A Shrinking Violet

Moi? Ha, not really.

But I do know that my leg stump is shrinking and that's both expected and desired as I progress. I know it has shrunk in the five weeks Schooner and I have been together, as Schooner has been a fraction big for my leg of late, meaning I've had to put extra thick ply cotton socks over the leg so the fitting is nice 'n' snug.

The fitting has to be real tight so that your leg is well secured but also so that there is minimal movement of your leg inside the fitting as you walk. As my leg got smaller, it allowed some vertical movement inside the fitting, which in turn rubbed a bit of skin off my shin. I couldn't feel that part of my leg (no nerves there at the moment) so I didn't know I'd rubbed anything off until I took Schooner off at the end of the day. Sod. The other sore has healed fine, so now I have to get this one fixed.

Anyway, today I had another visit to the Limb Centre at Redfern where George, the prosthetic specialist, had a look at me walk and inspected the stump and fitting. Then George whisked Schooner's inner liner away for some additions to reshape it and make for a more snug fitting. Once that was done, then a few walks up and down the corridor to inspect my gait resulted in an adjustment to the angle of the pipe section between Schooner's upper mould and his foot. That's resulted in an improved gait. With allen keys twisting industrial grade bolts, it was just like having your cycling cleats adjusted by Steve Hogg! My gait still ain't perfect but with trousers on you may not even know I didn't have a real leg.

Today was also the first day I got about without a crutch. Granted I didn't do huge amounts of walking but certainly more than I've attempted before and I can walk at a reasonable pace, standing tall and looking ahead, as long as the ground is flat. Once there is a camber or slope, then I have to be a little more careful.

Speaking of trousers, I haven't been able to wear any, as I can't get the cuffs over Schooner's outer moulding (suppose that means I have no flares in the wardrobe)! Even if I could, I wouldn't fit into anything as I've, er, grown my waisteline a tad you could say. :(

So Mum turns up from a trip to the shops with a pair of trousers that'll fit the waistline and maybe squeeze over Schooner's "skull". Well only just and with a bit of fighting they do. No matter, a trip to Aunty Hil sees the sewing machine out and a short hidden zip installed at the bottom of the inner leg seam - problem solved! Nice one.

Another nice thing to note was George saying I've made as much progress in five weeks as some people do in 50. With that in mind of course I pump him for when we can fabricate something to get me back on the bike, even just on the trainer. Puhleeaasse? Can I? Huh?

"Let's look at it in the New Year - we'll sort something out - we can do anything". He's right of course and knows that the money to set me up now would probably be wasted in eight weeks as the leg would change so much any expensive fitting made now would be useless.

Patience Alex, patience.

PS - the pic above is from this site:
http://www.betterphoto.com/

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Mr X-Ray

I had an appointment at the rehab clinic today to see my Rehab Doc and the Prostheticist. I took them through my progress since getting my new leg (Schooner) 4 weeks ago. They had a look at my stump, Schooner and his associated bits. Then I got up and did a little walk for them to show them how I was going.

The look on their faces sort of said it all - as far as they're concerned, I am going great guns. Excellent progress, they were a little amazed in fact. My stump has shrunk somewhat (it's meant to) and so I will be in to see my prostheticist again next week to make some adjustments to my fitting to make Schooner sit more snugly onto my stump.

The only down side due to the improvement is the up 'n' down motion of my stump inside the leg fitting has rubbed a bit more skin off the shin. It needs to toughen up a little but really I shouldn't be able to move much inside the fitting.

Doc also thinks it won't be too long before I can move to the next type of prosthetic fitting (a silicon sheath version) that will enable a cycling leg to be made up. I still think it may take a couple of months.

While at the hospital, I decided to pop into Radiology to see if they could give me a copy of the x-ray images of my leg. Apart from 'grumpy pants' behind the counter, it wasn't too painful to get organised and a little while later I walked out with a CD with images of my knee, including before my first operation, after operation to insert the plate and screws and again after amputation. Thought I'd share a few with you.

First the original fracture of tibial plateau and the fibula. You can click or right click on any image to see the full size version.













On the left is the front on shot and you can see the multiple fracture of the tibial plateau (the top section of the bone below the knee) with the main displacement running diagonally from bottom left to top right.

On the right is the side on shot, with the fracture being at the top of the tibia bone on the right.


Here's what they put inside to pull it all back together. Again front and side on shots.













The plate runs across the tibial plateau and down the tibia with six screws running through the plate into the bone.

There is an extra screw through the two separated sections of the tibial plateau to hold them together. You can also see the staples holding my skin together after the operation.

And here are the shots after my amputation.













You can clearly see the shortened tibia and fibula, where they have been cut/sawn or whatever it is they do.

At the bottom of the image on the left, you'll see a dark patch. That was where I had a stubbon hole in my closure would that wasn't healing. It was about 2 inches (5cm) deep and took about 10-12 weeks to heal properly.

So that's what it looks like from the inside. All those screws and plate are still inside. I'll spare you the real life shots!

The other bit of good news is it looks like my scans from last week (a white cell scan and a sulphur colloid scan) show an improvement, which is great since I've been off the antibiotics for a month now. Looks like I have the all clear from the infection.

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Phantom of the Ditch?

OK - latest developments...

The Ditch

I reported the other day about my first few tentative steps without crutches. Well since then I've also ditched one crutch and spent the last few days just using the one crutch to get about. A walk around my local street and another day walking around one of those old warehouse conversion shopping centres - you know the ones full of homewares stores. Big and lots of dead flat floors with hardly anyone about - great training territory actually!

