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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!
 

IMG_0433.JPG


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.
 

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Me and my new ankle - one hundred and thirty seven days after surgery

 

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

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Me and my new ankle - sixty seven days after surgery (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

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Me and my new ankle - twenty two days after surgery (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

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Me and my new ankle - ten days after surgery (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

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Me and my new ankle - seven days after surgery (S+7)

I left you drifting off to sleep the night of my ankle surgery just over a week ago, so this post picks up the following morning,

I had a surprisingly good sleep that first night, what with having to lie on my back (not my favourite), two-hourly BP checks, and one of the loudest snorers I have ever come across two beds away (if you're reading this blog, you know who you are!).

Thankfully, as previously mentioned, no pain, and so I was able to enjoy a light breakfast at about 8 o'clock. 

The rest of the morning passed quite quickly, in between watching a couple of episodes of the final series of MadMen on my iPad (fantastic series IMHO); continuing regular BP, pulse and temperature checks; and the general hustle and bustle of the ward, with another group of patients arriving from admissions from about 8 o'clock onwards, and then gradually going off for and subsequently returning from procedures - I "counted them all out, and counted them all back again"!

I had been coping fine with bed bottles during the night and through the morning but, after lunch, decided it was time for a proper sit down, and so I gingerly moved off on my crutches in search of the bathroom. As if on cue, the physiotherapist appeared - their principal task being to ensure that patients can use crutches properly and safely. Despite my having practised with the crutches for several weeks before-hand, I didn't really feel very comfortable now using them for the first time "in anger", and it seemed the physio was not over-impressed either, as she said I would have to demonstrate better use of the crutches before I could be signed off. Despite that hiccough, I am pleased to report a successful bathroom visit as I think that is another of those often unspoken concerns when on one's back after surgery (though this proved to be a bit of a false dawn - see later posts)).

Watching films, supper and calls to family and friends made the rest of the day whizz by and, although I was now off two-hourly observations, the nurses were still regularly with me, both doling out my medicines, and topping me up through my cannula with antibiotics (one particular risk-factor with any implant surgery is (deep) infection) and with a blood-thinner (I should also mention that on return from surgery the previous day I found myself sporting a rather fetching grey/green pressure stocking on my non-operated leg).

With the cessation of the two--hourly checks, and having been disconnected from the morphine drip (though with cannula still in place), I was able to settle down quite comfortably and, despite the renewed efforts of "Mr. Snorer", I had a remarkably good night's sleep.

After breakfast the next morning, the mind started to focus on discharge. I had been advised on admission that, all being well, I would be discharged roughly late morning two days after my op.; to do so, four things had to happen - the physios needed to sign me off on use of crutches; I had to go to the Plaster Theatre to have a new cast installed; I had to have the cannula in my left hand removed; and I had to be prescribed and given the various medications I needed.

My brother had kindly agreed to make the trip down from Norwich to pick me up and, as luck would have it, he was able to combine that with the taking of his very final exam to qualify as a Flying Instructor in nearby Luton, so we anticipated he would arrive at the hospital at around midday.

At around 9.30, the bathroom called again, so it was out on the crutches again and, would you believe it, another member of the physio team chose that moment to come and (re)assess me, prior to sign-off. Whilst I felt steadier on the crutches than the previous day, he was still not especially happy so, after using the bathroom (unsuccessfully on this occasion), we did some practice up and down the ward - with some corrections to my technique I was soon moving along better and more securely. We then practised going up and down stairs, this time to immediate satisfaction. In my view, it is really worth spending time with the physio team making sure you are fine on crutches as this becomes crucial in the weeks ahead.

Literally as e stepped out from the stairs practice, there were two guys with a trolley to take me down to the Plaster Theatre, so off we went.

The team there first removed the existing back-slab plaster cast, and replaced it with an identical back-slab - i.e. the cast surrounds the entire foot and ankle (except the toes), and most of the way up the leg to just below the knee.

As I was to discover, the way to make a half-cast is to make a full-cast and then cut half away! So, the whole leg was duly plastered from toe to knee and then a gentleman with what looked suspiciously like a circular saw approached my leg with clear intent!! He assured me that it was a vibrating blade rather than a rortating blade, and, with a smile, that he had "never even nicked anyone yet". Thus reassured (!) he proceeded to saw off the front half (shin-side) of the cast, and finally the whole thing was over-bandaged.

