last September.
However, when the chance arose to do something really silly to focus my attention on getting fit I just had to go for it.
In September 2011 I will be taking part in the Princes Trust Wild UK Challenge which involves Walking, Kayaking and Cycling about 100 miles from the North Somerset Coast to the South Devon Coast in two and a half days. I've not done anything on this scale since I was a student, so this would be a big deal even if I hadn't been through a few medical problems over the last few years.
In any event, I'm in light training now and will gradually ramp this up so I can hopefully be ready in September.
If anyone would like to provide some moral (OK, financial!) support, my sponsorship page is: http://my.artezglobal.com/personalPage.aspx?registrationID=343184&langPref=en-CA
Wish me luck. Please.

Full Circle?

2010-06-03T20:42:00.002+01:00

It's taken a while but last Monday I made my first solo flight on my return. Great feeling; not apprehensive at all and very rewarding as I have enjoyed my dual flying in preparation for this.
Onwards and upwards

One Year On

2010-01-10T15:49:00.002Z

Well, not exactly 1 year, but close enough.

This is really an excuse to say that I've made it back onto the ski slopes.

We went to Winter Park in Colorado as it was the best place to get back to the slopes.

My thanks go to Jacques at Le Feet Lab who made the custom boots (for some reason my old boots didn't fit any more!). He really is a star when it comes to such things and I couldn't have done it without him.

I also had a couple of sessions with guys from the NSCD (National Sports Centre for the Disabled) to check me out and give me some tips about how to adapt. Thanks Beth for your support. This organisation seems to be pretty unique and to see some of the Winter Paralympic athletes training rather put my situation into perspective. If anyone reading this needs, and has the opportunity, to visit the NSCD I'm sure it would be life changing.

I only had one significant fall (a graceful somersault into a snowdrift when I hit a rock) and an embarrassing topple over when I was standing still! I found my fitness levels obviously depleted but managed to ski 11 days out of 12, only taking that 1 day off having twisted my knee and wanting to spare myself for the last day.

The company was great, the food gargantuan in portion size and I lost weight?

I shall refrain from commenting on the travel except to complement the bus driver who drove us back from Heathrow to Manchester in a blizzard.

The moral, as always, is never diminish your ambitions. If you want it, go and get it!

The Last Post?

2009-06-04T19:14:00.005+01:00

Hospital today.
In the nicest possible way I've been told that they never want to see me again!
X-Rays look great. Ankle still very very stiff, but getting a bit better all the time.
Just back from a week in the French Alps, including a 2 hour walk on alpine paths - I think I even surprised myself a bit.
All my thanks go to the whole team at the NGH. Also, thanks to Maggie who has had to put up with my ups and downs. Much harder for your friends and family than it is for the patient.

First Flight

2009-04-27T13:46:00.001+01:00

As some sort of milestone I had my first flight since the accident on Sunday. Nothing at all eventful but great to be back in the air again. I'll need to do a fair bit of two seat flying and catch up on 3 1/2 years lack of practice but that first step has now been taken and I look forward to getting some solo flying in later this summer.
In the intervening period we have had a couple of weeks in France. Pretty good weather for the time of year and a chance to build a little more fitness during some interesting walks. I suspect the good food and wine won't have helped the fitness levels but certainly didn't do me any harm.
Due back at the hospital early June, but nothing particularly exciting to tell them. Mobility continues to improve slowly and I do recover much faster now following a bit of a walk. Only time will tell how far I can take my recovery.
We do have a ski holiday booked for next season so that will be an interesting experiment

On Yer Bike

2009-01-31T17:20:00.002Z

So far, so good.
I'm gradually improving the movement in my ankle and my recovery rate from walking is getting better as I try and exercise more. I've no idea yet how things will pan out, but if I keep trying I'll achieve whatever is possible. I've bought a bike so that I can work on my leg muscles and over all fitness. I can't believe how much muscle and stamina I've lost, but I suppose 3 years is a long time without being able to exercise properly.
Excitement is mounting now as we are putting the plans together for a skiing holiday next Christmas. I've no idea how to get my boots on now as the lower left leg is quite a different shape now. But I do have custom boots with a lifetime guarantee so perhaps I can get them adapted.
Nothing much more specific in the planning yet, but as much walking as I can attempt.

Phew.....

2008-12-04T21:29:00.005Z

3 years after the accident. 7 weeks after the frame removal. Here is the anniversary cake Maggie made for the team at the NGH. She appears to want me to take up the can-can!

XRays today - all looking good.

I was naturally somewhat apprehensive about todays visit as we have passed the point of no return. Now I can focus on improving my fitness and mobility and get back to all those things I have missed. I have been warned off parachuting, and I imagine that a bungy jump might leave my foot attached to the elastic and the rest of me down below, but otherwise I've plenty to go at.

Back in 6 months just in case, but in the meantime we wish all the best to the orthopeadics team. We owe them all a great deal.

Waiting

2008-11-15T16:44:00.002Z

It's been 3 or 4 weeks since the frame was removed. As best I can tell there has been no movement in the leg so am hoping that things will look OK in early December when I have my next XRay. I feel that if it looks OK in December then I can be pretty optimistic for the future.

It's definitely not straight and I have restricted movement in my ankle, but it continues to get easier and less painful as I use it more. We were hoping to do a few mountain paths in France during half term, but the photo will probably explain why I had to stick to the low ground.

It's strange how quickly you get used to not having the frame on, even after nearly 3 years. It's certainly more convenient and less damaging to my clothes.

Standing on my own two feet

2008-10-19T20:46:00.002+01:00

Well, it finally came off on Thursday. The XRay didn't show any movement since the dynamisation so the go ahead was given.

It was quite an interesting process - especially when one of the wires wouldn't budge so Maria had to get the mole grips out. They were, quite honestly, the largest pair of mole grips I have ever seen!

Still, bravery lollipop in hand we set off back over the hills to go to a concert that evening. No hanging about before enjoying my first frameless time for a while. We just have to keep our fingers crossed now that the bone is really solid this time. The leg looks a bit of a mess and possibly still not quite straight, but if it stays in one piece that will do for me.

Anyway, a couple of photos as much for my benefit as anyone elses.

Two weeks and counting

2008-10-04T17:52:00.003+01:00

The CT scan last Thursday was very promising indeed, so much so that the frame has been dynamised and I go back on the 16th October, hopefully for the frame removal.
Comparison of the 3 CT scans quite clearly shows how the gap has filled with bone although we can't be sure how strong it is until it gets a real work out. I can't see any obvious problems since the dynamisation; perhaps a bit of soft tissue discomfort, but no significant movement. I gave it a small test last night at a reunion of some old (or should I say former) workmates. A bit sore by the time I got home, but that was perhaps because I was driving so couldn't dull the discomfort by drinking excessively. I'm hoping things continue to be positive and that October will see the start of the end of the journey.
After congratulating Emma in my last post I got to see some photos of the new arrival posted on the treatment room door. I'm sure everyone who attends the clinic wishes Emma and Jessica all the best. I wonder if this means I get an apprentice to work with Maria on the frame removal?

Too busy to post

2008-09-06T17:29:00.002+01:00

I just realised that it was April when I last updated things. To be honest, the Lizzie now has little impact on my daily life. I work hard, relax in much the same way as before and generally get on with life. True, I can't walk as far or fast as I used to, and once a week we have to suspend activities while we get the dressings changed and the pin sites cleaned.
Where are we now then.
Since I last posted in April I've been "oscillating" the frame to stimulate the bone growth. A second CT scan in June looked quite positive with definite evidence of new bone bridging the gap. My last visit in August confirms that things still look OK on the XRay, but the key date now is 2nd October, when I have my next CT scan. I am told that I should expect the frame to be dynamised on that day unless the CT scan shows anything untoward. That would then suggest frame removal later that month.
As we have agreed that this is the last chance the results of that activity will determine whether I keep my leg. I'm feeling very positive, but also realistic. There is new bone, but is it strong enough to support an overweight fifty-something layabout? Only time will tell!
One final word, congratulations to Emma, limb reconstruction nurse and proud new mother.

The April Update

2008-04-20T20:28:00.002+01:00

The biggest news this time is that the digital Xray is now working at the hospital and you can now look at the pictures on a PC monitor. I love the zoom feature!
Even with all this technology it's still not obvious what state my leg is in. It looks OK on the Xray, but we'll need another CT scan to be sure. I'm back in another 2 months so we'll see what is said then.
Since my last post (cue trumpet!) we've been to Malta for a holiday. Lots of walking, at least until I got a fine blister on my toe which went septic. I've also had some attention from Laurent who is training as a Reiki instructor.
Of course, we'll never know exactly what is having most effect on the leg but we'll keep on trying and many thanks to everyone who is helping out.