Apart from walking about, while there I picked up an external hard drive for the PC, as I'm getting a bit tired of backing up to disks, so have set up an automated option. I was also looking for kitchen stools to go with my new benchtop. Yadda yadda, I found some I like but didn't buy today. Another day perhaps.

So today, I decide to give the no crutch walk thing another go and wouldn't you know it, I was walking semi-normally. Way to go Schooner! Good enough to get around the house sans crutch but a far cry from a long walk. Still, I've only had Schooner (my new leg) for three weeks today, so I reckon that's not bad going. I even carried a cup of tea with me, from the kitchen and down a few stairs to my "home office". I couldn't keep it up all day but not a bad start.

The only downer is I've rubbed a small patch of skin off my shin - I can't feel it as the nerves on that part of my skin are non-existent, so I only found out when I took the leg off. It's not that bad but I have to take care of it and make sure I don't get an infection.

Also today dropped in to say gidday to my buddy Steve Hogg at Pedal Pushers (my LBS). Steve runs Cyclefit Centre and if you want to know anything about making a bike fit a rider, Steve's your man! Steve (and wife Margaret) also made some visits to me in hospital - one day he looked at me in the eye and then walked out of my room to keep going down the corridor to find me - I'd lost so much weight at the time he simply didn't recognise me! When I make it back on the bike, Steve's going to take on the challenge of fitting me again.

The Phantom

People ask me and wonder what it "feels" like. Well since I've been using the leg again these last few weeks, I've noticed more senstations coming from my non-existent foot. Sometimes referred to as "phantom" sensations and not an uncommon phenomenon for amputees. Mostly I get a light pins and needles like sensation from the ball of foot and toes area. Sometimes sensations of light pressure on other parts of my "foot". No pain fortunately. It's weird though, I have to admit. But strangely reassuring, like sitting here at the PC, it's like I have a real foot still down there with a really tight sock on it.

You also notice some of the little things, like lying in bed and your foot has an itch - you can't just use your other foot to give it a quick rub/scratch.

All up - I have a new level of freedom which is continuing to improve.

Keep biking!

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Tip Toe through the Tulips

Well, not quite.

I did something new today. What's that ad say - "how long has it been since you did something for the first time"? An airline ad I think.

Anyway, as reported in my last post, I've started walking along on my new leg, which I've decided to call "Schooner" by the way, with the aid of crutches. I've been gradually able to walk further, with a walk to my local shops and back last weekend (that's about a mile) and another cruise this afternoon of a kilometer or so. My knee is getting stronger, a little less pain as I begin to bear my weight on it walking.

So what's new? I started this walking caper last time I wrote. Well today I tried to take some steps without putting the crutches down on the ground. Up until today, this resulted in immediate pain and feelings that the knee would give way, quickly getting me to put the crutches down again.

Well today I tried again, and low an behold the knee held up, just, with no pain. It was a bit wobbly. So I tried another step and it worked again. Very small steps mind you and not exactly a pretty gait but I got from the lounge room to the kitchen without the need to put the crutches down.

OK - so I have done this before, when I was a baby and took my first steps - but in this case I qualify since I can't remember taking my first steps as a baby.

It was a pretty weird feeling I have to say. So while on my walk around my local streets today I walked while holding up the crutches for about 10-15 metres. Again, slow, not exactly super steady but just being able to do it was a great feeling. Well done Schooner.

It's nice to do something new. Why not give it a go yourself?

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What's up Skip?

Meet Stuey....

Go on, say hello - she won't bite!

Stuey turned up at my place yesterday, looking for a good home. Stuey also has a joey in her pouch but I don't have a name for the young one just yet.

Stuey came my way courtesy of a fellow competitor who happened to win a World Title at the world masters track champs. This kind hearted Victorian suggested the roo might make a good daily reminder to me of a goal to ride at next year's championships. What a good idea. I'll just have to find a good place for Stuey to hop around. Just watch out for the magpies round here Stu.



You'll also notice Stuey has a medal around her neck - that's a UCI world champs medal. You see Stuey was one of a special breed of kangaroo that was waiting for the day to become the favourite icon in households around the world.

Stuey's cousins are now all over the world in Germany, Great Britain, the USA, New Zealand, France, Italy, Argentina, South Africa, Canada, Japan, Austria, Russia and of course all throughout Australia.

Onya Stu!

Only other news to report - I walked about 1,000 metres today, still with the aid of crutches, so bit by bit I'm getting stronger. That's seven days after getting my leg so I reckon that's pretty good going. Next goal is to walk unaided. Not sure how long that will take but hoping for weeks and not months.

Seeya Stu!

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Legs 11

Thought I'd share a couple of things.....

Firstly, my new leg that I picked up last Wednesday. Here's a pic for you.

This is the bog standard govt. issue prosthetic that will serve me in these inital months. It's such a lovely shade of pink! The top part will probably need replacing as my leg stump changes shape and size with time and use.

In the meantime, I manage the fluctuations in size by using various numbers of "socks". Leg stumps tends to shrink as the day goes on, so the need to add more socks to keep the fitting very snug.

Another really important thing to be done is to name the bugger! You know, "Larry the Leg" or "Cruncher #1" or something much more creative or funny.

Any ideas and suggestions gratefully accepted. The winning entry might even get a prize (or most likely a thank you and a laugh).

Anyway, it's not much good sitting over there by itself, so I took [insert clever new name] for a slow walk around the block today. I still need the aid of crutches as my leg and knee are not up to bearing my full weight as yet but it's a darn sight easier than lugging myself around on crutches alone.

My walk was about 500 meters I suppose, but that's more than I could do this time last week when I couldn't walk at all!

