Inchoate

Two years after the fall

Posted in: Injury Time

It's coming up to my two year anniversary of ending up with a bilateral calcaneal burst fracture, that is, shattering my heels falling off a house. Prompted by an email asking how I am now, I thought it was a good time to jot down some thoughts two years down the road.

The good news is that over the last year it's improved to the point where its effect on my day-to-day life is pretty minimal. There are only very subtle giveaways that I ever had the accident, like occasionally I stumble sideways (because my capacity to press on the insides & outsides of my foot are much less as my subtalar joint is much stiffer) but this is pretty rare. I try to avoid standing upright for long periods as this becomes uncomfortable as well. That said, I never liked standing--dread memories of working in a photography shop still haunt me decades later--so this isn't all the heels.

The bad news is that every morning and sometimes if I've been on my feet for hours, e.g. walking around the house cleaning, my feet ache. They overall feel weaker too. I am constantly reminded by the background pain of my mistake falling off that house. I imagine this will be with me to varying degrees the rest of my life. My main hope at this point is that it doesn't get worse; so far it's been getting better.

On a positive note, here's some examples of what I'm doing with my feet these days:

Walking. I can walk for hours now, especially with MBT shoes. Actually these shoes are a real boon for me and I'm ordering more so I'm not always wearing red... I am still limited by walking. Recently visiting Prague there were a couple of times where hours upon hours of sight-seeing took its toll and I was suffering. An excellent leg & foot massage helped dramatically though.

Hiking. Over the Easter weekend I volunteered to drive a bus around Ireland on a "4 peaks" type of challenge. The loons who were doing it cranked out four "mountains" in less than two-and-a-half days so were sleeping in the van. On the third one in Killarney I hiked with them for about three hours on the gentle early part of the slopes. That was enough although I wasn't hammered and my feet/joints didn't hurt too much later and the next day.

Running. I have had a recent pleasant surprise with running. Some background first: I never much liked running as a sport so not being able to really only impacted my being late for the occasional bus/plane/train. In the last two years I have literally run for a total of about two minutes, most of that one time in an airport. Just recently however, at work there's a timed "gym challenge" that involves a bunch of body-weight exercises (push-ups, sit-ups, etc) plus, for the Gold challenge, a 2km run. Being the competitive type this tipped me over the edge to try running again, and 2km isn't that far so I figured I'd see how it went. The first time I did it I was going at 12km/h for 10minutes. I've done it once more since at 14.2km/h (8:30). I have no intention of training any more than I have to to win this, but I know have to get at least 18km/h which is reasonably quick.

Each time I've run like this my feet ache somewhat the next day and I cannot walk around totally comfortably.

Overall if regular longer-than-sprint running is a necessary or desired (you freak! :-)) part of your life and you break your heels badly I'd say you're screwed. Find something else to do. On the other hand, it seems like despite a serious heel fracture I can run for short distances at a useful speed, and go about my life including some competitively athletic pursuits like rowing for the most part unaffected. So, considering I was so close to being paralyzed, not a bad result at all!

Sub-talar joint strength

Posted in: Injury Time

Look Ma, no hands!
(This is on my right foot which had the surgery. My left foot can do this relatively easily.)

Woohoo!

The act of balancing on a beam (or kettlebell in this case) directly targets the subtalar joint, the one that got hosed by my climbing antics in both my feet. Still a little unsteady as you can see by the blur but I was holding it up there easily long enough for the 10s camera timer to fire. It's also on a slightly long exposure so any wild waving around would've been caught too. But there wasn't any! Well, ok, not much ;-)

Discharged from physio

Posted in: Injury Time

At 08:25 this morning my physio decided there wasn't much more she could do for me long-term and that I was fit to take care of my own care.

(The irony of being up at 2am the night-before-starting-work doing experimental cooking with tabasco, popcorn, and whisky wasn't lost...)

I'm at a stage where I can walk pretty much like a normal person biomechanically. I say "pretty much" since I still have to avoid full heel impact so there's a bit of difference in my gait in that I tend to land flat-footed. It's also still uncomfortable walking generally so I try to avoid long distances. That said, with the aid of some mulled wine I managed to stay on my feet for much of the day during Santacon this year finally needing to be carried across a bridge after about 7hrs or so.

So my discharge form physio has occurred seven and a half months after my original accident. What's been interesting over the last few months is that each time I've been into physio I've had the impression I haven't improved too much and then when I've done the reference exercises it's clear there has been some improvement, sometimes marked.

For the physiologically curious, those references exercises are as follows...

They're all done barefoot with clothing rolled up so the physio can see what's going on. They're also all later-stage recovery, when I was actually at a point where I could physically attempt them.

Walking: initially this was on a padded mat and then hard wood gym floor. This shows basic biomechanics, gait, etc. As I've noted in previous blogs walking is actually one of the toughest exercises. We can get robots to ride bicycles but not walk, at least particularly well.

Standing on toes: strength test for calves and plantar fascia (muscle running along bottom of foot). There's some, we think, impingement of a tendon under the ankle bone on my right foot when my foot is (plantar-)flexed which causes a sharp pain. This is the only remaining sharp pain and only seems to manifest in this exercise(!)

Walking on toes: the physio is watching for strength and coordination to see if I can keep my foot flexed with all my weight temporarily on one foot. I can do this no problem now on my left foot and somewhat with my right. My bone structure's changed enough in my right foot that I cannot fully flex my foot any more anyway. My career as a ballerina is over!

Walking backwards on toes: more strength and coordination test.

Bouncing and jogging on a trampette (small trampoline): a more dynamic test. Good for active recovery too; I had this prescribed in my advanced rehab courses (which embarrassingly I only showed up to one of).

Today I could do all these quite easily. Woohoo! No more hospital until my year review in June.

Three month check-up

Posted in: Injury Time

This morning I went to visit Mr Klinke, my foot surgeon, at Guy's to have him check up on my heels healing. It's hard for me to summarise these meetings as in a sense nothing really happens, yet it does. He looked over my feet, twisted and turned them and generally seemed happy with their progress. We talked about how I have trouble walking and landing with my heels first due to the damaged heel pad - it feels like I'm walking on bone if I don't have my insoles in. Instead I tend to walk flat-footed. There's persisting nerve damage around the back right of my heel where the knife went in. No substantial impact besides occasional bizarre and entirely illusory neural reports of excess heat, or being cut at.

He made a comment that the long-term effects of bone/joint damage are worse than strokes or heart attacks. While strokes & heart attacks have an acute effect, and sometimes leave damage (e.g. partial facial paralysis) their perceived effect tends to fade and be assimilated into one's background senses. Whereas, say, my calcaneal fracture damage, it's constantly there, constantly reminding, every footfall, every time I wake up, every time I stand to go for a piss, every time I play footsie under a table. Eh.

Klinke said I need to avoid impact sports or long duration work on the joint, such as hiking or distance walking. I don't feel any particular loss about those as I never really enjoyed hiking and have spent considerable energy in pursuit of avoiding walking (for me, an inherently time-consuming and dull activity).

It's weird to think though that a decision about getting into a house one early morning has now effectively prevented me from finishing learning front and back flips, an incredibly fun move I almost could do without support in gymnastics the month of my accident. I'm just not going to be able to do them. End of story. Better luck after the reincarnation. Perhaps I'll come back as a dolphin and end up performing in a zoo to make up for it. That would probably be quite fun.

So I'm back in hospital on June 14 2006 which will be 13 months after the accident, and the time at which the recovery will have essentially be finished. At that point further surgery could be possible to trim down the jagged bone in my heal. Here's hoping it sorts itself out on its own...

Proper actual walking

Posted in: Injury Time

Today for the first time I have been walking around the house in ordinary shoes (trainers) without use of crutches or any other support.

As it happens, it was the same shoes I had on when I fell three-and-a-half months ago. It was a bit of a squeeze getting into them but I managed it and they feel fine now they're on. It was an odd melancholy moment putting on these particular shoes, whose inshoe and heel was subjected to, and transferred enough of a force to burst inch-thick bone. The shoes seem OK :-)

Quite surprisingly, I'm not shuffling like I was a few days ago, and have been making a reasonable approximation of normal walking gait. Even took myself off to the grocer's. My heel pads were starting to hurt a bit later in the evening.

Overall though, very encouraging!