Long Time No Progress

2008-02-25T21:04:00.002Z

It's been a long time since there's been anything much to report.
Having put everything back onto the frame we've been waiting for something to happen. X Rays continue to show good bone growth but remain inconclusive.
Last Thursday's visit still showed nothing dramatic so it was agreed that they would squeeze me in for a CT scan. Very interesting process and certainly gives a better picture than the normal X Rays. It appears that the fracture site is still non-union at least on one side. After all this time it's a bit frustrating and we have decided to repeat the oscillation process that we used on the last frame to try and stimulate things.
It is starting to get to the point when we need to consider what next if this doesn't heal. We're still a few months off knowing, but I've been asked to consider my attitude to the two fundamental options. Another operation to remove the odd bit of bone, try and fix the rest onto the ankle and stretch the leg to make up the difference is certainly possible, but there's still no guarantee of success. Amputation is the other option, which would at least be a reasonably known quantity. Too early to need to decide but it doesn't sound like my mobility would be much different in either case.
As Mr Dennison said, "the main difference is whether you have to put your leg back on to go for a pee in the night". Now, you can't make it more succinct than that.

Long time - no post

2007-12-15T14:11:00.000Z

I hadn't realised just how long it had been since my last post, but so much has happened.
Busy at work (as ever) and trying to catch up on a few domestic duties but failing miserably time has just flown by. No special celebrations for the second anniversary but marked by a few thoughts of what had happened in the interim.
At one stage it looked like we were on the last stretch with the fixator. The X-rays look great and we started the dynamisation process. After 2 weeks with the vertical rods slackened off the snaps still looked good, but I was sure my ankle had gone over at a bit more of an angle again. Nothing much, but the two lower rings were definitely closer on one side than on the other. We decided to be extra careful and tighted the nuts up again applying a small distraction to the site by pushing the rings a little further apart. This might show if anything is going wrong and can often stimulate a bit more bone growth.
Back again early in January so we'll see then. In the meantime, best wishes for Christmas to anyone who is still reading this.

Before and After

2007-09-02T10:54:00.000+01:00

Time to post some photos.

Having got the foot ring off it is easier to see the current situation. It looks like the foot is not totally straight, but pretty close. Actually, with the flap looking so bulky it's difficult to get a real perspective of the leg.

Going back to look at the situation before the latest operation it is obvious why another frame was necessary.

Fun with a foot ring

2007-08-30T18:43:00.000+01:00

I've had an infection in the pins of my foot ring pretty much continuously since my last post. It got really bad for a few days while on holiday in the middle of France, but that's behind me again now as the ring was taken off today at the hospital.
The latest X Rays look really good and everyone seems very happy - there is even a suggestion that we might dynamise the frame if things look good in 6 weeks time which would be an amazing step forward. It would be a long period of dynamisation, but I'll take every positive step forward that is being offered.
I suspected that having the wires taken out of the foot would be more painful than higher up the leg and I wasn't wrong. More blood and certainly more initial discomfort, but it all feels so much better a few hours later.

OP 1:Broken Bones 0

2007-07-20T08:01:00.000+01:00

Seems like a while since I posted but things have been hectic.
Clinic session back in Sheffield during their flooding crisis was an eye-opener, at least the hospital was quiet as very few people could travel to get there. It took 3 hours to do a normal 1 1/2 hour journey. Worth it as things were looking good at that point with the free flap seemingly part of my leg rather than my thigh now.
Yesterday went back for X Rays and they look quite stunning. The bone that was grafted in is really firming up with the help of the OP 1 stuff, known affectionately as pixie-dust. It's quite noticeable on the X Ray how much more opaque the bone is and eveyone is very pleased. So much so that I hope to get the foot ring off when I go back in 6 weeks if progress continues at this rate. I'll be glad to see the back of the foot ring as it only took 5 weeks to get a nasty infection in one of the lowest wires this time around. Just hope it's not my MRSA back although I did swab clear of MRSA when I went in to hospital but you just never know.
The wounds around the flap are still being dressed twice a week but they are healing pretty well too, so fingers crossed for the next few weeks

Lizzied again

2007-06-21T14:50:00.000+01:00

Back from hospital with my new lizzie attached. I managed to get away with just over a week in hospital which is impressive bearing in mind what they did and the fact that I was "on the table" for 12 hours for the operation.
Lots of interesting new things to learn about from this process.
Because there wasn't enough flesh around the original break site I had to have a free flap taken from my right thigh and plumbed into my left leg using micro-surgery. The donor site was then stapled up and a skin graft applied, also from my right thigh. The flap is very delicate at first so I had 3 days in a sweat box - well a side ward with all the heating on and a strange heater called a "Bear Hugger" to pump hot air around the leg. It looks a bit like someone has attached a flesh coloured tennis ball to my leg, but 2 weeks on it still seems to be OK. The graft sites are also settling down now two (I had a second skin graft from my left thigh onto the wound on the back of my leg to help close it up).
The bones were chistled out again, straightened up and packed out with bone from my pelvis and some clever "pixie dust" that stimulates the healing. The donor site for the bone is certainly the most painful bit right now but even that is getting much better.
I've two appointments next week, one each for plastics and orthopeadics. The plastics is mainly to change the dressings and probably remove the staples, whilst at the ortho clinic I think they want to take another 5% out of the angle of my foot, presumably using the lizzie nuts and bolts - sounds painful but let's wait and see.
Walking is difficult even on crutches and I keep falling asleep so I guess I've a bit more recovering to do.

New Nose

2007-05-11T20:25:00.000+01:00

Well I've had the nose fixed so I can breathe again.
Nothing dramatic, but I wish the consultant had remembered that he had put 2 stitches into the plastic split up my nose before he tried to pull it out.
Now I'm heading towards my second lizzie.
I have a pre-op assessment for the plastic surgeon on Monday and then I go in on 6th June for the operation on the 7th. Not sure how long it will keep me out of actions but I'm strangely looking forward to having the fixator back on as without it I have to be so careful on my crutches as I can't afford to break the foot off before the surgeon does it for me.

Non Union

2007-03-29T20:11:00.000+01:00

Bad news.
Today's XRay shows that the bone hasn't healed and that my foot is now at much more of an angle than it was when the frame came off. The Dr is concerned that it will collapse completely so I'm now waiting for a return to lizzie-land.
This one will be awkward as there is nothing much to work with so we are going to have a bone graft mixed with bone morphogenic protein (OP/1) to try and get the bones to join, and a free flap to cover up the wound - this is basically a muscle graft (not sure which muscle I can afford to donate to this).
It'll be back in a lizzie for perhaps another year - whoopee!

It's off

2007-02-15T20:00:00.000Z

After a bit of a panic when I thought I might have damaged the break site again, the XRays were encouraging today and the frame is now off.

I posted a few of the photos of the process which was a bit painful but I did get another "bravery lollipop" for being good. I didn't need the gas & air but it was more painful than last week, especially where the pin sites were infected.

It does feel strange and I have to take it very easy for the next few weeks, but it's amazing how quickly your leg adjusts. It really does feel better already!

The foot is at a bit of an angle, but that can be adjusted later if really required (yes, that would mean another lizzie), but I need to find out how things settle down when I start using it again first.

Thanks to everyone for their best wishes. Let's hope that things continue to get better.

Three Ring Circus

2007-02-10T11:28:00.000Z

Well, not quite what I was hoping for but 2 rings down and 3 to go.
The Dr wanted to make sure of my original break site so the vertical rods between the two bottom rings have now gone so the ring is just attached to the leg now - very strange. No sideways support at all so quite vulnerable after 14 months.
The top two rings were removed along with the 5 wires. A bit painful, but I got a "bravery lollipop" for my pains. No gas & air and I even pulled one wire out myself.
If everything is OK this week the rest comes off next thursday!
Having said that I do have a sharp pain in the leg today - I hope it's just a dodgy muscle or tendon!

Dynamised

2007-01-11T18:41:00.000Z

Just got back from the hospital. Maggie produced a wonderful cake decoration - a leg with attached Ilizarov made in marzipan and icing. Very amusing and well received.
I've had one wire which was causing a bit of discomfort removed - not really painful fortunately.
They've also decided that things look ready to consider removing the frame. I've had it dynamised, which means releasing some of the nuts so that the frame is no longer supporting my leg. It does feel quite strange, but not painful so far. The idea is that I now walk on it extensively for the next few weeks. If it all seems OK they'll take the frame off in 4 weeks, if not we just tighten it up and try again.
I have to remain optimistic, but after this length of time I'm not too impatient.

Happy New Year

2007-01-07T17:59:00.000Z

This is a sort of Candid Camera shot - the lights were a festive addition but the photo was taken just before our office party.
Well, it's 2007 and the lizzie remains. I'm walking pretty well without any crutches now, but hills and rough terrain remain interesting, as does any significant distance. But I can reasonably confidently tackle half a mile now, probably twice that with a nice rest. Can't wait to be able to get back on the hills.
More XRays next week - here's hoping for some nice new bone.