I can also stand up at the bathroom sink to have a shave and brush my teeth, which sounds like a novelty but is just one of those little things you forget about doing easily when able bodied.

As it stands, the leg and the supplies that go with it cost me a $200 contribution with the government's Artifical Limb Service funding the rest of the >$3,000 cost. That will have to be repaid though should I receive any compensation.


The second item to share is my new toy, a Canon digital camera that my friend Tanya bought for me as a thank you for coaching her. I actually got it while in hospital but have to admit I wasn't in much of a mood to be taking photos in there.

My problem then became - how do you take a photo of your own camera? Well I had to cheat of course by taking a pic of the photo on the box it came in. I suppose I could have borrwed someone else's or stood in front of a mirror!

So there it is. An overly generous gift but I am very grateful as I didn't have a digital camera before and haven't dug the old film based SLR out for many years.

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Irony 101

The astute reader would have noticed a small item in a recent post called Bureaucracy 101, where I outlined the tale of obtaining a Mobility Parking Card from the Motor Registry.

Well today I have another funny tale to tell. More of that in a tic.

Today was a pretty important day. I went to the amputee clinic and received my first prosthetic leg. I have taken my first somewhat tentative steps although I still need to use the crutches for support when bearing weight on the "new" leg. I can stand unaided, which is a real novelty, even swinging my hips around in a little jig!

The knee is a little sore in motion and I'm a little awkward as you would expect, my leg has not borne any weight for 7 months and let's face it - it got smashed up pretty badly in my accident.

I'm off to the the rehab ward at the Hospital now to do some training on using the leg. I'll be learning all about things like using these special socks to adjust my fitting, how to walk properly with the leg, exercises to try etc. All a whole set of new sensations to learn and adjust to.

So what about that funny tale?

Well today, of all days, being the day I got my first prosthetic leg, was also the day the local Council decided it would rip up the footpath outside the front of my home and make it a real bastard to walk across for even the able bodied! They'll be installing a new one in the next day or so!

I suppose that's irony.

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Index

Riding Goals and Reviews

http://alex-cycle.blogspot.com/2007/04/season-in-review.html

http://alex-cycle.blogspot.com/2006/10/current-cycling-goals.html

Specialised Power Training & Analysis items:

An Attempt at the World Hour record (Masters)

http://alex-cycle.blogspot.com/2008/02/hour-of-power.html

A Graphical Representation of Training Levels:

http://alex-cycle.blogspot.com/2008/01/graphical-representation-of-training.html

Maximum Accumulated Oxygen Deficit:

http://alex-cycle.blogspot.com/2007/02/darth-vader-rides-teams-pursuit.html

Aerodynamic Drag Testing:

http://alex-cycle.blogspot.com/2006/10/aerodynamic-drag-testing-using-power.html

http://alex-cycle.blogspot.com/2008/03/funky-things-with-power-meter-77.html

Pursuit Pacing:

http://alex-cycle.blogspot.com/2006/11/in-pursuit-of-perfect-pacing.html

Training with a PM:

http://alex-cycle.blogspot.com/2007/03/claytons-power-meter.html

http://alex-cycle.blogspot.com/2007/03/sneaky-peaky.html

http://alex-cycle.blogspot.com/2006/12/tss-vs-kj.html

http://alex-cycle.blogspot.com/2006/12/map-testing-where-failure-is-success.html

My Own Ergometer/Trainer project:

http://alex-cycle.blogspot.com/2008/02/my-own-trainer-project.html

Performance Testing with a Power Meter:

http://alex-cycle.blogspot.com/2006/12/map-testing-where-failure-is-success.html

http://alex-cycle.blogspot.com/2006/11/trials-and-tribulations.html

http://alex-cycle.blogspot.com/2006/11/testing-times.html

Methods of Estimating Funtional Threshold Power:

http://alex-cycle.blogspot.com/2008/05/the-seven-deadly-sins.html

Interval Training with a Power Meter

http://alex-cycle.blogspot.com/2007/02/spiders-web.html

http://alex-cycle.blogspot.com/2007/01/getting-there.html

http://alex-cycle.blogspot.com/2007/01/two-by-twenty.html

Performance Manager

Explanation of the PMC:
http://alex-cycle.blogspot.com/2006/10/my-...ager-chart.html

Further update on PMC during season and pre-race build:
http://alex-cycle.blogspot.com/2007/02/tough-love.html

http://alex-cycle.blogspot.com/2006/12/map-testing-where-failure-is-success.html

Season review with the PMC:
http://alex-cycle.blogspot.com/2007/04/season-in-review.html

Using the PMC to retrospectively analyse an previous season and learn from training/planning mistakes:
http://alex-cycle.blogspot.com/2006/12/chr...s-training.html

Using the PMC to plan a comeback to racing (parts I & II):
http://alex-cycle.blogspot.com/2006/11/pla...erformance.html
http://alex-cycle.blogspot.com/2007/02/sec...oming-back.html

Use of the PMC to predict rider performance in a Team Time Trial:
http://alex-cycle.blogspot.com/2006/10/tea...ce-manager.html

Racing:

