ANKLE SURGERY HERE WE COME - 67 DAYS TO SURGERY (S-67) (R-14)

Hi - good to see you back here again.

Today is my 63rd birthday, which is as good an excuse as any for a new post to my blog. I shall be celebrating doubly in style with my wife - not only will be getting on our glad rags to dine in style at our favourite local restaurant, it's also a milestone in my efforts to lose weight - see below.

However, before that, I promised I would tell you more about my second visit to the RNOH, so here goes.

Before getting into my first meeting with Deirdre Brooking, and my MRI, I wanted to just reflect on something that really struck me on my second visit to the RNOH site.

My first visit was in early January, so it was almost dark when I arrived, I was dropped off right at out-patients by the hospital bus, and I was short on time, so I guess I didn't really have time to take in my surroundings.

On this my second visit, I drove myself, arriving both in daylight and with time to spare, although I then had the significant task of finding a parking space, so did a bit of a tour of the RNOH site.

As you either already know, or will soon find out, RNOH has not just a national but an international reputation for clinical and research excellence, and is a world-renowned orthopaedic centre. Yet the physical infrastructure of the facility is almost antediluvian - wards housed in what are, for all intents and purposes, second world war Nissen huts, crumbling exteriors, patients being wheeled along corridors open to the elements - the list goes on. It's a miracle frankly that the staff at RNOH are able to achieve what they do, and have earned such an august reputation, in spite of facilities which are clearly very far away from being fit-for-purpose. Imagine what they could do with up-to-date infrastructure and facilities! From what little I know this problem has long been recognised but it seems a solution has never been implemented. It doesn't take a rocket scientist to calculate that they must be spending a fortune just trying to muddle along with and patch up the existing facilities, and it would be a huge shame if such a centre of excellence were threatened for want of some investment.

Anyway, after that brief digression, let me tell you more about my second visit.

I first met with Deirdre Brooking, who is the Clinical Research Coordinator at RNOH, and who has been my main point of contact since my first visit to the hospital (though this was my first chance to meet her). If you want to put a face (and indeed a voice) to a name, then you could do no better than watching the excellent TARVA video in which Deirdre is one of the principle narrators - www.youtube.com/watch?v=VTzOS5dRhm4

Deirdre took me through the next steps on the route to surgery, and was very helpful in answering a number of questions that I had, although I felt I had already found a lot of information, especially on the TARVA website and through the RNOH factsheet on the subject.

The other main purpose of my second visit was an MRI of my dodgy ankle, so Deirdre took me to the reception for the Imaging Department, and I was then seen very quickly. The MRI scan took about 20 minutes, and fortunately for me I went in "feet first" (I've previously had a spine scan - to confirm a diagnosis (see first post) of ankylosing spondylitis - which involved going in "head first"; I'm not particularly claustrophobic, but after nearly 90 minutes I was mighty glad to emerge!!).

After the end of the MRI I was free to leave, and blessed my decision to drive on this occasion (I had to be in the London area anyway), since my departure coincided, just like the first visit, with the changeover time for the hospital bus.

In the next post, I'll start to tell you some of the things I've been doing in preparation for my surgery in early July, but I'll round off this post by talking a little about what is, perhaps (other than having an excellent surgical team), the most significant thing I can do to make sure I give myself the best chance of benefiting from the operation, which is losing weight.

As I mentioned in my first post, I am significantly overweight - two months ago, after an indulgent holiday in Dubai, I tipped the scales at 107 kg., which is the heaviest I've been for about ten years. I resolved that I must shed a significant amount of weight before my procedure, not least to reduce the current stress on my ankle, but also particularly the load on either the replacement or fusion resulting from the operation.

Co-incidentally, a very good friend had tried Jason Vale's Super-Juice-Me 28 day all juice diet, with great success in terms of both weight loss and overall well-being. Although it is only fair to point out that medical opinion IS divided on both the merits and the efficacy of a juice-only diet, I felt I needed something fairly radical to help start to shift a significant amount of weight.

So, courtesy of Amazon, I purchased both a juicer and a blender, and then caused great curiosity at the checkout of our local supermarket when I stocked up with enough fruit & veg apparently for a small army (e.g. 63 Golden Delicious)!

The results have been nothing short of dramatic. As well as feeling significantly better overall, in the first 28 days (I finished yesterday), I have shed 13 kg./28 lbs., bringing me down to a still hefty 94 kg. but with the added bonus of reclassifying me from "obese" to just "overweight' - result!

I am taking a break of two weeks of just moderate eating (still including some juices), and will then go back for a further 28-day session - my aim then will be to get down close to 80 kg. by mid-June in readiness for my operation, though I suspect the next 28 lbs. is going to be more difficult than the first!

So, just over two months to go to surgery, and two weeks to "randomisation" - next post will review some of the other preparations I've been making for this major event.

Enjoy the long holiday weekend, and please give me some feedback if you've read this blog and are finding it helpful.

TTFN

David

ANKLE SURGERY HERE WE COME - 73 DAYS TO SURGERY (S-73) (R-21*) (*see below)

Hello again!