Latest update

2006-12-03T20:05:00.000Z

Finally laid hands on the photos from the holiday and these two are representative of the extremes - craziest places to wear a lizzie and the effect of taking a long walk.
I've had a really painful infection in my leg recently. I'm on antibiotics which is helping, but it's still pretty painful. The most recent X-Rays (last Thursday) show pretty good bone at the distraction site but it's so difficult to be sure about the original break site. The latest plan is to wait until the distraction site is ready and then dynamise the frame - that means undoing the nuts but leaving the frame in place. I then get to walk around and see how things feel. If it's all OK the frame can come off, if not we tighten things up again and try Plan B.
I'm next back in January so won't know more until then, but I'll keep up the exercise and just hope this infection goes away.

Infection?

2006-11-19T11:29:00.000Z

Looks like I've picked up an infection although it looks more like a really nasty bruise. Came on early last week and felt like I had flu initially, then a real pain in my leg which meant I couldn't even stand comfortably, let alone walk. I started antibiotics and increased my painkillers and it does feel better than it did, but the colour is really deepening and it really does look badly bruised. I'm waiting for an opportunity to get a second opinion, but after such an encouraging couple of weeks walking this is a real frustration. Just goes to show that it doesn't pay to get carried away with success any more than you should get really down about a bit of a setback.

Best Foot Forward

2006-11-12T20:18:00.000Z

I was hoping to have some photos of me from a recent trip to France, but my accomplice on that trip has a computer malfunction so these will have to wait. I was hoping I could convince people that I am in this photo, but since I took it I guess I'll struggle. It's taken from the Aguille du Midi on Mont Blanc.
Things have settled down following the oscillation process and I'm now getting around the house without crutches, including up and down stairs - but don't take the stair rail away! By the end of a week in the Alps I was walking 2-3 kilometers a day, with crutches and rest stops, but that is building up some sort of stamina in my weary legs.
Had a brief bout of excitement just before going away. I was about 5 minutes into a business presentation when one of the wires in my leg broke with a very loud noise. It didn't hurt at the time and I got by with no problems. Fortunately Maria at the NGH managed to reattach the wire using a slotted bolt which nips the wire tight as the nuts are tightened. A bit uncomfortable for a short while but much better than having it removed and replaced I've no doubt.
Things are really busy at work now with loads to do before we wind down for the Festive Season - chance would be a fine thing. I've got the anniversary of the accident and the fitting of the Lizzie to come before then though. Perhaps I should bake a cake?

I'm a union man

2006-10-19T20:22:00.000+01:00

Just back from the hospital. After 7 weeks of "oscillation" to stimulate the original fracture site the X-Rays showed a huge change. There is definitely new bone and the clean lines of the original cut tibia are now well blurred indicating that the bones are starting to grow together. We have a union at the fracture site.
With a following wind it's now just a matter of time for the bones to really firm up. Sometime in the new year, but hopefully not too far, and we'll be thinking of lizzie removal.
Apart from this being good news, it's also nice to think that I can settle to more walking and general exercise without the discomfort that came with daily adjustments to the frame. This really has slowed me down over the last few weeks, but I've a weeks holiday coming up later this month so hopefully I can start to get back to some real exercise

Patience

2006-10-08T15:47:00.000+01:00

I feel that I am now on the period where patience is the key to getting by. I'm working on the neccesary activities to get the original fracture site to heal, but otherwise it's just a matter of getting back to as normal a routine as possible. The next set of X-rays in a couple of weeks time will give me a clue as to how things are going.
I'm able to do short walks with no crutches and longer ones with just one, but these are still too short to be of practical use other than around the house. Any walking does take it out of me and makes things ache a bit.
At least I'm able to get to work, including visits to customers, and also to my french classes. Last Friday I met up with many of my former work colleagues for a few beers which was a real treat. Social interraction is key to coping with the situation and although I am happy to be pretty solitary I really do enjoy chances to meet up with friends.

Back from hols

2006-08-31T18:56:00.000+01:00

Just got back from a couple of weeks hols in France. Lots of walking around the markets and brochantes (flea markets). My new car arrived the day before we travelled so just a bit of a close thing, but it worked fine for the nearly 2300 miles.
Hospital this afternoon. X-Ray looking OK especially the distraction site which is filling in nicely. The bone continues to grow at the original break site, but it's not joining properly yet so I have to start an oscillation regime involving lengthening and shortening at this site. The plan is 1/4mm per day for two weeks in each direction. This, along with loads of walking, is supposed to trigger some action.
The latest prognosis is frame off sometime next year - that leaves a little bit of wriggle room.

Down to the wire

2006-08-08T08:54:00.000+01:00

Things have gone fairly well since my last post.
I'm now driving again quite happily, indeed my new car is arriving today.
Physio was happy with me yesterday, had me balancing on one of those boards with a ball underneath. I say balancing, but it was more of a controlled wobble most of the time. I can get by a bit without crutches indoors and this can only improve my balance and stamina.
Had an unscheduled trip to Sheffield last week with a sore pin site. Found that the wire was so loose that I could move it abour 1/4 inch. It took a lot of tightening but all OK now apart from the remains of the inflammation and the enlarged hole from where it was working loose.
Hoping to get a bit of R & R over the next couple of weeks amidst the continuing exercise.

Downhill only?

2006-07-20T20:33:00.000+01:00

Hopefully we are on the downhill slope now.
The X Rays showed some reasonable bone growth. "Just a matter of time" was the prognosis; I've learned not to ask how much time.
Physio went well yesterday too, definite improvement in mobility and weight-bearing. Now working on balance - how long can I stand on the left leg? Target is 20 seconds (I can do 1-2 seconds right now).
I have a rental car to practice on. Nice to have some freedom again.
Let's see what happens from here on.

Driving miss lizzie

2006-07-09T14:18:00.000+01:00

Nothing much on the medical front recently.
Since I stopped lengthening my leg has become less painful and I have reduced my painkillers considerably. I can now just about fully weightbear on my left leg, but my balance is wretched so the crutches remain a necessity. More practice required.
I'm getting help with regular walks in the park which is great.
I'm back at work although mostly from home. The office is two floors up and last week the lift broke down with me inside. It's interesting getting out of a lift when it's 2-3 feet above the floor level.
My driving license is back from the DVLA. It's endorsed to permit me to drive an automatic only, but I think it still allows me to drive an automatic JCB or road roller! I've a new car on order but it won't arrive for a few more weeks, so I'll have to be patient.
Hospital on Thursday for X-Rays - here's hoping for some nice clear pictures of new bone.

Fixation?

2006-06-17T15:54:00.000+01:00

Help! I think I'm getting fixated.
I really must apologise but we went out to the Rocky Horror Show last night and I couldn't resist dressing up. At least some of the people didn't spot the Ilizarov with the other distracting aspects of my costume.
Nothing much to report recently. Another pinsite infection which hopefully the Erithromycin has accounted for. A bit more exercise and time at work so not too much trouble sleeping.
I'm just waiting to get my driving license back from the DVLA - they've switched entirely to photo licenses now so I had to find a photo booth before I could send back the form.
All I need now is an automatic car.

Dun Stretchin

2006-06-03T13:31:00.000+01:00

We settled at just under 39mm of lengthening which has left my left leg roughly the same length as my right. They always were slightly different lengths but I can't recall which was longer, so the new situation will have to do. The bone was still not filling in quite as hoped which was another good reason to stop now.
I have a few painful pin sites. Some are due to the cheese-wiring from stretching and we also found a couple of wires which had worked a little loose. I may have been on my feet a bit too much as my foot was really swollen last night and the wound has been weeping a bit, much feeling better today after a nights sleep. The physio session on Wednesday probably didn't help either.
Next appointment in Sheffield is 6 weeks away so back to a "standard" routine now while the bone continues to heal and consolidate

Cleaner & Taller

2006-05-26T11:04:00.000+01:00

I'm now almost finished with the stretching and have got rid of any "lifts" from my shoes so that I can tell when the legs feel the right length. Last night was dressing change night so took the opportunity for some pictures. You can see how, as the ring gets pushed down by the screw threads the wires have to find a way through the leg. At this particular site you can see the flesh pushed up in front of the wires just waiting for the skin to part so the wires can move through. Also the scars left by the passage of the wires. This effect is known as cheese-wiring and is responsible for some of the pain of stretching. I'm told it also leaves some very fetching scars when the frame comes off. Those will enhance the beauty of the incision scar from the osteotomy when they had to go looking for the leaking blood vessel. The stitches are now gone but the scar remains as you can see.

The real highlight of last night was my first shower. No longer will visitors need to carry a pomander and handkerchief. At last I feel stable enough to stand in the shower without falling over. I practised this first by doing some grass strimming in the front garden. All in all I'm feeling less of a passenger now despite still needing both crutches to walk with.

To sleep, perchance .............

