Morale

I now think I should have been keeping a tracker of morale.

I am really quite surprised at how low my (whatever) has dropped over the last few days.

Last Adjustments ... I hope

Today is the last day on which I should have to adjust the frame.  Hooray. 

The last few days have been more painful than usual. I assume that the bones are making contact and that pain is the result.

Once again I am a little concerned that I have been told to skip the weekly clinic. Surely, if something was wrong about the way it has been adjusted, then we should find out on the last day of adjustments and not in a week's time when the problem has had to time to settle in, like last time.

Strange

There are moments when I stop and can't move on.

I think they happen most when the pain has been minimal, I've been sitting comfortably, and distracted by normality. And then I have to get up and do something, i stumble or bang my frame, and suddenly the whole weight of the situation lands heavily. For a short while it is impossible to push things into th bacground.

the normal future seems a long way away, and I have to admit to what' real. I've got a le full of metal pins, I can't walk, I can't see what the builders are doing in the loft, I can't look for a girlfriend

The future seem a long time away.

A quiet week

Not too bad.

That sums it up.

I got some good sleep this week, only waking 2-3 times during the nights. I take 30mg of Codeine just before sleeping, then again if I wake up due to pain. One night I managed 5 hours of uninterrupted sleep. The strange thing is that I now have to sleep in a different position. I use a recovery position with the broken leg on top and the good leg straight. I've stopped raising the leg at night. It was more painful than lying flat.

Yoga has been good. I put far more weight onto the leg after every session. Today I also hobbled back home rather than taking a cab.

Maz gave me a lift to Beach's flat where we sat around discussing broken legs, autism, and buttering toast right to the edges.

Xray shots show the gap between the ends of the bones getting smaller.

Time

Time.

Time x pain = ?

After 11 weeks of pain I am becoming desperate.

Imagine if you will, someone stuck a needle in your leg and left it there. When you move, it hurts. Sometimes it hurts even if you don't move.

Now multiply that by 10. Imagine you have 10 needles in your leg, and four of them are 5mm thick. They all hurt like the first one.

Now imagine that the thinner of those pins all have inflamed boils or spots on them, and that they are incredibly sensitive. Any contact is very sore.

Now put a vice on your leg and clamp it so tight the you can feel the bone stress.

Finally add a pain that you will not know unless you've broken a bone. It's a sharp fiery sort of pain deep in your leg. You can't quite work out where it is located. It pulses with your heartbeat. It is strong enough to make you wince every now and again.

When the pain is at its worst you can't think. You just sit and stare, blankly unaware of things going on or what people are saying to you,

Now imagine that pain being present to varying degrees, 24 hours a day, every day for 11 weeks.

Week 11 - Leg Shortening

After a week of lengthening the leg, last week's X-rays showed that the upper part of the shin was well clear of the loose segment. The adjustments were all about moving the upper shin across the top of the segment.

Today the X-ray pics show that the ends are fairly well aligned. Week 11 will be all about shortening the leg to bring the ends together. 

Broken bones do not heal well if the gap is too big. Ideally the bones are in contact. We are now dropping the upper shin onto the top of loose segment to make contact and make the healing process quicker.

The lower part of the break is now showing signs of calcium deposits appearing in a mist around the break.  That's really good news. However, we can't see anything appearing around the upper break, though there is a mist in between the broken ends...

I'm worried about a strange thin line running down the shin bone. To me, it looks every bit like a hairline fracture! What is it?

There are also signs of calcium loss around one of the upper pins. "Nothing to worry about yet" was the verdict. Well that depends on whose leg it is I suppose.  If the loss becomes excessive, they take the pin out and move it to a new location. I could end up with a leg that looks like Swiss cheese. 

  

Drugs

Drugs...

I've been taking antibiotics for about 10 weeks now. (Flucloxacillin).  The leg is still weeping a clear yellow liquid which I assume to be lymph fluid. There is no opaque pus. The stabbing pain in the old empty pin site has stopped. I've stopped taking the Flucloxacillin.

They've given me a new pain killer; Gabapentin. This works on the nerve endings, not the neurons that carry the pain signal or the areas of the brain that interpret the pain signal. I wish I'd known that sooner! I was given a prescription for Gabapentin two weeks ago and avoided getting it because I am sick of taking painkillers.

Many painkillers slow the processes in the colon, will the result being a severe bunging effect. Luckily, most antibiotics have the reverse effect and so cancel the problem out. I suffered constipation very badly a little while ago; not a simple lack of movement, but instead an intense pressure as the upper part of the colon pushed, only to be met with an immovable lower colon. Imagine that you have desperate need for a bowel movement, so strong that you are running/waddling to the toilet, but you just can't go. It's painful.  However, one bag of prunes later, and the problem was sorted.  The effect took only 15 minutes to initiate, and lasted about 4 hours!  What a sense of relief!

So faced with a third painkiller, you can imagine my reluctance.

However, the leg pain became intolerable. Elevating the leg relieved the pain of swelling and strain around the pins and wires, but introduced a new sharp pain on the bone.  I couldn't sleep. I'd prop the leg up on a pillow as normal, and within 5 minutes I'd have to hang it over the side of the bed. Minutes later I'd put it back on the pillow.

I took the first Gabapentin on the Thursday evening, and suffered less pain. On Friday the dose increased to two capsules (the dose has to be increased slowly) with one taken at night. I was amazed and surprised to wake up at 6 a.m. and realise that I'd slept 7 hours with only one brief period awake in the middle of the night. I took the first Gabapentin of the day and drifted back to sleep. I was woken by Maz calling on the phone at 11 a.m. !!  I'd slept almost 12 hours.

Fantastic!

Week 10

Just back from the clinic...

The plan is to leave the tilted bone segment where it is and let the leg heal.  There will always be a large lump on my shin. But I'm sick of the pain and immobility. I am now prepared to put up with a degree of disfigurement.

We've been moving it for 10 weeks now. The fracture should be in the middle of the soft callus phase and it's probably becoming difficult to move the segment by hand. The leg will still be mechanically straight and strong which is what counts.

I have been given another week of adjustments to make, in which the two ends are to be realigned by about 5 degrees. 