National Champs:

http://alex-cycle.blogspot.com/2007/04/bailing-out.html

http://alex-cycle.blogspot.com/2007/03/bronzed-aussie_7343.html

http://alex-cycle.blogspot.com/2007/03/national-lampoon-pursuit.html

State Champs:

http://alex-cycle.blogspot.com/2007/03/shoot-em-up.html

http://alex-cycle.blogspot.com/2007/03/track-champs-day-3.html

http://alex-cycle.blogspot.com/2007/03/track-champs-day-2.html

http://alex-cycle.blogspot.com/2007/01/gold-gold-gold.html

http://alex-cycle.blogspot.com/2006/12/making-point.html

http://alex-cycle.blogspot.com/2006/10/team-time-trial-and-performance-manager.html

http://alex-cycle.blogspot.com/2006/10/ttt.html

General Racing Track/Crits/Road:

http://alex-cycle.blogspot.com/2007/02/power-crash.html

http://alex-cycle.blogspot.com/2007/01/australia-day.html

http://alex-cycle.blogspot.com/2006/12/making-point.html

http://alex-cycle.blogspot.com/2006/12/christmas-pudding-racing-vs-training.html

http://alex-cycle.blogspot.com/2006/12/short-sweet.html

http://alex-cycle.blogspot.com/2006/12/give-dog-bone.html

http://alex-cycle.blogspot.com/2006/11/young-ones.html

http://alex-cycle.blogspot.com/2006/11/farewell-crit.html

http://alex-cycle.blogspot.com/2006/10/2-races-in-one-day.html

http://alex-cycle.blogspot.com/2006/10/olympic-park-crit.html

Pursuiting/Team Pursuiting:

http://alex-cycle.blogspot.com/2007/03/track-champs-day-3.html

http://alex-cycle.blogspot.com/2007/02/darth-vader-rides-teams-pursuit.html

http://alex-cycle.blogspot.com/2007/01/winning-formula.html

http://alex-cycle.blogspot.com/2007/01/gold-gold-gold.html

http://alex-cycle.blogspot.com/2007/01/perrshoot.html

http://alex-cycle.blogspot.com/2006/11/trials-and-tribulations.html

http://alex-cycle.blogspot.com/2006/11/in-pursuit-of-perfect-pacing.html

Racing skills/tactics:

http://alex-cycle.blogspot.com/2007/03/elimination.html

http://alex-cycle.blogspot.com/2006/12/give-dog-bone.html

http://alex-cycle.blogspot.com/2006/11/young-ones.html

http://alex-cycle.blogspot.com/2006/10/2-races-in-one-day.html

http://alex-cycle.blogspot.com/2006/10/killing-nerves.html

My Accident & Recovery:

http://alex-cycle.blogspot.com/2008/04/hurry-up-and-wait.html

http://alex-cycle.blogspot.com/2008/04/bon-anniversaire.html

http://alex-cycle.blogspot.com/2008/03/dr-smith.html

http://alex-cycle.blogspot.com/2008/03/sock-it-to-em.html

http://alex-cycle.blogspot.com/2008/02/what-about-me-100-degrees.html

http://alex-cycle.blogspot.com/2008/01/279-days.html

http://alex-cycle.blogspot.com/2007/12/mistaken-identity.html

http://alex-cycle.blogspot.com/2007/12/anyone-for-golf.html

http://alex-cycle.blogspot.com/2007/12/who-says-real-men-dont-hold-hands-i-bet.html

http://alex-cycle.blogspot.com/2007/11/shrinking-violet_3518.html

http://alex-cycle.blogspot.com/2007/11/mr-x-ray.html

http://alex-cycle.blogspot.com/2007/11/phantom-of-ditch.html

http://alex-cycle.blogspot.com/2007/11/tip-toe-through-tulips.html

http://alex-cycle.blogspot.com/2007/10/whats-up-skip.html

http://alex-cycle.blogspot.com/2007/10/legs-11.html

http://alex-cycle.blogspot.com/2007/10/irony-101.html

http://alex-cycle.blogspot.com/2007/10/we-have-clearance-clarence.html

http://alex-cycle.blogspot.com/2007/10/clutches.html

http://alex-cycle.blogspot.com/2007/09/gettin-fat-what-happened.html

http://alex-cycle.blogspot.com/2007/08/home-at-last.html

http://alex-cycle.blogspot.com/2007/08/rehab-week-8-homeward-bound.html

http://alex-cycle.blogspot.com/2007/08/rehab-week-7-matter-of-degrees.html

http://alex-cycle.blogspot.com/2007/07/rehab-week-6-weighty-matters.html

http://alex-cycle.blogspot.com/2007/07/rehab-week-5-glowing-in-dark.html

http://alex-cycle.blogspot.com/2007/07/rehab-week-4-waiting-for-godot.html

http://alex-cycle.blogspot.com/2007/07/rehab-week-3-iv-league.html

http://alex-cycle.blogspot.com/2007/07/rehab-week-2-waiting-for-one-patch.html

http://alex-cycle.blogspot.com/2007/06/rehab-week-1-dr-william-tan.html

http://alex-cycle.blogspot.com/2007/06/rehab-here-i-come.html

http://alex-cycle.blogspot.com/2007/06/pumping-iron.html

http://alex-cycle.blogspot.com/2007/06/nearly-in-rehab.html

http://alex-cycle.blogspot.com/2007/05/new-dawn.html

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We have Clearance, Clarence

Over the last few weeks I’ve had a lot of trips to the hospital for various bone and leg scans (three different types!) as well as sessions with Infectious Diseases Docs, prosthetics people, Rehab Doc and my GP. Good news is that the leg scans are much improved on previous ones and the Infectious Diseases Docs have suggested I stop taking the antibiotics for the time being (yay!). Not quite out of the infection woods yet - I will have another set of scans in 4-6 weeks to ensure I am in the clear and will continue with blood tests in the meantime just to be sure nothing flares up.

I’ve also dropped or lowered several other medications, just down to two now.

I go into the amputee clinic this week to have my first prosthetic leg fitted and then after that go back to rehab ward at the hospital to learn how to walk again. I don’t know how long or how many sessions will be required nor what bumps in the road I’ll face along the way (everyone is different) but it’ll likely be a process of gains with some set backs along the way. Still, the days I can mostly do stuff without the crutches will be marvellous.