2006-05-22T16:37:00.000+01:00

I think I may have finally cracked the sleeping enigma.
I was getting really fed up, especially recently with the stretching activity, waking up loads of times at night and taking hours to get to sleep in the first place.
Last week I decided to take action and tried 3 initiatives. I've no idea which had the best effect and I've no plans to experiment just in case, but this works for me:
1. Get rid of some pillows. Since my back injury I have been sleeping in a more upright position with a pillow under my upper back. This made lying on my side almost impossible. It is difficult anyway with the frame on my leg, but by going back to two pillows and being careful and I now lie on my left side reasonably comfortably.
2. Painkillers. I discovered that one of my painkillers can cause insomnia so I've halved the dose and supplemented it with another drug. Sadly, this second drug can cause constipation, but a small price to pay for better sleep
3. Melatonin. Some other lizzie wearers suggested using Melatonin so I thought I'd try it. I had to order it via the internet and it was shipped from the USA despite the UK web address, but it arrived and seems to help.
Like I say, can't say these will work for everyone, but they have for me. So far.

Slow down

2006-05-12T14:11:00.000+01:00

This last week has been hard work as the lengthening has been quite painful. The painkillers have worn off too quickly and my sleep has been badly disrupted. Once I got to the point where I couldn't straighten my leg the physio started to get more painful too.
Yesterdays clinic session was perfectly timed as I was ready to discuss things. The X-Ray showed that the bone is growing but the gap is not filling quite as well as hoped so we have slowed down the stretching back to 1/2mm per day which might also reduce the pain levels a bit. I certainly slept better last night.
I am about 10mm short of equal length, so that will now take the best part of 3 weeks to complete. Then a long wait while the bone grows back and consolidates. On average that takes twice as long as the stretching time so we'll wait and see.
The original healing at the base of the leg, and also my right femur, are still looking OK which is good.
I've had some nice walks recently in the warmer sunshine. There's a local park where I can do 50 yards and then sit down and rest while looking at the plants and listening to the birds. A real treat after spending so much time indoors. I've also started my french classes again which is a real treat after such a long lay off.

Normality?

2006-05-03T16:50:00.000+01:00

It seems the longer you stretch it the more it hurts. My leg is now starting to be a real pain (excuse the pun), especially at night when the painkillers wear off about 3am. The bone feels like I've been kicked severely in the shin (actually it was a hammer and chisel but that's just being picky) and the muscles and tendons have obviously given up any slack they possesed. My kneecap feels like it belongs somewhere else on my leg.
To counteract this I'm trying to get back into some enjoyable routines.
We went to a concert last Friday - having carefully booked seats with extra legroom we were shown to seats which you had to squeeze through a narrow gap to get to. The manager found us suitable seats to change to in the interval.
I also returned to my French class last night. Two hours of conversation was a good workout for the brain. It's a taxi ride into Manchester as the nearest bus stop is too far for me to walk from/to, but well worth the money.
Only another 3 weeks or so to go with the spanners then perhaps we can settle down a bit.

Longer still

2006-04-28T15:43:00.000+01:00

I'm starting to realise that I was pretty lucky with my initial experiences of the Ilizarov. I had been told that the lengthening process was painful and it's difficult to deny that it is much more so than before I started lengthening. I certainly can't take anywhere near my whole body weight on the left leg and I'm back with two crutches which I can't do without. This is quite a change from just before the leg break when I was going pretty well.
On a positive note the latest X-Rays at the hospital yesterday showed that the bone is growing in the break just as it should. At the time I had "turned" for 14mm but this probably only represented 10mm of real growth (you always lose a few mm as the wires bow). I've about 25mm left to go so only another 3-4 weeks and then I can start to let things settle down as the bone grows back and consolidates. The physio is geared to making sure that I keep good movement in my knee and ankle and is painful but well worth it.
The Consultant was also pleased with the healing on the wound and has now given my the OK to have a shower and allow it to get a little wet - a nice bonus.
So, we'll keep up the exercise and the stretching, go back for another X-ray and check-up in 2 weeks and keep smiling.

Best Foot Forward

2006-04-14T20:21:00.000+01:00

Started lengthening yesterday (Thursday). Using two 10mm spanners I adjust each of the 4 nuts by 1/4 turn 4 times a day. That makes 1mm per day in total. I'm two days in with no adverse effects but am told it starts to hurt after 3-4 days, and that I really need to work on my physio to ensure that the muscles and tendons stretch at the same rate as the bone.
Managed a really good walk today. Dunham Massey park, from the car park to the Tea Rooms and back, with only one stop each way en route. Must be over 400m in total - no prizes for speed though. I'm now absolutely worn out and aching. Must be good for me!
A few words about clothing.
Maggie has made me a pair of semi-retro flared trousers by buying two pairs and letting a flare in to the left leg made from one of the "spare" legs to cover the frame. Now having no foot ring you can't see the frame at all when I have the trousers on - fewer stares.
I can now also get some form of decent footware on. We adapted a pair of Teva boat sandels(veterans of the Colorado Raft Trip through the Grand Canyon) by cutting out sole shaped sections from an offcut of vinyl flooring. These were glued together and then two large velcro pads were used to fasten them to the sole of the left sandel. Seemed to work OK and will be easy to remove when my leg gets longer and I no longer need the elevation.
12 more days of stretching before I go back for a clinic session, by which time I should be over over 1/2 inch taller.

Latest Leg Photos

2006-04-09T11:46:00.000+01:00

These photos were taken 5-6 days after the breaking and removal of the foot ring and the leg is still pretty swollen and brusied. The incision used to break the leg is really tiny but the one used to find the leaking artery is rather larger. It's nice to see the foot again without the foot ring but it needs a good wash. Just waiting for the pin sites to heal up before it gets a good lathering.

Hospital Again

2006-04-06T11:41:00.000+01:00

A mixed bag of experiences from this weeks hospital stay.
The main job was to break the leg so that I can start lengthening. I was last one in theatre on Monday due to the MRSA so had a nice long wait with no food. Could tell it wasn't my lucky day when I can round in recovery and was told that I was a bleeder. To be more accurate, a small artery had bled and lost about 1 litre of blood, so I now have a nice wound on my calf, about 4 inches long, where they had to track down the leak and fix it up.
I must be honest and say that they broken leg is painful. It's still pretty swollen and is frustrating when I was getting so much more mobile beforehand. Still, it's the start of the last major step that we can see at this point. I start lengthening next Thursday - I have been presented with my pair of 10mm spanners!
At the same time as breaking the leg, the foot ring was also removed which will hopefully see the end of the worst of the MRSA. It feels strange to be without this major chunk of metal. I now need to work hard on my ankle to keep the muscles moving and avoid foot drop.
I've also been warned to work hard to keep my knee active when I am lengthening so that the muscles will stretch along with the bone so I can keep my leg straight.
Sounds like physio is going to become even more critical over the coming period.
The skin graft too is now looking very good - much more like real skin
I'll sort some photos out in the near future.

Latest Pics

2006-04-01T15:07:00.000+01:00

These latest photos show how well the skin graft has worked. There's still a bit to heal up but comparing these with the older photos shows just what a great job the VAC dessing did and the benefit of the graft to get some skin on the wound quickly.

Hopefully this is also the last time I will post a photo with the foot ring on the frame as this should be off on Monday.

Break a leg

2006-03-30T18:07:00.000+01:00

Today's clinic session was very interesting.
I think I must have spent longer in X-Ray than I did in Theatre. It's very difficult to get a clear picture of the bone healing through all that metalwork. I feared that the problem might be because there was nothing to find, but when we got good pictures there is a significant amount of new bone growing in the right place.
We also had a good look at the skin graft which seems to be looking good too.
We are now all systems go for admission on Sunday so that we can start the lengthening process. On Monday morning I go into theatre for the breaking of my leg at the top of the Tibia. After 10 days to get used to the idea I start turning the screws. I have been told that it will be a bit painful and that I will need to work on the physio so that my calf muscles stretch with the bone, otherwise I will end up with a bent knee.
We also talked about the infection which has been quite painful recently. It seems to be focussed on the heel pin and it is now possible to remove the foot ring which will hopefully settle things down. I could have had this done today, but decided to leave it until theatre on Monday.
Without wanting to start getting too optimistic Mr Dennison seemed to be suggesting that the frame might be off a bit earlier than he had expected. That would be a good result if we can achieve it, but I'm just pleased that things keep moving in the right direction.

Moving On

2006-03-24T15:38:00.000Z

It's strange to think it's over 16 weeks now.
Just when you start getting into a routine it's time to change it. I've managed a couple of trips out courtesy of Maggie and some friends - it's a real pain needing someone else to provide transport. A friends birthday dinner was followed a few days later by a walk in the park. Well, a short hobble is nearer the truth. Single crutch only these days, but probably no more than 100 yards with two long rests on the park bench.
I went to the office on Wednesday and we started planning for my return to work on a scheduled basis rather than doing the ad-hoc stuff that I have been asked to help with over the past few weeks. I definitely feel able to make commitments to a certain level of performance now although I have to acknowledge that the painkillers do slow the brain down a bit, and I do tire a bit too quickly for comfort.
Can't wait to find out whether we can get on with breaking and lengthening my leg - more news after next Thursday. I've not even sneaked a peek at the skin graft so don't really have any idea how it looks, but no obvious sign of distress.
The MRSA seems to be back. I lasted about a week after the antibiotics ran out before it started up again. If we can lose the foot ring I'm sure that will do the job as it's really only evident in the heel area.
Looking back now I remain delighted how things have progressed. There's still a long way to go and many potential pitfalls, but I really am now starting to feel capable of getting back into real life. Still no long term targets cast in stone, but I do have flight tickets booked to travel in October so I suppose I've started to put my own expectations into action.
Now, when can I start gliding again.........

