ANKLE SURGERY HERE WE COME - 25 DAYS TO SURGERY (S-25)

Less than four weeks now to my surgery!

Since my last post, I've been spending quite a lot of time practising with both my crutches and my "hands-free" crutch (see previous post for more details), and also in the gym, so this post will concentrate mainly on those activities.

First, the two types of crutch. I think it's worth saying up-front that I, personally, have got on significantly better with my "hands-free" (peg-leg) crutch than with the "traditional" forearm crutches.

I have been using a (roughly) 1,000 yard route on a road outside my house to practice with the crutches, and also to try to get some valid comparisons between the two.

After about ten days practice with both, the first thing I note is that I find the arm crutches significantly harder work than the peg-leg over this distance - physically I find them harder (despite the gym work I have been doing specifically to strengthen myself for using arm crutches - see below), and I find that at the end of the route both my heart rate and my respiration rate are higher using the arm crutches than for the peg-leg. Despite this (and although speed per se is not a prime consideration), I have also found that I can cover my route using the peg-leg in about two-thirds of the time it takes on the arm crutches. I also, and perhaps a bit counter-intuitively, feel MORE stable on the peg-leg than I do on the arm crutches.

Add to that the fact that you do have your hands free and, on the face of it, the peg-leg seems to be first choice.

So, what might be any downsides to the peg-leg. Well, thinking ahead to use in practice, one of main (potential) drawbacks to the peg-leg is that it does take a few seconds to put it on and take it off. So, if you were moving a short distance around the house (say from one chair to another, or from bed to bathroom), then the ease of use of the peg-leg will, I think, be outweighed just by the time it takes to get it on and off. (Especially as it's really not feasible to sit down in a chair/armchair with it on).

The other major drawback to the peg-leg I can foresee relates to post-operative weight bearing. It is my understanding that, depending on the view of the surgeon, you will progress over time from totally non-weight-bearing to fully-weight-bearing, via one or more gradations of partial-weight-bearing. If you are only using the peg-leg, the choice is binary - either fully-weight-bearing, or fully non-weight-bearing, so if a transition through partial-weight-bearing is required, then it will be necessary to swap to the forearm crutches.

Over the next couple of or so weeks leading up to the operation, I shall be testing both alternatives in more "difficult" situations - e.g. up and down stairs, up and down inclines, getting in and out of a car etc., and will report back to you on my experiences. However, inevitably, the real "proof of the pudding" is going to be when I have a cast/boot on for real, and again you'll get a blow-by-blow account of what works and what doesn't!

Now to the gym; I was fortunate to find in my local gym one of the instructors who had had two episodes of being in lower-leg plaster himself for some time, and who used arm crutches, and who kindly put together for me a whole series of exercises designed to do two things - first to strengthen those parts of the body/muscles that would be called on when using crutches, and second to strengthen, in advance of surgery, those muscles that will inevitably tend to atrophy during the time I am in a cast/boot.

So, for the record, and as a potential help to anyone else coming up to a similar operation who wants to do a bit of advance preparation, here is a list of the exercises that I am doing, together with a note of the part of the body and the specific muscles involved. I typically do three sets of twelve of each of the exercises - starting weight will obviously vary by individual.

Seated Leg Extension - front of thigh (quadriceps)
Seated Leg Curl - back of thigh (hamstrings)
Lateral Dumbbell Raises - shoulder (anterior/medial deltoids)
Calf Raise - calves (gastrocnemius/soleus)
Lateral Pulldown - (middle) back (latissimus dorsi)
Seated Row - back (erector spinae/middle + lower trapezius/rhomboids/latissimus dorsi)
Back Extension - lower back (erector spinae)
Crunch - stomach (abdominals)
Seated Lever Fly - chest (pectorals)
Reverse Machine Fly (Rear Deltoid Machine Fly) - shoulders (deltoids)
Cable Pull/Twist/Pull - upper arms (biceps/triceps)
Triceps Cable Pulldown - upper arm (triceps)
Incline Fly (Dumbbells) - (upper) chest (pectorals major)
Knee Raise - pelvic area (gluteus maximus/rectus abdominis/hip flexors)
Reverse Bar Curl - upper arm (biceps)
Wrist Curl - forearm (extensors + flexors)
One Leg Band Stand - pelvic area + core (hip flexors/hamstrings/quadriceps/gluteus)
One Leg Romanian Dip - posterior chain (gluten/hamstring/abductor magnus)
Triceps Seated Push-up - upper arm (triceps)
Pullover Machine - upper back + arms (latissimus dorsi/pectoralis major/trapezius/ rhomboids/posteriod deltoids/triceps) 
Plank- stomach/back/shoulders (erector spinae/rectus abdominis/trapezius/rhomboids/ deltoids/pectorals/glutes/quads/gastrocnemius)

Those of you who have read most/all of my posts will have noticed that I've concentrated mostly on the practical/physical side of preparing for my surgery, and that I've had relatively little to say about the "emotional"/mental side.

That's due, in large part, and as I indicated in my very first post, to the fact that I'm not a "wear your heart on your sleeve" individual.

However, a comment/question a couple of days ago from my wife did make me stop and think a little bit about the mental side of preparing for my op. She asked me whether I had had any second or third thoughts about going in for what is - in the end - an elective operation which does have some risks attached (and which I must say were carefully reinforced to me during my pre-op assessment). My answer was - "yes" - I had had occasional second thoughts - there are days when you have woken up without the ankle having disturbed your sleep, and where you've not been very active (so the ankle is only mildly painful), and someone drives you right to the door of a restaurant, and you start down the line of thought - "maybe I could live with this", especially knowing that there are both risks and no guarantees with the surgery.

But then you remember when the ankle has kept you awake half the night, and you've turned down another round of golf, and shied away from that job that needs doing on the stepladder) and you (or at least I) know that the decision to go ahead with surgery was the right one, based on a rational assessment of the potential gains against the risks.

Next time, more on the crutches, update on fighting the flab, and why I'm going to be a movie star!!

Look after yourselves.

David