One example of set back – although seemingly small – the elastic wrap I have on to shape my stump must have been a little tight one day and rubbed some skin off my shin (I can’t feel that part– no nerves there at the moment). I don’t think you can wear a prosthetic when that happens – due to risk of infection. Hopefully I’ll still get to try on my new leg.

The first leg will last 2-3 months, then I get another type of fitting which will also probably last about 3 months before needing replacement. All due to the stump changing shape and size over time.

I managed to take myself out to the velodrome to watch some of the World Masters Track Champs last week. A bittersweet experience, good racing, nice atmosphere but hard watching and not participating. Lots of people from around the world and Australia said hi, which was cool. Sorry if I didn't get to catch up with some. I pretty stuffed just lugging myself around on the crutches and my back was not agreeing with me so I gave the final days a miss.

I’m still working with my GP on a return to work plan. He is not keen for me to start just yet, he wants me to be settled on the leg first and is keeping an eye on the mental side of things. Broadly I am positive and going well (but we all have out moments, don’t we?). It’s all taking longer than I thought but I am grateful for the support I get from everyone.

Bureaucracy 101

It took three trips to the RTA to get my disabled parking card.

Apparently dropping into the Motor Registry with half your leg missing along with the correct RTA form signed by a Doctor to say that you have half your leg missing, is insufficient evidence that you have half your leg missing and could possibly be eligible for a disabled parking card.

Go figure?

Renovation Rescue

I have a new kitchen!! Aside from a few finishing touches (tiling of splashbacks, range hood ventilation pipe and painting!) it’s all but done. The new dishwasher, oven and stove have been put through their paces over the last few days. Other renovation marvels continue. The irony of building an attic that I can’t at the moment climb up to see hasn’t escaped me either!!

House next door sold at auction on the weekend and, well, I was gob-smacked by the price. Glad I bought when I did, no way I could do that nowdays.

Stay safe!

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Clutches

What now?

OK, it’s been a few weeks again, so what’s new since last time? Well apart from giving Mum a break so she could go home and do some stuff for herself for a while and having my brother stay for a week and a half to make sure I didn’t do anything stupid, the last few weeks have been fairly busy, mostly with trips to the doctors and staff at the hospital as an outpatient and some progress with my house renovations. I had a session with the rehab Doctor and met my prosthetics guy for the first time. We discussed my current situation and made a decision on the type of leg I will use for the first few months. A script was written for the leg and sent to the government for funding approval.

I then had a meeting with the Doctors at the infectious diseases unit to discuss my progress in dealing with the MSRA infection I picked up while in hospital. It would appear I’m doing well based on simple examination of the leg and blood test results, however some scans are needed to properly assess the infection status. This will determine whether I can stop taking the drugs and then just monitor my status with regular blood tests, or possibly at the other end of the spectrum require lifetime medication and maybe even another surgery to remove the metal plate in my leg. I sure hope not the latter two. I’ve had enough time in the hospital bed thanks very much!

The little bastard MSRA:

So it was back to the hospital for three days this last week for these various scans. First was a normal bone scan on Monday, then one using a technetium isotope to look for infection hot spots. A few “warm areas” were seen but these were inconclusive, so it was back on Wednesday for another irradiated white cell scan. I’ve had this scan twice before and described it in this post. That was then followed by a sodium colloid scan on Friday, which is designed to isolate out real hot spots from those that are just due to bone marrow left stranded after the amputation surgery. As yet I don’t have the full results. There is one more potential scan they may require – a gallium scan but hopefully not.

Meanwhile, the government funding approval for my prosthetic came through, so I made a visit to the artificial limb clinic to be sized up for my first leg. That involved a few things, a pencil line around my right foot, presumably to match the other side, leaving a good pair of my walking/running shoes with them and taking a cast of my stump with key positions marked. George (the prosthetic specialist) also showed me the different systems, including his own funky carbon and titanium model with fully self-controlled vacuum system to keep the leg on nice ‘n’ snug. I learned that this first leg may not last long (a few months maybe), as my stump will change form significantly and that I will change to a different style of fitting next time. Even then I may need a third leg fitting in six months.

So, the prosthetic is currently under construction and I’ll be trying it out in about two weeks. It’ll be the bog standard govt issue leg but given the short useable life span of this first leg, no point wasting money on some fancy gear. Bit like buying your first bike I suppose.

The worst part about all this of course has been the time it all takes. It’s now more than six months since my accident and I’m not walking yet. The bike will be many more months away yet, so patience is key. I still get pretty tired, getting about on the crutches is certainly not ideal and combined with my lack of symmetry now it completely buggers my lower back – sometimes getting up is quite painful. Early nights and often lie down rests during the day are needed to relieve this.

Then of course I have to start losing weight, really hard when you can’t exactly do much exercise.

One other thing I did amongst the less interesting stuff (like trips to the bank and chemist) was to test drive a car. You see my nice Subaru Impreza is pretty useless to me now since I have no left foot in order to operate a clutch. I really like that car but I have to be rid of it. So while I did test drive the new model Impreza with an auto transmission, I also tried the VW Golf. The Golf’s six-speed auto transmission was light years ahead of the Subaru four-speed offering and for that reason alone I’m likely to go for the Golf. Shame for the Subaru – it does everything else well but the four-speed auto transmission lets the motor down.

Anyone want to buy a 2006 Subaru Impreza with low kms and in perfect condition?

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Gettin’ Fat / What Happened?

OK, it’s been a few weeks since I last posted. In this case it is no news is good news (or just no news?).

