RETURN OF THE ANKLE BLOGGER - ME AND MY NEW ANKLE 30 MONTHS ON

I'm embarrassed that it has been over a year since my previous post to my blog. I've been reflecting on why that is, and also as to why I've just now, almost out of the blue, decided to add this new post to my blog on my ankle replacement.

I think the overriding reason that I have NOT posted in the last year is fundamentally a good one - I have had precisely zero problems with my ankle over the past year, and indeed virtually since the date of my surgery. I had my routine check-up with Mr. Goldberg and his colleagues last June, and all was well. It is therefore perhaps a sad reflection (on me) that, since all has been well, the motivation to talk about it dipped somewhat.

So, if that is the case (and all continues to be great), then why have I suddenly decided to do another post? Well I guess it's down to my brother.

Three Christmases ago, when we spoke on Christmas Day, we knew already that there was a chance I would be accepted on the TARVA trial. And on that day, he said to me "David, I hope this time next year, we can again enjoy a round of golf".

Well, on Boxing Day 2016, we played THAT round of golf, and we celebrated greatly, but it was only three weeks ago, when we spoke again on Christmas Day, that he reminded me of those two conversations.

So, I want to echo what I said in my previous post around this time last year. Participation in the TARVA trial, and the consequent surgery, has literally transformed my quality of life, and I suspect that of many other participants. Moreover, I have been honoured and humbled to be part of a clinical trial which will help our medical professionals form a view on the most appropriate treatment for ankle arthritis, including a view of what makes the most sense not just in patient-outcome terms, but also in health economics terms for our hard-pressed NHS.

What do I mean by that? Well, in my own words, I think it's something like this .......... I've had an ankle replacement, courtesy of Mr. Goldberg and his surgical team. For me, that operation has been transformative. If the replacement survives for at a minimum ten years without need for intervention, then in my view (and probably the NHS's view too), that has been a success. If it lasts 20 years, and I'm still not six foot under, then amazing. If it only lasts five years before requiring intervention, then mmmm....

Meanwhile, my fellow participants who have had an ankle fusion may, I suspect (and purely anecdotal from other patients NOT involved in this trial) have taken a little longer than me to feel the real benefits of their surgery, BUT if their fusion surgery has been successful then, unlike me, they will have the "benefit" of knowing that their "new" ankle is  -  forever!

It may well be (being a scientist myself by training) that there is no definitive outcome to the fusion v. replacement discussion, not least given the large range of patient presentations, but I am absolutely certain that the results of this study will hugely inform ankle/orthopaedic surgeons in their discussions in future with patients, and will also help the NHS direct resources appropriately.

I cannot end this post without doing two things :

• first, encouraging anyone who reads this blog, and who is considering surgery to address ankle arthritis, to consider participating in this ground-breaking study, since not only will you get a resolution to your issue, but you will also help in creating knowledge for physicians to best advise their patients in decades to come

• second, and whilst there are many centres participating in this study (see the TARVA website for one near you) I really must once again thank the whole team of people at the Royal National Orthopaedic Hospital (RNOH), led by Andy Goldberg, for not only a brilliant surgical outcome for me personally, but also for truly wonderful care from admission to discharge and beyond. I truly owe you all a sincere debt of gratitude.

I definitely WILL post within the next six months following my next check at RNOH, but in the meantime just starting to get involved in rock climbing! (Last sentence not for Mr. Goldberg's eyes)!.

Cheers

David

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.

ME AND MY NEW ANKLE (S+137)

My apologies to those who have been anticipating my next posting, which I had promised would be in October, shortly after my three-month check-up.

I can only plead in mitigation that the delay is largely down to the many more things I am now able to do, that were not possible before my operation, and also to the considerable amount of time I have been investing in ensuring that the rehabilitation of my ankle (and the rest! - see below) proceeds as quickly as possible consistent with advice from my surgeon and physiotherapist.

