Catharsis

This is a completely non-constructive and angry blog entry written with the sole intent of allowing me to vent my feelings.

6 months ago I underwent my second fixation. I had a total of 2.5 months non-weight bearing and 4 months non-running. I lost near 95% of my right quad strength. And yet, I look at that time off running...only 4 months....and expect my body to be able to pick up where we left off. Oh, sure, I'd have lost a bit of CV fitness but that would be easy to build up. I know other people who've had 4 months off with knee injury and they've got back to it with no problems.

I've been comparing myself to other people. About the same time as I did my knee, Emelie Fosberg tore her ACL. She's just made an amazing comeback, winning races already. Last year Jo Meek had several months off with injury, and she was winning marathons by the autumn. Why can't I do the same?

Logic tells me it's because of the difference in injury. Logic tells me that I am still functioning on 1.5 legs rather than 2. Logic tells me that it's going to be a long process, and that I need to be patient. It was a fracture, my whole quadriceps mechanism was disrupted, I lost most of the muscle in my right leg.

But I've had enough of logic and patience. I want to be back where I was, going into races to win, running like I'm flying. And I want it now!

So I signed up for the Ridgeway Challenge 86 mile ultramarathon. It was a stupid thing to do, but I had the tantalising memory of my wonderful run at Race to the Stones 2015 in my mind, that memory of just sailing along. I wanted that SO badly.

I didn't get it. I made it to 44 miles, most of it thoroughly miserable at my legs wouldn't allow me to sail. The 'achievable' 10 min mile pace made me exhausted. As my left leg got tired the pain in my right knee got worse and worse and my gait became more and more of a lurch. At 42 miles I had to walk through exhaustion and pain. At 44 miles I stopped. I felt nothing like the old me. Now the races I had started to plan for in the next year seem like a distant and unobtainable goal.

I'm angry. I shouldn't be in this position. I think part of the problem is the bubbling underlying helplessness I feel. Then the anger of the mechanism of injury sets in. I want to scream at the person who did this to me. Shake her and make her see how much mental trauma she's caused me. My entire life has veered off path because of this. Just because of her carelessness.

Then I remember, it's just a knee injury. It's just running. Other people have to deal with so much worse. And I feel overwhelming guilt for being so selfish and childish.

And I go back to my trainers.
And I try again.

Running broken

Once again I've looked back at my blog and realised how long it's been since I updated things. The blog is proving to be really useful to me these days, as I'm back running, but the frustration of how much fitness and endurance I've lost can be overwhelming, so it's really useful to look back and see how far I've come.

Yes, I'm running again. And I have been since the 2nd of June. That was the date of my 3 month follow-up with my consultant. That day I had an x-ray, and, feeling very nervous (I'd been spending a lot of time in the gym and the niggling thought of 'what if I've damaged the fixation' was always at the back of my mind) I asked him if my knee was up to running yet. He pulled a face and told me not to do anything stupid (yeah, as if!!). Later that evening I ran 0.5 of a mile, lurching to one side like a drunk as my right leg had minimal proprioception or strength. It felt so good. Within a week I was back up to one mile. It's painful, always painful, but the pain would never get any worse during a run. Night time was a different matter, and my sleep was now constantly disturbed by a feeling I can only liken to toothache in the knee. Now, 2 months on and that is still the case. I'm hoping that this is partly to do with the metalwork, and that the pain will ease off a lot when this is taken out.

Now I'm back up to running most days, and so far I've managed a max of 18 miles. The thing I'm struggling most with is how SLOW I've become! I used to breeze along at 8 minute mile pace comfortably for a good 20 mile run. That is now a sprint pace that I can maintain for around half a mile before my legs just give up. And hills, I used to sail up a nice hill! Now I can just about plod to the top before I have to stop and let the feeling come back into my legs. And the weird thing is, it's my good leg that gives up first! I went running with Jason and he noticed that my gait was still slightly uneven. I can only assume that this is putting extra stress on my left knee and quad. Anyway, it's intensely frustrating, and for the time being I've given up running with any form of timekeeping or GPS due to the despair I feel when I check my time and find out how slow it is. I work hard, I feel out of breath, my lungs burning and sick to my stomach, and I'm just about hitting a 7mph pace, and for a second I'm disgusted with my body.

It's been hard watching other people I know do races and achieve such amazing things. I've watched races go by, seen course record get broken, seen friends selected to the GB team. Meanwhile I can just about manage my old routes without stopping every mile to rest.

So, I read my blog the other night. And I counted back and realised that it's only been 5 months since my second op and only 3 months since my brace came off. 3 months!!!! I remember the despair, the feeling of loss, the terrifying unknown before me when I lay in ED and they told me just how smashed up my knee was. And now, I'm out running EVERY DAY! I don't think I could have anticipated this back then, and I feel incredibly lucky that everything is actually going so well! When it first happened, I read about the severity of my injury, the biomechanics, the healing process and long term functional limitations and I was prepared to never be able to run properly again. I know that what I should be doing is counting my blessings every single second.

