ME AND MY NEW ANKLE - 20 MONTHS ON

Hi everyone

Here we are on the cusp of yet another New Year and, since I've had some contact from actual/potential TARVA patients, I thought I should update my blog with a reflective/forward-looking post.

The god Janus looks both backwards and forwards, and that is an appropriate metaphor for this post to my blog. In some ways, this will be quite a reflective post.

Two years ago, I was crippled with end-stage osteoarthritis in my left ankle. Not only had I stopped those things I enjoyed (golf, walking with my wife, gardening), but the condition had affected every single element of my daily life (not least my need to pour so many pain-killers down my throat).

Then, I discovered TARVA.

It's not that I had not explored potential solutions to my problem, it's simply that TARVA both brought it into sharp focus, and gave me a potential solution to my dilemma.

To cut a very long story (see my earlier posts to this blog) short, with the help and encouragement of Mr. Goldberg and his team at the Royal National Orthopaedic Hospital, I agreed to participate in their national trial which is examining the relative merits, particularly in terms of patient outcomes, of the two available surgical procedures for managing end-stage ankle osteoarthritis; those options are either fusion of the ankle, or ankle replacement.

As this was/is a randomised trial, it was the computer which selected whether I would have a fusion or a replacement.

In my case, the computer said "replacement", so that's what Mr. Goldberg and his brilliant surgical team did in June last year.

However, and for anyone contemplating this type of procedure, and although I'm a total rationalist, if you see one of my earlier posts you will see that, at the 11th hour, and the 59th minute, when I was being wheeled down to surgery, I had this sudden, transitory, and yet almost primeval urge to throw myself off the trolley and abandon the surgery.

Thank goodness I didn't!

My life has been transformed by my operation, and I don't say that lightly.

All the things I couldn't do before my operation, I can now do.

I now have no restrictions on my movement, flexibility etc. - without becoming too dramatic, I am renewed.

So, again, my message to anyone who has diagnosed ankle arthritis, is - through your GP - to contact the TARVA trial (see the website), and consider participating in their trial - if you do so, not only will you likely have a good outcome as an individual, but you will also be contributing to a body of knowledge which will help our Health Service decide not only which is the best clinical outcome for patients, but also what makes the most economic sense.

This is written on 31st December, so Happy New Year to anyone reading this post, and I wish all potential ankle patients good luck with your procedures, and I wish to record a special thanks to Mr. Goldberg and his wider team at RNOH not only for pioneering this valuable study, but also, from a very personal point of view, of having deployed their immense technical/surgical skills in ensuring that, today, no-one other than me and my wife know which was my dicky ankle!! Thank you all so much.

ME AND MY NEW ANKLE - 18 MONTHS ON

It is now nearly 18 months since I had my ankle replacement at the Royal National Orthopaedic Hospital (RNOH) as part of the TARVA trial and, I am horrified to find, also almost a year since I last posted on this blog.

So, not before time, here is an update on all that has happened so far as me and my new ankle are concerned since the end of last year.

In the period between my three-month check in September 2015, and the six-month one scheduled for early January, I continued to gradually wean myself off the air cast boot and with intensive exercises, guided by my physiotherapist, all of which I referred to in detail in my last blog.

So, by last Christmas, I was no longer using the boot at all, and concentrated on continuing to strengthen the ankle and learn to walk properly again.

My six-month check at RNOH was the briefest I have had - Mr. Goldberg was not there himself, so on this occasion I saw his Senior Registrar, Karan Malhotra, who was happy with progress and who said he was happy for me to start (gently at first) back at golf. I also as usual spent some time with Deirdre Brooking to complete the regular questionnaire that is an essential part of the TARVA trial process.

March brought a big personal milestone for me when I was able, for the first time, to complete a full round of golf - it really brought it home to me as I sat with a drink in the golf club afterwards what a huge difference the ankle surgery has made to my quality of life. I followed this up in April with several rounds of golf over the space of ten days when I got together with my golf-mad brother - the ankle was gently protesting at the end of that, but nothing that didn't disappear with a couple of days rest.

I continued with visits to the physiotherapist until the end of May - whilst we had discontinued individual sessions working directly on the ankle in March, I continued to go to the physio gym twice a week where she supervised a series of exercises designed specifically for continued ankle rehabilitation and strengthening.

This I continued until just before my 12-month check at RNOH. We did quite a number of X-rays on this occasion, including the technically very advanced procedure of taping a paper-clip to my knee to identify (I'm guessing) the top of my fibula for an X-ray!!

With the X-rays complete, I then got in very promptly to see Mr. Goldberg who pronounced himself pleased with progress, and then the usual session with Deirdre to complete the esssential questionnaire.

Three days after seeing Mr. Goldberg, I was stepping off a plane at Preveza and, gingerly, onto a 12 meter yacht in the Marina at Lefkara in the Ionian. A week under sail was to prove the ultimate test of my new ankle, as not only is sailing a yacht quite physically demanding, but it really calls for a keen sense of balance, especially when on the side decks/foredeck under sail.

It did take me a while to find my "sea legs", but I think that was as much about not having sailed for three years (because of the ankle arthritis) as anything - it was clear to me that all the work I had done with my physiotherapist both on proprioception, and on building core strength was now really paying off.

Since then not too much else to report, except to say that I have been able to increase the endurance of my ankle considerably, through walking and cycling, and as well as another marathon golf session with my brother recently, and some fairly challenging walks with him. We have also joined a local walking club which has walks of varying degrees of strenuousness twice a week.

Thought you might like to see a photo taken just now of how my "new" ankle looks in comparison to its non-bionic brother!

So, again reflecting back on the last eighteen months (and remembering that there was a brief moment, just as I was being wheeled down to surgery when I nearly called a halt), I would urge anyone with significant ankle arthritis to explore via their GP whether a replacement or fusion might work for them, and if so consider participating in the TARVA trial - it's being done at quite a number of centres throughout the country now, and participating will mean that - like me - you not only get your ankle fixed, but you are helping to determine whether there is a significant difference between fusion and replacement, especially in terms of patient outcomes. I was one of the first to participate in the trial, and it gave me an extra sense of purpose in knowing I was making a contribution.

But most of all, it has immeasurably improved my quality of life in so many ways, and knowing what I know now I wonder why I ever hesitated.

Major developments aside, I will aim to add my next post around the time of my two-year anniversary.