So let me split this particular post into roughly three sections. In the first, I'll tell you about my three month check-up, which was in early October. Then, for those that have not already seen it, I must introduce you to the video record of my own journey through surgery which has now been captured for posterity. Finally, I'll relate to you what I've been doing since my three-month check on my journey to rehabilitate my ankle, and some of the challenges that has presented.

My three-month check was scheduled for 1st October at 3.00 p.m., and fortunately I had been able to slightly reschedule my first (RNOH) physiotherapy appointment for an hour earlier. The physio went through my relevant history, and then taught me several exercises, mainly aimed at developing core strength, including gluteal strength (through "kickbacks"), plus working on the muscles etc. of the foot by "scrunching" a towel on the floor with my toes.

I then inevitably bumped into Deirdre Brooking before meeting briefly with Mr. Goldberg to review progress. Mr. Goldberg seemed happy with the progress of the ankle, but asked that I only gradually weaned myself out of the Aircastst boot, especially outside the home (partly because I had to have some cysts filled as part of my surgery). He also re-emphasised to me the need to develop core strength.

Then it was off to Radiology to have another set of scans done on their Pediscan (??) machine, and finally a meeting with Jan Letocha to do the final recording of the voice-over for the film of my patient experience.


For those of you who haven't read my earlier blogs, and as a refresher, I wore a Go-Pro camera during my entire hospitalisation to capture the "patient" experience, and the edited highlights of this, with my voice-over, have now been published on the TARVA website - if you want a direct link to it, here it is -


https://www.youtube.com/watch?v=K80DmM-s4HI

As I mentioned in a couple of my previous posts, I have been fortunate, in addition to the RNOH physiotherapy, to have had access to private physiotherapy on a regular basis, with the bonus of having the same physio all the time. 

During the time leading up to my three-month check, we had been concentrating on ensuring the healing of the operation wound, and on managing the inevitable swelling of the ankle post-operatively.

Following the three-month check, we have moved on to concentrating on core strength, getting me to walk (properly) again, proprioceptive exercises (to do with balance and space/body perception), and on gradually increasing the range of motion in my ankle.

The most obvious visible gain has been the almost complete elimination of swelling in my ankle (unless I do "too much" on my feet at a time), to the extent that I am now able, for the first time for almost two years, to wear "normal" shoes (in fact I'm off to a black-tie ball this weekend, and was delighted to find yesterday that I could get into my dancing pumps)!

We have a one hour session each week in the physiotherapist's gym, where we go through a range of exercises, including -

• walking, slowly at first, on a treadmill
• cycling on a static bike
• proprioception exercises using a BOSU ball (essentially a gym ball cut in half) - amazingly difficult at first, but really good for strengthening around the foot and ankle, and for balance
• proprioception exercises involving standing on a wobble-board, and trying to keep a dot inside a circle as the circle moves around a screen - maddeningly difficult at first
• strengthening exercises for core (including work on the BOSU ball), glutes, quads and hamstrings, and calf muscles.

I supplement this with walking on my own treadmill three or four times a week (I'm now up to five kilometres (reasonably) comfortably (see below), and the core, glute and calf exercises.

The major challenge for me has really been in learning to walk properly again - I knew I had been walking with my feet spread outwards (mainly to compensate for the arthritic pain) and, as I have started to try to walk with my feet straight again, this has inevitably put pressure on ligaments/tendons/muscles in other parts of my legs, so I have had more than a few aches and pains in both knees and hips on both sides of the body, but I'm gradually working through that and can see improvement virtually every day.

Ever since I came out of plaster following my six week check, my own personal goal has been to walk a full round of golf following my six-month check in early January (subject of course to Mr. Goldberg being happy), and I really feel I'm on course (no pun intended!) to achieve that.

As I alluded at the beginning of this post, life for me has changed so much for the better since my operation - we have a large garden and what with my restricted and painful movement pre-op, and the fact that I was "hors de combat" for six weeks following surgery, I have needed to and been able to devote a great deal of time to getting the garden back into shape. I can also enjoy quite lengthy walks with almost no discomfort, and nor do I feel like I'm always the one holding up a group of people I'm with.

