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
Thursday, 11 June 2015
Monday, 1 June 2015
ANKLE SURGERY HERE WE COME - 35 DAYS TO SURGERY (S-35)
For those who remember their multiplication tables, that means exactly five weeks to surgery.
Sorry for the delay since my last post, but I had promised you some information on post-op non-weight-bearing aids that I am looking at, and I've spent the last few days getting some initial experience with two of them.
First, crutches. As I mentioned in an earlier post, quite early on I discarded the possible option of underarm crutches partly because they seem to give many people a lot of underarm pain, and also because they are very unwieldy.
So, I focused on forearm crutches, but again my research told me that many people had issues as a result of most of the weight being focused on the hands, resulting in callouses or worse. As part of the research, I cam across a new(ish) design of forearm crutch called "smartCRUTCH". Essentially these have an additional component in the forearm design, in the form of a "rest" or "platform" for the forearm, which can be rotated through almost ninety degrees. The theory is that you can start on these crutches with most of the weight being taken (conventionally) on the hands but, as you gain experience and confidence, you can rotate the forearm platform from near vertical gradually towards the horizontal, thus enabling you to take more and more weight distributed along the forearm rather than almost wholly on the hands.
I must say that getting used to using these crutches, even just in the conventional vertical position, has proved more challenging than I anticipated, especially in graduating to a decent "stride" length. I think I've finally got the hang of it, though this has taken much longer than I had assumed, so over the next few weeks I will start to take advantage of the unique design of these crutches and distribute my weight more evenly across my forearms.
The other aid that I have decided to try out is perhaps even less well known than the smartCRUTCH. It is a "handsfree" crutch, if that doesn't sound like an oxymoron. It's probably more accurately (or more understandably) described as a knee crutch, and essentially involves creating a peg-leg, a la Long John Silver.
The product is called the "iWALK2", and it's probably easier if you look at their website - http://www.peglegs.co.uk - to see a description and a diagram. Essentially you bend the knee of your affected foot at right angles and then strap on a false lower leg!
Even more than the smartCRUTCH, this product requires very careful assembly (good instructions in both cases) and, particularly, very careful fitting to tailor it exactly to you as an individual. I am quite methodical and meticulous, and so others might well beat the two hours I took over the assembly and fitting, but at the end I actually, despite the odd feeling and all the straps, felt quite comfortable that I had succeeded in achieving a very good fit.
I think that then translated into my surprisingly easy introduction to actually using my "peg" leg - as soon as I summoned the confidence to let go of the wall, I found I was able to walk comfortably and with a lot of security and stability within a very short space of time. Within fifteen minutes, I was walking almost naturally and with great confidence. My only reservation is that I suspect that comfort may become an issue once I start to use it for extended periods of time, but I'll let you know about that as I increase my practice distance for both the smartCRUTCH and the peg-leg over the next two or three weeks.
The third item I am intending to use post-op is a knee-scooter which is pretty much as its name suggests - you rest your operated leg (knee) on a four-wheeled scooter with a raised platform, and use the good leg to scoot yourself along. The scooter is expensive to purchase, so I shall be hiring one immediately after my surgery, so I won't be able to give you feedback on that until later, but my guess is that that will be the easiest of the three to use.
I suspect that each of these three methods is going to have its strengths and weaknesses in specific situations (e.g. I can't imagine wanting to strap on the peg leg just to use the bathroom in the middle of the night), so hopefully I can tell you about my own experiences with each of them, and perhaps nominate a "best buy" in the event that you decide, or have to, opt for just one.
In the next post I'll update you on progress with the crutches, and also give you a bit more detail on the gym (and other) work I'm doing to prepare for the operation and its aftermath.
I'll close this post by hinting that you may soon be able to see me in glorious technicolour!!
More will be revealed in posts to come, so make sure you keep reading the posts, and pleeaaassse give me some feedback on whether you're finding this useful, even if it's just by "liking" the post.
Thanks - see you soon.
David
Sorry for the delay since my last post, but I had promised you some information on post-op non-weight-bearing aids that I am looking at, and I've spent the last few days getting some initial experience with two of them.
First, crutches. As I mentioned in an earlier post, quite early on I discarded the possible option of underarm crutches partly because they seem to give many people a lot of underarm pain, and also because they are very unwieldy.