Back on the trolley for another trip though the (very) undulating corridors of RNOH to arrive back at my bed, where shortly the delightful Normita, our Health Care Assistant, carefully removed my cannula.

Just about then, my brother arrived, so only one remaining hurdle before discharge, which was to complete the prescription and dispensation of all my medicines.

My medicine bag included :

 

  •     morphine sulphate - a strong pain-reliever (and controlled drug), which I fortunately have not had to use (and must return to my local GP for controlled disposal)
  •     dihydrocodeine - moderate pain reliever
  •     paracetamol - pain reliever
  •     senna - laxative
  •     docusate - stool softener
  •     enoxaparin - an anticoagulant (blood-thinner) used to mitigate the risk of DVT; in the form of an injection to be administered subcutaneously

I was asked to demonstrate that I could self-administer the enoxaparin injection, which basically involves stabbing oneself (gently) in the gut with a sharp but relatively short syringe and pressing the plunger - surprisingly UNpainful.

We then completed the final discharge paperwork before me being loaded into a wheelchair for the journey down to the carpark to find my brother's car.

Before rounding off this post, I really must stop for a moment to record my intense admiration and thanks for ALL the staff I encountered at RNOH during my stay - they are a dedicated team, all thorough professionals, who are focused on delivering the best possible medical care to their patients in an efficient yet caring manner. From porter to surgeon, tea lady to pharmacist, they were all cheerful, pleasant and above all communicative in a way which can but be reassuring to the patient.

If I were doing a "TripAdvisor" type review of my stay, and being particularly pernickety, there are two comments I would make. 

The first, which I have touched on before, is that the professionals of RNOH achieve what they do DESPITE the RNOH infrastructure, which is in dire need of refurbishment/replacement.

The second was the food. Whilst I am the first to realise that a spell with the NHS is not an invitation to a gourmet event, and although I am sure the food was nutritious, virtually nothing I had even tickled the taste buds and nor (probably back to the infrastructure) was it ever more than lukewarm.

Those two small points aside, my experience as a patient has been excellent, and I would thoroughly recommend the RNOH to anyone.

So, as I close this post, it's back up the M25 and M11 to Norwich courtesy of my brother. In my next post (probably tomorrow), I'll relate my experiences the first few days back home, including my review of the bits and pieces I've bought to assist my recuperation. 

All has been far from a bed of roses ..............!

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Me and my new ankle - five days after surgery (S+5)

Well, here I am again - at last; just looked back to my last post and realise that almost a month has elapsed since my last post.

I guess I just got so tied up in making preparations for my surgery, and especially in making sure that the home was as ready as possible, that time ran out and I was on my way down to the RNOH for my op!

i have a lot of information to pass on about my preparations for the op., the hospital admission and stay, the procedure itself and immediate aftermath, and my experiences since arriving back home, that I think I'll split it into two different posts -

In this one, I'll cover the period I was actually in hospital, from admission to discharge, and in the next will focus on both my preparations for being at home after the op. and the actual experience, particularly in terms of the various gadgets I decided to buy to hopefully aid/facilitate my recuperation,and my actual experience of using those items.

So, first,  the spell in the Royal National Orthopaedic Hospital in Stanmore.

I had been asked to check in to Admissions at 7.00 a.m. on Monday, 6 July for an operation that same day. I was subsequently told, in the week before the op., that my procedure would be fourth on the consultant's list, meaning roughly early afternoon. Having to travel from Norwich, I called admissions and asked whether I could be admitted somewhat later than 7.00 a.m., given the likely timing of the procedure, but was told in no uncertain terms that it was 7.00 sharp for everyone! Although this struck me as slightly bureaucratic at the time, I guess - having been through the admissions process - that I can understand the need to process all admissions at the same time, as it fits in with the rhythms of the wards.

So, an early start (4.30 a.m.) from Norwich; thankfully both the M11 and especially the M25 were very well-behaved for a Monday morning, and so we arrived just after 6.30 a.m.