The main item to report on the health front is that the leg wound finally healed over about two weeks back, which is great and the first time in five months I haven’t had an open wound. No more plastic bags in the shower!! It now means the Docs and I can start to plan for the next phase – getting a prosthetic leg sized up, made and fitted.

I’m still on a number of medications, mostly to mitigate against the chance of the MSRA infection that I picked up in hospital reoccurring (but also to deal with other consequences of a leg amputation). It’s a pretty nasty bug and I must be diligent to ensure it doesn’t flare up, especially in the bone. The drugs are fairly powerful, so no doubt they contribute to a feeling of tiredness at times. Also, the inability to exercise in an aerobically meaningful way is also having an effect.

This sedentary state, combined with an overly healthy diet, means the weight has gone on and I’m probably as fat as I’ve been in years. I’m not game to jump on the scales.

Many people have asked me what actually happened.

Basically, it goes like this: 11 April 2007 - I was on a normal morning training ride as scheduled by coach, fairly steady as I was taking it easy in the transition week or two following the National Masters Track Champs, where I had good form. As usual it was an early morning ride, out at about 5.30am. I wasn’t doing a long one, so I rode south from my place out to Taren Point, a route I’ve ridden literally hundreds of times over the past decade. Turn around via Sylvania Waters and back over Taren Pt Bridge on the way home using the cycleway on the eastern side of the bridge. That cycleway leads you into the car park of the St George Sailing Club in Sandringham and straight onto Riverside Dr. It was 6.15am as I crossed the bridge, the sun was poking up over the horizon.

See the picture below courtesy of Google Maps (click on the pic to see a larger version). The orange dots mark the path.

As I entered the car park, all was normal – quiet. I checked the traffic left and right on Fraters Ave. And Riverside Dr. and nothing was about. I’m usually pretty careful at this point as there are a number of potential hazards (speed humps, gravel, glass etc) on what looks a pretty straight little piece of road. I did nothing different today. I have been through here dozens and dozens of times over many years. Suddenly, out of nowhere, a boomgate, closed across the entrance to the car park appears right in front of me, and I mean with only a fraction of a second to spare. Crunch.

I hit it flush at speed, no time for braking or avoidance manoeuvres. The left leg, just below the knee took the full force and this impact caused all the damage. I wasn’t actually sure what part of my leg had broken at the time, I found out later in hospital: a fractured tibial plateau (the upper bulge section of the shin bone or tibia) – pretty well smashed into lots of fragments, a fractured fibula, a severed posterior tibial artery and severe damage to tissue and capiliaries of lower leg, leading to compartment syndrome and operations to graft in a new artery and a knee to ankle fasciotomy on both sides of my lower leg to deal with the severe nature of the inflammation. Multiple operations and many weeks of treatment later, the complications could not be resolved, too much flesh had died (almost all the lower leg muscle tissue bar the upper calf muscle) resulting in the need to amputate the now non-viable lower leg.

So how come I didn’t see the boomgate? I have no idea but it must just blend into the background. It’s a single steel horizontal boom about 4” in diameter (i.e. very solid), hinged at one end, latched at the other side of the road (so it wasn’t moving nor have any "give" in case of collision), is white in colour and with no warning signs. Nasty. As I discovered later on, many other riders had hit it before or had near misses as it is so hard to see at times.

When I visited the crash site after finally getting out of hospital (a bit over four months), it was good to remind myself that I wasn’t an idiot and it was an accident waiting to happen. Someone has since hand painted with a spray can some warnings on the road and suggested an alterative turn just before the gate location to another bike path (which is obscured by the bushes).

So I went from my best ever personal race result, to losing my leg in a short space of time and dreams of competing at the world champs dashed. I was really looking forward to donning the Aussie skinsuit in the points race (an honour granted due to my result at the Nationals).

Still, I look forward to getting my prosthetic, walking again, losing all this puppy fat and ultimately getting back on the bike and being as competitive as before. It will take a while though but it will happen.

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Home at Last

A short post today. Mum has taken ill, so I need to pay her some attention. After all, she has been there for me these past four months, making life so much better for me while enduring the trials and tribulations of the hospital stay. Let's hope she improves soon.

But at least the good news is that the hospital sent me home earlier this week. I got home on Tuesday - it's been hard work since then as it takes quite a bit to get about on the crutches, up and down on chairs - all those one legged squats.

The community nurse visits each day to change the wound dressing. All going OK there. A visit to my local Doctor, the pharmacy and the bank (!) on Thursday wore me out but in a good way.

Anyway, pretty tired so that's all for now.

See you next time.

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Rehab Week 8: Homeward Bound

It seems that my long stay in hospital is finally coming to an end. Yesterday marked my four-month anniversary. Seems like I’ve been here a year. Of course I don’t remember much of the first eight weeks I was in so much of a drug-induced daze. But the dreams were amazing, mostly very dark and scary but amazingly real at the time. But back to now…

On Thursday, the wound was inspected again and revealed some more good progress. So much so that the Doc suggested I’ll be going home this coming week. But before I get too excited at that prospect, we decided to do another of those irradiated white cells gamma camera tests I talked about in this post.

I found out a little more about the test. For instance, the second blood extraction of 20 ml is used to separate out some extra plasma, which is then combined with the white cells extracted from the first blood sample before they are reinjected.

The other tidbit is the isotope used to irradiate the white cells, a metastable nuclear isomer of the element Technetium, 99mTc. OK, enough of today’s chemistry lesson.

The test was conducted on Friday afternoon, full results not known until Monday I’d say, although the technician did say the initial scan showed a much improved result over last time. Promising at least.