So, I focused on forearm crutches, but again my research told me that many people had issues as a result of most of the weight being focused on the hands, resulting in callouses or worse. As part of the research, I cam across a new(ish) design of forearm crutch called "smartCRUTCH". Essentially these have an additional component in the forearm design, in the form of a "rest" or "platform" for the forearm, which can be rotated through almost ninety degrees. The theory is that you can start on these crutches with most of the weight being taken (conventionally) on the hands but, as you gain experience and confidence, you can rotate the forearm platform from near vertical gradually towards the horizontal, thus enabling you to take more and more weight distributed along the forearm rather than almost wholly on the hands.
I must say that getting used to using these crutches, even just in the conventional vertical position, has proved more challenging than I anticipated, especially in graduating to a decent "stride" length. I think I've finally got the hang of it, though this has taken much longer than I had assumed, so over the next few weeks I will start to take advantage of the unique design of these crutches and distribute my weight more evenly across my forearms.
The other aid that I have decided to try out is perhaps even less well known than the smartCRUTCH. It is a "handsfree" crutch, if that doesn't sound like an oxymoron. It's probably more accurately (or more understandably) described as a knee crutch, and essentially involves creating a peg-leg, a la Long John Silver.
The product is called the "iWALK2", and it's probably easier if you look at their website - http://www.peglegs.co.uk - to see a description and a diagram. Essentially you bend the knee of your affected foot at right angles and then strap on a false lower leg!
Even more than the smartCRUTCH, this product requires very careful assembly (good instructions in both cases) and, particularly, very careful fitting to tailor it exactly to you as an individual. I am quite methodical and meticulous, and so others might well beat the two hours I took over the assembly and fitting, but at the end I actually, despite the odd feeling and all the straps, felt quite comfortable that I had succeeded in achieving a very good fit.
I think that then translated into my surprisingly easy introduction to actually using my "peg" leg - as soon as I summoned the confidence to let go of the wall, I found I was able to walk comfortably and with a lot of security and stability within a very short space of time. Within fifteen minutes, I was walking almost naturally and with great confidence. My only reservation is that I suspect that comfort may become an issue once I start to use it for extended periods of time, but I'll let you know about that as I increase my practice distance for both the smartCRUTCH and the peg-leg over the next two or three weeks.
The third item I am intending to use post-op is a knee-scooter which is pretty much as its name suggests - you rest your operated leg (knee) on a four-wheeled scooter with a raised platform, and use the good leg to scoot yourself along. The scooter is expensive to purchase, so I shall be hiring one immediately after my surgery, so I won't be able to give you feedback on that until later, but my guess is that that will be the easiest of the three to use.
I suspect that each of these three methods is going to have its strengths and weaknesses in specific situations (e.g. I can't imagine wanting to strap on the peg leg just to use the bathroom in the middle of the night), so hopefully I can tell you about my own experiences with each of them, and perhaps nominate a "best buy" in the event that you decide, or have to, opt for just one.
In the next post I'll update you on progress with the crutches, and also give you a bit more detail on the gym (and other) work I'm doing to prepare for the operation and its aftermath.
I'll close this post by hinting that you may soon be able to see me in glorious technicolour!!
More will be revealed in posts to come, so make sure you keep reading the posts, and pleeaaassse give me some feedback on whether you're finding this useful, even if it's just by "liking" the post.
Thanks - see you soon.
David
Tuesday, 19 May 2015
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
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
Monday, 18 May 2015
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
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
Tuesday, 12 May 2015
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
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
Thursday, 30 April 2015
ANKLE SURGERY HERE WE COME - 67 DAYS TO SURGERY (S-67) (R-14)
Hi - good to see you back here again.
Today is my 63rd birthday, which is as good an excuse as any for a new post to my blog. I shall be celebrating doubly in style with my wife - not only will be getting on our glad rags to dine in style at our favourite local restaurant, it's also a milestone in my efforts to lose weight - see below.
However, before that, I promised I would tell you more about my second visit to the RNOH, so here goes.
Before getting into my first meeting with Deirdre Brooking, and my MRI, I wanted to just reflect on something that really struck me on my second visit to the RNOH site.
My first visit was in early January, so it was almost dark when I arrived, I was dropped off right at out-patients by the hospital bus, and I was short on time, so I guess I didn't really have time to take in my surroundings.