But I don't really get it. The more I think about what they are doing with my leg, the more baffled I become. 


Two weeks ago I had an operation in which they intended to straighten the tilted segment of shin.  The fact that they used a beaded wire and the way the pin and wire sites were forcefully re-opened seems to confirm that. But that part of the op failed, and the consultant said something about the bone or leg being too strong.

A week after the op we took some more x-rays and the they gave me a new set of adjustments to stretch the leg by 8mm. My understanding last week was that they would then push the bone back into place and then we would shorten the leg.

However, this week the plan seems to have changed. There is now no intention of correcting the tilted bone. The senior consultant tells me that if we adjust it then we may cut off the blood supply and the separated chunk of bone could die.

But by separating the upper part of the shin from the loose segment we will extend the time it takes to heal. So why did we bother separating it? And why don’t we shorten it and put it back?

Each time these guys make a decision and set me on a particular course, it all sounds very logical, but in the end it seems to be a mistake. 


I’m very concerned.

Post Op, the results

Today's x-rays show that last weeks operation was not hugely successful.

On the good side, a new pin was fitted, and the old infected pin was removed. That hole now has a rather unpleasant mess at skin level, but the aim is to let the infection out as the soft tissue closes up.

The main aim of the operation was to move and stabilise the large chunk of shin bone that was forced out of alignment by the last set of adjustments.  A hole was drilled through the piece of loose tibia and a new wire was threaded through. There's a bead fixed to the wire, and when the wire is pulled through, the bead locks against the bone. The surgeon should then have been able to pull on the wire whilst an assistant stretched the leg and so manoeuvre the bone into position. It seems that the bone was stuck and the attempt failed.  Given the amount of metalwork already on the leg, it was not possible to get the wire to the ideal position.

We are now going to stretch the leg by 8mm by lengthening each of the struts by 1mm per day. The aim is to move the upper shin-bone out of the way so that the loose piece is then moved back into the correct position by the surrounding soft tissue.

I'm worried that the wire will hold the bone in the wrong position, even if it the upper shin-bone releases it. I think the wire will have to be released first, and that this will involve another visit to the theatre.

Two of the struts needed to be changed for longer versions in order to get the extra 8mm. This is done by inserting a temporary strut to hold the frame in position, then swapping the short struts with longer struts, and then removing the temporary one.

When the second strut went into place, for some reason the consultant could not get the new strut to the correct length, and it is 4mm short of where it should be. The next half hour was incredibly painful. I have to get that 4mm back as quickly as possible tonight. Maybe 1mm per hour?

Where does the pain come from? The bone itself does not have any nerves... Apparently there is a close fitting sheath attached to the outside of the bone, and this has a nerve supply. When the bone breaks, the sheath can pull away from the bone, and then obviously any contact with it will cause pain. Believe me. it ******* hurts!

Is Aviva the worst insurance company in the country?

The only reason I'm insured with Aviva is because there is almost no alternative in the world of motorbike insurance. Any other company asks for far more money. I know this fact, and yet I still insured myself with Aviva because I was prepared to take the risk that I would have to pay for repairs, and I have medical insurance.

Aviva are rubbish:-

• When my neighbour's car caught fire and burned mine, Aviva would not pay his claim because it was a "mechanical fault", so I had to claim against my insurance at a cost to my no-claims bonus.
• When an Audi TT pulled across in front of me and I claimed for damages to my bike, they lost the claim, then were unable to trace the other car owner, then eventually offered me £35 which was less than the cost of my no-claims bonus. I turned it down and paid for the repairs myself.
• Try phoning them. "Press 5 for 52 more options, and speak to someone in Little Bombay who can just about read a script but doesn't understand what you are telling them."
• ...I had several other unfortunate dealings with Aviva, and so it goes on.  Every time I come across Aviva they refuse to pay or else offer a ridiculous settlement.  Even their pension plan actually LOST money last year. (Yes, I'm moving my money out.) 

So now, it is over 7 weeks since the accident, and they have done nothing about my motorbike. First they tell me not to get the repairs done because they may want to inspect the damage. Then they demand estimates etc from me (which I sent), then they wrote to me to say they have closed the claim. The lawyer wrote to them telling them that the claim is still open. And at long last they have decided to inspect the bike to check the estimate.

Today they have asked me to send a sketch of the accident with names of people and registration numbers of vehicles. ... SEVEN weeks after the accident?

I tried to call them. A recorded message tells me that they seem to be having technical problems and cannot connect my call. I should "call back in an hour" by which time they will be closed for the day.

If you ever hope to be properly insured, do not use Aviva. They are only a useful service if all you want to do is tell the DVLC that you have insurance so that you can get a tax disc. But they will never be of any use to you as an insurer.

Operation 2

Thursday, very early... I set two alarms last night to make sure I get up and have a hearty breakfast. I'm supposed to finish eating by 07:00, and then it's "nil by mouth". I realise that the clothes I intended to wash the previous night have not been washed but I need them in hospital, so I put them on a speed-wash cycle and go back to bed.
I get up again at nine, hang the clothes over the radiator to dry, and absentmindedly have a cup of tea. Ooops.


I arrive at the hospital at lunch time and am shown straight to my room. The next 2 hours is spent answering questions about the drug regime, my health, my "current worries", next of kin, etc. The nurse measures my leg and gets a stocking that should prevent thrombosis. Sexy. Erm not.  The nurse covers me me in ECG patches (she shaves me to enable them to stick) and then prints off 3 or 4 sheets of ECG report. She seems happy, I still have only one heart. The sticky bits are removed. Ouch. Ouch. Ouch.


I do some work on a project plan whilst I wait. Then someone knocks and says they've come to take me to theatre. On with the gown and off with the undies. More sticky patches are attached for the monitors.
It feels strange to be carted around in a bed when I could easily get there faster on crutches. Still nervous, still frightened of a repeat of the last time.


The anaesthetist checks my tag and ask asks me my name and date of birth. A junior consultant marks an arrow on my leg, pointing at the frame. This time the canala goes in first time and something cold is pumped into my arm. He asks me about the drug regime and then injects some antibiotic.
"You should be feeling more relaxed now."  No chance. Nervous as hell.
A mask goes over my nose, I adjust it, he says "thanks" and suddenly the lights are brighter, I am in a different room and agony is coming from my leg.