If the test comes up clear, then I’m heading home, possibly on Tuesday.

That’s pretty cool news, it will be great to be back home. Of course that just presents a few more challenges. My wound has not yet finished healing and so I’ll still need community nursing care for the dressings and it could still be 6-8 weeks before I get a prosthetic. So still quite a while getting about on crutches in front of me.

Keep safe out there guys.

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Rehab Week 7: A Matter of Degrees

Honestly, this hospital stay is getting pretty tedious. But that’s good news really. I seem to have fought off the MSRA infection successfully. Latest swabs are not growing any cultures, blood tests are clear and the wound looks clean with no signs of inflammation.

The remaining wound is getting smaller, if only by millimeters per week. It’s about two centimetres deep now and pretty skinny now, so hopefully I’m on the home stretch with that.

On the rehab front, well there’s only so much arm work I can do and I’m basically fit and strong enough to go home, it’s just the medical issue with the wound to be cleared up. Walking around on the crutches is a bit tricky. I’m good on the crutches but as I’m still hooked up to the vacuum unit, it means someone has to carry it along behind me if I want to have a walk.

The main rehab issue now is the range of motion of the knee joint. Over the past few weeks I’ve been working to improve the amount I can straighten and bend it. Right now I’m getting to 10 degrees in the straightening motion and 82 degrees when bending. I’ll need a lot better than that for riding. The doc says that it’s the amount of scar tissue inside that’s restricting the motion and that once I have the prosthetic on I’ll have much more leverage to help improving. Let’s hope so.

That’s all folks!

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Rehab Week 6: Weighty Matters

Another week, with Room 12 being my home for these past three and a half months. For some reason I managed to score the exact same room position in both wards I’ve been in since leaving the High Dependency Unit.

The bright spot of the week was my surprise birthday party on Thursday evening. Of course it meant a couple of birthday cakes from friends and relatives. There was lots of cake so the nursing staff scored well and I got plenty of brownie points for sharing around. It was a fun night, thanks to Sam and Tanya for organizing and the rest for popping in to share.

Wound continues to do well, gradually getting smaller and staying nice and clean. Seemingly there’s no further sign of infection, so that’s good. If this keeps up I might be outta here in a few weeks. In the meantime I’m still on the vacuum dressing.

Since coming out of the dark days, I’ve put back on all my weight and some more. At the lowest point I had lost 14kg after entering hospital already in race trim having finished the Australian Masters championships a couple of weeks earlier. I was nearly as skinny as Rasmussen!

I’ve regained a lot of strength and now having a bit of fun wheeling myself about in the chair. I’m also about to have my first full day/night without any painkillers.

So a pretty good week.

Nice ride Cadel, we’re proud of you.

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Rehab Week 5: Glowing in the Dark

Whatever you want,
whatever you need,
you pay your money you take your choice.

For those still wondering, that’s some lyrics from an old Status Quo song. Status Quo being the operative words. Not much change to report but a few things on the positive side, I mean I’m not sick nor has the wound got worse.

On Monday I had an irradiated white cell gamma radiation test. What the hell is that?

Well it goes like this: First withdraw 70ml of blood, two lots, 50ml and 20ml. The 20ml sample goes for a range of standard blood tests. The 50ml is then put through some processes to separate out the white blood cells (they’re the ones that attack foreign bodies and bugs inside your body).

The white blood cells are then irradiated using nuclear medicine products (probably produced at the Lucas Heights nuclear reactor in Sydney) to make them carry radionuclides. That means these white cells are now emitting gamma radiation. The cells are then reinjected into my blood stream.

White cells, being what they are, will congregate around infections. So a couple of hours later, I’m lying on a table with this big gamma camera slowly circling my leg picking up the gamma radiation emitting from my leg. The 360 degree gamma ray picture then matches to a CT scan to form a 3-D picture of where the white cells and possible infections lie.

So what did it find? Three clusters or “hot spots”. One around the wound, one at the top of the tibia and another around the screws in the metal plate just below my knee. However at the moment there aren’t the other markers (pain, inflammation, fever, blood test markers) to indicate these are serious. If the wound continues to heal, that’s means I’m in control and not the bug. So far so good on that front as at each change of the vacuum dressing has found a very clean and smaller wound. Let’s hope that trend continues. Otherwise they’ll have to open me up again. We don’t want that.

Also, no more IV antibiotic. The Vancomycin I was on is a powerful drug and two weeks is the maximum time the Docs would let me be on it, lest it do more damage than good.

So what about those radioactive white cells? Well the radiation doesn’t last long as the rarionuclides have a half life of six hours and the total radiation exposure was less than for a typical x-ray image. Just as well, otherwise I might have started to glow!

Catch you next time!

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Rehab Week 4: Waiting for Godot

Yep, another week in paradise! Still on the inside wondering if it will ever end. While I’m not a Beckett fan, nor profess to really get what his plays are about, I sometimes wonder if there is anything out that window…. (OK, so I’m getting my plays mixed up, call it poetic license).

This week marked my 3-month anniversary inside the hospital.

OK, it’s not all that bad. Last week I talked about the new hole in my leg and the infection. On Monday this week, a new dressing was fitted – a vacuum dressing. It’s a seal put over your wound and hooked up to a vacuum pump that keeps sucking away. Along with some special foam-like dressing inside and around the wound, it drags out the bad stuff and encourages new flesh to grow. The downside is I am now hooked up to a machine via a hose and mobility is much more limited again. I have been on vacuum dressing before but that was when I was far less cogent and when the docs were trying to save my leg.