Final mid-term surgeon visit

Posted in: Injury Time

Just back from Guy's Hospital, my third post-operative check-up. The usual round of xrays and commentary from Mr Klinke (my surgeon) provided this frank Germanic assessment.

K: Ah, they're looking quite good. Me: Like normal feet again? K: No.

He went on to explain that they're healing well and that for three months post-op they're in good shape. OK, perhaps "shape" isn't the right word as both my heel bones were mashed to pieces, some of which still jut out here and there, and half a dozen screws and a piece of honeycomb mesh puncture and perforate my right foot. He thought the mobility in my right foot subtalar joint had improved. Which wouldn't take much since it was practically seized last time he saw me.

I've been directed to start walking without the Aircasts whenever possible. After his rebuke last time I coyly admitted to having already done this "a bit" but thankfully my confession didn't draw any stern admonishment this time...

Next appointment's in three months, by which time I'll doubtless be drawing accolades in international breakdance competition, and effortlessly somersaulting ticket barriers...

Back in the gym...

Posted in: Injury Time

Since leaving Leytonstone in Dec 2003, I haven't had a gym membership. Early 2004 I just slacked but then through Karen I discovered kettlebells which pretty much took care of strength, endurance, and fun. And since I could do them at home I actually trained more often and got stronger, fitter, and had more fun.

So my local gym has a pool which was the clincher in signing up - and boy, was it good today. It's 1.2m deep the whole length which is a bit weird but meant I could do little calf raises with most of my weight supported. I think I gave my feet a useful, functional workout. They felt sort of "cleaned out" after the swim and bouncing. Also a sign of progress (in particular how much weight my heels can directly bear) was that I got to the pool barefoot with only a crutch.

A bit disappointingly the gym is one of those "no-one talks to anyone else" jobs. I've been to a couple of gyms where there is a social vibe (e.g. Gold's, Monterey, CA--almost 100% men) and it's 1000x more fun. Bucking the trend I ended up in a long chat with another guy in the pool who'd had a car accident and taught me a rehab move with the floats. I taught him how to make veggie broth, although whether that's a good thing for him, hard to say ;-) Mmm, swamp water.

I did an actual weights work-out too. That was quite odd, I really haven't done that for ages. I'm pretty sure I'm lifting heavier weights than I used to but with those complex, abstracting, space-age machines it's hard to tell. 60% down stack on bench press. Keeping tight logs now so curious to see how it changes... Ah, such a geek.

Strida saviour

Posted in: Injury Time

Mum came to visit and she very kindly signed me up for a gym membership. She took this pic after we got back. It's fair to say without this bike I simply wouldn't be getting around nearly as much; it's too painful to walk long distances, and any other type of bike would be harder to use on transport. (Brompton might be OK. I think they're another 3kg. With my feet the Strida's 10kg is perilously close to about as much as I can handle anyway.)

NB Green belt sling for the crutch. Yay for little fold-ups!
PS Today is the 3 month Landing From A Great Height Anniversary, phew...

Physio session

Posted in: Injury Time

Had an hour with a senior physio at St George's who did a full assessment. In practice, this meant him taking a thorough description of my various aches and pains. It was quite a strange exercise as for each one I had to rate it 0-10, 0 being "no pain" to 10 being "worst pain imaginable" along with a description of the pain -- specific, dull, ache, pinch, stab, ... There were about half a dozen or so things I could identify still causing me discomfort (4/10). An elderly lady in the next booth was having real social difficulty with this "oh, I hate to sound like I'm complaining...".

I am a pain, not a number!

The pain scale was tricky. 10, "worst pain imaginable", doesn't seem in my mind to have a limit. Try imagining that pain, and what it would take to inflict that pain. Now, double that. I bet you can. Double again. And again. It doesn't seem to end. Needle in the foot not painful enough? Heat it up. Still more? Try twisting it back and forth once you've hammered it into a joint. Still more? Pull it in and out so the cartilege and tissue are perforated. Still more? Jam it into the bone. Still more? Apply an electric current. Still more? Turn up the voltage. Still more? Change the voltage so it pulses. Still more? Increase 'til the current is causing the surrounding flesh to burn. Once you're foot's done, move onto your knee, nose, eyeball... Needle worn out? How's those thumbscrews and pliers doing.

There was a documentary on TV recently about people who have woken up in surgery and been without pain relief but unable to signal it because they're still paralyzed. Their descriptions were horrifying. A couple of them reached pain levels so high they just passed out. So I suppose there is a limit.

Apart from the sympathetic pains, destruction of karma, and conscience, torturing someone must be about the easiest job, limited only by creativity and sadistic cruelty.

Where was I.. Ah yes. So after some mild prodding and poking Tom essentially thought I was ready for some functional/proprioceptive rehab but was hesitant to do without clearance from the surgeon. I'm so ahead of schedule in my healing, and he could see that and wanted to capitalise on it, but at the same time was worried that I only had surgery two months ago...

My right foot is quite damaged. The talus bone which sits between the bottom of the shins and heel has really thickened up, a normal response to bones breaking ("it'll repair stronger than it was to start!"). Great, except for the fact it could be a while before I can fit the damn thing into my shoe collection... That excess callous bone build-up will recede over time but it takes ages.

My calcaneus/heel has also set at a slightly tweaked angle. I'm not sure if it was like that before though; I do have some minor asymmetry in my feet/leg mechanics.

Eh, the fat lady's not singing yet... And thank goodness I'm not a runner/construction worker/long jumper...

Round up

Posted in: Injury Time

Gosh, over a week. Some notable events:
* Thursday, first time on the Tube(!)
* Apparently got hooked on transport using it Fri, Sat, Sun too.
* Lovely trip on Mat's canal boat documented by him on travelog. It was a very lazy afternoon and I met some cool people. Yay Mat!
* Discovered the flute has very similar fingering to a saxophone, so bought one of those too. My god it is so much fun! And loud. And fun. I've wanted to play one for ages; why the hell didn't I just freakin' get one?! Anyway, after a breathless sax session I went back to the flute and managed to sound a bunch of the tricky top register ("altissimo") notes I couldn't before. I hope sax+flute turn out to be complementary to learn together.... (Started inline skating and ice hockey together years ago and came to the firm conclusion they are not complementary.)
* Cycled on the Strida fold-up to physio at St George's (4km) today in ordinary shoes. Strapped a belt around me as a sling for the crutch. I only need one crutch now for short distances. More on the physio at some point. I swear I was born to be on wheels - it felt 100% smooth, zipping about, up hills, down ramps, ... Once I'm off the bike I'm immediately reduced back to a shambling wreck again.
* Cheered by the success of using the fold-up, embarked on a mission this afternoon to Richmond Music to get my sax checked out (only a minor tone hole fix needed). Richmond Music were very helpful indeed. The journey: I took the Tube, and had with me: the fold-up bike, an alto sax, a left crutch, two feet in casts. It's a rock 'n roll lifestyle, baby.
* Interesting observation: number of men who spontaneously offered me help (I blatantly needed it): 6 or 7. Number of women: big fat zero. It was during the day and there were more women around. Cutting it on another axis, all my helpers were over 35, and there were plenty of younger people around.
* Weather's fantastic!
* Woo!
* The sax is really fun, did I mention that?

Walking, for real

Posted in: Injury Time

Last couple of days I've been out on crutches, probably about a kilometre there and back, and then the day after that cycling at walking speed alongside a friend on foot. Cycling is actually far easier than walking and more controlled both in terms of graduated effort and random incidental forces, especially on a little fold-up bike. Both resulted in me back home with feet in ice water, in a tired-but-OK way.

Today I was in hospital for routine x-rays and my surgeon twisting my feet about. He couldn't induce any pain which was good, and the only specific pain I've been having I couldn't even reproduce either. Radiographs showed everything fine too. I took a bit of heat for having walked around without my boots on though, oops. Eh.

Well aaannnyway. Today, quite out of the blue, I can walk in Aircasts completely unaided! Not just teeter about like an early Segway prototype but actually stably move around (garden, kitchen, hallway, etc) without any substantial discomfort. Wild! The healing process definitely seems non-linear. This last ten days or so it's felt like there's not been much progress: Monday I'm still struggling on crutches. And then Wednesday *whoomph* I can walk. w000t!!