Nonetheless Admissions was open and bustling, but I was processed very quickly and efficiently, gaining the first of two identifying "LaserBands" round my wrist. I was then asked to wait in the main reception area for further processing.

This is when my time in hospital took a departure from the experiences of most other patients waiting for surgery that day.

Partly as a result of my writing this blog, the foot and ankle team, on behalf of the TARVA trial, had asked me whether I would mind doing some filming during my time in hospital, to which I had readily agreed (hence my references to "becoming a movie star" in my previous posts). Well, I was certainly involved in a lot of filming, but it was yours truly who did most of the filming! The production team had decided that it would be more impactful (and more practical) to present the filming from my - the patient's - viewpoint. 

So, Jan Letocha, Film Director at RNOH found me in the waiting area and presented with a "go-pro" body-worn camera, which was to be my constant companion for the next 72 hours - I was wearing it all the time I was in hospital (except when sleeping and in surgery), and was filming what I was seeing all the rest of the time (except during bathroom breaks!!). I do believe we may be adding edited highlights of the footage to this blog.

Also, in the same vein, my surgeon, Mr. Andy Goldberg, wore a headcam during the operation, in addition to fixed cameras in the theatre (my understanding is that that footage will be used principally for training, but some bits of it may be included on the material available through this blog).

So, with camera strapped on and running, I was taken through to the surgery reception area, where I then shortly met my anaesthetist - Dr. Nadaraja. He explained to me what the team would be doing in terms of anaesthesia and pain relief (general anaesthetic plus nerve blog in the leg during the procedure, and morphine drip pump immediately afterwards).

i then met Mr. Golberg's registrar, Dr. Ali Najefi (whom I had also met at re-admission), who (re) examined my ankle and, to my great delight and relief, pulled out a black marker pen and drew an unmissable black arrow running down my left shin and pointing squarely at my left ankle. (I have to tell you that, despite my being an absolutely rational being, and having already built up considerable admiration of and faith in the team who were to operate, I had nonetheless considered using a similar marker the previous evening to mark my right ankle 

 "NOT THIS ONE!"

(In fact I must say that right through my stay in hospital, everyone was meticulous in carefully identifying me (name and DOB) on every occasion when they interacted with me "medically".)

I was also introduced by Dr. Najefi to Dr. Amana Ifie, SHO, a new member of the Foot & Ankle team.

Thus reassured, I was taken off by wheelchair to my ward (Jackson Burrow), and my bed (no. 15)

By this time it was around 9 o'clock and, having had it confirmed to me that I would not be called for surgery until at least 1.00 p.m., I had plenty of time to settle in. 

Having read the admission guide, and although I was on an open (male) ward, I was pleasantly surprised at the amount of space around my bed - enough for my two bags (one with clothes and "tech", the other with my (disassembled) crutches).

For those of you like me who have come to rely on tablets and mobiles, make sure you take your recharge cords with you, and either an extension lead or a multi-plug, as you may well find there is only one socket available to you.

My first bed visit was from the two day-shift nurses looking after me that, and when they introduced themselves I guessed from the name (Marcelle). that one of them might be French. She actually turned out to be from Brussels, and so I was able to resurrect my rusty language skills for a few exchanges then and subsequently in French, somewhat to the amusement of other staff on the ward. Marcelle turned out to be the life and soul of the ward, always smiling and joshing with her patients, so it's sad in a way to learn that she will be retiring at the end of this year.

I then met the pharmacist, and went through my existing and likely future medication, which was then locked away in my nightstand. I was also pleased to renew contact with Deirdre Brooking, the Trial Coordinator, who has been my main point of contact from the start.

It was now just about that time of day for a much anticipated cup of coffee, but with the dreaded NIL-BY-MOUTH writ large on my board, no chance of that (though I was allowed to drink water until a couple of hours before my scheduled time).

I then whiled away the time before my op. catching up on The Times on my iPad, and a couple of old comedy episodes of Yes, Minister and Only Fools and Horses. Just managed to get in my order for supper, and change into my hospital gown, before the men in blue arrived to transport me down to the operating suite.

As I said right at the beginning of this blog, I'm not particularly one for wearing my heart on my sleeve, and nor am I particularly introspective, but I must confess that - on what is quite a lengthy trip down to surgery - I did have one big moment of doubt, such that for a brief moment I thought of aborting the whole thing, but that quickly passed.