Hard graft pays off

2006-03-14T15:55:00.000Z

Just returned from a check up.
The skin graft is healing really quickly, just a bit of seepage from the remains of the hole but otherwise nicely scabbed over now. A light dressing has been applied (sorry, no photos this week). The donor site is now dry and healing so the dressing has been taken off.
I have an appointment for X-Rays on 30 March and, assuming things are OK, I go in for an operation to break my leg and start the lengthening on 3 April!
Mr Dennison can start sharpening his chisels as my leg is on it's way.

Sound of Silence

2006-03-07T20:34:00.000Z

The vacuum dressing has gone!
The Consultant was not around today so Maria took this picture on a mobile phone and mailed to him for review. He then called back and discussed it with Maria while one of his colleagues had a look at it.

The skin graft seems to have taken OK over most of the wound. On the photo the "string vest" is the graft and I am told this is a great result although it will need to look a bit more like skin before I am able to see it. This has now been covered with a light dressing to protect it.

The donor site has been dressed again and is still a good deal more painful than the grafted wound.

Back again next Tuesday.

Thoughts on Skin Grafts

2006-03-05T11:03:00.000Z

It's 5 days on since my skin graft.
I wasn't entirely sure what to expect and I'm certain that different people have different experiences, but I have learned a few lessons.
Firstly, I was told that the donor site was more painful that the graft site. This I can confirm first hand. The wound site has given me no trouble at all. I suppose this might have something to do with the vacuum dressing which is anchoring the graft in place on the wound but somehow I doubt it. The donor site however was fairly uncomfortable when the painkillers wore off and frankly is a real nuisance. It is quite high on my left thigh and was initially dressed with a crepe bandage around it. As soon as I stood up the dressing slipped down my leg. The second dressing put on by the nurses on the ward suffered the same fate. In the end we opted for a guaze dressing secured by tape onto my leg. This didn't slip, but it did leak. About 3am Thursday I woke up in a small puddle that had oozed from the dressing. Temporary relief was provided by more tape and a couple of old towels until the district nurse came to change the dressing. We have now gone with a dressing of Mepilex which is like a large elastoplast which allows air to circulate. This has proven so successful that I can feel a scab forming under the dressing, which is great until they want to change it! Every time I flex my thigh it does stretch the scab and can be a bit painful which has curtailed some of my physiotherapy.
Perhaps the biggest potential problem was the need to keep weight of my left left for 4 days so as not to disturb the graft. This was sprung on me by the physios who made me walk through the ward and up and down a flight of steps before they would let me go home. I don't mind admitting that this was hard work. My right leg is better that it was, but it is still broken, and hopping even with the aid of crutches was not entirely comfortable. I was able to complete the task in the hospital but must confess to the odd relapse at home. Sadly, I had already made two trips to the toilet with full weight taken on my leg before the news was broken to me, so hopefully that didn't do any harm. Frankly, my ankle is so well anchored that I don't think the wound site moves very much when I walk and bear weight on that leg.

Admittedly I don't know the results yet, but based on my experiences so far the discomfort is certainly not disproportionate to the benefits. I don't expect to have a perfect leg after this, but anything that reduces the healing time and protects against infection must be worth doing. The pain is all in the donor site and is easily managed by the painkiller regime already in place.

Did you bring a toothbrush?

2006-03-01T17:54:00.000Z

Yet another surprise.
Went to Sheffield for a change of VAC dressing on Monday 'cos the Consultant wanted to see how far we were from being ready for a skin graft. He took one look and made arrangements for me to stay in so that he could do the graft the following morning. That's just 5 weeks of VAC therapy to get the wound ready for grafting.
The graft was taken from me left thigh and has been fixed under a VAC dressing which will remain in place until next Tuesday when hopefully the graft will have taken and we can start thinking about the next stage of the process - breaking my leg and starting the distraction phase.
I took the opportunity to ask Mr Dennison how he would break the leg and was given a very thorough explanation of the options available (basically; hammer and chisel, saw or drill). He prefers to make a small incision and then use a hammer and very sharp chisel to break the bone from the front. I'm glad I now know what I will be missing while I am asleep in theatre.
This Monday news came on the back of a pretty good weekend of progress so things are still pretty positive apart from the MRSA which is clinging on into my second course of antibiotics.

We discovered an interesting new product recently. Ellactiva are sweets designed to supplement calcium intake. Two chews contain 100% of the RDA of Calcium and Vitamin D. They aren't cheap but are a simple way of getting extra calcium. I've discovered that you can only eat so much Yoghurt every day.

Office visit

2006-02-23T19:02:00.000Z

Spent a very enjoyable couple of hours in the office today just catching up with people and seeing what the problems might be when I can get back to work. Frankly, I can't see any major issues and strange as it may seem I really miss work and can't wait to get back at least part time.
Maggie has been on half term this week so was able to give me a lift. She squeezed this in between 2 days at school and piles of marking. So much for holidays.
The wound continues to heal and the bone is well covered now, the hole appears to be less than half it's original depth. Rachael did the vacuum dressing yesterday and made it so airtight that the pump has hardly made a nois since. I think it must have been the silence that stopped me sleeping last night.
Looking forward to going back to Sheffield on Monday to find out how close we are to fixing up the skin graft. As best I can tell the MRSA is still alive and well in my foot, so we can cjat about that on Monday too.
I'm reducing my painkiller dosage slowly. Initially I cut down on the DF118 (dihydrocodeine) and am now reducing the paracetamol. I was never comfortable taking the maximum daily dose because so many other preparations contain paracetamol and the effects of an overdose are very unpleasant.
Walking with a single crutch going well, but it makes the muscles in my side ache so I think I may need to look at my posture and the length of the crutch. Still, plenty of time for that.

Dem bones, dem bones

2006-02-18T16:16:00.000Z

.....
the thigh bone's connected to the knee bone
the knee bone's connected to the shin bone
the shin bone's connected to the ankle bone
.....

Well, not quite, but things are starting to take shape.
X Rays on Thursday showed that my back is now OK to get rid of the brace over the next few days. I'll probably always be prone to backache but that's a small price to pay.
My right femur has now pretty much bridged the break in the bone and seems to be healing OK.
The great news though is that my left leg has started to grow new bone at the point where we need it to join so we are starting to get optimistic. I get the impression that this is well ahead of expectation for such a traumatic injury. The race is on now to get the wound healed and grafted so that my leg can be broken and stretched. It might even be possible to free up my ankle while the leg bones are still healing so I can start some physio and get a bit of movement back into it.
Thursday was a long day, and my broadband has broken so I couldn't even share my excitement that evening, but I slept far better than usual. It's amazing what a bit of good news can do for you.
And finally, obviously some of the team in Sheffield have been looking at this blog. The first (and I believe only) comment that Simon Royston made to me on Thursday was to point out a typo!

Monday update

2006-02-13T13:47:00.000Z

The wound continues to heal nicely as the latest photos show. The current plan now is to allow the "hole" to fill in and then do a skin graft to the whole lot to cover it up quickly. It sounds like this won't be too far away now which is good.

I have a new batch of antibiotics (tetracycline and fucidin) which apparantly my strain of MRSA is sensitive to. A two week course which will hopefully kill off the current infection although the bacteria hang around on the metalwork so this might be a regular treatment.

Confused everyone today by walking from the car to the clinic rather than using a wheelchair. A bit slower but much more satisfying.

Weekend musings

2006-02-12T17:56:00.000Z

Following the disappointment of finding out about the MRSA on Friday I got some useful feedback from other wearers who had overcome the same infection. There do seem to be a couple of antibiotic options so we'll see what is suggested. I really don't fancy a treatment which would mean hospitalisation.
Just to confirm that progress is being made elsewhere I decided to try a few experiments and found that I can now walk a few steps without crutches. This is a big deal for me and I was really chuffed to achieve it. More practice and it will continue to strengthen the muscles which I need to walk properly.
I also managed to stand up out of a chair using my legs alone - no arms!
I am also trying to go the whole day without my back brace. So far so good, as long as I don't fall over going up stairs I shall feel that I have had a great weekend.

Another week passes

2006-02-10T17:12:00.000Z

Just had the dressing changed again. As you can see from the picture it continues to heal well, but you can still see bone down the hole. At least the machine has run for over a week without breaking - that's a record for me. We are now using only white foam as the main wound is now quite shallow and unsuitable for the black foam.
The nurses were commenting on how well the wound was healing, but confided in me that I was likely to have a scar! I was so surprised.
Not much other activity this week to report, but they have found out what infection I picked up in my pin sites. Yes, it's MRSA. Just waiting now to find out what antibiotic they fancy trying as the Erythromycin clearly isn't going to shift it.
C'est la vie.