Walking, kinda

Posted in: Injury Time

Progress since my cast came off about ten days ago has astonished even me. Last week's two outings into the city to Optronica helped find, and quite honestly step over, the boundary of what I'm capable of then, and set a benchmark. Since then it's been solid daily progress.

And I'm loving the opportunity for all this guilt-free sleep...

Wednesday, less than a week after my cast was off, I came out with crutches and ordinary shoes--no Aircast support boots. 200m felt like a 20km hike, and I ended up in a restaurant with my feet in ice. Well, you don't know the limits 'til ya step over 'em :-)

Five days later, i.e. today, I can almost walk unsupported in ordinary shoes. My right crutch (only!) has to touch down during a small phase of the movement. I look like someone walking rather than someone fiercely concentrating on coordinating four limbs and staying upright... Earlier I got up the stairs without crutches at all, hanging onto the handrail.

I can bear all my weight on my left foot, standing. This is three weeks ahead of schedule. Exciting stuff - I have been visualising hard on walking unaided to my next surgery appointment next Wednesday. I'm tantalisingly on the point of daring to believe it might actually happen.

Limiting factor in terms of biomechanics at the moment isn't my heels oddly enough but the tendons running alone the bottom of my right foot, and (thus?) flexibility in my toes - the time in a cast has clearly allowed them to fade away. Of course, the whole foot gets tired -- the 20km hike effect. They're lasting more and more each day though! Woohoo!

Osteopath visit

Posted in: Injury Time

This afternoon had an hour with Ratna the osteopath at the Vitality Centre up the road. I wasn't sure what to expect and it turned out rather well.

After some background history she set about with a calf massage to help wake the muscles up, and then a back massage which included some single needle acupuncture. I've never had acupuncture before - it was painless and worked fast. Within about 5-10min of massage + acupuncture my back had demonstrably released. She showed me this midway by running the side of her hand down the side of my spine on both sides: the side she'd worked on felt internally smooth whereas the other was still knotted and rippled.

There were a few spots on my back where she was doing the work - this is apparently a sign of stagnation and toxin build-up, the body trying to expel it through the skin. Curious to see if my back is still spotty in a few days...

She repeated a similar exercise with my two ankles and feet. Bizarrely, the usual discomfort I have with the partial numbness and ultra-tenderness around the surgery cut was about nil. Good hands! The acupuncture was, hmm, less unpainful on the right - definitely conscious of the needle entering the swollen tender skin. Wasn't quite as far as discomfort though, so no big deal. Afterwards I could see the tendons running alone the top of my right foot where I couldn't before due to the (now gone) swelling. Considering that was about 20mins, a dramatic reduction! I asked whether I could've had this procedure even a few days after the accident and, with surgeon approval, yes. Wonder how much of that 16days before surgery could've been eliminated? I just had no idea such a thing was possible.

She told me it was rare for someone to effectively just come in off the street and take osteopathic treatment this early after surgery, as I did. More usually she sees people months down the line disillusioned with physio or still needing help. Maybe my physio did me a favour in disillusioning me so early in the process :-)

I've been told to drink lots of fluid after the treatment (I had some of Ratna's broth) to help clear the toxins, put my feet in cold water (doing this now - too cold, ouch!), for up to five mins each, swap, repeat, and massage daily between my toes which is connected with the lymph system.

Overall, worthwhile £40. Will do business with again A+++++

Upright!

Posted in: Injury Time

Snazzy, molded-grip, bronze pimp canes came today:

Upright for first time since Friday 13th

I donned both Aircast boots and headed into the garden. Trickiest bit with crutches seems to be when it's all going wrong (i.e. more or less immediately) the reflex, despite not using my feet for eight weeks, is to transfer all my weight to my feet, off the crutches. Which is obviously exactly the wrong thing to do. Still, managed to shamble around outside and even up the ramp into the living room later in the day. In the evening I was a little more coordinated and wearing a shoe on my left, un-surgery-ed foot: it held up fine.

Mum found this article on calcaneal fractures. I find reading these kinds of text tough: difficult to face the likely reality ("few people go back to high-impact or contact sports") but useful for learning what to expect, and whether I might be doing something too early.

All very promising though!

Foot free at last

Posted in: Injury Time

Yesterday my fibreglass cast was sawn off, and the pins pulled out, and I was given another Aircast boot for my right foot, and my physio is my local hospital where the lovely Dawn is training, and I went to the theatre yesterday, and they upgraded me and Adrian to a box seat which I've never been in, and we felt like royalty, and then hung out with and made new friends at the Hayward Gallery, and even got a lift home with two of those very nice new friends, and, and it was all great! Even being stuck in traffic in the morning rocked as I was in a car, seeing buildings and trees and people and stuff.

Phew...
So anyway, my new boot is a size "large" as my foot simply now is bigger than the left. Not exactly sure why, but all the screws and plating might be a clue...

Pic below. Owing to a beginner mistake with my video phone I managed to get it to not take any video of the pin removal which has unfortunately "deprived" the world of seeing my surgeon pull out, with rather gnarly-looking medical pliers, the two 10cm/4" rods from my foot. Which was a shame as his commentary as he tugged the pins out was quite amusing.

All this was done without anaesthetic. He grasped my foot with his firm, sturdy, confident surgeon's left hand, got a solid hold of the pin in the pliers and pulled. And pulled. And then ... ssscchlick it came out immediately followed by a two foot pulsing stream of blood from my anxious pounding heart, liberally spraying the floor, splattering ... No, just kidding. There was some blood but nothing a thick lump of gauze couldn't staunch.

(taken a few weeks ago)

Oh, and then the other pin. My macho points will have to stay as they are, as the whole experience was completely painless even while he was pulling.

My new foot:

It's a big relief. I feel like I'm a bit more in control now too as I'm responsible for its recovery beyond just diet and not stubbing my toes. I had a proper bath too, without the huge cast "sock". Lots of baby oil and soap to remove the layers of dead skin, and I have a shiny new foot! (And going straight to bed after a baby oil bath is never a bad thing...)

The heel is still numb in places, or responds to touch/pressure oddly. More disturbingly, at least for now, is that my little toe motor nerves seem to have been cut/damaged so it can't flex down (as though pressing a key on a piano). It can flex to the side, inwards, but not down. I really hope that comes back! Especially since once of my party tricks was being able to move my little toe independently from the rest. Actually, I've never demonstrated that at a party. But I might want to!

All the joints and tendons are stiff as hell. It's a little more than barely mobile. Well, that's 6wks in a cast + surgery I guess.

Assuming the Royal MFail can do their job, I'll have my crutches tomorrow. They're bronze. Exactly like pimp canes. I'm going to stick plastic diamonds on them.

Make me some money, ho!

Next hospital trip: Thurs 14th

Posted in: Injury Time

Bunch of us got confused last time for a meet-up so posting it here for ref: Thursday 14th July 2005, Guy's hospital, orthopaedic dept.

This time the cast is coming off, and the pins removed too. This won't need surgery: rather the surgeon will apparently tug them out. Looking forward to that; life's been a bit boring on that front recently without regular stabbing pain.

My troubles are nothing to this guy: Danny Way, skater extraordinnaire, has knee surgery, fully conscious. Great quote: "I can feel it." Yeah, wonder if you can smell your own marrow cooking as the drill bores through your bone? Mat Hoffman, equally if not more insane on a BMX, gives a horrifying description of this kind of surgery experience in his book.

Check out Danny Way's recent stunts, including on Saturday 360'ing the Great Wall of China. "Jump 2" video you see right down the on ramp. Wild. (The guy's almost identical age to me as it happens; another Aries Wood Tiger.)

[Thanks to Nik and Chris C for the Danny Way heads-up.]

Double trouble

Posted in: Humor, Injury Time, Language

Came up with this just now in an email conversation... What do you call it when you are invited to several things across town but can't make all of them 'cos you're in a wheelchair? You're "cripple-booked".

*keels over*

Early "steps"

Posted in: Injury Time

Last couple of days something interesting happened - I've got this strong intuitive feeling, reassuringly backed up by lack of pain and discomfort, that my left foot's ready for a bit of gentle reintroduction into the realm of carrying me about. I've been giving it, and it's been standing (as it were) a lot more manipulation/physio recently. I've been going up and down stairs and sleeping in my own bed (woohoo!) which has given me another chance to gently push my weight up through my toes with static support from the rest of it. It's still mostly my arms doing the work but my left foot is definitely in more than a cameo role now.