I call for help, someone comes over and tells me it's ok. Huh? "Painkillers! Please!"
"Carlos" and I then go through a cycle of injecting morphine, waiting, then injecting more until I can tolerate the pain and tell him to stop.

Another bed is wheeled in beside me, containing a women who moves briefly, but then lies quietly. Somewhere behind me another bed is wheeled out with it's sleeping passenger.


We spend 15 minutes watching the monitors until Carlos is satisfied, and he leaves for the day. My trainee  nurse arrives and then it's my turn to be wheeled out.


Back at the ward the nurse sorts out the drip and monitor. I try to hold a conversation but my memory is shot. She keeps reminding me to breathe. "Don't forget to breathe." She stays for a long time and keeps me awake.
I ask for food, and someone has kept a sandwich for me. That's nice. Two bits of Mothers Paste white bread with a slice of ham which is oddly exactly the same outline as the bread. Not so nice. I eat a bit, and drink some water.

I worried about water retention again, I don't want another catheter, so I ask for urinal bottles. But I just can't pee lying down. I have to get up. The nurse helps me swing my legs over the side of the bed and I stand very gingerly, dizzy dizzy dizzy. After 5 minutes of standing holding a bottle I manage to dribble, and I get back into bed. Really dizzy.

Eventually I'm sick, vomiting harder than I can remember ever before. But it feels better.

And eventually the lid is cracked and the urine begins to flow. I heave a sigh of relief. This is a major target in getting home quickly, they won't let me out until I can pee properly. If you ever find yourself in bed after an operation, pee as much as you can at every opportunity!

Weirdly I don't need my glasses to see the TV. I've temporarily gone non-short sighted. I have no idea what time it is, so eventually I realise that the TV programmes have reached an intellectual level which will interest rodents an so it must be time to sleep.

Friday morning;  Full breakfast with tea. I'm starving and surprise myself by eating every crumb and morsel as if I had been starved for 24 hours.

A very pleasant Physio called Jo comes to inspect my leg. I'm sure I've seen her face before. She thinks maybe so too, but we can't place it. She puts rubber gloves on before touching my foot.   Is it that bad? She takes me for a crutch walk along the corridor and after a few tips on how to walk says "OK, I'm discharging you."
I'm somewhat taken aback. Already? I can go?  Yes. We just need the drugs, the paperwork etc.

The troop of doctors and consultants arrive immediately afterwards. There are lots of smiles and jokes. Yes, I can go home.  :-)

About 5 hours later we manage to get a supply of antibiotics, a letter saying that I'm free, and a cab booked to take me home. It's a really painful ride, but I'm happy to be out.

Going back in...

Going back in for another op. They're going to move one of the pins (the pin site refuses to heal) and manipulate the lump of bone that has become dislodged.

If all goes well this will be a quick turnaround but given my previous experience I'm still worried. At least this time I will have the opportunity to take essentials with me and will not have to put up with having nothing to wear except an arse revealing hospital gown.

Increasingly Worried

It's been a painful day.
If the team had arranged to have the leg checked every week, rather than sending me off for a full fortnight of adjustments, we would have spotted the current problem a week earlier and the solution would have been decided upon immediately.
If the consultant had been available at the clinic last week then the decision would have been made 5 days ago.
If we count from the first day of the adjustments which caused the problem (the painful day) it has now been 20 days since the pain started. It's been 13 days since we should have discovered the problem. It's been 6 days since we knew about it. It's 6 and a half weeks since the surgery, and one of the pin sites is still bleeding and seeping clear yellow liquid.
And yet nothing has been done.
I was expecting a call from the hospital today, but have heard nothing. I emailed them to ask if it had been discussed, or if there was a plan. There was no reply.
This is my leg. It's my future. I am worried.

Two weeks forward, 4 weeks back

Here's a little game for you. One of the two X-rays below was taken two weeks ago, and one was taken today.

Which is which?

You would be forgiven for thinking that the left hand picture was today and the right hand two weeks ago. Unfortunately you would be wrong.  The clue is in the head of the bone near the two bolts.  Today's picture shows that the vertical split has almost healed. The bad news is 2/3rds of the way down the bone.

The series of adjustments that were started two weeks ago were intended to align the bone as seen from the front. (The lateral alignment had already been done, and is still good.) However, it appears that moving the top half of the bone laterally across the bottom half, it has opened up the fracture which was an inch or so below the main area of breakage. You can just see the break above the bolt in this picture below.

That thin line is now a major gap.

So what do we do now? The options are probably;-

1. Reverse the adjustments and hope that the bone goes back to its previous position and leave it. Or maybe stretch the leg and adjust again, hoping that this time the bones won't touch until dropped back into place. The problem is that new bone is now growing, and it may be difficult to get a leg of the original length without operating.

2. Go for another operation, and manipulate the errant bit of bone back into place. They would loosen the struts, reposition, and then reassemble. They might fit another wire through the large loose section of tibia. Given my previous experiences, I'm really not keen on having another operation.

The consultants will discuss this over the weekend, and I am expecting a call to visit the hospital on Monday.

Physio?

My biassed opinion is that Bikram yoga was a major factor in making post-accident life easier. All the medical staff seem to be surprised at the degree of movement and the ability to do most of the physio exercises.

So I've been determined to get back to Bikram as quickly as possible. It also works as a "get out of house-arrest free" card. 3 to 4 days trapped at home is scary.

I discussed the idea with the consultants, the physios, the yoga instructors, and got the all-clear. Today was my first class for 5 weeks and 3 days.

What I had thought about but discarded was the reaction people have to the admittedly gruesome sight of a leg with 6" steel pins sticking into it. I dont really se the problem. People have pierced ears, nose studs, hoops in their eye brows (yuk!) and things in their tongues. What's the difference? Ok, so eight bits of metal going into the leg and a fancy bit of Meccano is definitely top trumps in the world of body piercing, but it's not that different!

There was a brief panic before the class as the staff grew concerned about th effect, and I found a small towel to wrap around the frame and hide it from sight.

The class was great.

Not only did I feel far better afterwards, but also the swelling was reduced and there was less pain.