Sucking harder now

2006-02-04T19:50:00.000Z

Saturday afternoon and another dressing change. You can see that the wound is healing well, but the bone is still visible down the hole.
Sam, the KCI rep came to advise and we are now working at 150mmHg rather than 125 or even 100 which is what we have used before.
She also suggested we might go to white foam all around rather than use black and also perhaps go to intermittant therapy which would improve the healing. I'll check with Sheffield on Monday.
What's more, I didn't miss the rugby!

Reflections on a hectic week

2006-02-03T13:15:00.000Z

It's now Friday pm. The doctor has just popped round to prescribe some more antibiotics, obviously a 10 day course is not enough to kill the infection in my heel as it started to flare up again as soon as the course finished. Perhaps another 2 weeks will be enough.
The vacuum pump (number 3) is working so far. The local expert, Julia, came round yesterday with a district nurse to try her luck at putting the dressing on. Credit where it's due, in an hour she got the best airtight seal I've had so far.
Mind you, the dressing needs changing every 48 hours so they've arranged for the local rep for the suppliers to come around Saturday at 3:30 and show another one of the district nurses how it is done. Perfect timing, that's the kick-off of the England-Wales match!
Following the dressings clinic (Sheffield) on Monday and physio (local) on Tuesday, it was back to Sheffield on Wednesday to get my nose looked at. No point in doing any more now so review in 6 months and possibly take me in to do some work then.
I'm really not sure how all of this gets fitted in. I was seriously shattered by Weds night and my leg was aching quite badly. It really saps your stamina and that's when even simple tasks become risky.

Another one bites the dust

2006-02-01T11:24:00.000Z

Weds 1st Feb, 2:15am - woken by alarm on VAC pump unit. "Internal Device Error".
Can't get nurse to change dressing at this hour so hope that morning will be soon enough.
Nurse arrives at 9am and replaces with conventional dressing.
Replacement pump arrives at 11am.
Excellent service all round but I do wish they wouldn't break down. Perhaps we live on a ley line or something equally spooky

Keep on sucking

2006-01-30T16:44:00.000Z

Just got back from Sheffield having got the vacuum dressing reinstated.
The new pump was delivered to my home Sunday evening ready for my clinic visit. First rate service I thought.
The dressing nurses couldn't believe how much tape had been applied to get an airtight seal when the dressing was first fitted. They stripped everything off and started again. As I suspected the pain of having my leg hairs ripped out was far worse than anything I have had from the wound so far, although as I type this I am having second thoughts as the pain killers are wearing off.
The wound is healing well, such that they have not bothered to reinstate the vacuum over part of it. Perhaps that's just as well as it took two nurses over 2 hours to replace the dressing and get it airtight. Much less leg covered with sticky tape this time so a much neater job.
District Nurse will replace the dressing on Thursday and it's back to Sheffield next Monday.

For the devotees of gory photos I apologise for not taking my camera today. Apparantly when the white foam was removed (we left it in place on Saturday when the pump died) you can see the bone down the hole. Must try and get a shot next week if possible.

Missing Photos

2006-01-29T12:39:00.000Z

I'm not sure how these missed the last post. They are also in reverse sequence, with the gory ones first, sorry! You can just see the white foam packing in the wound on the first pictures.

The second set are Chris and Diane (with me in the background - my apologies)

The third set is the before and after of the wound.

See previous post for the full story

Back Home Again

2006-01-28T14:42:00.000Z

Well, I now have my vacuum dressing in place after an interesting trip to hospital.
After the ambulance didn't appear on Monday it was arranged for early on Tuesday when, fortunately, it turned up. I arrived on the Ward at a busy time and it took a while to get organised by which time the Consultant was on the phone from Theatre wondering where I was! I was rushed down to theatre and given a general anaesthetic so they could scrub the wound clean before fitting the dressing.
I thought a before and after view might be interesting.

When I awoke I found myself attached to a small plastic brick which makes some very unpleasant noises all the time. Well, no more trips to the library for me - Sshh! In order to get an airtight seal they have had to apply a lot of tape to my leg which impinges on about 10 of my pin sites (with 28 sites there are plenty to go around). Since the dressing requires changing every week it looks like I will need a good long book to read while they apply the tape. I suspect that I get a free leg-wax into the bargain.
After a decent nights sleep I was told by the Dr's that I could go home. Sadly there appears to be an ambulance shortage and they couldn't find one to take me home on Wednesday. Thursday arrived and still no ambulance. I was about to get a friend to come and spring me from my jail cell but following discussions with the ward sister and the occupational therapist we decided that I could go home by medicar. I think that has now set a precedent as I now have a car booked to take me back for the dressing clinic on Monday morning.
I have become accustomed to the noise of the suction when I am sleeping, but it irritates the heck out of me when I am listening to quiet music or speech on the radio. It is a pain to carry around and the tube between the pump and my leg must be 8 foot long. If I trip over the tube and break another bone I shall be very unhappy.
That said, I am much happier with this set up than the open wound leaking blood when I walk. It also protects the wound and promotes healing so infection risks are reduced and that has to be good. Apparantly most of the wound was forming new skin and it was only a small hole that was still open so that too is positive.
As for the heel pain, the antibiotics seem to be working and I am pretty much back to normal levels of discomfort now.

UPDATE:
6:30 pm Saturday - Vacuum machine broken "Internal Device Error".
Suppliers suggest removal of sponge dressing and return of unit for fixing. They will supply a replacement, hopefully for Monday.
District nurses (Chris and Diane) hack off the sealing film around the wound site, and replace sponge with another temporary dressing - good photo-op! They leave just after midnight.

Having removed the black foam the main wound looks reasonably OK and the hole which goes down to the bone is packed with white foam which the hospital (night staff nurse on the ward where I spent by internment) suggests we leave in place (Thank You!)
District nurse (Marilyn) comes Sunday morning to check. There has been some leakage so she adds a bit more dressing.
Here's hoping that the new unit makes it to Sheffield for Monday so I can be plugged in again.

Heel Pain - Update

2006-01-23T12:22:00.000Z

I've decided it is an infection.
The pain is really intense and even my strongest painkillers won't shift it for long.
I have started a course on antibiotics to try and calm things down and was really looking forward to seeing the medical staff in Sheffield today so they could take a look and advise me. That was when I found out there was a problem with the transport and I won't be going today after all. The latest plan is for me to go very early tomorrow just in time for theatre. Not a great plan but the best we have to work with. In any event I need to get the wound dealt with quickly so whatever it takes......

Heel Pain

2006-01-22T14:43:00.000Z

On the eve of my return to Sheffield to have the new wound dressing fitted I have really been struggling with heel pain. The area under my left heel has swollen and it is really painful to stand, let alone, walk on. There doesn't seem to be any evidence of infection so I am assuming it is bruising, perhaps from one of the footbeds I have been using in my temporary built up shoe in an attempt to make walking more comfortable. Another possibility is that when Maria tightened the wire on Thursday it placed additional strain on the other wire through my heel.
Hopefully someone will tell me what is happening when I get to the ward tomorrow. I am taking extra painkillers but walking is still really bad news.
I have had some positive feedback on the suction dressing from a couple of previous wearers. They both report positive results but the idea of fitting it under the Lizzie still concerns me, especially as it appears I have to change the dressing every 2 days.
Still, time will tell, and any respite from bleeding every time I stand up will be really welcome.

Seven Weeks - Good News/Bad News

2006-01-19T19:26:00.000Z

The clinic session today was to X-Ray my back and check the healing. The good news is that it is on target to be fully healed in another 4-5 weeks. In preparation for that I can now start weaning myself off the brace. Initially just a few periods of sitting without it, but to be ready to do without it completely in another month or so. In practice I shall still be very wary of walking without it. As the Consultant said, "You do not want to fall over without the brace until you back is fully healed".
Unfortunately, the same optimism didn't run to the wound on my left leg. It is still bleeding when I walk and it is a major infection risk to the bone junction which is supposed to be forming. Careful removal of a section of the "scab" showed a mass of something which looks rather unpleasant. A swab has been taken to test for infection, but it apparantly most likely to be liquid fat! Why can't the fat I want to get rid of just leak away like that?
After some debate about plastic surgery, the decision was taken to take me in next week to clean the wound and fit a "sucky dressing". I was introduced to a fellow patient who has one of these and it appears to be a portable vacuum pump connected to a pipe which leads to the sealed wound. It is supposed to be almost impossible to fit one of these under an existing "Lizzie", but when did that stop anyone trying. It has been done before so why not again?
So, Monday I get driven over to Sheffield for theatre on Tuesday and, I hope, home on Wednesday. At least it will stop me leaking on the carpet and protect the wound from infection meaning I can venture outside a little when the weather is clement.
Apart from these big things I had been having some pain from a pin site in my foot. As Maria suspected the wire was loose - how did that happen? The tightening was totally painless.
I also discovered that a pin which was giving me some grief a few weeks ago has cheese-wired about 7mm through my leg. Just shows what happens when your muscles start working again. I reaaly am a lot more stable than I was and even the stairs are seeming less daunting.
Finally, Maggie goes back to work on Monday. We have an hours care each morning to get me washed and downstairs after Maggie has left for work. What a shame I'll get one day of this and then miss 2 days. C'est la vie!