The limiting factor in much movement 'til recently has been pain in my heel. As revealed by last week's xray a bit of bone fragment hasn't quite set right in my calcaneus (heel bone) which has caused pain under any pressure. Like I say, until recently: I have gingerly applied pressure through my left foot AND heel in the last couple of days, and it's taken it. Great!

And then... today easing very carefully out off my swiss ball, I stood up. It was brief, and it was unsteady, and I had my hand very definitely hovering right over my desk, but goddamit I stood!

Gonna give Ratna the osteopath a call and see what's up this week too. Hope I can get crutches soon. And ten days til right foot cast comes off...

New cast and forecast

Posted in: Injury Time

Went to Guys' for an orthopædic assessment all morning. Had my left and right feet xrayed, old splint/half-cast removed, four week-old blood and sundry skank cleaned off, and a new fibreglass cast fitted, in fetching Forest Green no less. I was only originally slated to have my right foot xrayed but a bit of social engineering and induced cross-departmental confusion had my left foot done too.

Surgeon (Martin Klinke), reassuring as ever, is happy with my left foot and its mobility, and reckons my right foot needs only another two weeks in a cast before it and those two scary pins come out. That won't need surgery mercifully, they just pull out, although I hear worryingly more like 'tug' than 'pull'...

Left foot will probably be ready for weight bearing within the next two weeks. I have already tested it and put in excess of 35kg through it (as measured by my scales) using the Aircast boot. Still bits in there that are hurting though.

The new cast is much more comfortable than the old splint - I can lean on it without the thing shifting about. Psychologically a relief as before this I was a bit clueless about what was happening. Sensation in my right heel is coming back, although the manifestation of this is occasionally stabbing pain. C'est la vie, eh?

Meeting people story: I've come to accept that when I walk out the house I seem to bump into someone I know. This even happened the first day I left St Thomas's, meeting an old friend from A-Level's within about an hour (she works in dermatology there). Well, it sort of happened today too: the woman who was in my hospital-taxi at 8:55am ended up in the same car as I was at 1:35pm. What are the chances?

The other foot...

Posted in: Injury Time

Since a few people have asked me this - my left foot is "being treated conservatively" which means they're not taking a knife to me, just yet. There wasn't enough bone as I understand it to do much in the way of pinning anyway. Since a couple of weeks ago I've been doing physio on it and it's moving around much as a foot ought to albeit it slowly, with less range, and with discomfort at the limits of its movement. No weight on it yet, altho' I'm sneaking a bit here and there...

I have something called an Aircast PneumaticWalker, a robocop-esque lower leg brace that includes inflatable cells to support and provide compression. Apparently this compression increases venous pressure, i.e. constricts the veins so the blood shoots back faster which encourages osteoblast (bone precursor cells) adhesion. Read the instructions for more. I'm not at a stage where I can walk with this yet, I just wear it at night to keep my foot at about 90° to prevent calf tendon shortening. It's often really uncomfortable - it gets hot and setting the right cell inflation pressure is an art form. Several times woken in the early hours with a strong desire to tear the thing off...

Probably have another xray of both feet in a week or two's time to see what's what. As soon as I can start to bear weight on my left foot I get to use crutches.

Foot redressing

Posted in: Injury Time

Earlier this afternoon popped down to Southfields Group Practice to complete the registration as a new patient and do various nursey things. Notable events were using Mo's super slick wheelchair she lent me to get there - quite fun and good little aerobic workout. Other one was having the dressing on my foot changed, and stitches removed. Whilst wincing I took some camera-phone pics. If you don't like the sight of metal protruding from flesh and 10cm stitched-up slices do not proceed... (I don't particularly but didn't have much choice on this occasion :-)

I had thought that the people who put on the cast after surgery had done something clever with it so that my damaged heel wouldn't bear any weight, like have the force transferred to my calf or other part of the foot. Actually it turns out, having briefly been able to touch it directly, my heel is mostly numb. The random hot flush pains around there I've been experiencing recently I'm hoping like crazy is evidence of nerve regrowth.

Anyway, on with the show...

At this point Clare took the sixteen or so stitches out. Apparently some pretty hardcore needlework was employed in their making which didn't make her life any easier, and certainly gave my pain receptors plenty to talk about...

Stitches removed

Ta da!

New wheelchair!

Posted in: Injury Time

Thanks to the lovely Mo (and Guy, who helped tweak it for me) I have on loan one of her wheelchairs. A wonderfully smooth, light, high performance one to zip about on. How smooth, light, etc? As much as £2,500 buys of carbon fibre, aluminium, squishy gel, and custom engineering. It is really nice.

One useful move is being able to under reasonable control get the front wheels up while rolling to mount kerbs or small heights. Especially with this chair as its front wheels are tiny (it's intended for indoor use, so minute turning circle). Entertained myself learning to do this and can now even roll and turn on two wheels.... The irony of ending up back in hospital having fallen out of a wheelchair hasn't escaped me :-)

At home, at last, part 2

Posted in: Injury Time

Saturday afternoon... ambulance rolled into Hamilton Mews and already a crack taskforce of agents of household transformation were at work: Nik, Eva, my parents, and some passing South African party-goers, building plinthes, shifting boxes, hoovering, gardening, occasionally cursing...

The conservatory was converted into a bedroom, made easier by my recent(ish), and almost prescient futon purchase. The leftover boxes from NZ were put outside under tarp, the lounge cleared for access mostly by pushing the coffee table back. Some immense amount of hoovering, sweeping, cleaning, cleansing, and caring went on. The ground floor, besides being wheelchair accessible(!), looks incredible.

Thank you everyone!

Saul and Stephen joined, and the evening was rounded off with a trip to Calcutta Notebook, a fantastic Bengali restaurant right outside the house. Paying for the dinner felt like so much blowing in the wind compared to what everyone had done.

As I write this Monday 13th, it's been a few hours since my parents left and in effect the first time I've been out of direct care for exactly a month. An odd sensation. Initially, after the accident, I felt awkward with all these people doing things for me, frequently unbidden, and always incredibly helpful and thoughtful. There's no point fighting it (which I think I did a bit), or being mock "oh, really, you mustn't" (which I hope I didn't, at least much). Being able to accept help is something I had at least a slight difficulty with, as I think it is with many people. Rationally, I similarly suspect most people would realise this is daft since they would help out in the exact same circumstances. When I'm asked for help it very rarely feels like an imposition, unless I'm really, really under definite and immediate pressure. I think most people it's the same; there's a gratifying, life-affirming reward from simply helping another. So why should it be that way for anyone else?

Ask for help, you know it makes sense! :-)

At home, at last

Posted in: Injury Time

On the fourth week anniversary of being ambulanced into St Thomas' A&E I was ambulanced out at a more leisurely pace taking in the delights of Clapham's Saturday afternoon traffic. The discharge (as they term it) was somewhat involved and in some cases quite irritating and, disappointly, costly but the joy of being at home at last far outweighs those niggles.

Yay, back home!

Urban Wheeled Exploration

Earlier on Saturday Nik, Eva and I "escaped" from the hospital and went to see Urban Freeflow at Trafalgar Sq, the UK free-running group jumping around Nelson's Column and a sparse but workable obstacle of four fences joined in a square. I was super keen for this but as it turned out the music was so low energy it didn't raise the perception of what basically looked like the guys goofing about in a chilled training session. That said, there were some superb jumps from the lions, and a few neat "precisions" and spins off the railings round the column. I was gratified to see that none of the freerunners were attempting jumps remotely close to the one that shattered my heels on Friday 13th...

Wheel life

Pushing myself in the wheelchair from St Thomas' to Trafalgar Sq, a 1.4km / just under a mile journey, was quite some effort; Nik had to help on several occasions. Partly lack of skill and experience with a wheelchair, partly the distance, partly the lack of really any aerobic activity for a month, partly my body still undergoing a heavy healing process, the whole trip was pretty tiring. It was also really exciting - to be in the "real world" unmediated by beeping equipment and uniformed nursing staff. It's also quite odd to be at waist height in a crowd. There are benefits to this though...