Another Day

What would I give to take a day off? Or even just an hour.

...to wake up without a headache, without a burning shin, and itchy skin.

Imagine that my leg weighs so little that I can swing out out of bed and just stand up.

Imagine that the cramping vice has gone.

Imagine that I can stand up without feeling like my leg is about to explode.

Imagine that I can just go to the kitchen, make a cup of tea and take it to the sofa.

It's almost 5 weeks since the accident. It has become annoyingly boring, it seems to go on and on without improvement. This morning I almost threw my toothbrush across the bathroom in frustration, just because I couldn't quite reach to put it in the right place, and 4 times it fell into the basin.

This last week has been worse than the previous weeks. The bones grind together when my leg moves or shifts position. I have stopped using it when I walk, because of the fiery pain that is the inevitable result. Progress has retarded by more than a week.

I realise that I tend to go to bed early because it shortens the day, and so reduces the time I have to wait until I can walk again. 

Party

What do you do if you are a year older and recently split with your girlfriend? Yes, you throw a party. Well, you do if your name is Beach. :-) Beach, how do you know so many people?

I spent most of the day on the sofa with my leg raised, knowing that I'd have to spend several hours with my leg down and swelling painfully. I got a cab and joined the party. I sat on a bar stool for 3 hours keeping company with a French lady who is also on crutches due to a torn Achilles tendon. I'd confess to some envy of those people who could just pop down to the dance floor and move with the music.

It's fun watching the reactions of people seeing the frame or the first time. So many people have a physical swoon... But I'm getting bored of telling the story. It gets briefer every time.

I'm also frustrated that there seems to be only one topic of conversation. And the cause is my own problem; I don't have much else to think about.

Eventually too much pain. I had to leave.

Curate's Egg 12 Jan

Woke up in pain. Too few painkillers yesterday?

Had breakfast, washed, etc, but then just couldn't do anything. Lay down on sofa for a few hours.

Reheated some old food for lunch, got a cab and went to the clinic.

The xrays show that the leg is very well aligned when viewed from the side, but not so good from the front. So Mr Lohoti has calculated a new batch of adjustments which will pull the joint apart and stretch the leg. I guess that once the alignment improves he will then reduce the gap again.

Still in pain for the rest of the day.
1. The skin feels like it has an infinitely severe nettle sting.
2. The bone aches like there is a vice on my leg.
3. The occasional shooting pain zaps through the shin like a stabbing knife.

It saps the will to do anything.

10 January 2011

The end of the 4th week!

The whole leg goes a red-blue sort of colour when I first get up and move around in the mornings. (The picture was taken sometime after I got up, and so doesn't show the massive difference between the two). From thigh downwards the leg is much darker than the healthy leg. It's still painful when I lower it down, but not so bad as previously.

I don't think the infection is completely gone yet.

I have a slight tingling sensation in my right hand, near the finger tips. Must talk to physio/doctor about it, but is suspect it is caused by the crutches. (After-note; probably pressure on the nerve, it happens whenever I use the crutches.)

Physio appointment at 3pm.

Exercises going reasonably well. Must focus on adding the extra moves, and on imposing a more disciplined routine.

9 January 2011

The purple bruise on the base of my heel and foot is now gone. After the accident, I had a purple-maroon bruise covering the whole of the rear half of my right thigh. The muscle and flesh were hard and stiff to the touch.  And painful too. I realised that the bruise had largely disappeared about a few days ago.

I still have an occasional shooting pain in the shin where the 3rd pin and wire enter the leg.

Took a taxi to St John's Hill and had lunch with Beach and two of his dancing friends, Julia and Claire. They were going dancing after lunch, which made me a bit envious.

Beach and I went to see Tron. We were late, but we didn't miss much. In fact, the film is not really worth the effort. Don't bother.

Beach kindly drove me home afterwards.

8 January 2011

I took a long hobble into Balham, only resting once on the way. (I now know every place to sit on the way.) I've still only got the borrowed shorts to wear, so the metalwork gets really cold (the temperature is just above freezing) and extracts the heat from my leg. It's a bone numbing pain.

I noticed a couple of girls from yoga in Starbucks, so I swerved inside to say hello. ...Managed to make them squirm at the sight of my kebabish leg.

One of them is an instructor. She tells me that some disabled people do yoga on chairs, so now my determination to restart classes is doubled! I'm going to speak to the doctors and physios this week and get the all-clear.

I have lunch in "the poncy place" (Harrisons) where there are low seats and footstools. Then I hobbled down to the seamstress to collect my jeans. I fit the sleeve she's made, tighten the ribbons around the frame, and the leg feels warmer already! Great. Jeans and sleeve £28 all in.

Hobble back home, resting twice. Try on the jeans... they just squeeze over the frame if I pull hard. No more cold knees for me!  A good day at last.

The Taylor Spatial Frame

What a gadget! This scaffolding enclosing my leg (otherwise known as an external fixator) is worth as much a small car. ...But don't get any ideas about undoing it and leaving my leg dangling in the breeze! They are only used once, with the exception of those that are "scrapped" and sent to India.

If anyone says "I've never seen one of those before!" then you can now educate them:
The modern method was adapted by Professor Gavril Abramovich Ilizarov in the 1950s after having to treat orthopedic conditions in the Kurgan region of Siberia, but like most new ideas the first use seems to have appeared in ancient Greece!

http://en.wikipedia.org/wiki/External_fixation

It is based on the same mechanical concept as a flight simulator used to train pilots. Flight Sim's need to be able to swing around in all directions so that the poor air-sick trainee gets used to hitting the brown paper bag in motion. The 6 angled struts can change length according to a fixed algorithm, and so can change the position of one ring with respect to the other through all dimensions (except the 4th). In aerodynamic terms (isn't aero-dy-manic a much better word?) the rings can rotate, pitch or yaw. And that means that the fixed bone can be repositioned as required. In the flight sim, the struts are hydraulic rams, in the limb reconstruction device, they are simple screws.

