ME AND MY NEW ANKLE (S+10)

As promised in my last post, this one is going to concentrate on my first week home after surgery..

I arrived home a week ago and, after a cup of tea, faced the first challenge of my non-weight-bearing spell (which is scheduled to be two weeks, until my first check up).

We are fortunate to have a smallish spare bedroom, which we decided to allocate to me to sleep in initially after my operation - I was pretty sure I would sleep fitfully, and didn't want to unnecessarily disturb my wife's sleep, and it has also meant that we have been able to arrange it solely focused on the needs of the "patient".

The room in question is upstairs, and so the challenge was to navigate quite steep stairs. Despite my practice on, and comfort with crutches, and the presence of my fit and strong brother, I still decided that the safest way of mounting the stairs would be, inelegantly and slowly, on my bottom. That's fine until you get to the top and wonder how you're going to get upright - I could have managed with crutches, but my brother and the handrail seemed the surer option.

For reasons that will become apparent later, that one-way trip up the stairs has been the only encounter with the stairs to date!

In the days before my operation, I installed a small TV in the designated room, and I also decided to purchase an overbed table, which has really been an absolute godsend; with the table, and a "reaching stick", I really do have most things to hand, saving my wife from running up and down stairs all the time.

In order to help with the essential elevation of my ankle above heart level for two weeks (to minimise wound swelling), I had also procured a shaped wedge of soft foam, with a cotton cover, which has been excellent in helping me ensure the leg remains elevated, especially when sleeping, and has also been very comfortable.

I actually got a good first night's sleep, despite the efforts of the dawn chorus outside my open window. After tea and some juice (I'm back on my juice diet), I manoeuvred myself on my crutches to the bathroom for a constitutional (unsuccessful), and a shower.

In preparation for showering in relative comfort and safety, I had bought an adjustable-height shower stool, and a waterproof cast cover. The latter pulls on from your foot up to mid thigh, where there is an elasticated collar to provide a seal - this works really well, and ensured my cast remained totally dry during a lengthy shower.

What didn't work as anticipated was the (adjustable-height) shower stool - even on its highest setting, it felt too low to me to safely lower myself on to it from my crutches, especially in a shower, and I was even more daunted by the prospect of getting up from the stool at the end of the shower, especially with only my slight wife around to assist.

However, a bit of improvisation sorted the problem.

I had acquired an adjustable frame and seat to assist in using the toilet, and fortunately this fit within the shower cubicle. With a higher seat and arms, this was much easier and safer, so I was able to have the first real shower and hair wash for three days.

With the aid of my wife, and my crutches, we moved the toilet frame next to the sink so I was able to shave quite comfortably, brush my teeth, spray on some deodorant etc., before heading back to bed on my crutches.

My second night's sleep was not quite as good as the first at home, mainly because I was finding pressure on the bottom of my spine and my bottom from essentially being in one position most of the time, with little opportunity to move around because of my elevated leg. I was also concerned about ensuring that I had no problems with pressure sores.

Back to good old Amazon, and I found a pump-driven air mattress, which has about two hundred air pockets, and where the pressure on each pocket is varied every few minutes. In combination with a quiet motor/pump, I have found this has almost completely removed the pressure issue, thank goodness.

I/we settled into this pattern, interspersed with TV/email/meals, for a couple of more days, and I thought ' "this is going to be easier than I thought",

WRONG ................ things started to go amiss last Sunday.

I had felt a twinge in my right (i.e. non-operated leg) knee on Saturday night; to be fair, I have had problems with this knee previously (probably also arthritis-related). Well, on Sunday morning when I got onto my crutches in preparation for a trip to the bathroom, it was immediately clear to me that my "good" leg would not support my weight. Dosed up on Paracetamol and tried later, but same result.

So, no way to make even the short journey from bedroom to bathroom, which also exacerbated another burgeoning problem - the desire but inability to "take a weight off my mind" (more of this later).

My wife gave me a bed bath, and I settled back into bed somewhat frustrated and grumpy to watch more TV.

When I woke the following morning with no improvement, I decided I needed some physio work on my dicky knee. Spoke to my local GP surgery, who agreed on the basis of a phone conversation, but then said it would take at least two weeks to arrange through the NHS. Contacted a private physio firm, and they agree to make a house visit on Wednesday. The physio took history, examined the knee, manipulated it and did some ultrasound, and said she thought that an anti-inflammatory (which had been discontinued after surgery) would help the process. She undertook to speak to my GP, who understandably wanted to see me before prescribing more medicine, but the fact that I could not get to the surgery meant another day's wait for a home visit. (I'm in no way being critical of my GP partnership here - it's just the way things are, and they're actually very responsive and helpful within the limit of their resources).

A GP came to see me on the Thursday and agreed an anti-inflammatory was appropriate, so finally on Friday I was able to add that to my daily intake of medicines. Clearly had the desired effect (together with the exercises the physio had given me) because today, for the first time for almost a week, I have been able to take myself off to the bathroom, much to my relief (and that of my wife I suspect, though she said nothing and has been remarkably stoic, as I'm not exactly a model patient!).

In the interim, we'd had to improvise toilet arrangements in the bedroom using the toilet stand and a bucket, which although regularly deployed had not been successfully "initiated" until a couple of days ago (those of you who are squeamish please skip to the next paragraph). It's a fact of life that opiate-based medicines tend to result in constipation (exacerbated by general inactivity), which is why my bag of medicines included both laxatives and stool softener. Despite these I had not had any success for more than a week, and started to get concerned about solid build-up (impaction). I was becoming very uncomfortable, and so I decided that I had to take matters into my own hands (or fingers rather!) and so undertook a bit of manual unblocking; not pleasant, but absolutely had the desired effect, opening the floodgates and, touchwood, no further problems in that department. I make no apologies for including this last paragraph - it is these sort of issues that seem to make (the aftermath of) surgery often more difficult than it should be, and impact on one's sense of dignity, which then has the potential to make one feel "down", and yet are very rarely written or even talked about.

So, at the time of writing, I'm feeling comfortable, the sun is shining in Norwich, and I've been enjoying watching the Open Golf from St. Andrews. Plus, the ankle itself seems fine, in-so-far as I can tell - toes get wriggled regularly, are a nice rosy-red colour, and respond to a daily "touch-test".

Day after tomorrow, I'm back to RNOH for removal of stitches, new cast (probably, though possibly a boot), and - if all going according to plan - a big change from non-weight-bearing to fully-weight-bearing on my operated ankle.

Most likely I will update you on return from that visit, so talk to you soon!

David