I hope you had a chance to read my first post to this blog several days ago - if not, suggest you do so before carrying on as it will give you some useful background.

In the last post I explained a bit about how I had come to the decision that I needed surgery on my ankle, and also gave a little background about myself.

Let me now pick up the story where I left off last time - my first appointment with Mr. Andy Goldberg at the Royal National Orthopaedic Hospital (RNOH) in Stanmore on 8 January 2015.

First, a little bit of information about getting to and from the hospital - in this first instance, by public transport. Having arrived from Norwich at Liverpool Street, I took the Circle Line to Baker Street and changed to the Jubilee Line which I took to the end of the line, alighting at Stanmore. I then took the RNOH bus transport direct to the hospital site. The bus stops right outside the outpatients' building, which is where I was headed. 

A few tips on using public transport combined with the hospital bus :

• the bus also goes to Edgware station
• the bus timetable is published on the RNOH website
• the pick-up point at Stanmore station is just to the left as you exit the station
• beware the "changeover" periods for the bus (shown on the timetable) when the bus doesn't run for quite a while - I got caught by this when I was leaving at around 5.45 p.m. on my first visit, exacerbated by the fact that, when I called for a taxi, I was told the wait was at least 40 minutes - I ended up waiting for the first bus of the evening shift.

Anyway, I checked in at outpatients' reception, and was then asked to do several X-rays of my ankle and lower leg. I then saw Mr. Goldberg. He viewed the X-rays, and asked me about the history of my problem; seemed a little puzzled when I told him my ankle had not been subject to any significant trauma (though a lot of twists and sprains when younger, especially whilst playing squash). He wondered whether possibly the problem was inflammatory in origin, since I was diagnosed several years ago with ankylosing spondylitis (which otherwise has no real effect on me). He then advise me that my ankle was suitable for either a replacement or a fusion and thus, as I met the other criteria, I could be accepted onto the trial.

This is an appropriate point - as foreshadowed in my previous blog - to spend a little time talking about the trial itself, and thus to explain why I don't know, right at this moment, whether I will be having a replacement or a fusion.

Without repeating all of the excellent information on the TARVA website, and at the risk of over-simplifying things, the main thrust of the TARVA trial is - through a clinical trial - to try to establish whether there is a difference - measured principally in terms of patient outcome (essentially quality of life) - between ankle replacement and ankle fusion as a technique to treat end-stage ankle arthritis.

in order to achieve that objective, use is being made of a randomised trial approach. This means that potential patients, as well as meeting certain other criteria (e.g. age), must be suitable to undergo either surgery type. The actual surgery type will then be allocated randomly (by a computer), such that half of the total patient population for the trial receive a replacement, and the other half have a fusion. There will then be follow-up for patients in both groups after their procedure to establish, by means of questionnaires, what effect the surgery has had on their overall quality of life.

So, like all the other patients on the trial, I have to wait until my "randomisation date" to know which of the two procedures I will undergo. Though I guess some people might feel a little uncomfortable with a computer making a final decision on which type of surgery they were going to have, that actually sits fine with me since - to be honest - I genuinely couldn't decide ( having reviewed all the information I could find on the pros and cons of both procedures) which was the best choice for me, so I'm happy for a computer to make the choice! 

I have just been given a date when both my surgery pre-assessment and my randomisation will be done - it is 15 May which I have dubbed "R" day, hence the "R-21" in the introduction to this blog. If I am selected for a replacement, I shall also have to have a CT scan at the same time.

In my next post I will tell you something about my second visit to the RNOH in March, when I had an MRI and also met with Deirdre Brooking who is the Clinical Research Coordinator at RNOH.

Bye for now - more coming soon!

ANKLE SURGERY HERE WE COME - 80 DAYS TO SURGERY (S-80)

If you've ended up at this blog, then I guess it's because you have some interest in ankle surgery.

My name is David Shaw, and I'm going to have ankle surgery quite soon.

I need my surgery as a result of end-stage osteo-arthritis in my left ankle. My surgical options are essentially either a total ankle replacement (TAR), or an ankle fusion (arthrodesis).

Right at this moment, I don't know which procedure I will have (see below and next blog for explanation).

My journey towards my ankle surgery started some 18 months ago and, along that journey, I've found it quite difficult to find two things in particular :

• detailed, preferably research-based, data on patient outcomes for ankle surgery in general, and specifically for relative outcomes for the two options
• patient accounts of their own experiences both in the lead up to, and the aftermath, of the operation itself

So, as I have today just been given a confirmed date for my own surgery - 6 July 2015 - I thought I would start this blog with the aims of :

• creating my own diary of the experience
• giving an account, useful to others, of the whole journey up to and past surgery - as well as the obvious...... how was the surgery/how is the pain/when is the cast/boot coming off/when can you start walking again etc. - also an insight into some of the day-to-day practical issues associated with preparing for and managing after ankle surgery
• creating a forum where interested individuals can ask questions and share their own experiences.

