ANKLE SURGERY HERE WE COME - 49 DAYS TO SURGERY (S-49)

Amazing how the time has flown since I was first given a date for my surgery - now only seven weeks to surgery, and counting!

As I mentioned in my post yesterday, the big event for me over the last week was my pre-op assessment at RNOH, including the "randomisation" process which decided that I would be undergoing a Total Ankle Replacement (TAR) in seven weeks' time.

In this post, as promised, I'm going to tell you more about the pre-op assessment, and also talk some more about the various aids I've been looking at to assist me during the period after surgery when I need to ensure nil or only partial weight bearing on my post-operative left ankle.

First the pre-op assessment. The challenges of the M25 on a Friday afternoon, and of securing a parking place at RNOH, should not be underestimated by anyone attending a consultation at the site, so please make sure you allow plenty of time. I failed to do so, and thus instead of arriving calm and composed for my pre-op assessment, I was rushing and even then was five minutes late.

My appointment for my pre-op assessment was at the Patient Centre, which is on your right when you are looking up the hill at the Outpatients Department.

Partly as a result of too much time on the M25, the first thing I needed to do when I arrived was to "use the facilities". The staff in the pre-op unit are smart - as soon as you ask - "where's the loo" - they just pop a little plastic bottle into your hand and let you draw the obvious conclusion.

So, that's the urine sample taken care of. Next was a (self-managed) swab of nostrils and groin to check for the dreaded MRSA (Methicillin-resistant Staphylococcus Aureus) which has been a major concern for hospitals over recent years. This was followed by an ECG, though clearly my skin was not in co-operative mood, as the nurse had to move the electrodes around a couple of times before the machine would provide a decent output.

Blood pressure to follow and (I think because I had a slightly elevated BP), some blood was to be taken for analysis. There then ensued a rather interesting little conversation between me and the nurse -

Nurse - "How good are you with needles?"
Me - "Normally pretty good"
Nurse - "Great, that will be fine then"
Me - "Probably, but isn't the real question how good YOU are with needles?!"

This seemed to amuse both the nurse taking my blood, and her colleague in the room - I told her that, based on my previous experience, I would only know how good she was a day later, based on the degree, if any, of bruising (and I'm happy to report there was none).

Her colleague then took over and went through a quite detailed history, including a list of current medications (in my case to control high blood pressure) - remember to have a list of your medications with you as and when you attend a pre-op).

That was the end of the main pre-op session, so I was collected by Deirdre Brooking and we then did the much-anticipated "randomisation" (see second paragraph and previous posts).

I then met Mr. Goldberg's Registrar (Dr. Najefi) who reconfirmed some points on my history, and then answered a couple of questions I had related to the actual TAR device, and the reason for a CT scan of the lower left leg which was scheduled for later (this is only done if you have been selected for a TAR).

Deirdre Brooking then took me up to the scanning area, where we checked in with the receptionist, and I was offered and accepted a much-appreciated cup of tea.

I then spent some time with Deirdre going through a series of questionnaires, which I guess are a key component of the actual TARVA trial. One questionnaire is to measure, pre-operatively, your degree of discomfort/immobility, and the impact of your ankle arthritis on you day-to-day life, obviously as a basis for post-operative comparison - the so-called patient outcome. Another looked at the degree to which you were able to care for yourself, and also some questions around the personal costs incurred as a result of the condition.

That just left the final process - a CT scan, which was the only glitch in what had otherwise been a very smooth afternoon. Unfortunately the scanning department was running quite late. They did keep us informed of the likely delay, but it meant that I was just over an hour late for my scan (but every cloud has a silver lining - the delay meant that the M25 was a little less rammed then it would otherwise have been had I left earlier, so I had a reasonably comfortable and speedy return journey).

I think this is already quite a lengthy post, so I'll save my comments on walking aids until the next one, but I would like to thank all the staff I met during the pre-op asessment for their professional yet personal and cheerful approach - very much appreciated.

Post on walking aids to follow shortly.

Regards

David

ANKLE SURGERY HERE WE COME - 50 DAYS TO SURGERY (S-50, R+2)

Hello again.

I'm going to make this a very brief post - just to let you know that I had my pre-op assessment last Friday, of which more in the next post, as well as the promised information about various aids I'm looking at for the non-weight-bearing phase(s) after the operation itself.

However, I just wanted to let you know the outcome of my "randomisation". Deirdre Brooking DID use the computer (rather than a coin-toss) to decide which procedure I was to have, and it is ......... a Total Ankle Replacement.

I said in my previous post that I did have a vey minor preference for one of the operations over the other, and the computer happened to come down on the side of my preference, so I was a very happy bunny after that. As I mentioned before, I was equally prepared to go ahead with a fusion, but I guess for me the decision on the TAR was just a little bit of icing on the cake.