Back at the hospital I was flagging hard and nearly fell asleep by my bed in the chair as my stuff was packed into green hospital-issued patient sacks. While I was away a guy I'd seen a few times hobbling about had moved into my bay. From the department of It Could Be Worse, he had more-or-less out of the blue come down with septic arthritis, an appalling, infectious, suddenly-occurring condition where the severe pain it causes is symptomatic of bacteria eating away the body's joints. He'd been rendered immobile at home in agony for two days until neighbours found him and he was swept to hospital, and undergone an operation every two days for a ten days or so. When we met he'd been in hospital for three months, contracted a mild form of MRSA, and could barely walk. I think his prognosis was somewhere between "won't die" and "reasonable eventual recovery with arthritis". Perspective check.

[Continued tomorrow...]

Disorganised discharge

Posted in: Injury Time

I was really freakin' cheesed off with my OTs. Despite having had for several days a target discharge date of Friday or Saturday, and having checked out my house for suitability on Wednesday, the OT still somehow only got around to telling me, on Friday afternoon at 14:30, they wouldn't discharge me. And that I'd have to wait until Monday or Tuesday. 14:30, that's one and a half hour's before they left for the day, and right at the end of the working week for the rest of the world who otherwise might be able to help. Which in this case consisted of delivering a suitable commode.

That's right, for the sake of a toilet I was otherwise stuck in hospital!

It was utterly absurd. They wouldn't write a safe discharge plan as they couldn't supply a commode with removable side handles. I apparently needed removable side handles in order to transfer safely from a wheelchair. Putting aside the fact for a moment that this awareness of the lack of equipment had come a full 48hrs after the house assessment, I was in a position where I either had to stay another few days in hospital or supply my own privately. So literally for the sake of a £12/week commode I potentially could've been on the taxpayer's tab for probably another £1,000. (I never quite worked out how much a NHS bed costs per day but by some detective work back-calculating from private insurance costs we came up with £200/day. Plus food, meds, etc.)

The either lack of creative solution seeking or legal hamstringing by the OTs blew my mind. Their attitude was literally as plain as "we don't have the equipment so you can't go home yet." It just stopped right there. No "we've got a goal, how can we solve this?" at all. No sense of "holy resource management , Batman, this guy is costing the NHS a royal f*ckload of cash, consuming a valuable and highly limited resource, not to mention exposing himself to a much higher possibility of infection, and sitting on his ass in hospital!" or "whoa, imagine how I would feel being told I could leave on Saturday and then f*cked around at the dying hours of the working week because I couldn't go find out whether we had a piece of equipment I knew he needed two days ago!" or "how about I get off my ass and find a list of national mobility suppliers?!?!". Nothing.

What was even more galling was that as I rattled through about half a dozen what seemed imminently viable solutions one of the OTs, a thoroughly humorless individual, actually seemed irritated I wouldn't just suck down the bad news and accept my sorry situation.

Legal nonsense

Get this. Even if I demonstrated I was capable of moving from wheelchair to fixed-handled commode, and demonstrated it to the OTs, they wouldn't release me. Even if I signed a legal disclaimer saying I would take no action in any commode-related incident they wouldn't release me. Apparently the manufacturer sells equipment under contract it not be issued in cases where it can't be used. Who ultimately deems that I don't actually know, suffice to say the OTs either couldn't or wouldn't see past this ludicrous bureaucracy.

As it turns out, it is trivial to transfer to a commode with its handles in place. In fact, it's possibly the easiest transfer off the chair to anything I've had to do to date. So it was, literally, pure bureaucracy that got in the way.

So I was left with calling private firms late on Friday afternoon for a next-day delivery on a Saturday. Grrrrreat. My doctor at least helpfully provided one number, but the company couldn't deliver 'til Monday. Thanks to having a wireless hospital internet connection I could at least find other mobility hire places. With great fortune, I pulled myself out of this pickle by finding a place that would deliver on Saturday. So for £112.00 I had myself a commode and wheelchair (you have to supply the latter yourself, or wait for social services) and could get a medically approved discharge plan for a Saturday leave... yay!

I'm tempted to call these folks dumbasses but I really don't know - whether it was laziness, incompetence, uncreativity or genuine legal issues, the bottom line is their action is costing the state, i.e. the taxpayer, money. In pure accountancy terms, I bailed the state out by paying my way privately and expending a fair amount of effort in doing so. It's just that simple. If I'd chosen to take their way I'd be sitting in hospital for at minimum four more days. Crazy.

Anyway, good news is I'm outta here Saturday!

It could be worse

Posted in: Injury Time

Guy opposite me was thwapped in the back of the head by a bus's wing mirror as he was crossing the road. As he went down his foot was caught up in the vehicle's wheel arch. He lost a couple of toes, has had the others pinned, and most of the top of his foot had a massive skin graft. I managed to catch a snap (with permission) between dressings. Warning: it's ugly.

This is the foot four week's on - can't help wondering what state it would be in if he didn't smoke, and ate anything besides sweets and puddings (i.e. had some protein). Bummer.

Escape!

Posted in: Injury Time

This afternoon, for the first time in nearly four weeks, I left the building. Spurred on by Emir's suggestion and accompaniment (thanks mate!) I wheeled myself into the lift, downstairs, and for once took the turning away from surgery, xrays, and the mysterious dude playing the piano in the ground floor hall toward the Exit. Way Out. Sunshine! Fresh air! Patients standing around smoking cigarettes with IV drips!

It felt fantastic. In the hot early summer sun, we "walked" over to the hospital square with lawn and mesmerising rotating water sculpture. Apart from running aground on a small bump I managed to get around completely unaided. Once by the fountain the lure of grass and water was too much, and pulled myself out of the chair onto the lawn. Fab! By a probably comical looking process of walking on my hands and butt hopped over to the water. Emir & I chatted there for quite some time, and I goofed about with some gym moves and surprised myself by a) some I could still do b) how quickly exhausting it was. We had some pix but for reason not on the phone any more...

In other news, after some phone calls and registering with a local GP purely by telephone (something of a feat), looking like I might be able to leave for good very soon...

The NHS Hospital Plan Diet

Posted in: Injury Time

I lost over a stone / 7kilos / 15lbs in the first two weeks after my fall. Wanna now how? I'll share my secret this one time... I used The NHS Hospital Plan Diet!

The NHS Hospital Plan Diet

1. Qualify for entry - e.g. fall off a building
2. Immediately upon starting the program, you'll automatically have your body divert most of its biological resources into cellular trauma, reconstruction, and calling the nurse for more morphine
3. All your meals prepared and provided for you, at no direct cost. No calorie counting, complex rules, or tracking the latest trends in broadsheet weekend supplements. NHS serves up your diet with its computerised food menu - and it's wholesome solid English stodge too. Sausages in onion gravy with swede, mash, and boiled cabbage? You got it! Apple tart and custard? Yes, please nurse!

That's not all! The NHS Hospital Plan Diet features these great benefits:

* Sit in bed all day. Talk about stress-free!!
* With tea, coffee, and digestive biscuits served five times daily from 07:15 to 22:00 your metabolism will remain jacked to the max shifting those frustrating last few pounds, day after day
* No alcohol? Around surgery you ain't eating or drinking anything, Sunshine.
* We don't even rely on willpower: As you helplessly loll about after the general anaesthetic your sneaky temptations to snip even weight-gaining water will be rewarded with a swift and merciless bright green blast of bile

It works! In just two weeks, and that's pre-surgery, baby, I went from 77.8kg to a lean 70.5kg! A loss of over seven kilos/one stone of body mass! And I barely had to lift a finger! Who cares that my bruised calves look like a pair of jaundiced uncooked frankfurters, or that my maximal strength has probably halved..., I lost a whole lotta weight!

Sometimes your measured weight may go up on the NHS Hospital Plan Diet. Recent results show I've put a little under two kilos back on in the last week. But don't worry, it's not stubborn, hard-to-shift fat, it's just a bunch of screws and an immobilising plaster hanging off my right foot...

Terms and Conditions apply: by partaking in the NHS Hospital Plan Diet you agree to be subject to any of the following:
* substantial pain, severe debilitating injury, trauma, musculo-skeletal damage
* administration of drugs so powerful you barely know who you are anymore, Captain!
* total demobilisation and months of a bed-ridden "lifestyle"
* months, possibly years of physiotherapeutic work just to approach exactly where you were before
* early onset arthritis
* lost earnings
* pissing into a bedside bottle and wearing bright green pajamas

But hey, if you want to shift half a kilo of troublesome weight per day: get climbing!