The repositioning is done slowly, 1-2 mm per day, to avoid damage to s

oft tissue and more importantly, the nerves. The consultant displays the Xray pictures on a PC and draws various lines to work out where the bones should be as compared

to where they are. Th

e programme then calculates the adjustments needed to correctly align the busted limb. The wearer makes the adjustments every day, preferably in the morning due t

o the period of pain that will follow (not easy to sleep after making the adjustments!). Sometimes the whole strut has to be changed to fit a longer or smaller one. That's done with an extra strut

added to temporarily brace the frame.

The problem... The markings are quite fine, and the device is on a leg quite

a long way away from the owners eyes. It's difficult to see the readings!

So the solution is a camera. I tried a web cam, which required too many hands and a quantum leap in spatial awareness and remote control. Try patting your head whilst rubbing your stomach whilst checking your performance in a double mirror... You get the idea. The best solution was the camera on my mobile phone. It auto-focuses, adapts for lig

hting conditions and is easily controlled.

So, take a photo to check current settings, then adjust, check with anoth

er photo. Mostly I get it right in 3 attempts.

But I've learned to take painkillers about 1 hour before making the adjustments. :-(

Tips for a new life in a new year

This is life Jim, but not as I knew it.

There is a great list of collected tips and advice for anyone with broken bones:- http://www.mybrokenleg.com/tips.html

Some Early Lessons At Christmas

Christmas was spent at "home".  That is, at my mother's house.

Following a flip-flop series of discussions on how to get there, I opted for the train, and found out some realities the hard way.

Firstly, travel by minicab can be painful. MPVs tend to have suspension designed for 6-8 people, so when the  car has only two people the ride can be "firm". Given the state of London roads at present (snow damage and low council budgets...) it's a bumpy ride, and I felt every bump. I also discovered that acceleration and braking is just as bad as bumping. I resorted to holding the leg in the air by grabbing the frame and lifting. It's probably a good biceps workout.

[I have since come to the conclusion that about 80% of minicab drivers need driving lessons. But more of that later.]

Secondly, be ready for unexpected issue when you use "mobility assistance" at railway stations. On the face of it, the offer of an electric buggy to transport you to the train is wonderful, and so it is! The driver even managed to manoeuvre the buggy to with easy reach of the ticket machine.  However...

On arrival at Paddington you are advised to go to the yellow telephone on the wall at the cab rank, and press the button. I pressed the button and waited, and waited, and waited. The line eventually went dead. After several button-presses and several long waits, a lady answered and, since I had pre-booked, she knew who I was and what I needed. She told me that a buggy would come very soon.

Note that there are no seats / chairs / benches anywhere near the mobility assistance telephone.  I was standing on one leg, and, given the freezing cold weather of December 2010, I'm getting colder by the minute. I've still only got the torn shorts that Debbie gave me at the hospital. With the pain, the cold, and no sign of help, I was in a state of near-panic.

After a further 10 minutes a member of the station staff passed by. I called to him and pleaded for assistance. He radioed someone, and after about 2-3 more minutes the buggy turned up.  Now, try climbing into one of those buggies with a frame on your leg, and supporting most of your weight on crutches. (Rumour has it that when the British Army bought the Clansman radio system back in the Eighties, the Trial team received the first radio sets and backpacks for testing. They immediately invited the designers to help with the trials. They gave each of the designers a pair of army boots, a rifle, a tin hat, and a radio mounted in the back pack. They then took them on a relatively short walk around Blandford camp. It didn't take long before the designers received appropriate enlightenment, took the radios back, and completely redesigned  the back packs.)  Whoever buys these buggies should get some invalids to take part in the selection process.

Once you are on-board, the buggy is great. At least the mobility assistance service gets you onto the train as soon as it is available, in advance of other passenger being allowed on. Just one little problem... I pity the drivers! Are you one of those people who wander down the platform, dragging your wheelie bag and nattering to your fellow traveller, utterly oblivious to the sound of beep beep beep behind you? We must have been inches behind some of these people who just didn't know we were there despite the continuous use of the buggy's horn. ...To be fair, it's a pathetic little horn.  These buggies are surprisingly busy, and any delay means that someone is waiting, probably in the cold, and standing on on leg. So please make way!

They kindly put a ramp down form me to hobble onto the train. That's good. Very good.  Also very good was the similar treatment at the sleepy rural station where I disembarked.

And now to lesson three.  I shuffled into my reserved seat. I'd booked a table seat so that my leg would have plenty of room. A few minutes later an attractive blond lady sat down opposite me. I said "Excuse me. Would you mind sitting in that seat?" I indicated the seat diagonally opposite across the table.  She looked at me as if I had asked her for £50, or perhaps to take another train. I said "Look under the table." She did, and instantly turned powder white, said "Oh my god!" and quickly moved to the next seat. The majority of people are horrified by the site of a leg with spikes in it. Leave it exposed and people give you a wide berth, but if you cover it up, they are far less helpful and will even bump into to you despite your crutches.

Lesson 4. If you tell the reservations people that you have a broken leg, they kindly book you a seat at the end of the carriage so that you don't have to walk half way down it. Now, train carriages rotate around the centre of the carriage. The ends are effectly on the end of a long lever, they move the most, swinging and bumping at every opportunity. And rails are not a smooth as you think. If you have a broken leg, and the bits are rubbing together with every movement, and the swelling is painful every time the leg is bumped, sitting at the end of the carriage is not a good idea. By the time we arrived I was in extremis. For the return trip I booked a seat in the middle of the carriage, despite the protests of the kindly booking agent.

Finally, number 5. Travellers, and by extension, most of the people in London, fall into two widely separate groups with very little in between; the considerate people who offer to help and are apologetic towards invalids, and the totally inconsiderate people who just don't know you are there or who manage to blank out your existence. If I have ever been a member of the latter group then I apologise! I hope to always fall into the former group given my recent experiences.

And so to Christmas...

Unfortunately my father died of prostate cancer in September and my mother has had a hard time getting over it, but she's getting there slowly. As she puts it, forty years being totally dependent on someone leaves you unable to do very much yourself. Which meant that one invalid and one shell-shocked OAP needed quite a lot of help.

Thankfully my sister and her husband looked after us throughout the Christmas period. They bought and cooked all the food, and fetched and carried.

My most grateful thanks to them.

The Smallest Room

I woke up on Saturday morning with a strange realisation... I had slept.  Ah.. the benefits of a private ward!