My first progress check was on Thursday when the wound dressing was changed. Good news – the wound had halved in size since Monday (the previous week it had hardly changed at all). It was also nice and clean. Tick one to the vacuum dressing. It also enabled the nurse to shave a little more hair from the leg around the wound - ripping off the op-site dressings frm a hairy leg ain't fun! Yeah - that's right - my legs are hairy again. Yuk!!

Other signs, blood pressure, temperature, pain have all been steady and good and blood test infection markers are low, so it looks as though I have the infection in check at least, if not beaten. I’m still on the IV and oral antibiotics though, presumably until the wound heals. How long? Who knows.

Next check of wound is Monday, so will be really keen to see if progress has continued.

Otherwise all is OK and watching Le Tour is a great distraction.

Ride safe

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Rehab Week 3: I.V. League

No, not Yale or Harvard, I mean the intravenous kind. Yep, I’m back on an IV antibiotic drip this week along with some other oral antibiotics.

See I've had a bit of a set back this week – the one remaining patch of wound stubbornly wasn't healing so they dug it out leaving a half inch wide hole an inch and a half deep - and now I've picked up an MRSA infection or commonly known as Golden Staff. If it makes its way to my metal work or bone I'm in trouble.

I'm now being hit with big time antibiotics in a shock and awe campaign to try to knock this bug over (hence back on an IV drip) plus some other oral drugs (I've been through about half a dozen different antibiotics). I have to admit I am pretty worried about it. Hopefully it will all clear up but the downside is not worth thinking about (more surgery, possible further removal of leg).

Otherwise I'm going OK - getting stronger, crutch walking with confidence (up and down a couple of flights of fire stairs) and pushing myself around in the wheelchair when we go for trips out of the building.

At least le Tour has started although I’m not sure I’m gunna manage to stay up every night to watch!

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Rehab Week 2: Waiting for one patch

OK I made it through another week. Energy levels are up on last week and gym work/exercise is now regular although still not huge by my normal standards. On Friday I had my biggest day, with 6 minutes of pull downs, 9 minutes on the hand cycle ergo (3 x 3min “intervals”), climbing two flights of fire stairs (and down again!) along with the usual one-legged balancing and stretching exercises and a lap or so of the ward on the crutches.

On the weekend the ward gym is closed, so yesterday I made it a rest/recovery day (you know, let’s watch the footy kind a day) and today I simulated the effort by pushing myself in the wheelchair down to the ground floor cafeteria and outdoor eating area and back up to my ward/room again. For experienced chair users that’s barely a warm up but for me that was a big deal. Then I managed a couple of laps of the ward on the crutches.

One funny “exercise” is lying prone on a special bed/table, which has a hole in it so your face can look straight down and not ruin your neck with it jerked sideways (bit like a physio’s massage table, just a lot wider). The idea is that it helps to straighten out your knee and other muscles that have been lying the other way for a couple of months. Mine knee’s got to 13 degrees so far, I need it to get as close to zero as I can as that helps to fit the prosthetic and re-learn to walk.

Remembering I had smashed up my tibial plateau (the big round bit at the top of your shin bone) and fractured the top of my fibia (the smaller shin bone). There are a plate, rod and lots of screws in there, which went in on day 1. After all those weeks of being confined to bed, it’s no wonder the knee joint is a bit restricted in movement.

The leg closure wound that I’m waiting to heal up has progressed OK, although the stubborn patch is still there and will probably take some weeks to finally close up. That’s a bit disappointing as I was really hoping I’d be fitted with a prosthetic before I leave hospital but it looks like I’ll be home before that happens.

Nevermind, life on crutches for a while won’t be so bad. Each day I grow more confident but ever watchful that I remain careful, I don’t want any falls jeapordising my progress. One problem will be the house renovations going on at the moment, there are builders’ tools, materials and furniture everywhere apparently and I wouldn’t be able to go back until that is substantially completed. I’m hoping for some good news on progress this week. Fingers crossed.

Stay safe out there folks.
Catch you next time.

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Rehab Week 1 / Dr William Tan

Well after finally making it up to the rehab ward, it’s been a case of hurry up and slow down. My large leg closure wound is all but healed, with one stubborn patch taking its time so I have to be patient, exercise needs to be moderate while I’m still healing.

Pain killers are still on the agenda too, although dosages have been wound right back, I still get plenty of reminders of the nerves in action. Think overactive pins and needles sensations and short little jolts that make you jump unintentionally. Not really painful, just weird. Occasional breakthrough painkillers are needed to settle down the “noise” which is enough to keep you awake. I reckon it’s just the leg’s nerves re-wiring themselves.

It’s probably just as well that exercise needs to be moderate, with all the changes recently, I found that even with the limited amount of exercise along with all the recent changes to medication and change of location really flattened me during the week and I spent a couple of days pretty well completely exhausted. Being very physically tired also lowered my emotional state for a while but this is just a bump along the way and I’m sure there will be a few more speed humps to drive over.

Anyway, I’ve had a few days of going easy, light gym sessions and short walks and extra sleeps during the day and have ended the week in reasonable shape.

On Friday I attended a talk by Dr William Tan. What an inspirational guy. Diagnosed with polio as a child and growing up in a poor family, Will fought against the odds to go on to become a Medical Doctor and an endurance wheelchair athlete, holding world records and competing at Paralympics. But the story he told was about his attempt to complete 10 marathons in 7 continents in 65 days, all part of a fundraising drive. The marathon on Antarctica and the non-continent at the North Pole was pretty amazing. Here’s a link for interest:

http://staff.science.nus.edu.sg/~sivasothi/cycling/rideforhope/williamtan.html

Nice work Dr Tan.

‘til next time.

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