Six Weeks On

2006-01-12T13:55:00.000Z

It's now 6 weeks since I was united with my metalwork. Things are still progressing to plan as best I can tell. Without wanting to tempt fate I haven't yet acquired a pin site infection and my painkiller regime seems to keep me pain (but not discomfort) free most of the time.

On a really positive note I am now feeling much more alert and have just been reunited with my work laptop and can now pick up emails from my office. The next breakthrough will be to get back to doing something useful even if it has to be done remotely as I don't intend to go back into an office environment until my leg wound has healed properly as that is the biggest risk of infection, much more so than my pin sites.

Perhaps now is a good time to reflect on what I have learned over these 6 weeks. In no particular order I offer the following personal guidence:

Get over it! Once I had realised that it wasn't a dream and that I wasn't going to wake up without broken bones I realised that I had no option to accept what fate had delivered. Be positive, everyone is doing their best to help you, but ultimately your attitude and actions will be the biggest factor. If nothing else, just remember that the alternative is far worse.
Seek help. This will naturally come from friends, family and colleagues, but also from the various agencies both government and charity funded. Before I came home we were loaned various items such as toilet frames and bed levers to make it easier for me to manage. I have just had a Social Services assessment to see what assistance they can provide to make it possible for Maggie to go back to work. I also have an emergency alarm button around my neck which will automatically connect to a 24x7 call centre in case I need assistance. This is important for Maggie to make her comfortable to go out and leave me without chaining me into a chair so that I can't hurt myself. There are other agencies who focus on getting the injured party i.e. me, back to work by offering such services as transportation, specialist furniture etc. I have also previously mentioned Slim's website but he also moderates a Yahoo group which is very active and can provide much needed moral and practical support - http://finance.groups.yahoo.com/group/Ilizarovs-and-fixators/. Bear in mind that positive support from whatever source is a force you can channel to strengthen your own resolve should you ever need it.
Be realistic. Don't set yourself targets that are either too ambitious or so far away that you can't see how close you are to achieving them. Try to take things a week or two at a time and guage your progress on that basis. One really powerful measure is your response to any physio you are having. You will be able to see the increase in repetitions and how much easier it is to do certain exercises. If you don't have any externally imposed targets then try and invent a few yourself to keep you focussed.

OK then, what practical hurdles have I had to overcome and what is still giving problems.

Pin sites. Although I have had no infection as yet, they remain a source of wonderment. I am on a weekly regime of changing dressings which Maggie does for me. This takes about an hour and involves cleaning with Hydrex and replacing the dressings over the wounds. This is complicated by the open wound which keeps bleeding. Depending on whether and to what degree my leg is elevated I get blood flow over a number of the pin sites. By agreement with the nurses we do not put dressings onto those pins but just clean the worst off the pin with hydrex and leave it. The wound itself is not dressed. This process is a chore and different hospitals advise different procedures but we are now into a routine and it does give a regular opportunity to note any changes in the appearance of the sites.
Clothing. Slim's sites have some really useful patterns for adapting trousers to go over the frame. Even in my youth I never had flares quite as wide as those necessary here, but I guess fashion is fickle. Personally, rather than cover the frame fully, we have adapted a pair of jogging pants to open down the seam and put toggles and loops on the sides to fasten them with the leg terminating part way down the frame. This is mainly to give the wound some air circulation unless I need to cover it when going out.
Protection. The leg itself needs protection from extremes of temparature (in England this means cold as we rarely have to worry about overheating our Lizzie). You can get covers made up which fasten with velcro, but because I have a foot fixing on the frame this wouldn't work well so we use a quilted pillow case which is put over my foot and leg and fastened with string or velcro above the frame. Not really suitable for walking in, but at present I am only going out to hospital appointments and have ambulance transport which involves wheelchair transfers so not an issue. Protection is also needed for anything that might come into contact with the frame as it has several sharp points. We have managed to find a suitable rubber sleeve to cover a sharp end of screw threaded rod which sticks out the back of the frame. I think this came off Maggies sewing machine, but I'm sure there are more conventional sources. Bear in mind that when elevating your foot the frame will be resting on something that you probably don't want to puncture so look for, and do something about, any sharp projections from pins and frame components. I do not concern myself too much about protecting the public from my frame, at present I need all the advantages I can get.
Footwear. This is still an on-going saga. The OT unit made me up a platform shoe for my left foot to compensate for the bone they removed. This was fine initially but as I walk more I am noticing its limitations. I am currently supplementing this with a footbed from an old pair of trainers but we need to improve on this. I have studied Slim's solutions (from the website) and plan to try and adapt these to fit my foot. My problem is the pin directly into my heel and the position of the side pins which make it necessary to remove the whole heel cup of the shoe. I am afraid that this will make the shoe liable to fall off which will be a problem half way up the stairs. I will provide details when we solve this problem.

My other challenges have been more related to my other injuries than to the frame. It has taken ages to get comfortable sleeping on my back. Last night was a revelation as Maggie bought and fitted a foam "egg roll" between the mattress and the sheet which spreads the load wonderfully and stops me sliding down the bed as quickly as I was doing without it. Since bed is the only place where I don't need to wear the brace for my broken back this is a real bonus.

Apart from some more visits from friends & colleagues (it's costing a fortune in tea and biscuits but I wouldn't change it for the world), there's nothing to look forward to now until my next visit to Sheffield on 19th January. They are going to check my back and it may see the start of the end of the brace. I have a new physio exercise to tone up the muscle that acts as a corset to support the back which may be important when I start to get used to life without the brace. I still can't put my full weight on my broken right leg, but it is getting stronger every day and you can almost see some of my leg muscles again.

Finally, since joining the Yahoo group (see above) I have been contacted by Patrick who, following a nasty motor bike accident, was treated at the same hospital and by the same staff as I am. He now has his frames off after 7 months and is continuing his recovery. I take such communication as a positive inspiration and look forward to being able to pass on similar encouragement to others

Picture This

2006-01-07T13:08:00.000Z

The physio regime is pretty mild but does look as if it is starting to improve the mobility and strength of my right leg. Most of the exercises are constrained by the frame on my left leg but that is already in better shape than my right. As far as this leg is concerned my priority is to visualise the movement of my foot based upon muscle stimuli. Time will tell how successful this is.

I managed the stairs twice yesterday so either my stamina or technique is improving - perhaps even both. As I do more exercise I can really feel the need for the painkillers. An earlier attempt to cut down the dosage was a big mistake and I will not try that again for a while.

I have attached a couple of photos to this post. These were taken in hospital and show the frame from both sides. The top picture to some degree shows the wound which is still healing and bleeds when I walk on the leg. The two additional rings at the top will come into play when they start to lengthen my leg to replace the 3-4 cm they had to remove.

I've no idea how much the metalwork weighs, but when I stood on the scales this week I am now 7 lbs lighter than I was when I had the accident despite the extra weight (including my crutches). I think this loss of weight might become very useful when it comes to increasing the exercise load further.

First Physio

2006-01-03T15:05:00.000Z

Today was my first physio session at the local hospital. Having been collected by ambulance I met Nick who will be the person who is going to inflict a series of torturous exercises on me in the coming months.

A detailed discussion about the nature of the injuries, the pain I was experiencing and the range of movement that I could manage at present was followed by a review of my situation and my ability to walk on crutches without damaging myself.

Nick stressed that during periods of relative inactivity the muscles can waste very quickly and it is important to keep up even a minor level of exercise to prevent and reverse this. Interestingly, this also applies to exercises which apparantly have no effect. For example, whilst I can push the toes on my left foot down, I cannot pull them up. By exercising as if they were rising, and visualising the process ie imagine the muscles contracting and lifting the toes, this will stimulate the body to continue to detect and respond to the signals, even if the effect is not apparant.

We settled on a programme of 5 exercises to keep my leg muscles active. At present we are looking at a small number of repetitions but the message is to listen to my body and respond accordingly. If an exercise gives excessive pain then reduce it, whilst those which are easier can have the repetitions increased gradually.

Nick did want to introduce a back muscle strengthening exercise, but felt that he needed to consult with the hospital in Sheffield before doing so in case it is at odds with their treatment plan for my back.

I am back in a weeks time to review how things have gone.

Over the last couple of days I have been having a lot of pain and have slept very badly. I think my initial mistake was to try and reduce the dosage on some of the painkillers since things seemed to be settling down. I have now returned to to original dosage which seems to be helping the pain and spasms in my left leg. The real problem is being in bed. I am constrained to lie on my back, but I do need to rest my head on 2-3 pillows to help me breath at night. This configuration seems to be giving me a load of backache. I have now tried supporting the length of my back between my hips and shoulders and this does seem to reduce the pain. Still no sleep though.