Fair enough, it was still so early that the morning shift nurse had not yet arrived, but the relief was a godsend.

I'd gone to sleep despite the dull mechanical roar of air con units outside. The window was open and I'd been too confused and tired to work out that closing the window might reduce the noise level. I feared having to put up with the background nuisance for several days.

It was snowing outside. Turning on the TV I discovered that I had missed the last four days. The Arctic had arrived in southern England., and the world was coming to a halt whilst I'd been elsewhere. Nevertheless the window was too high for me to close, and only the fact that the heating system was burning money was keeping me warm.

Then the heating broke down.

All my clothes were shredded, having been cut off me in A&E.  The nurse checks for pyjamas but can't find any. I was getting cold.

I use the alert button to call for help. This is a MAJOR improvement; a 5 second response time (compared with 35 minutes in the public ward)! On several occasions I hear alerts from other patients and immediately hear the footsteps of someone moving quickly down the corridor. I also hear the same quick response to monitor alarms.

I asked the nurse if we could close the window... It was way above her limited reach and she wasn't prepared  to climb onto a chair. She produced a small electric heater which was to save my bacon over the next couple of days.  Other people in the private ward were not so lucky. Eventually I precariously tottered below the open window and managed to close it by using my crutch as a lever. This amused me by baffling the nurse. She couldn't work it out.

I stayed in the Guthrie Ward for 3 days. Saturday and Sunday were phenomenally boring. The snowy view from the window includes the corridor into several of the operating theatres (and so I see faceless blue-green clad people walking up and down) and down onto another ward which I initially mistake for some sort of factory floor. There were no staff other than the basic weekend duty team. ...Something like being in limbo. Imagine day-time TV programmes in the run-up to Christmas; just how many ancient repeats is it possible to show?  Guns of Navarone, Navarone the Sequel, Navarone part III, Navarone Returns....  zzzz.

A nurse came to remove the catheter, a highly desirable event which he assures me will not be painful.  Donning rubber gloves, he uses a syringe to extract the water from the internal balloon and then without warning pulls the tube out. I scream as I feel my guts being extracted from the inside. For the next three days it will be painful to take a pee. I became extremely worried about the possibility of having to have another catheter fitted, so I pee at every possible opportunity. When the nurse returns later that day he glances at the two urinal bottles by the side of the bed and says that we might need to refit the catheter. (Oh no!)  I point out that the bottles are both full. A trick of the light has made him think that they were empty, but he still managed to scare me witless.

The room has an "en-suite" toilet. Well, more accurately it's a broom cupboard with a toilet in it, but they don't seem to have any brooms.  It's so small that I have problems getting in through the door with my frame on my leg.  I have to get the crutches inside first, then hop carefully around the edge of the door to get my left leg in, and then manoeuvre the frame through the gap.

The ward room is filled with furniture. Given that I have;-
(a) a bed
(b) a toilet
(c) only one visitor
(d) no drinks,

...it seems odd to provide;
(a) 3 chairs
(b) a commode
(c) a small fridge.

There is also a wardrobe and drawer units which could possibly hold my clothes if they were not shredded and in plastic bags.

Maz paid me a visit on Sunday. It's nice to talk to someone, and I realise that I'm losing the ability to communicate. She was perhaps suffering from the previous nights party, and probably would have preferred to stay at home if she hadn't already said she would visit on Sunday, and so gratefully welcomes the opportunity to help me with consuming my lunch. (The food is much better here in Guthrie, but the menu is the same for lunch and for dinner.) Maz brought me oranges, shaving foam, and a book. I used the hospital-issue razor with shower gel that morning, and resemble someone who dived face first through a thorn bush.

By Monday I am planning my escape. If I can't knot my sheets together, maybe I can tunnel out through the loose floorboard in the tiny toilet.  Everybody who comes in (there is a stream of nurses, doctors, physios, etc) has to hear my plea to let me go. I'm shown how to go up and down stairs with crutches (quite scary the first time you try it). I demonstrate how well I can move my leg and how conscientiously I'm doing my exercises.

Eventually I am told that I will be allowed to go once Debbie (the limb reconstruction specialist) has redressed the pin sites.  I call Natalie and ask if she will pick me up.  Debbie must be the busiest person in the hospital. Most of the staff I see are wandering around, having a chat, ambling from one adequately performed task to the next. Debbie rushes from place to place, talks quickly and succinctly, and clearly has a lot to do because she always ( errr.. twice) arrives much later than I'm led to expect. In just a few minutes she shows me how to dress the pin sites, hands over a large plastic bag of wound dressing kits, swabs and sterile water sachets, and  gives me a bag of split-seamed shorts left behind by previous patients.

Luckily Natalie has been to Pete's house and collected a T shirt, sweat shirt etc.

A porter is called to wheel me out to the exit, Natalie pulls up in her car, and I suddenly realise how frightening it is to be weak with an injury, and attempting to negotiate icy pavements on crutches.

A short but painful ride home is followed by a proper curry. It's great to be home!

Catheter

By Friday lunchtime I've got a severe pain in my bladder and I can hardly take a pee. All I can do is lie on my back, wince with each stabbing pain, and groan. A nurse comes by and I tell that I think I may have a bladder infection. They fetch a doctor. He prods, pokes and taps at my abdomen. A light tap is enough to make me shout in pain. A small group of doctors and nurses discuss what is to be done, there are veiled suggestions of checking the prostate, but the conclusion is drawn; no infection.

The blue curtain is whipped into place and minutes later I've got my bits sticking out of a hole in a large sheet of waterproof paper. The doctor applies some lube, and pushes a plastic tube inside me. I can't say it was gentle, though it probably was. It's supposed to be painless... On the second attempt I was "arrrrrrghing" at the top of my voice and eventually the tube entered my bladder. He had not yet connected the bag and so urine starts to pour everywhere. The nurse rapidly connects me up and then all eyes are on the calibrations on the catheter bag to see how much comes out.