Once down there I saw the anaesthetic team, and then Mr. Goldberg came to see me to show me the operating plan (I researched this later and discovered just how technically sophisticated it is), and also covered a small issue that had been previously mentioned - some cysts which had showed up on the MRI scan and which he explained would be filled to hopefully avoid any subsequent problems.

Then the anaesthetists started to ply their trade and .....................

woke up about four hours later (I think) in the ward (I think) feeling quite "woosy". I guess one fear most of us have in relation to surgery is pain, but with the anaesthetic and the nerve block, I felt nothing then and, mercifully, for the rest of my time in hospital (and nor, touch-wood, up until the date of writing this piece).

Managed some water and a cup of tea, only to find I had quite a sore throat (I believe I had had a tube down my throat during surgery). Nonetheless, and feeling quite hungry, did manage to demolish my pork sausage and mash, and subsequently a cup of coffee, before "lights out".

During this time, I am having my BP, pulse and temperature taken every two hours, and being given regular feeds of medication. I was given a morphine pump on a drip to use for pain if I needed it, but thankfully I didn't.

I think this has become quite a long post already, and there is a lot more to tell of my time in hospital, so I'll post this one now, and do part two of my hospital stay in the next day or two.

As a final point, I had been a little puzzled - despite the number of views of my blog - at the total absence of any comment. Well, mystery solved. I did finally have a comment from another individual awaiting a TAR, and she told me that comments are apparently restricted to those having a Google/Wordpress account, which I guess most don't have - I'm going to see if I can resolve/correct that tomorrow.

So I'll leave you at the point I was drifting off to sleep the night of my surgery.

Hope to see you here again soon!

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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

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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 - 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

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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

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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

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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

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Ankle surgery here we come - 67 days to surgery (S-67)

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

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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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Ankle surgery here we come - 80 Days to surgery (S-80)

If you've ended up at this blog, then I guess it's because you have some interest in ankle surgery.

My name is David Shaw, and I'm going to have ankle surgery quite soon.

I need my surgery as a result of end-stage osteo-arthritis in my left ankle. My surgical options are essentially either a total ankle replacement (TAR), or an ankle fusion (arthrodesis).

Right at this moment, I don't know which procedure I will have (see below and next blog for explanation).

My journey towards my ankle surgery started some 18 months ago and, along that journey, I've found it quite difficult to find two things in particular :

  • detailed, preferably research-based, data on patient outcomes for ankle surgery in general, and specifically for relative outcomes for the two options
  • patient accounts of their own experiences both in the lead up to, and the aftermath, of the operation itself

So, as I have today just been given a confirmed date for my own surgery - 6 July 2015 - I thought I would start this blog with the aims of :

  • creating my own diary of the experience
  • giving an account, useful to others, of the whole journey up to and past surgery - as well as the obvious...... how was the surgery/how is the pain/when is the cast/boot coming off/when can you start walking again etc. - also an insight into some of the day-to-day practical issues associated with preparing for and managing after ankle surgery
  • creating a forum where interested individuals can ask questions and share their own experiences.

It is my intent to publish regular updates to this blog (aiming for two to three a week), both in the lead-up to my surgery, and for perhaps a year thereafter. I will endeavour to give both a medical and practical account of my experiences and - although I guess I'm a typical "stiff-upper-lip" Englishman - I will try to share with you some of my feelings and emotions on this journey, which I must say, and despite all the information I have acquired, I approach with not a little trepidation.

To round off this very first post, let me tell you a little about myself, and also a brief history of how I've arrived at where I am today, so far as my ankle is concerned.

I am 62 years old, and I have a home both in Norwich in the UK, and on the Costa Blanca in Spain, and we (my wife Barbara and I) divide our time between the two. I retired just under two years ago, having spent almost 40 years in a career in Human Resources, mainly in the Banking industry.

I have enjoyed pretty robust health for most of my life - the only previous surgery I have had was a tonsillectomy in 1975. I have played a lot of sport, and have been an active gym-goer over the last 15 years. Notwithstanding that, I am currently significantly overweight (though see below and next blog in particular).