Out of the fuzz!

Posted in: Injury Time

Woohoo! No morphine for me today! After dropping the dose from 50/60mg to 30mg yesterday and then zero today I'm free of opiates. Toward the end of yesterday I was coming up as I hadn't had a Sevredol for most of the day and the difference was dramatic enough to freak a friend out. I took another one around 22:00 and she watched me sink into the slow pit which apparently was also quite odd.

Being on morphine is a terrible experience. Of course, having variously searing, thumping, crushing, stabbing pain is worse but make no mistake, being on opiate analgesics is horrid.

Injury status

The surgeon saw me for the first time on Sat evening and gave me his account of what's up. Contrary to what I've understood to this point, my left foot (the one that wasn't operated on, and which I thought was hosed) will be the first I'll be putting weight on. He was also "disappointed" that none of the orthopod team on my case or the physios had got me mobilising the foot this whole time either. To say I was a little pissed off to hear this would be putting it mildly. He ordered up a splint so that at night it's not flattened/pointing out which would ultimately cause the tendons and calf to shrink.

So since Sat night I've been on it like a demented nut - stretch bands, parcel tape DIY splint while they rustle up a proper one, hand work, self-talk. I can now bend it back beyond 90° and there's a fair bit of inversion/eversion which is the one that works the subtalar joint. This is still a bit sore so going easy on it for now.

Scat city

Used my wheelchair a couple of times recently, both for the purposes of evacuation. A side-effect of the opiates is constipation to an almost epic extent. After my fall I didn't take a shit for literally nine days. Tonight's movement was a fecal legend in its own right. Let's just say if I'd thought about it I would've snapped on the rubber gloves. Oh, did I mention the laxatives? OK, I'll stop now...

World's Best Constipation Joke

Q. Did you hear about the constipated mathematician? A. It was solved after he worked it out with a pencil...

Thigh tourniquet and nerve damage

Posted in: Injury Time

Just slugged another morphine pill (Sevredol; 10mg/4hrs; "the blue pill") so a quick one before descending into the void...

During surgery to prevent bleeding my thigh was held in a tourniquet. There are really strict limits to how long this can be done for before nerve damage occurs; it's around twenty minutes or so. The surgeons run right up against this limit time and time again throughout the operation to minimise blood loss. The downside is, in my case of a 4hr op, I've come out with a lower leg that has been producing nerve misfires for the last three days - lightly brushing the ends of my toes produces a sensation of having needles shot deeply into them; moving them back and forth creates a feeling of having ice water pored into my cast. Very weird! And almost entirely unpleasant.

The first day or so the nurses were regularly testing for adequate blood flow to my toes by looking for sensation and mobility. It was, fortunately briefly, excruciating even though I logically knew and could see nothing untoward was happening. All these peculiar facets of post-operative recovery...

Wheelchair practice

Posted in: Injury Time The Occupational Therapists came around today and showed me how to use the wheelchair, and adjusted it to keep the right foot elevated and in position. So now I can at least get about the ward and practise with it. I haven't taken up this opportunity yet. Surprisingly, it's not quite filling me with the veritable dripping sense of intrepid exploration and anticipation you might expect from seeing a bunch of other sick and broken people... Boy, do these drugs make you a miserable sarcastic f*cker :-) Actually I'm quite looking forward to seeing the day room--it's got a great panoramic view so everyone's said. And I can do some tricep dips and L-sits in the chair...

Xray excitement and food fun

Posted in: Injury Time

A highlight of today was mildly starving myself in anticipation of Claire bringing Ben's Cookies! Woohoo! Thank you very much Claire! Big thanks too to Pei who brought yellow flowers, M&S mini-cookies, and the interesting observation that hospitals don't have much yellow, and a reminder how good we in the UK have it with hospitals compared to say Malaysia.

So a bunch of us saw the xrays and CT scans today - us included a vet friend and a nurse friend. I'd only seen the post-op ones that look an awful lot like these (thanks Claire for the link). I think I had a quite good idea of what the damage was but it's always interesting seeing what it physically looks like. The left heel literally had fragments of the calcaneus bone (big lumpy one which constitutes the heel) floating about it. The right foot looks really well repaired; the damage is localised to just the calcaneus, and thus the subtalar joint it forms with the talus bone above it. This is quite a low mobility joint so at worst shouldn't affect me too much (*cross fingers*). Essentially: all good news for my right foot. The left foot is still an open question - have to wait for more ossification (bone formation) and see what develops. I'm awaiting a chat with Mr Klinker the surgeon who repaired my right foot to discuss things like whether it should be in a cast, repair time, more surgery, etc.

The CT scans are amazing, photographic series of slices with incredibly high detail. You have to mentally reconstruct these slices into a 3D shape but even so exactly where the fractures and so on are are minutely reported. Awesome - this technology is definitely a fantastic aspect of Western medicine.

Switch and bait

Posted in: Injury Time

Yesterday started off rough but finished well. After the three hits of morphine in the afternoon, the Wimbledon posse, Nik, Eva, and my mum all coming by yesterday I was completely painfree from 9pm on all the way through the morning. Woo-hoo! The nightcap of a cup of horlicks and a temazepam helped too... This morning, awestruck and pathetically grateful I'd got through all this mangling with only a half day of pain I was wheeled down to xray cheerfully listening to tunes and feeling fab.

The lateral, axial, and joint xrays showed a whole lot of screws and a mesh of metal to hold the heel (calcaneus) together. Who knows, but it looked OK to me. Back upstairs, 11am, chatting with mum, with only a couple of random muscle spasms as warning it felt like someone rammed a hot soldering iron into my heel. My fifteen painfree hours came to an abrupt end and after the nursey drug form filling I had to sink back into a dull indistinct drug haze malaise the rest of the afternoon.

Really, there is nothing fun about being on morphine or any of the hospital analgesics. In exchange for not involuntarily twisting about in your mattress and randomly clawing at things you are mostly robbed of sensation, motivation, pathos, hunger, satiety. Best thing to do is vaguely sleep through it and hope that it's kept at bay long enough for the next round.

The other crappy thing about painkillers is there's no strong sense of feedback on the healing. At least last night without the dosing (I don't take it unless I absolutely have to) and without the pain there's a sense of it getting fixed. Also when you move into a bad position there's immediate feedback--turn over, ouch, tweak position, ahhh, fine. When you're constantly ripped on painkillers you don't know what's going on; your nerve-endings could be caught in a blowtorch, or you could have twisted something, or subjected it to continuous pressure, or, ... and you just wouldn't know.

So I hope that's the last ever write on this. Sorry to folks who've been by and I've been totally out of it, I promise to be better next time :-)

Post-op

Posted in: Injury Time

Quick note while the morphine is in effect...

Went into surgery around 13:45, op took 3.5-4hrs, and I was in recovery til just before 22:00. Apparently I started bleeding quite badly after being sewn up hence the time in recovery.

Operation I've been told went well. I'm in a cast, with a blood drain to catch any more, and foot's elevated. Puked a couple of times even just trying to drink last night, so switched to IV, and that's also how my antibiotics are coming in. Pain earlier in the day was not at all fun. I'm too drugged right now to express it, which is probably just as well. I recommend not falling off the side of a house.

Head's swirling, time to lie down... I'm very happy to see people, if you don't mind me being a bit woozy.

Pre-op Party Monday!

Posted in: Events, Injury Time

The surgeons reconstruct my right subtalar joint on Tuesday afternoon, and what better way to usher in the start of a painful healing process than a party!

That's right, Monday evening, 30th May please do drop by my bed in the ward, chat, have a drink, hang out with folks, and taunt me with scalpels (lord knows I deserve it). Drop by any time after 7pm; stay as little or as long as you like. They honestly don't mind people drinking...

Full info on the events listing, 2005-05-30 // Pre-op "party" at St Thomas' Hospital

Recovery timings

Posted in: Injury Time

Had a chat with yet another of the doctors here and apparently if the surgery goes well (which of course it will) I could be out of here by this time next week. I can then start to bear weight on that foot within about six weeks, expecting decent usefulness in eight to twelve weeks. Since my left foot at the moment is more damaged it'll be longer. An immobile summer awaits.