On this my second visit, I drove myself, arriving both in daylight and with time to spare, although I then had the significant task of finding a parking space, so did a bit of a tour of the RNOH site.
As you either already know, or will soon find out, RNOH has not just a national but an international reputation for clinical and research excellence, and is a world-renowned orthopaedic centre. Yet the physical infrastructure of the facility is almost antediluvian - wards housed in what are, for all intents and purposes, second world war Nissen huts, crumbling exteriors, patients being wheeled along corridors open to the elements - the list goes on. It's a miracle frankly that the staff at RNOH are able to achieve what they do, and have earned such an august reputation, in spite of facilities which are clearly very far away from being fit-for-purpose. Imagine what they could do with up-to-date infrastructure and facilities! From what little I know this problem has long been recognised but it seems a solution has never been implemented. It doesn't take a rocket scientist to calculate that they must be spending a fortune just trying to muddle along with and patch up the existing facilities, and it would be a huge shame if such a centre of excellence were threatened for want of some investment.
Anyway, after that brief digression, let me tell you more about my second visit.
I first met with Deirdre Brooking, who is the Clinical Research Coordinator at RNOH, and who has been my main point of contact since my first visit to the hospital (though this was my first chance to meet her). If you want to put a face (and indeed a voice) to a name, then you could do no better than watching the excellent TARVA video in which Deirdre is one of the principle narrators - www.youtube.com/watch?v=VTzOS5dRhm4
Deirdre took me through the next steps on the route to surgery, and was very helpful in answering a number of questions that I had, although I felt I had already found a lot of information, especially on the TARVA website and through the RNOH factsheet on the subject.
The other main purpose of my second visit was an MRI of my dodgy ankle, so Deirdre took me to the reception for the Imaging Department, and I was then seen very quickly. The MRI scan took about 20 minutes, and fortunately for me I went in "feet first" (I've previously had a spine scan - to confirm a diagnosis (see first post) of ankylosing spondylitis - which involved going in "head first"; I'm not particularly claustrophobic, but after nearly 90 minutes I was mighty glad to emerge!!).
After the end of the MRI I was free to leave, and blessed my decision to drive on this occasion (I had to be in the London area anyway), since my departure coincided, just like the first visit, with the changeover time for the hospital bus.
In the next post, I'll start to tell you some of the things I've been doing in preparation for my surgery in early July, but I'll round off this post by talking a little about what is, perhaps (other than having an excellent surgical team), the most significant thing I can do to make sure I give myself the best chance of benefiting from the operation, which is losing weight.
As I mentioned in my first post, I am significantly overweight - two months ago, after an indulgent holiday in Dubai, I tipped the scales at 107 kg., which is the heaviest I've been for about ten years. I resolved that I must shed a significant amount of weight before my procedure, not least to reduce the current stress on my ankle, but also particularly the load on either the replacement or fusion resulting from the operation.
Co-incidentally, a very good friend had tried Jason Vale's Super-Juice-Me 28 day all juice diet, with great success in terms of both weight loss and overall well-being. Although it is only fair to point out that medical opinion IS divided on both the merits and the efficacy of a juice-only diet, I felt I needed something fairly radical to help start to shift a significant amount of weight.
So, courtesy of Amazon, I purchased both a juicer and a blender, and then caused great curiosity at the checkout of our local supermarket when I stocked up with enough fruit & veg apparently for a small army (e.g. 63 Golden Delicious)!
The results have been nothing short of dramatic. As well as feeling significantly better overall, in the first 28 days (I finished yesterday), I have shed 13 kg./28 lbs., bringing me down to a still hefty 94 kg. but with the added bonus of reclassifying me from "obese" to just "overweight' - result!
I am taking a break of two weeks of just moderate eating (still including some juices), and will then go back for a further 28-day session - my aim then will be to get down close to 80 kg. by mid-June in readiness for my operation, though I suspect the next 28 lbs. is going to be more difficult than the first!
So, just over two months to go to surgery, and two weeks to "randomisation" - next post will review some of the other preparations I've been making for this major event.
Enjoy the long holiday weekend, and please give me some feedback if you've read this blog and are finding it helpful.