So, if you're as I was six months ago contemplating whether to have an operation on your ankle because of arthritis, then I would say to you - yes, everyone is different and maybe I have been fortunate - but go into it with your eyes open, understand and discuss the risks with your doctor(s), but from my perspective it has absolutely been worth it.

If anything interesting/significant in my journey occurs before Christmas then I'll post again, otherwise please anticipate my next post right after my six-month check in early January.

As I may not therefore post before the end of the year, can I wish everyone who reads this blog a Merry Christmas and a Happy New Year.

David

ME AND MY NEW ANKLE (S+67)

August has flown by, and I've just realised that I hadn't added anything new to my blog since  late July, so here goes.

As I mentioned in my previous post, I was allowed to go "weight-bearing" two weeks after the operation, and that has meant life was a lot easier than the first two weeks when I was flat on my back.

Also, as time has progressed during August I have found myself feeling much less weak than I was when I first started weight-bearing, and so I have been gradually increasing the distance I am covering during each day.

Just over three weeks ago, I was back at the RNOH for my second, six-week check.

I actually arrived a couple of hours before the scheduled time for my check-up, because I had agreed to record the voice-over to accompany the filming that I did of my time in the hospital for the surgery - see my previous blogs for details, and also see the latest (summer) TARVA newsletter for a picture of yours truly wearing both the camera I used for recording, and a great big beaming smile! I am assuming that at some stage the filming with the voice-over will be added to the TARVA website, so anyone who is preparing for similar surgery will be able to get a more detailed view, from my perspective, of the actual experience.

Once that was completed it was off for my second check-up, which - as anticipated - was lengthier and more involved than the first one.

First port of call was the plaster theatre to have my cast removed (and with fingers crossed that, after X-rays and a meeting with Mr. Goldberg, I wouldn't be returning there). That done,   and with my ankle not at that point supported, I was wheeled to the X-ray department. On my previous visit there, at pre-admission, I had had a bit of a wait, but this time it was straight in for a series of mainly weight-bearing X-rays, mainly to show the alignment of the whole of my lower leg, and also of course of how the implant was looking.

Back to the foot and ankle section, and I caught up again with Deirdre Brooking, and we were then able to get in quite quickly to see Mr. Goldberg. After looking through my X-rays and a discussion of my progress, I was delighted to be told that I would be moving into an "Aircast" boot - Google it if you want to see what it looks like, but it's essentially designed to secure and protect the ankle, but with the big advantage that, with the surgeon's agreement, it can be removed at night and (for example) when sitting watching television).

Another little-advertised but highly valued benefit of having a removable boot was the ability at long last to have a looong scratch at those itchy bits that had been inaccessible for six weeks!

A word of warning here - the first sight of my naked leg after six weeks in plaster was not a pretty one - the whole of my leg below the knee was shedding skin and looking decidedly unattractive - about the only bit that looked in good shape was the ankle itself!

So, with Deirdre Brooking's much appreciated assistance, it was then off to find the orthotist to have a boot fitted, and a brief explanation of how it worked, and then I was free to go, with a request to ensure I continued to wear the boot up until my three-month check-up, which is due in just about three weeks' time from the time of writing.

I have been fortunate to be able to access some (private) physiotherapy to supplement my first appointment with the RNOH physio three weeks from now, and we have been working on managing the expected swelling and starting to improve core and gluteal strength in preparation for starting to walk "properly" again, which I'm guessing will mainly happen after the three-month check-up, with Mr. Goldberg's blessing.

Before closing, there is one point I would like to make, which is that I have been personally surprised at the total absence of any pain or even the slightest ache around my operated ankle - I am sure that my walking ability, gait and range of motion are indeed going to improve over the coming months, but even now, because of the absence of the often significant discomfort I experienced before the operation, I would already view the procedure as having been totally worthwhile. I must record my thanks to Mr. Goldberg, his surgical team and all the other support staff for the very high standard of care they have given me, and for their skills which ensured my operation was successful.

It only remains for me to say once again how great the staff at RNOH were, an experience which appeared to be echoed by several of the other patients that I had a chance to chat with.