It is my intent to publish regular updates to this blog (aiming for two to three a week), both in the lead-up to my surgery, and for perhaps a year thereafter. I will endeavour to give both a medical and practical account of my experiences and - although I guess I'm a typical "stiff-upper-lip" Englishman - I will try to share with you some of my feelings and emotions on this journey, which I must say, and despite all the information I have acquired, I approach with not a little trepidation.

To round off this very first post, let me tell you a little about myself, and also a brief history of how I've arrived at where I am today, so far as my ankle is concerned.

I am 62 years old, and I have a home both in Norwich in the UK, and on the Costa Blanca in Spain, and we (my wife Barbara and I) divide our time between the two. I retired just under two years ago, having spent almost 40 years in a career in Human Resources, mainly in the Banking industry.

I have enjoyed pretty robust health for most of my life - the only previous surgery I have had was a tonsillectomy in 1975. I have played a lot of sport, and have been an active gym-goer over the last 15 years. Notwithstanding that, I am currently significantly overweight (though see below and next blog in particular).

The months after my retirement were incredibly busy, and quite physically demanding, especially in establishing our second home in Spain, and I spent the whole of the summer and autumn of 2013 on my feet doing DIY or gardening all-day-long.

In late Autumn I noticed that I was getting significant and regular pain on both sides of my left ankle; I put it down to tendonitis (which I'd had before), and went along for some sessions with a physiotherapist. That treatment did provide some symptomatic relief, albeit temporarily, but during the third or fourth session the physio - based for sure on his experience - advised me to get an X-ray of the ankle.

When I showed him the X-ray at our next session, whilst being reluctant (not being a physician) to provide a diagnosis, he nonetheless strongly urged me to consult an orthopaedic specialist. Based on the X-ray and an examination, the specialist made a preliminary diagnosis of osteo-arthritis, which was confirmed by a CT scan.

Faced with that unwelcome news, but armed of course with the internet and Google, I did a great deal of research, mainly into non-surgical management of the condition, and resolved to give myself 12 months to see whether I could manage the condition without resorting to surgery.

This included :

• weight loss (mostly unsuccessful until recently - see next edition),
• shoe inserts - fitted by a podiatrist, these initially gave me some cause for hope, but I could only use them in certain footwear, which meant I couldn't/didn't wear them a lot of the time,
• strapping, with some quite sophisticated ankle braces - I found very little benefit from this at all,
• cortisone injections directly into the ankle joint - these did provide significant immediate symptomatic relief, including reducing the considerable swelling I was experiencing all around the  ankle; however, that relief (and reduction in swelling) proved transitory (say a couple of weeks), and it is not recommended to have these injections more than quarterly,
• and, of course, dropping far too many pain killers - both conventional (e.g.paracetamol) and anti-inflammatories (in my case initially diclofenac (Voltaren), though I have subsequently been prescribed etoricoxib (Arcoxia) which I have found to be far more effective),
• modifying my lifestyle

The last of these proved to be the most effective at managing my condition and the pain associated with it, BUT (and it took a little while for this to dawn on me), I ended up modifying my lifestyle to such an extent that the end result was unacceptable. My great love of golf proved almost impossible to satisfy, certainly not walking the course and, even with the aid of a buggy, I would pay for it afterwards with three or four days of increased discomfort. Working in the garden, which I love, became a painful and uncomfortable chore, especially since I now found walking on any sort of uneven or sloping ground something I approached with great trepidation.

I suppose my "light-bulb moment" was last (2014) summer. My wife and I have been very fortunate to remain close friends with a group who got to know one another at University some 40 years ago, and a dozen of us try to get together at least once a year for a "reunion".

Last summer we rented a most delightful villa in the middle of the Tuscan countryside but, after our first visit to one of the many splendours of that part of the world, I realised that I was proving a drag (almost literally) on the rest of the group when walking around sightseeing. Rather than face that, I spent the rest of the week, albeit agreeably, relaxing around the villa, but feeling guilty both towards my friends but especially towards my wife who had nobly elected to stay with me.

Having resolved that I could/would not tolerate this any longer than necessary, as soon as we arrived home, I started researching surgical treatment for my condition, which is when I first came across mention of the TARVA (Total Ankle Replacement v. Arthrodesis) trial. (If you have come to this blog via the TARVA website, then you probably already know something about TARVA; if not, and rather than repeat their excellent information, can I refer you to their website ( ankle arthritis.co.uk ).

The TARVA trial appeared to offer me the chance to explore options for surgery for my ankle osteo-arthritis and at the same time participate in an important piece of research (which will hopefully fill one of the knowledge gaps I found when first considering surgery).

So, I spoke to my GP in Norwich and arranged to be referred to the Royal National Orthopaedic Hospital (RNOH) in London (my nearest centre in the initial stages of the trial). After a short wait I received a letter from RNOH confirming an appointment in early January 2015 with Mr. Andy Goldberg, a foot and ankle specialist consultant at RNOH who is also the Lead Investigator for the TARVA trial.

So, my ankle surgery journey begins.

In the next blog I will relate my initial interaction with the TARVA trial, starting with my initial  appointment with Mr. Goldberg and bringing you up to the present day. I will also explain in more detail why I don't yet know which operation I will have.