TTFN
David
Today is my 63rd birthday, which is as good an excuse as any for a new post to my blog. I shall be celebrating doubly in style with my wife - not only will be getting on our glad rags to dine in style at our favourite local restaurant, it's also a milestone in my efforts to lose weight - see below.
However, before that, I promised I would tell you more about my second visit to the RNOH, so here goes.
Before getting into my first meeting with Deirdre Brooking, and my MRI, I wanted to just reflect on something that really struck me on my second visit to the RNOH site.
My first visit was in early January, so it was almost dark when I arrived, I was dropped off right at out-patients by the hospital bus, and I was short on time, so I guess I didn't really have time to take in my surroundings.
On this my second visit, I drove myself, arriving both in daylight and with time to spare, although I then had the significant task of finding a parking space, so did a bit of a tour of the RNOH site.
As you either already know, or will soon find out, RNOH has not just a national but an international reputation for clinical and research excellence, and is a world-renowned orthopaedic centre. Yet the physical infrastructure of the facility is almost antediluvian - wards housed in what are, for all intents and purposes, second world war Nissen huts, crumbling exteriors, patients being wheeled along corridors open to the elements - the list goes on. It's a miracle frankly that the staff at RNOH are able to achieve what they do, and have earned such an august reputation, in spite of facilities which are clearly very far away from being fit-for-purpose. Imagine what they could do with up-to-date infrastructure and facilities! From what little I know this problem has long been recognised but it seems a solution has never been implemented. It doesn't take a rocket scientist to calculate that they must be spending a fortune just trying to muddle along with and patch up the existing facilities, and it would be a huge shame if such a centre of excellence were threatened for want of some investment.
Anyway, after that brief digression, let me tell you more about my second visit.
I first met with Deirdre Brooking, who is the Clinical Research Coordinator at RNOH, and who has been my main point of contact since my first visit to the hospital (though this was my first chance to meet her). If you want to put a face (and indeed a voice) to a name, then you could do no better than watching the excellent TARVA video in which Deirdre is one of the principle narrators - www.youtube.com/watch?v=VTzOS5dRhm4
Deirdre took me through the next steps on the route to surgery, and was very helpful in answering a number of questions that I had, although I felt I had already found a lot of information, especially on the TARVA website and through the RNOH factsheet on the subject.
The other main purpose of my second visit was an MRI of my dodgy ankle, so Deirdre took me to the reception for the Imaging Department, and I was then seen very quickly. The MRI scan took about 20 minutes, and fortunately for me I went in "feet first" (I've previously had a spine scan - to confirm a diagnosis (see first post) of ankylosing spondylitis - which involved going in "head first"; I'm not particularly claustrophobic, but after nearly 90 minutes I was mighty glad to emerge!!).
After the end of the MRI I was free to leave, and blessed my decision to drive on this occasion (I had to be in the London area anyway), since my departure coincided, just like the first visit, with the changeover time for the hospital bus.
In the next post, I'll start to tell you some of the things I've been doing in preparation for my surgery in early July, but I'll round off this post by talking a little about what is, perhaps (other than having an excellent surgical team), the most significant thing I can do to make sure I give myself the best chance of benefiting from the operation, which is losing weight.
As I mentioned in my first post, I am significantly overweight - two months ago, after an indulgent holiday in Dubai, I tipped the scales at 107 kg., which is the heaviest I've been for about ten years. I resolved that I must shed a significant amount of weight before my procedure, not least to reduce the current stress on my ankle, but also particularly the load on either the replacement or fusion resulting from the operation.
Co-incidentally, a very good friend had tried Jason Vale's Super-Juice-Me 28 day all juice diet, with great success in terms of both weight loss and overall well-being. Although it is only fair to point out that medical opinion IS divided on both the merits and the efficacy of a juice-only diet, I felt I needed something fairly radical to help start to shift a significant amount of weight.
So, courtesy of Amazon, I purchased both a juicer and a blender, and then caused great curiosity at the checkout of our local supermarket when I stocked up with enough fruit & veg apparently for a small army (e.g. 63 Golden Delicious)!
The results have been nothing short of dramatic. As well as feeling significantly better overall, in the first 28 days (I finished yesterday), I have shed 13 kg./28 lbs., bringing me down to a still hefty 94 kg. but with the added bonus of reclassifying me from "obese" to just "overweight' - result!