It's a Foley catheter which has a small balloon inside the bladder to stop the tube falling out, or in my case, to stop the patient extracting it! Catheters are scaled according to "the French Gauge".  The French gauge was devised by Joseph-Frédéric-Benoît Charrière, a 19th-century Parisian maker of surgical instruments, who defined the "diameter times 3" relationship. 
The catheter is now my constant companion. I can feel it every time I bend at the waist. It's the strangest thing; not being able to stop yourself peeing. You can feel it draining out drip by dribble, non-stop. All day, all night. Periodically, the nurse measures the contents of the bag, and sometimes she empties it.

The Ward - H Bosch was 'ere

When I come to some sort of sensibility on Friday morning I find that I'm sharing a ward with 3 others.

There's an old Irish guy who knows everything. He tells the consultant what he should be doing. He tells the nurses how to do their jobs. He phones people and tells them how the nurses and doctors don't know what they are doing. He mutters to himself, probably to argue that he knows better than himself. He says one thing to one person and two minutes later he says something else to another. Total bullshitter, the whole time, non-stop. There's no peace. If I could move I'd go and shut him up.

There's a young father who wanders about carrying his catheter bag. It's full of a mixture of urine and blood, splashing about in a frothy mix for all to see. He speaks an East European language. His wife and small child come to visit. The child plays on the ward floor whilst her parents cuddle and my monitor alarms go off and the pain or drugs move my mind to strange places.

There's a guy, maybe late 40's, who has a fractured skull. He fell over and banged his head, but he doesn't know where or how. There's blood from his ears, but it's apparently a minor injury and they will send him home. He doesn't have any family. His mother died a few year

s ago. He lived with his mother all his life. He has a friend who might help. He has a speech impediment and maybe he's not the sharpest stick in the box. He's a floor polisher who used to work at a nearby hospital, but he lost his job. He stares, mainly at me. He stares whilst the nurses do things for me. I'm trying to take a pee in a bottle, and he stares. He stares while I'm in pain and about to get a catheter installed. He freaks me out. Shudders go up my spine.

The food is so bad that I can't eat it. Dry, over cooked, tasteless, and not enough to drink. There's no attempt to substitute for milk. A diet like this will have me losing pounds!  (After-thought: Why did nobody talk to me about nutrition for bone growth?)

They move the Irish bullshitter out of the ward. Not much later they wheel in a guy whose

bed is festooned with monitors, oxygen bottles, etc. He has a mask on, covering the site of the surgery, presumably a broken jaw, but he seems to be able to speak. The gas hisses and monitors beep. Maybe I looked like that the previous evening. Later some friends come to visit him. It's like a party. Joking, laughing, eating and drinking.

Pete appears at the door. At last a friendly face. He brought me ginger beer, jaffa cakes, and other sweet eats. It's nice to hold a relatively normal conversation, but I'm wired, a very strange over-alert state of fight or flight. It's a state of near panic. I really want to get out of the ward as quickly as possible. The nurses seem annoyed when I ask if Pete could have a cup of tea. I realise that apart from mealtimes, and my small plastic glass of orange just, I'm not drinking anything. The p

leasure of a cup has been absent for quite some time. I've been living on a drip.

Pete leaves.

The new patient needs to use the toilet so the nurse gives him a bed pan. He misses it, and then tries to clean up the mess ith his hands but just makes it worse. The nurses are angry, the ward stinks like... I don't know, but it stinks and nobody opens a window. I feel very ill.

A couple of hours later I am told that my request to move to a private ward has been granted. A nurse helps me move to a chair with wheels. She piles my bike gear, smashed helmet, and other chopped-up belongings in plastic bags on top of me, I feel like a bag lady. Then she wheels me off to another part of the hospital, (jeez the corridors are cold) and into a tiny single room that's full of furniture. But at last I have peace and quiet.

I tell the nurse that I don't want anythig and that I'm going to sleep. She tells me that I have to wait until I have had my obs done, and she's given me my drugs for the night.

She comes back a couple of hours later. I refuse the Tramadol because it gives me wierd spooky dreams. Imagine Hieronymous Bosch creatures and scenery on a sort of board game filled with little boxes each containing Bosch's monsters and moving around like

some 2-dimensional Rubik Cube.

I refuse another painkiller because it's an anti-inflammatory and shouldn't be used for bone fractures (according to the therapist). The nurse argues with me because she has got her instructions and the doctor knows best. I tell her to speak to the doctor and consultant and the therapist. Next day the drug regime has changed.

That night I sleep well. The catheter means that I can't roll over, but I do so in my sleep and the bed gets wet.

After the Op

I wake up in hell.

When I say "wake" I mean that I have become vaguely aware. It's dark. There are quite a few people standing around talking.

Beep beep beep beep beep beep beep beep...

I seem to talk to anyone who talks to me. When we talk the beeping stops. When they stop talking, I go away, the beeping comes back. It's not that the world goes away, instead I go down, falling into nothing. Again they talk, I know they are there. They stop, and again I go away, falling, sinking, stopping.

Beep beep beep beep beep beep beep beep....

There's a discussion.

"When we talk he's here, but then he goes..."

"Better do blah blah." "Blah blah". "Blah"

Going, gone. Stopping, stop.

I can feel my arm move, they're fiddling with something.

Beep beep beep beep beep beep beep beep....

Cold in my arm.

AWAKE!

Suddenly I'm in the room. There's four or five people here. My head is clear but I'm busy taking it all in. I get the impression that I'm in corridor under the hospital, in a basement. (I'm not. I'm in a ward.) I'm alert and talking. They ask me how I am, but I can't work out the answer, I'm completely stunned. I don't know if I'm standing, sitting or lying down. There's just too much to work out. What's happened, where am I, when is it?

"Better give him one more." Eh? What? Hang on...

Cold in my arm... a blinding heat goes across my chest, I think my heart is going to burst, there's a sharp pain in there. They're going to kill me! Help! Get a doctor! And now I'm shouting, going completely wild, I think I'm about to die. I have no idea what I said or did, but I know it got discussed with a few chuckles afterwards. Everyone seemed to know.

A young guy turns up, and tells me he's a doctor. He asks what's wrong and I tell him that I am panicking, I hurt, my chest hurts, I don't know what they are doing, I don't know that they know what they are doing. I want someone who knows what he's doing. Take these idiots away.

I tell him my colour is wrong. My hands are the pale yellow of old candle wax. Things aren't right.