Knowing how busy I am going to be over the next few weeks, I suspect the next time I'm going to be posting to this blog will be straight after my three-month check at the beginning of October.

See you again then.

David

ME AND MY NEW ANKLE (S+22)

Just over three weeks since my ankle replacement surgery, and the big event of the last week has been my first follow-up visit to RNOH since the surgery.

In preparation, made my first journey down the stairs at home since coming home from surgery - despite the presence of my brother, decided to be ultra-cautious and do it using the inelegant but effective "bum-shuffle" method!

Taxi arrived bang on time, with a driver I know well, and we passed most of the journey talking about cars. Once again (this luck surely can't continue), both the M11 and the M25 we're flowing remarkably smoothly, so as a result (having allowed a "cushion" for traffic), we actually arrived at Stanmore almost three-quarters of an hour before my scheduled OPD appointment.

They really seem to be well organised and patient-focused there; first, a porter appeared within less than a minute and wheeled me to the admissions desk, where I was quickly processed and asked to take a seat. I imagined I would have to wait at least until my scheduled appointment time before I started to get "processed", but to my delight, within five minutes, another porter appeared to take me straight off to my first stop, the plaster theatre.

There, I was wheeled straight in, and helped up onto a table. The plaster nurse then cut away my existing cast (easy, just needing scissors, as I only had a back slab), and then for the first moment of truth as the surgery wound was uncovered.

Whilst the actual incision was somewhat longer than I had anticipated, the really good news was that the wound was healing really well - the nurse did not need to do anything at all to it, and even my untrained eye could see that it looked "healthy", confirmed by the nurse.

A quick wash of the foot, which was probably a bit rank after more than two weeks encased in plaster, and then the staples securing the wound were taken out - mildly uncomfortable only.

They were then ready to do the new plaster, and you could have knocked me over when the nurse produced a colour palette and asked me to select my preferred shade! Just like being in John Lewis' upholstery department! I went for the rather fetching bright red.

This time they put on a full below-knee cast, which I shall be wearing at least until my next follow-up, four weeks away. The finishing flourish was a soft, velcro-fastened "over-shoe" to give a flat walking platform on the bottom of the cast.

As if by clockwork, the (same) porter arrived the moment the new plaster was finished, and took me back to the foot and ankle clinic where, after just a couple of minutes, I was wheeled in to see Mr. Goldberg's SHO, Dr. Amanda Ifie. Deirdre Brooking also joined us, and made some notes on my TARVA trial file. We reviewed my progress since the surgery. I was pleased to get the news that the cysts they had dealt with during the surgery had revealed nothing untoward on a biopsy, and more pleased still to be told that I could move immediately to full-weight-bearing on my operated ankle.

After a routine blood test next door, I gingerly made my way back under my own steam to the waiting room, and was able to tell my driver that I was ready to go home at least two hours earlier than expected - great news!

Well, what a contrast the last few days since have been, now I can put weight on my ankle. Able to move around the house fine by myself so life has become infinitely easier (for my wife also!). I did find one problem - because there is a significant "heel" on the cast, and with the over-shoe, I was quite lop-sided, which caused a few balance problems, but fortunately I dug up a pair of walking boots with a deep, cushioned heel; one of those on the right foot succeeded in evening things out.

The only slight negative since getting back home is that I have been feeling weaker than I had hoped for, but that's my fault for not setting my own expectations appropriately - improving day-by-day, but I do need to rest quite frequently at the moment if I am standing/moving around doing things.

Will be working on building up my strength/stamina over the next few weeks, and looking forward to my next OPD appointment in mid-August, when there is a chance I believe, and depending on X-rays and - obviously - the view of my consultant, that I may finally be able to cast off the cast!

I need to say once again what a great bunch of people they have at RNOH - I couldn't believe how quickly and efficiently I got processed through all my steps there last week, and always with politeness, professionalism and good humour - thank you all.

So, feeling pretty good about things at the moment - hope that continues as I start to actually use my bionic ankle in the future.

See you here again soon.

David

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