I am taking a break of two weeks of just moderate eating (still including some juices), and will then go back for a further 28-day session - my aim then will be to get down close to 80 kg. by mid-June in readiness for my operation, though I suspect the next 28 lbs. is going to be more difficult than the first!
So, just over two months to go to surgery, and two weeks to "randomisation" - next post will review some of the other preparations I've been making for this major event.
Enjoy the long holiday weekend, and please give me some feedback if you've read this blog and are finding it helpful.
TTFN
David
Saturday, 25 April 2015
ANKLE SURGERY HERE WE COME - 73 DAYS TO SURGERY (S-73) (R-21*) (*see below)
Hello again!
I hope you had a chance to read my first post to this blog several days ago - if not, suggest you do so before carrying on as it will give you some useful background.
In the last post I explained a bit about how I had come to the decision that I needed surgery on my ankle, and also gave a little background about myself.
Let me now pick up the story where I left off last time - my first appointment with Mr. Andy Goldberg at the Royal National Orthopaedic Hospital (RNOH) in Stanmore on 8 January 2015.
First, a little bit of information about getting to and from the hospital - in this first instance, by public transport. Having arrived from Norwich at Liverpool Street, I took the Circle Line to Baker Street and changed to the Jubilee Line which I took to the end of the line, alighting at Stanmore. I then took the RNOH bus transport direct to the hospital site. The bus stops right outside the outpatients' building, which is where I was headed.
A few tips on using public transport combined with the hospital bus :
- the bus also goes to Edgware station
- the bus timetable is published on the RNOH website
- the pick-up point at Stanmore station is just to the left as you exit the station
- beware the "changeover" periods for the bus (shown on the timetable) when the bus doesn't run for quite a while - I got caught by this when I was leaving at around 5.45 p.m. on my first visit, exacerbated by the fact that, when I called for a taxi, I was told the wait was at least 40 minutes - I ended up waiting for the first bus of the evening shift.
Anyway, I checked in at outpatients' reception, and was then asked to do several X-rays of my ankle and lower leg. I then saw Mr. Goldberg. He viewed the X-rays, and asked me about the history of my problem; seemed a little puzzled when I told him my ankle had not been subject to any significant trauma (though a lot of twists and sprains when younger, especially whilst playing squash). He wondered whether possibly the problem was inflammatory in origin, since I was diagnosed several years ago with ankylosing spondylitis (which otherwise has no real effect on me). He then advise me that my ankle was suitable for either a replacement or a fusion and thus, as I met the other criteria, I could be accepted onto the trial.
This is an appropriate point - as foreshadowed in my previous blog - to spend a little time talking about the trial itself, and thus to explain why I don't know, right at this moment, whether I will be having a replacement or a fusion.
Without repeating all of the excellent information on the TARVA website, and at the risk of over-simplifying things, the main thrust of the TARVA trial is - through a clinical trial - to try to establish whether there is a difference - measured principally in terms of patient outcome (essentially quality of life) - between ankle replacement and ankle fusion as a technique to treat end-stage ankle arthritis.
in order to achieve that objective, use is being made of a randomised trial approach. This means that potential patients, as well as meeting certain other criteria (e.g. age), must be suitable to undergo either surgery type. The actual surgery type will then be allocated randomly (by a computer), such that half of the total patient population for the trial receive a replacement, and the other half have a fusion. There will then be follow-up for patients in both groups after their procedure to establish, by means of questionnaires, what effect the surgery has had on their overall quality of life.
So, like all the other patients on the trial, I have to wait until my "randomisation date" to know which of the two procedures I will undergo. Though I guess some people might feel a little uncomfortable with a computer making a final decision on which type of surgery they were going to have, that actually sits fine with me since - to be honest - I genuinely couldn't decide ( having reviewed all the information I could find on the pros and cons of both procedures) which was the best choice for me, so I'm happy for a computer to make the choice!
I have just been given a date when both my surgery pre-assessment and my randomisation will be done - it is 15 May which I have dubbed "R" day, hence the "R-21" in the introduction to this blog. If I am selected for a replacement, I shall also have to have a CT scan at the same time.
In my next post I will tell you something about my second visit to the RNOH in March, when I had an MRI and also met with Deirdre Brooking who is the Clinical Research Coordinator at RNOH.
Bye for now - more coming soon!
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