Big gym

It's been a busy week, which is brilliant, makes time pass so much faster! I'm now 3 weeks from my second operation with only 3 weeks to go until (hopefully) I can start rehab!!

Monday, I went back to work, for the second time. I was so happy to be back again, I was really worried that after my re-fracture they wouldn't let me back on crutches. It felt great to be back again (again!). Friendly faces, hugs from friends and colleagues, feeling like I had purpose. Moving around in the hospital still fills me with a lot of anxiety, and so I'm lucky to be allowed to stay in one place doing discharge paperwork.

Tuesday was my birthday. I had been a bit worried about this, as every year since I turned 30 I've done a race to mark my birthday. I was prepared to feel quite sad this year. However, I had promised myself that I would enjoy the day the best I could, and try not to worry! This started with me having chocolate cake in bed at 5:30am. I've been trying to go easy on cake since this accident happened. For the past few years I've taken for granted the fact that my daily calorie expenditure is such that I can eat anything I like. Without this to fall back on I've been far stricter with my diet. But, it was my birthday, so I was going to eat whatever the hell I wanted with no guilt. And I did, I really did!! The day finished with a meal at 15 with Jason and my Mum and Dad. It was wonderful! If I'm honest, I think I probably enjoyed all the food even more than usual because it was such a treat now that I'm being more careful of what I eat!

And, to top off a fantastic birthday week, on Thursday morning at 6:30am (which was our normal routine) Jason took me to the gym. I cannot express my excitement. I've been regularly going to the gym in the morning before work for the past 4 years, so I know a lot of the other regulars. Jason had told a lot of them about my accident, so I didn't have to go through the story again and again, I just got loads of good wishes and people saying how amazing it was that I was going to the gym on one leg which made me feel really good about myself. I heard a really encouraging story from one guy there who was once told after a back injury that he would never run again and has since run a 2:40 marathon. All these little bits of positivity help me stay focused on recovery and make me realise that a lot of this will be about what I make of it. I know my patella is rogered. I know the articular surface is messed up and that I'll get problems with arthritis. I know that there were a few bits of it that were so smashed that they had to be removed or just left with no fixation because they were too small to fix. But I also know that every race I've run in the past year, I've run with screaming pain in my back and right hamstring, pain which I have just learned to put up with. If I can put up with that, then I can also put up with whatever pain I'm left with when this knee is healed. For me, pain is part of endurance running, and something to expect and deal with mentally.

In the gym I put one-legged erging to the test. The trick is to have a towel under your bad foot which lets it slide along the floor with no resistance. Then you can just ignore this leg, letting it slide back and forward whilst you row with your good leg, arms and torso. I  imagine it's probably the most 'whole-body' workout that you can get whilst on one leg. I can manage this for about 30 minutes before my left leg starts to really cramp up from the intense work and unaccustomed position.  After this I spent some time playing with the hand cycle in the gym which is a really massive version of my one at home, and gives a really good high intensity workout.
I could have stayed in the gym playing on stuff all day, I finally felt like I was at least a fraction of the athlete I was before this happened. I went back on the Friday for more!

So, now I know what's possible, I'll see you down the gym!

Angels without wings.

2016 has not been a good year for me so far. I'm hoping that I've paid my dues to whatever aspect of fate I owe, my run of bad luck is over and I can just get on with my life now. I suppose none of us knows what fate has in store for us. Despite that fact that I participate in relatively extreme sports I never saw myself sustaining an injury that would have such an impact on my life.

On the other hand, I am very lucky. Last week in Plymouth a cyclist the same age as me was killed by a dangerous driver. I know from the state of my bike, cycle helmet and patella that if I had landed differently I could have sustained far more serious injuries. My head smashed the drivers windscreen as I went over her bonnet and I escaped with whiplash alone, not even a concussion. Jason frequently reminds me how different that call he received from the police could have been...

Counting my blessings helps me through the difficult periods, the days that I cry and cry and just long to put on my trainers and run out of the front door. If I can just bear this period of recovery, then I will be able to get back to my normal life. Even if that no longer includes competitive running, there is so much that I can do. Had I landed differently during the accident then I might not have had that option.

But counting my blessings  alone is not what is getting me through this. It's you. Whoever you are, reading this, giving me positive input no matter how small.

I am truly lucky to be surrounded by such wonderful people. From the moment that this injury occurred I have had people beside me, supporting me, holding me up when I'm down. My wonderful parents; Dad who has put up with my constant questioning about whether he thinks the bone is healing properly, Mum who has looked after me as if I was 10 again, driving me to appointments and caring for me like only a mother could. My ever-patient husband who has dealt with my frequent and dramatic mood swings, my fears and my pain.

And my amazing circle of friends, constantly giving me encouragement, wishing me well, offering to help me out wherever they can.  I have received such amazing quantities of love over the past few weeks. I don't think I could ever express what you have done for me, and the words 'thank you' just seem so inadequate.

So, this blog post is by way of a 'thank you' card to each and every one of you. It's not enough, and no amount of thanks ever could be, but it'll have to do.