So, more detail on the pre-op itself in the next post, plus the mysteries of arm, and hands-free (!?!) crutches, and knee scooters.

I'll be back soon.

David

ANKLE SURGERY HERE WE COME - 55 DAYS TO SURGERY (S-55, R-3)

Hi, and welcome back to my blog - sorry that it's been a little longer than I intended to add this fourth post, but here goes.

It's just three days to go now before I'm back at the RNOH both for my pre-op assessment, which I'm told should take up to three hours and, the interesting bit, assuming the pre-op is fine, to be "randomised".

Those of you who have either read my earlier posts, or the TARVA website, or both, will know that "randomisation" is not some arcane and painful medical procedure, nor an attempt to make my life temporarily patternless of purposeless, but rather the process by which the RNOH's massive supercomputer performs gigaflops of calculations before deciding whether I am to have a an ankle replacement (TAR) or a fusion (arthrodesis). (Actually I think it's really Deirdre Brooking standing behind the machine flipping a one pound coin, but that would detract from a serious piece of science, and takes away the high-tech gloss ).

It has been very interesting for me to wrestle with this idea - especially for someone who is used to "being in control" - of essentially surrendering to a machine the decision as to which of two significant, but significantly different, surgical procedures I should undergo. Not only did this of course require my dear left ankle (and the body it belongs to) to be capable (physically/technically) of undergoing either procedure, but for me to accept at an intellectual level that I was prepared for a decision either way without my having any influence over that. Of course I have accepted that and, as I pointed out in an earlier blog, I am almost thankful that I don't have to make the decision myself (albeit with excellent input from specialists), since I have researched both procedures endlessly and still - because of the pros and cons of both - find it difficult to decide which would be best for me. 

However, the other day, my wife said to me - 'if you were forced to make a decision yourself on one or the other procedure, which would it be', and after some thought I gave her my answer; there is one of the two procedures for which I have the tiniest of preferences. I'm not going to tell you now which it was, but when the decision has been made for me on Friday I will reveal to you what my minute preference was, and what my reaction to the actual decision is at the time.

For the final part of this post, and as promised, I'm going to start to tell you about some of the preparations I've been making for my operation and beyond, and the first of these concerns post-operative mobility, since I shall be non-weight-bearing on my left leg for a number of weeks post-op (precisely how long I understand will be determined by the procedure I have and a number of reviews by my surgeon post-operatively of my progress.

Again, as I've researched through this particular issue, I've concluded that there are actually (at least) three approaches to dealing with the challenges of non-weight-bearing, all of which inevitably have their own pros and cons. They are : crutches - by far the most common and best known; knee-walkers (which seem to be better known in the U.S. than the U.K.); and what I will call a "hands-free crutch" - more of that, and the knee walker, in later posts. Since they all seem to have particular benefits in particular situations, and as I'm a bit of an experimenter, I'm actually probably going to try them all, and hopefully report for others' benefit my own experiences of each of them.

In this post, I'm going to concentrate on the most conventional "solution", which is crutches. I'm going to first look at the crutches I have selected and purchased, and secondly the physical preparations I'm now making for using crutches post-op.

I did a huge amount of research on the subject of crutches, and came to two major conclusions - first, that my selection of crutch was very important, and secondly that I needed to do some physical preparation for when I would be using crutches.

Based on my research, my initial decisions was to go for forearm crutches rather than underarm crutches - the latter seem to result in significant under-arm/upper-arm issues, and are very unwieldy.

So after my research on forearm crutches, I finally decided to opt for smartCRUTCH, which I believe originate from S.Africa. Unlike conventional crutches, these have additional forearm support, thus meaning that your weight is being carried on your forearms as well. They also look very stylish - I bought mine in blue!

As soon as I got them I started to practise, which is when you realise first, that you need a lot of practice, and second that - to make things easy - you need quite a lot of upper-body strength. So I went along to my local gym, joined up for three months, and asked the manager if he could give me a set of exercises specifically to strengthen my upper body for crutches. What a result! The guy had himself broken his ankle some five years ago, and so knew exactly what I was facing. He gave me a series of about 20 exercises designed exactly and precisely to strengthen my (mainly upper) body in anticipation of using crutches   - if anyone wants me to share these exercises, please let me know.

So, equipped with the exercises,I shall now be experimenting with the crutches next week, when I return from my pre-op.

To recap, the next post will feature my pre-op and "randomisation", and my reaction to that, plus some initial thoughts on actually using the crutches, and an introduction to the two other non-weight-bearing aids I am looking at - i.e. knee walkers and "hands-free crutches".

Talk to you soon!

David