The months after my retirement were incredibly busy, and quite physically demanding, especially in establishing our second home in Spain, and I spent the whole of the summer and autumn of 2013 on my feet doing DIY or gardening all-day-long.

In late Autumn I noticed that I was getting significant and regular pain on both sides of my left ankle; I put it down to tendonitis (which I'd had before), and went along for some sessions with a physiotherapist. That treatment did provide some symptomatic relief, albeit temporarily, but during the third or fourth session the physio - based for sure on his experience - advised me to get an X-ray of the ankle.

When I showed him the X-ray at our next session, whilst being reluctant (not being a physician) to provide a diagnosis, he nonetheless strongly urged me to consult an orthopaedic specialist. Based on the X-ray and an examination, the specialist made a preliminary diagnosis of osteo-arthritis, which was confirmed by a CT scan.

Faced with that unwelcome news, but armed of course with the internet and Google, I did a great deal of research, mainly into non-surgical management of the condition, and resolved to give myself 12 months to see whether I could manage the condition without resorting to surgery.

This included :

  • weight loss (mostly unsuccessful until recently - see next edition),
  • shoe inserts - fitted by a podiatrist, these initially gave me some cause for hope, but I could only use them in certain footwear, which meant I couldn't/didn't wear them a lot of the time,
  • strapping, with some quite sophisticated ankle braces - I found very little benefit from this at all,
  • cortisone injections directly into the ankle joint - these did provide significant immediate symptomatic relief, including reducing the considerable swelling I was experiencing all around the  ankle; however, that relief (and reduction in swelling) proved transitory (say a couple of weeks), and it is not recommended to have these injections more than quarterly,
  • and, of course, dropping far too many pain killers - both conventional (e.g.paracetamol) and anti-inflammatories (in my case initially diclofenac (Voltaren), though I have subsequently been prescribed etoricoxib (Arcoxia) which I have found to be far more effective),
  • modifying my lifestyle

The last of these proved to be the most effective at managing my condition and the pain associated with it, BUT (and it took a little while for this to dawn on me), I ended up modifying my lifestyle to such an extent that the end result was unacceptable. My great love of golf proved almost impossible to satisfy, certainly not walking the course and, even with the aid of a buggy, I would pay for it afterwards with three or four days of increased discomfort. Working in the garden, which I love, became a painful and uncomfortable chore, especially since I now found walking on any sort of uneven or sloping ground something I approached with great trepidation.

I suppose my "light-bulb moment" was last (2014) summer. My wife and I have been very fortunate to remain close friends with a group who got to know one another at University some 40 years ago, and a dozen of us try to get together at least once a year for a "reunion".

Last summer we rented a most delightful villa in the middle of the Tuscan countryside but, after our first visit to one of the many splendours of that part of the world, I realised that I was proving a drag (almost literally) on the rest of the group when walking around sightseeing. Rather than face that, I spent the rest of the week, albeit agreeably, relaxing around the villa, but feeling guilty both towards my friends but especially towards my wife who had nobly elected to stay with me.

Having resolved that I could/would not tolerate this any longer than necessary, as soon as we arrived home, I started researching surgical treatment for my condition, which is when I first came across mention of the TARVA (Total Ankle Replacement v. Arthrodesis) trial. (If you have come to this blog via the TARVA website, then you probably already know something about TARVA; if not, and rather than repeat their excellent information, can I refer you to their website ( ankle arthritis.co.uk ).

The TARVA trial appeared to offer me the chance to explore options for surgery for my ankle osteo-arthritis and at the same time participate in an important piece of research (which will hopefully fill one of the knowledge gaps I found when first considering surgery).

So, I spoke to my GP in Norwich and arranged to be referred to the Royal National Orthopaedic Hospital (RNOH) in London (my nearest centre in the initial stages of the trial). After a short wait I received a letter from RNOH confirming an appointment in early January 2015 with Mr. Andy Goldberg, a foot and ankle specialist consultant at RNOH who is also the Lead Investigator for the TARVA trial.

So, my ankle surgery journey begins.

In the next blog I will relate my initial interaction with the TARVA trial, starting with my initial  appointment with Mr. Goldberg and bringing you up to the present day. I will also explain in more detail why I don't yet know which operation I will have.

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