He wants me put on an ECG. The nurse wheels in an ECG machine. It has a heck of a lot of wires. I've already got 4 or 5 wires attached to sticky pads across my chest, oxygen pipes up my nose, a drip in my left arm and an arm band on my right for blood pressure checks. The nurse tries to add more sticky patches, but I'm hairy and they won't stick to the skin. The hair gets in the way and they hang off me like moths in a web. She's pushing uselessly at the pads and they steadfastly flutter away from my skin. Then she tries to attach the wires. She can't work out which one goes where. Even I can see the numbers, why can't she do it? I tell her to shave it, but she just pushes fruitlessly at the pads. She pulls off the failed patches and tries more, tries different types. And the more she tries and fails, the more scared I become. Now I'm trussed up like Gulliver. I must have 15 cables attached, plus all the drips and oxygen, etc. One slight move and the sticky pads rip out a few more hairs. (I don't think the ECG ever produced useful information.)

I'm decide I am going to stay awake. I don't trust the nurses. There's a night nurse sitting at the end of the room.

I need to urinate. The nurse gives me a bottle, but I can hardly pee. My guts are turning over, so maybe my bowel needs to move. She gives me a commode and somehow I shuffle onto it. I pee a bit, but that's all. All night, pee a bit, a bit more. The nurse measure how much I pee, and is not happy with the results. I'm on a drip, but I haven't drunk anything, so maybe that's why.

She gives me painkillers. The world seems very strange, it's a dark and scary place. Why am I in a dungeon? I'm covered in cables, my leg hurts. I have some very dark and desperate thoughts.

It's still dark when the daily routine begins. Nurses taking "obs". Painkillers and antibiotics being handed out like sweets in paper cups. Every time they give me morphine there are always two people present. And every time they check my patient tag ask the same questions; "What's your date of birth?" before giving me the drug. The morphine doesn't have an obvious effect, but presumably it's reducing the pain. There are none of the more pleasant effects that people have told me about.

The nurse arrives with a massive syringe. Good grief! Is she going to stick that into me?! Luckily the answer is no. She connects it to the pipe on my wrist (they had to remove the elbow cannula because it kept bending and coming free) and pushes the plunger. My arm goes cold, and then I can taste and smell the chemicals even though nothing has gone anywhere near my mouth or nose.

However, the daily warfarin jab does go straight into flesh.

It's light, I've survived the night. But now a new level of hell is revealed.

15-17 December, or thereabouts

My memory of the next couple of days is somewhat blurred. Rather like a long journey through similar towns, I can't remember the order of events, and there are gaps in between the memorable places. A few days later I realised that not only was there are problem untangling the days after the op, but also that I'd lost most of my memory of the few days before the crash.

I seemed to be in a pleasant peaceful ward. The nurses would give me morphine and other drugs according to a laid down schedule. They measured my blood pressure and took my pulse routinely; what I now know to be "obs".

I discover that I have "Tib + Fib" written on the top of my thigh in large black indelible marker, and an arrow pointing towards where my tib and fib are normally kept on the end of my femur, and just above the foot. It reminds me of the Voyage to the Centre of the Earth, and Arne Saknussemm who marks his route with the letters AS and an arrow just like mine.

He asked me if I was in good general health and whether I played sports:

A consultant arrived with a small team of followers, rather like the trail of students following the opinionated and self important consultant in "Doctor in the House".

"Fitter than most, and I love kitesurfing, snowboarding, dancing, cycling..."

"Ah. You should be aware that this is a life changing event."

Silence.

He explained the damage and the two options;-

1. A post inserted down the fibia, and some pins across the knee.

2. Some metal rings around the leg, with pins to support the bone.

"The first option will have you up and about quite quickly, but there are more risks because we make more cuts. The second option will take longer."

"Which would you advise?"

"I can't tell you that because it would influence your decision."

Huh? ...Must look up the meaning of consultant.

I asked some questions, and then said I'd have to think about it.

A girl came to ask lots of questions about allergies and diet. I explained I don't drink milk because it gives me migraines. It all seemed OK.

Later that day another consultant arrived, this time without a troop of white coats in tow.

"So, I think we should put two screws in across the knee, and mount two rings around the break. After about a month you will be able to bear weight, and after 4-6 months we'll take the rings off. Then you'll wear a big plastic boot for a month."

It seemed that accepting the extra time in re

covery would insure against long term deformity, and meant less risk of complications. I agreed, and the long wait started. "We might fit you in today, or maybe tomorrow morning." I guess this was Wednesday, the day after the accident.

A very pleasant and friendly young lady wheeled a computer

into the ward and showed me the Xrays and the CT scans:

Tibia fractured with bits of bone surrounding the break.

Fibula shattered into 3-4 pieces.

"Nil by mouth" is imposed, and I wait for the call to the theatre. Late in the day I'm told that I can now eat, because I won't be needed until next day, but that "Nil by mouth" will be reimposed at midnight, so eat.

A guy came to ask me what food I wanted. The menu was brief, and a bit plain, but I opted for the jerk chicken. As it turned out, that was the only reasonable food for several days, or maybe I was just hungry. (The suggested substitute for milk was... you guessed; water! And if I didn't want cereal then I had to specifically request something else. I got toast and butter. errrr wow.)

I can't remember sleeping, or not sleeping. But I can remember thinking "Why haven't I needed to urinate?"

The next morning passed. More painkillers arrived on schedule. I called the insurance company. I spoke to my sister or mother on the phone (can't remember). I suppose I dosed.

Then I hear my name called. I'm not exactly ready to leap out of bed, so I wave an arm. We're off to see the wizard. ...And boy am I scared!

It's a long journey. I ask how many theatres they have, and the porter counts on his fingers. When he runs out of fingers he looks toward his toes. They've got a lot of theatres. As we roll into the pre-op area, the blue clad wizard and his apprentice are leaning nonchalantly against the door posts. "Here he is at last." The anaesthetists begin work. Tubes go into my arm, and as usual, they miss first time. We chat, and then someone is waking me up, I say something, apparently everything is ok.

I have no idea that almost 4 hours have passed since I entered the theatre.

Then I wake up in hell.