Flexion mark 2.

Thursday 17th March - 7 weeks post-accident, 2 weeks post re-fracture with 4 weeks on crutches NWB left to go (provided I don't balls it up again). My clips from my second operation came out, and my brace was set to 40 degrees. My poor knee. 7 weeks during which the greatest percentage of time has been fixed in extension. This joint has become fixed nearly solid. I've been desperate to flex the joint. I'm convinced that most of the pain I've been getting for the past week has been due to stiffness not the fracture. When the brace reset, I made it to 10 degrees, and stopped. The only thing I can compare the feeling to is trying to bend one of your fingers back into forced extension. It won't go, and it feels like it shouldn't. In the case of your finger, that's because it's not meant to. In the case of my knee, it's because scar tissue and swelling are causing the joint to fix. I've spent the past 24 hours easing it into flexion, and now make it to 30 degrees, but it feels painful and tight. In honesty, I've probably overdone it, but I'm feeling particularly impatient at the moment.

My mood swings are still quite intense, the days at home along are long and tedious. My underlying depression gives me significant diurnal mood variation, so mornings are my best times. I'm countering this by doing all my exercises in the afternoon to try to balance my mood as best I can. The next 3 weeks should be better, as Jason is on holiday and so I won't have long periods of time alone.

I've been trying to improve my static exercise routine. I've been using the hand bike for at least 30 minutes each day, spending at least 15 minutes doing core exercises, focusing particularly on my right leg gluts and hamstring as well as my abs. I'm also able to get back on my turbo trainer now I've got some movement in the knee. I'm managing to maintain my weight pretty well. I've lost 2kg, which I attribute to the loss of muscle from my right leg, but my general shape is staying pretty static apart from an increase in the size of my arms and shoulders.

So, a bit more about static exercising.
Hand bike. I thoroughly recommend this to anyone who is immobilised for any period of time. You can get a whole range of styles. Mine cost around £50 from Amazon and has a basic resistance dial and a LCD screen which scrolls through time, rotations, distance in KM and calories. It sits comfortably on my kitchen table, and is easy to put away afterwards. The highest resistance setting isn't that taxing, but by varying resistance and RPM for periods of time you can get something akin to a spin session. You can also vary your arm and body movements as you 'pedal' so you can work your torso quite well (it's an action similar to hoola-hooping!)

I can't recommend this gadget highly enough, it makes it possible to get an aerobic work-out whilst sitting down.

Positives:
Working out a way to use my exercise regimes to balance my mood swings.
Managing to get from 10 to 40 degrees of flexion over 24 hours though a combination of gradual work and regular icing.
Finally having a shower! (now my surgical clips are out, I can sit in the bath with my brace off and shower. It felt AMAZING!)

Plodding.

It's been 12 days since my second operation. 12. Long. Days.

I'm struggling mentally to cope with the immobility this time round. Every day stretches out to eternity and I find it hard to deal with the time laid out in front of me until I can get back on 2 feet. I feel like I'm in a terrible never-ending limbo of misery and despair and I have spent an awful lot of time in tears (I'm actually crying as I write this). I've also started to suffer from real anxiety around mobilising, out of fear of falling again. I find it hard to be in public places for a similar reason, just in case someone bumps into me. And every time I get a twinge in my knee I become paranoid that the bone is becoming avascular and the healing process is failing. My GP has increased my antidepressant medication and added in a second agent to help me get through this period. I'm not sure that it's having any effect.

In short, I'm a bit of a mess.

So I've mostly been at home. I did venture out last Saturday, under the comforting and watchful eye of my wonderful mother. We went singing for the day, and it was wonderful to be doing something different. East Cornwall Bach choir put on a 'come and sing' day. We met at 10am, spent the day rehearsing Mozart's Requiem, and then sang the full work in the evening. By the end of the day I was exhausted, but it gave me a lift to have been doing something, focusing and then performing. I'd forgotten how much singing means to me.

I'm slowly getting back to my pre-fall static training. Initially I just started on my hand bike. That was about 7 days postop. The first time I did 20 minutes, I slept for 3 hours afterwards. It's amazing the demands healing makes on your body! The handbike helps me to work up a bit of a sweat, and I can now do 40 minutes straight (time mainly limited by the need to move my leg after this long). I can't manage to get onto my turbo trainer yet (my leg is still fixed in extension), but I'm now able to get onto the floor again, and so can do a range of core exercises. I've also been trying to focus on my right leg gluts, abductors and hamstrings, because I'm going to need some serious support from whatever muscle groups are left in this leg after 11 weeks non-weigh-bearing.

I'm also focusing on trying to keep my diet healthy with each meal providing high protein and eating lots of raw veg for vitamin content.

So, I'm getting there, but by Gods it's slow. This Thursday my surgical clips come out. Then I face another month on crutches before I can start physio. Of course, there's always the chance that I'll have gone insane by then!

Positives:
Spending the day singing with my mum.
Persevering with the static exercises.

On a lighter note..