I've mixed feelings about leaving the hospital.

On the one hand I share the bay with up to three other patients including one that is particularly annoying right now; I'm regularly descended upon with three-hourly blood pressure, temperature, O₂ saturation tests; daily anti-coagulant injections; painkilling administrations; food at set times; giving blood samples; hailing nurses for ice-packs; injury inspections; not having a proper internet connection; being woken at 6:45am; and so on.

On the other hand, none of that stuff actually bothers me particularly, and quite honestly I'm really grateful I'm getting it. Having my meals cooked for me is fantastic, despite not particularly wanting them, the bed is really comfortable, I have some kind of 'net connection, I can work, the view is amazing, and I am mostly in a place where I can get on with life, minus the physical bits. I'm being unbelievably looked after which I'm so grateful for it's hard to put into words (altho occasional tears seem to substitute).

My three-story house isn't suited for wheelchairs, even incredibly hi-tech expensive ones. I know this as I have a paraplegic friend and even her super-slick chair isn't much use chez moi. I generally sling her up on piggy-back and waft her to a comfy chair. Unfortunately I can't do that for myself, nor do I know anyone who could that with me, however much fun it might be :-)

In practice I think this means I will be living in my bedroom for three months. Not sure yet what I'm going to do about biological matters like food, and its ultimate expulsion. Simple stuff like ice packs will be extra work. My house is in Zone 3 which means for most people it might as well be in the horsehead nebula. Obviously, all this has solutions and in the scale of things probably straightforward but right now I'm in no hurry to leave here.

The other aspect is that after surgery it is going to hurt like fuck. There's no getting away from this, that's what happens when you're cut up, drilled into, and sewn back up. Last week I listened to my neighbour, a cool Latvian guy break from those sharp, pained, sucked-through-teeth inhalations into quiet suppressed weeping all night and into the next day after they operated on his foot. My current neighbour spent the night before last yelling for morphine, also post foot surgery.

On to more fun matters, Tom has already kindly offered me at least one outing to a conference in late June so that'll be good stuff. And not going out for literally three months will provide an unprecedented opportunity to clear a backlog and forge ahead with some cool projects...

Woohoo, a shower!

Posted in: Injury Time

As it approaches the two week anniversary of my injury I have finally been out of bed! Not only that I was fortunate enough to have a proper shower! Each day I wash myself with these "semi-disposable" wipes, a dishbowl of warm soapy water, and a fair amount of contorting. Today Azar (fast becoming my favourite nurse) and I braved the shower...

This involves getting into a sort of wheelchair called a commode which also doubles as a portable loo. She wheeled me into the shower room and then we had to perform this complex manoeuvre to get out of the wheelchair, onto a padded stool in the shower up a step, shift along on the stool to the shower itself, then onto a chair in the shower itself down another step, all while of course taking care not to slip.

Let's put it this way - I think without a fair bit of upper body strength and the bit of static gymnastics I've done it would have been much harder. As it was it was fairly tricky, and slightly tiring. But god sooo worth it! I've been using this dry aerosol shampoo, well really only a couple of times, and it's mostly worked. That, being in a clean environment, and not exercising's meant my hair's actually pretty presentable, not at all obvious it hasn't been washed in two weeks. It makes ya think how much skank is in the city air.

What would've made a huge difference would have been having rings or bars to hang from. I wish there were rings/bars above my bed, not just for exercise (a luxury) but to simply move around and turn. It is amazingly difficult moving about on an air mattress when you can't use your feet as pivots.

The other advantage of from having a shower it turns out is it gives the nurses a chance to properly make a new bed rather than this fiddly poking sheets around business while I roll back and worth.

Sun's out, bed's fresh, and I'm all clean! Woohoo!

Muscular atrophy

Another first in two weeks was getting to myself in a full length mirror. Mostly it all looks pretty intact, apart from one obvious change: my calves have become really wasted :-( It seems like even with minimal stimulus the muscles around my body are retaining shape and size, but for the one set that get to do nothing at all all day, my calves, they've dramatically shrunk.

So I have to figure out some way of getting them to do something but so far with my stretch bands haven't managed it. All I've seemed to have achieved is tensing them while I'm lying in bed (can't tell for sure how much is soleus and how much gastrocnemius?). I guess that's better than nothing. I wonder about those electrical stimulation devices? I asked the physio about them but she was quite cagey, to do with if she gave me one everyone in similar situations would want one. That's encouraging I suppose as it at least tacitly validates their usefulness. I think you can pick up a basic set from Argos...

I've started doing other exercises, crunches, pushups (tricky on an air mattress!), shoulder presses with stretch bands, leg raises, leg drops against stretch bands, trunk twists. Kind of hard to be motivated to do this when it's 25°C and you end up lying in your own sweat after. Generally keeping it light for that reason, just enough to remind the machinery what it'll be up to properly when I'm up.

I'm hoping like crazy I can put serious load on my feet and ankles in the not too distant future. I really really miss heavy weights leg work *pout*.

More updates

Posted in: Injury Time

More updates from the Man from A.N.K.L.E. The registrar who works with my appointed foot surgeon came by to have me sign a consent form for Tuesday afternoon's operation. This in essence involves explaining everything that can go wrong and have me sign that I understand. Oddly enough I was quite reassured; partly as I already knew from my smattering of medical knowledge and there were no surprises, and partly as the possible problems seemed on the whole fairly unlikely.

If I can remember, they go something like this: "DVT/PE", deep vein thrombosis/pulmonary embolism: a blood clot that might make it anywhere from wedging in my calf to as far as my lung; neurological damage: less said about this the better especially since it won't happen, now will it?; bone malunion: the reset parts of the bone that make up the joint aren't aligned correctly. What happens here is anywhere from sub-millimetre misalignment which generates point loads on the side where it's raised and then arthritis, to the malunion where the joint is actually stiff. The latter's pretty bad but it won't happen, now will it?

Turns out the damaged bone is actually in the sub-talar joint not the talus which is a relief because the former is far less involved in foot articulation: it allows some rolling motion although most of that is in the main ankle joint. So if it all went completely fubar and it ended up being fused I'd have some stiffness walking on uneven ground. But as we've solidly established, that won't happen, now will it?

(I'm about 80-90% sure what I've written above is right. There was quite a lot to take in, and it was some hours ago. Corrections welcome...)

My right foot is the only one being operated on for now. I thought it was more damaged; it's visibly more swollen, hurts more, and is less mobile both at the ankle joint and toe movement. Turns out however the bones in my left foot are more damaged, to the extent there isn't much corrective intervention possible at the moment. So why less swollen, etc? The soft tissue took the damage in my right foot rather than the bones which took the fall in my left, and it's the soft tissue damage that generates the lymph response.

Just as the guy was leaving he left with this marker.

You can't be too sure.
(Darren softening it all up. :-)

What's up, doc?

Posted in: Injury Time

For those interested in the gory details (and let's face it, you don't watch Formula 1 or Moto GP without a sneaky root for a crash): I have bilateral calcaneus fractures, extending into each talus joint, and an L2 lumbar vertrebra compression fracture.

What this means is both my heels are smashed with the fracture going up into a key joint between the leg and the foot. I have to stay in bed for two weeks (one down, one to go) until the feet's swelling has subsided enough to perform surgery. That is going to involve positioning the bone fragments in anatomical position and pinning them ("internal fixation"). Unfortunately this joint is key to a whole range of movements and takes months to recover, plus rehab, and chance of arthritis/restricted mobility. In my case, this all applies to both feet.

As for my back: the fracture is "stable" which means it's not at imminent risk of breaking and paralysing me. Which is nice. I'm at a stage now where it's not hurting any more. I am however a bit shorter (not sure how much; vertebra lost 20-30% of its height).

I had a nasty bruise on my elbow/ulna which I'm rehab'ing on my own with stretch bands.

Update: While I'm writing this the two doctors on my case relayed a message from the foot surgeon. Slicing and dicing for my right foot is set for next Tuesday when they'll do the reconstruction. My left foot, as it stands,--wait, bad expression--they're going to leave and review in a few weeks to see what can be done. There's apparently nothing they can do right now with it as the joint is quite badly shattered. As the doctor put it, "it's a Humpty-Dumpty case." So either it might sort itself out (go, foot, go!) or the joint might need to be fused (GAHHH!!! NOOO!!!)