It appears that recovery from multiple injuries is one long tale of finding and resolving problems. It is difficult to accept this with good grace, but there doesn't seem to be much of an alternative. My motivation must be my final recovery but the measurement of progress must be based on very small steps if I am not to get dispirited.

First Clinic Session

2006-01-01T17:16:00.000Z

My first clinic session was scheduled for Thursday 29th December. I was transported by ambulance from home to the hospital and back. Both my legs were X-Rayed and Emma checked over my pin sites.

I was concerned that I might have started an infection as I had some very specific pains in some pin sites. I was told in no uncertain terms that if I had an infection I would definitely know about it and that what I was experiencing was the common development of muscles and other internal bits sorting themselves out around the pins. Obviously as you exercise and your musculature changes it has to fit around the pins. I can honestly say that this is now a continuous process with odd cramps and spasms in addition. Thank you for the painkillers!

Emma also cleaned the blood from the open wound from the pins where it had flowed. This remains a real nuisance as every time I walk it bleeds, mainly onto my foot, but then when I sit down and elevate the foot it runs over some of the pin sites. This shouldn't necessarily mean increased risk of infection but it is messy.

The X-Rays were interesting as I finally saw how much damage I had done.

The right femur now holds a nail which is almost as long as the shattered bone around it, with a second nail into the hip joint to provide an anchor. There is evidence of new bone growth so perhaps another 2-3 months will see it fixed.

I had always assumed that I had broken my left ankle as well as the bones in my lower leg, but the Consultant (Mike Dennison) confirmed that my ankle and foot were pretty much undamaged and had only been left attached by a small amount of skin before they squared off the 2 bones and butt jointed them up to the ankle for healing. It is by no means certain that the bones will heal so there is still a possiblity that I will lose my foot, but they remain optimistic and have other options, such as bone grafting, to fall back on.

I have always accepted that there was no guarantee that my left leg could be saved so I am reassured that so far nothing has happened to diminish the optimism. I was a little disappointed when I asked how long the frame might have to remain in place. I had always hoped that 6-9 months might be enough but I am now not expecting to see the back of it in 2006 even if things go to plan.

The future?

I have a physiotherapy appointment on Tuesday 3rd January and return to Sheffield on Thursday 19th January to have my back X-Rayed to see if they can wean me off the brace.

Here's hoping.

Getting Home

2006-01-01T16:52:00.000Z

I was warned in advance that my first few days at home would be tough.

Even with careful preparation your home is not as "invalid friendly" as the hospital ward. Using crutches for walking means that carrying items can be awkward, especially food & drink. My particular nemesis is our staircase. It is steeper, the treads narrower and the risers higher than the ones I practiced on. Each stair also has a "nose" ie a bit that sticks out over the stair below and they are carpeted. This means lifting my feet higher and wider to climb the stairs where I lead with my left (frame) leg. Going down is even worse because my frame extends behind my foot making it almost impossible to lead with my left leg so I lead with my right (the weaker) leg and support myself more with my arms. Then I reach the bottom stair where I run out of banister (handrail) and have to go down using both crutches. All sorted now, but challenging for the first couple of days.

Establishing a daily routine is taking a bit of time, but at present revolves around the times I take my painkillers. I am able to spend about 11-12 hours a day downstairs in a chair, with the occasional walk to give me some exercise. I expect to do more exercise as my condition improves, but at present I have to be careful if I am to safely mount the stairs to go to bed.

The rest of my hospital stay

2006-01-01T16:17:00.000Z

The rest of my time in hospital seemed never ending although it only lasted less than 3 weeks.

I was fitted for a back brace which I had to wear any time I got out of bed. It is a fine creation of plastic and velcro but cannot really be regarded as comfortable. Having got the brace I was then "encouraged" to get out of bed and by the Monday I was expected to walk with a Zimmer frame.

I remain amazed that both my broken limbs are expected to be able to support my body weight, even though by now my weight had somewhat diminished. From the perspective of an Ilizarov wearer it is initially difficult to place your trust in the fixation device, but it really does allow you to weight bear and even walk. Of course it feels strange, especially as my device is fastened into my heel and my ankle is fixed, but even now I regard my left leg as my good leg compared to the right which, even with the femeral nail, is still weaker and less stable. As my left leg had been shortened, the Occupational Therapy team (Jill & Melissa) fixed me up with a customised sandle which pretty much balanced up my legs meaning that I didn't walk in circles all the time.

Daily physio courtesy of Jackie and her colleagues, and other support led me to progressing to crutches and, joy oh joy, the ability to get to the toilet unaided - no more bedpans! Unfortunately I have a large wound on my left leg where the flesh has yet to heal. This still bleeds when I walk and frequently leaves a distinctive trail, but more importantly is a potential site for infection which means no hydrotherapy.

Most of the rest of my stay was geared towards preparing me for going home. My injuries were carefully monitored and we were trained in the care of the frame and, most importantly, the cleaning of the pin sites. The pins which fix the frame onto the leg go directly through the flesh and the bone. This means that hygene is critical and infection common. We were trained to clean the pin sites and replace the dressings on a weekly basis. If we have any queries or concerns then the specialist nurses, Maria & Emma, are available to provide help.

Finally, the OT team fixed up the provision of medical aids for home and I was discharged on Thursday 22nd December being delivered home by Ambulance.

What a mess!

2006-01-01T15:43:00.000Z

This is very brief summary of the immediate aftermath of the accident and the injuries I sustained. Some of this has been reported to me as I was pretty much unconscious for several days and only recall the edited highlights.

Surprisingly, I was quite conscious during the initial rescue and able to provide information to the paramedics. I could tell that I had severly damaged my lower left leg and it felt like I had also broken my right femur. I also had a back pain which prompted additional caution in removing me from the wreckage. I could feel blood on my face but at that stage was not aware of how much damage I had done.

I was taken to the Chesterfield Royal Hospital directly from the crash site being the closest location with suitable facities. They made the initial assessment and concluded that my head and left leg injuries were the most threatening. They stabilised the limbs and then operated to patch up my face and broken nose. They also took X-Rays and a CT scan of my spine and confirmed the presence of a fracture.

The leg injuries were too severe to be fully treated in Chesterfield and I was transferred the following day to the High Dependency Unit at the Northern General in Sheffield and referred to their Trauma team. Simon Royston and his team were incredibly helpful in explaining the general nature of the injuries and the most suitable options for their treatment.
On the Tuesday they fixed up my right leg by inserting a femeral nail.
Wednesday they confirmed that the back injury was a stable fracture of the L2 vertebra and, as such, meant that I could reasonably expect to be able to stand and walk while it healed so long as I wore a suitable brace. This meant that there was the option to fix my left leg, where the Tibia and Fibula were both badly broken near to the ankle, using an Ilizarov frame.
Thursday saw the fitting of the frame. The operation took several hours and they had to remove about 4cm of "dead" bone so they added some rings to the frame to permit the lengthening of my leg when the initial healing was complete.
On Saturday they transferred me out of HDU and into a general ward, almost exactly 6 days after the initial accident.

Throughout this period my wife Maggie had been at my bedside, aided by some of our closest friends who provided food, shelter and transport. I can't help feeling that I had the easy part of that initial week since I was too dosed up on Morphine to really feel much pain and was unconscious for most of it.

Why Blog?

2006-01-01T15:22:00.000Z

Obviously I didn't plan the accident and so I certainly didn't plan to create this blog.

Having gone through the trauma of the initial hospitalisation and realising that I was to host my new Ilizarov frame for a while, I thought it a good idea to try and find out a bit about what to expect.

The hospital do provide some very useful information about how to improve the healing process and avoid the pitfalls such as infection and muscle wastage, but what about the practical day to day issues?

My initial web search uncovered The Ilizarov & External Fixator Wearer's Support Group run by Slim Haines which was an inspiration to me. I decided immediately that I should document my own experiences as they occur in the hope that they would provide information and, who knows, inspiration to others who find themselves in a similar situation.

In my next post I will provide some idea of my injuries and my progress to date. Beyond that I know no more than anyone else at this point.

Where to start?

2006-01-01T15:07:00.000Z

It is New Years Day 2006, a year that I now face with my left leg attached to a modest scaffold constructed from the finest Meccano I have ever seen.

The cause of this was an accident which occured while I was gliding in late November.

It is not important to this story to try and explain how the accident happened. Any aviation sport carries risks and all pilots acknowledge those risks when they fly. Gliding is inherently very safe and well managed at both national and regional levels. However, accidents can, and do, happen. My accident will be the subject of a formal investigation and report which will highlight the lessons to be learned for future pilots. Until then I will confine my comments to a plea that this, or any other accident, should not put anyone off engaging in this most wonderful sport.

As far as the tale goes, I have no idea where it will lead, but obviously I hope it will end with me fully recovered and flying again. Only time will tell.