This morning the following items arrived at my bedside courtesy of Jason. He is 'optimising my nutritional intake to get me running again' (his exact words)!

Then a second item appeared. This is, apparently, 'all about the presentation which is everything, look, I've used some leaves off a coconut, or a pineapple, or some kind of exotic fruit anyway. It makes it look all posh.'

I am lucky on so many levels!

off course

Here we go again.
2 days postop, the pain is very similar to the first time, but I'm managing to keep on top of it with a strictly timed analgesia regime which I didn't do last time. This does mean that i spend most of the day completely spaced out,  but it definately seems to be the best way to manage. Yesterday, before I started taking the pain meds at exact times I lost control of the pain and subsequently spent a good couple of hours crying because it was so severe.

I'm currently struggling with the disappointment that, as a result of this repeat injury,  I have missed my interview for a core medical training post. The deanery and the cmt recruitment people were really helpful and did try to get me a last minute stand alone interview, but in the end it wasn't possible. All I can do is hope that there are posts left that I can apply for through round 2 applications. This setback also means that I won't be able to go to Paris with Jason at the beginning of April to cheer him on in the marathon, as I will now still be non-weight-bearing and travel is too risky.

It's weird being here again, and difficult having to deal with further disappointments.  The only thing feel I can compare it to its getting lost in a race.  In fact,  I have the perfect example. Centurion South Downs Way 50, 2013. My first real ultra.  I had no idea what I would be able to achieve, hoping only for a finish. The weather during the race was atrocious and moving forward was a constant battle against the wind. I managed to climb the rankings throughout the race as my steady plod took me forward through the storm whilst others were picked off by the cold, wind and rain. At 40 miles I overtook the leading female, and was set to come in first, something i could never have imagined possible of myself. Then, at 45 miles I took a wrong turn. The subsequent detour added an hour to my finish time and caused me to lose 1st place, dropping me down into 3rd.  I was unbelievably angry at myself, my stupidity and my carelessness which I felt had lead me to miss the correct route.

This race really does work as a comparison for my experience since the accident. I set out with no idea what function I will achieve at the end of this,  I just hope to finish and be able to run. I have battled against the storm to get myself closer to the finish, and just before I made it i have gone off course and am now having to retrace my steps to find my way back to the correct route, adding a month to my 'finish time' and losing out on 'prizes' as a result (job interview and trip to Paris).

At the moment, I'm struggling to find any positives to take from this setback. But maybe that is ok.  I have worked to stay positive throughout what had happened so far, taking each experience as a chance to learn and develop. But maybe it is acceptable for me to just feel utterly disappointed and overwhelmingly sad about this, and to acknowledge that this setback is really really shit and will impact on my mental state to the point that I may require external help to get through it.
Just for a short time.
But I will become stronger as a result.

Victories
acknowledging that it is acceptable to be disappointed and disheartened when something goes wrong.
Realising that I may need extra help in mentally getting through this setback and acknowledging that there is no shame in asking for help.

I get knocked down.....

I slipped on wet floor in the main concourse in Derriford. My right crutch slid forward and I landed heavily on my right leg, putting all my weight through it. The pain was immediate and intense, and I screamed. Suddenly I was surrounded by people, holding me up, asking if I was ok. All I could do was cry.

 Someone put out a medical assistance call, and the crash team turned up. It was reassuring to see familiar faces, they put me in a wheelchair and took me round to ED where I was met by more familiar faces who put me in a bed and gave me pain relief. But I still just kept on crying.

I sobbed and sobbed while one of the ED consultants gave me the most motherly hug I have ever received from anyone other than my own mother.

My knee was swelling. It was tight, hot, agonisingly painful like a toothache within the joint. I cried, cried, kept on crying. Kirsten came down to ED and sat with me whilst I was clerked, cried, had my xrays, cried, took analgaesia, cried.

Toby, the ortho reg on-call, came to seem me. He looked sadly at me and told me that my xray looked like something had shifted but that he had to discuss it with a consultant. Later he returned with Mr Westwood the on-call consultant who agreed, the fixation had failed, the bone fragments had moved and the wiring was no longer holding them in place. I needed another fixation. I was, essentially, back to where I was on the day of the accident. I cried.

This is a speed-bump. My progress has been slowed, the healing that has occurred to this point has been reversed. But I am holding on to the fact that my position now is no worse than it was when this first happened. This will slow my recovery but it will not stop it, and it will not make me any more or less likely to have lost my ability to run.

And, because I HAVE to let my mind have priority right now, I will also consider these positives:

I have been here before, very recently, and so this time, I am prepared.
I know how to survive the postop period.
I know how to manage the pain, the immobility, the clumsiness.
I am more mentally prepared to manage the despair and frustration.
I have developed activities to keep me as fit as possible whilst immobile.

And most importantly, over the past 4 weeks  I have come to learn that I have a network, a circle, a sea of wonderful friends who have been supporting me every step of the way each in their own individual ways. Friends who have helped me to find worth in myself that I never believed I had.

...so I get up again.