Here's some more info on talus fractures. It's not particularly fun reading.

No more food, thanks!

Posted in: Food, Injury Time

One of the effects of being almost totally immobile 24h/day is your appetite shrinks to a diddly snack of its previous feast self. What also happens is the quality of the appetite shifts too. Regular physical activity seems to create a raw, animal need for food, and a concomitant satisfaction when it's sated. Every meal is a truly enjoyable experience. In fact, it's one of the really great side-effects of heavy exercise is that connection to a serious growling hunger.

Whereas without the exercise my appetite feels almost intellectual, a scrawning whining thing that makes weak mentions of its vague caloric insufficiency every so often but when actually presented with sustenance it seems neither grateful nor particularly excited. Lack of exertion has robbed me of a pleasure of being alive.

It's not the quality of hospital food - I'd say it's pretty decent, solid English fare, and they give the patients plenty of choice. No, the problem is physiological.

For example, right now, I am "hungry". Yet there's been a plate of roast chicken, sautéed potatoes, veg, and a pear sitting here next to be my bed cooling off for the last hour. My desire to eat is less than the effort required to simply shift the laptop off my legs and start the mechanics of consumption. Amazing, considering normally my hunger has been known (in admittedly extreme cases) to pull food out of bins rather than wait another 20mins before getting home.

To think that people who are totally sedentary live without the regular enjoyment of satisfying a proper hunger. Gah! Poor bastards.

Anyway, the meals here keeps me more than filled; it's generally an exercise in persistence, a sense of self-responsibility about nourishment, and strong aversion to waste that makes me even finish it.

So, no more grapes, thanks :-)

Come to think of it ... Green & Black's chocolate's fine though, hee hee

How to get internet from a hospital bed

Posted in: Injury Time, Tech

Since being in hospital Saturday 14th I've had no internet connection - there is no wireless here, nor any Ethernet, nor even a crappy bedside unit. There is a bedside unit that does TV and radio, and is supposed to do 'net but it doesn't work, and besides has an awful PDA-style keypad.

For the first few days Nik ever so kindly shuttled his powerbook back and forth with my mail downloaded for offline tinkering. This worked pretty well all-in-all but obviously I couldn't use the Web or do any work. We did try to set up a dev environment but it was quite hard work and out of both our areas of knowledge.

Word got out I was banged up in hospital and Saul Albert of wirelesslondon.info rocked up with two laptops, a 12V car jumpstart battery, a directional wifi antenna, and reams of various cables.

A miracle the nurses tolerate this kind of "ops centre" annexation...

By this stage I'd taken up residence closer to the window for precisely the purpose of getting a wireless signal at some point. And today was the day...

Saul set up his laptop and connected it to the antenna mounted on a tripod (with rubber bands and medical tape!). Using NetStumbler to scope out the radio space:

I can smell a Wireless!

We found a variety of nodes, some open, some encrypted. All unfortunately showed pretty weak signals ... apart from one! Down in Waterloo train station there appeared to be a commercial hotspot with a reasonable signal.

Firing up a webpage showed the usual "pay here" splash page. As it turns out only a handful of the usual internet "ports" were metered: web, mail, and SSH. Saul has SSH running on a non-standard port on his server so connected straight in. From there, I could get to my box and run my own non-standard SSH server (sshd -p 12435).

Now for the web: I needed to find a proxy to bounce all my requests through. The neat solution to this is that there's no need for additional software, simply point the browser's connection settings at another machine and all web requests go through there, very commonly on a non-Web port such as 3128 or 8080. Non-web port in this case means the hotspot isn't metering it! I.e. it's no cost to me.

Fortunately, there are collections of open proxies kept up-to-date minute-by-minute, proxies that are typically misconfigured to allow anyone to use them. These are normally a curse since they're abused by web spammers, but in my situation, a blessing. Using a text-mode browser on the SSH connection we found a few, tested their response with ping, and tried a couple. There was a very fast one in the UK that appeared to be a corporate proxy but turned out to be running quite a severe content filter (good enough to haul 30+MB of Windows Update though :-)). A couple of other usable ones in Germany and Italy we found without too much hassle and bingo, we were on the Web!

The Mozilla/Firefox Switch Proxy Tool was a great help in testing and switching between various sites.
As for mail, by the power of SSH's local port forwarding capability I now also have IMAP and SMTP tunneled direct to my server through the non-standard port. (ssh -C -N -f -p 12435 -L143:127.0.0.1:143 -L25:127.0.0.1:25. -C = compression; -N = no shell; -f = background. I've given the SSH command line but I actually did it with PuTTY.)

Since then I've at last figured out how to have Apache act as a proxy, which I'll write up since I couldn't find any copy-n-paste examples. In the meantime, here's a listing for a sample httpd-proxy.conf I wrote.

The final tweak was downloading and installing vendor drivers for the wireless card I'm using - under Windows 2000 the default wireless drivers aren't great and the connection would pop in and out every few seconds. Now it's solid.

I've moved over to my cute little tripod which is currently perched next to my bed:

Bedside aerial

The next upgrade, if I'm in here long enough to warrant it, is to get the antenna by the window attached to a router rather than wired next to me which is a bit of a pain. It's not that much of a problem since I don't actually move anywhere...

Thank you Saul! (And thank you unsecured hotspot owners!)

Shameless plug of Saul's project: Imagine anyone could share wireless internet all over London: that's the vision of wirelesslondon - check it out, anyone can help.

Oh, the irony

Posted in: Humor, Injury Time

Just got this email about a book that's been on my wishlist for over a year, and that was ordered over a month ago...

Your order #026-5565489-2650012 (received 08 April 2005, 22:53 BST)
-------------------------------------------------------------------------
Ordered  Title                          Price  Dispatched  Subtotal  
-------------------------------------------------------------------------
1        The Art of Running: With the A 9.99 GBP   1       9.99 GBP 
         Sold by Amazon.com Int'l Sales, Inc. 

As it happens, my MBT shoes arrived earlier this week too.

I'll be up and using all this stuff soon!

In hospital

Posted in: Injury Time

Coming up to nearly a week now I've been in hospital with two smashed heels and a crushed lumbar vertebra after having unsuccessfully scaled the side of a house to get in after some friend's keys went missing. The fall was about 5m onto the road.

Visits

I'm at a stage where I'm together enough for people to drop by, hang out, watch DVDs, munch through the EU grape mountain. So please do! Address is:

Bed 23 (yes, not 25 any more; window seat, baby!)
Alan Apley Ward (11th floor)
St Thomas' Hospital
Lambeth Palace Road
London SE1 7EH

Directions and info about St Thomas'. NB Despite the NHS Trust's full name ("Guy's and St Thomas'") this is NOT Guy's hospital.

Do drop by! Call/text first so I know though; may be having stuff done to me (ooer, nurse).

A longer "thank you" is coming but for now I almost cannot put into words how grateful I am to everyone who's helped me; I am so touched. Nik & Eva for more than can be listed right now, my parents for being parents, Nadia for solidity and physicianly comfort in the early moments, Saul for internet and practical toys, Adrian & Emir for entertainments, Teresa for being lovely and knowing how my bed works, and the nursing staff for being so so nice.

Now for the good, the bad, and the ugly...

Short term bad news: I won't be able to walk for three months, broken (as it were) into a month full-time in bed in hospital, and two months in a wheelchair.

Mid term bad news: my heels are as I write exploded, and a joint in my right foot is quite badly shattered. I may get any or all of arthritis, joint stiffness, and random neurological (i.e. "wrong") pain anywhere from day 1 to some point later in my life. I say "may" because I'm optimistic but chances are it'll happen.

Short term good news (given the context): not paralysed; vertebra stable i.e. not in imminent danger of collapsing; not in much pain; psychologically OK; have--now--an internet connection; the food is quite decent; I get to do tricks in a wheelchair (just kidding, mum!!)

Mid term good/bad news: I am literally indoors for three months which will be pretty interesting, and cool to see what I can get up to...

Ugly: my feet, never the most attractive, are bloodshot, yellow, and very swollen, not to mention (mildly, in the scale of human catastrophe) disfigured through swelling and atomisation. I'll post some pics when I'm less exhausted.

If you're in the area, please do visit! :-) Hope you're all well!