So, here I am, counting my blessings.
If you're reading this, then you're probably one of them.

Dear diary

As I sit here, 3kg ankle weight on my leg, straight-leg raising and munching on a protein bar, I can't believe it's been so long since I last wrote a post.
So much has happened. I'm now walking, brace-free and slowly regaining muscle in my quad. I'm able to swim again and I have the flexion to manage the bike. I've spent more time on the elliptical trainer in the past 4 weeks than I ever wished to experience.

So, as I've been so remiss in posting updates about my experience, here is a brief diary.

14th of April. 6 week follow-up. Consultant said I could start fully weight bearing. I punched the air in excitement and nearly told him that I loved him...embarrassing considering that I used to work for the orthopaedic department. I went for a walk around the hospital. Just because I could. I spent the rest of the day with mum, walking around with both crutches, occasionally reducing down to one crutch whilst shouting 'mum, mum look at me!!' Must of been like having a toddler again for her! When I got home, I made cup after cup of tea and carried them around the house, just because I could.

15th of April. Went to the gym with both legs working. Got on the elliptical trainer. Got off again. Got back on again. Got off again. Finally got on and did 5 minutes. It felt weird and naughty. Stuck to the rowing machine for the rest of the week.

17th of April. Went for a WALK on the COASTPATH with my dad. Still using both crutches, but I felt like I was free.

18th of April. Got Jase to drop me off 2 miles before work and walked the rest of the way in.

17th April. Went for a proper off-road walk around one of my shorter running routes. Cried a lot.

22-24th of April. Did my first full weekend on call. I can't describe how wonderful it felt to be doing clinical work again. I love my job.

25th of April. My brace developed a squeak. I don't think they're designed to do quite as much as I'd been doing with it. It was due to be off completetly on the 28th, so I decided to ditch it a couple of days early. I was finally BRACE FREE!! Had my first physio appointment, he gave me a load of exercises to help develop my quad. It wasn't until this appointment that I realised how little function I had in this leg. I could balance on it for about 5 seconds, but it was like I was standing on a wobble-board I was so unsteady.

26th of April. Got back in the pool. Swimming was fairly alright really, as I don't use my legs a lot anyway. Managed 1km without too much of a problem.

28th of April. Went for my first walk without a brace. Decided (probably stupidly) to leave my crutches at home and only use walking poles. And to wear a 10kg weighted pack. 7 miles later and I thought my leg was going to drop off.

30th of April. This was the weekend that I should have been up in Scotland running the Hoka Highland Fling for the GB trail team selection. It was also the weekend of the TP100, and someone running it beat my previous centurion 100 record of 16hrs 13 minutes with a new record of 16 hours. I spent a lot of this weekend in tears.

7th of May. Went for a row out in the gig followed by a swim in the sea. All the while, all I could do was stare at the coastpath and wish that I was running it.

11th of May. Went out on my mountain bike for the first time. It felt great to be outside, but I hurt a lot afterwards. Realised how much further I had to go with this rehab lark.

It's been an emotional rollercoaster, punctuated with highs as I progress on to new things and lows as I inevitably do too much and my knee starts to hurt like hell. When I get pain, I start to despair and feel like I'll never run again. Sometimes I end up in a panic that I've caused further damage. I have a whole host of caring friends and family telling me to take it easy. If only it was that simple. I'm still having to make use of my designated sad time to help me deal with this.

So, onwards. For now I'm mainly focusing on trying to regain muscle and function. I'm back to swimming a lot as it's the only exercise I can really throw myself into without the fear of damage.

It's a long long road.

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.

Static exercise set mark 1

Here are some details of my initial 'floor' work outs. All of these can be done without any equipment. I started doing these workouts as soon as the pain allowed me to get onto the floor. I aim to do at least 15 minutes of these a day. I'm now adding in additional workouts that I will include in each subsequent blog.

Issue one: getting down onto the floor.
This can be surprisingly tricky if you're non-weight bearing on one leg. Here's a video of how I managed it. It took me a while and I could only manage this once the pain had eased sufficiently (if I'd tried this in the first 10 days the jolting would have been too much to bear). Once you're on your front, you can then flip over onto your back. I'm limited by the fact that I can't kneel on my good knee either due to the soft tissue injury on that side.

floor sets for core:
Abdominal crunches - you can do these with legs in full extension. you may need some help to stabilise your legs for comfort, but this can be done with no supervision as you become more confident. If like me you're in a Donjoy brace, you may find it helpful to lock it at 0.


Full sit ups - these required a slight flexion in my leg before I could manage. It helps to have someone with you at first to stabilise your legs for you whilst you work to engage your core.

Leg raises - lying on your back, and using your good leg to support your bad leg, raise both legs simultaneously off the floor and lower again. Again, with a Donjoy, it helped me initially to lock it at 0 until I got used to


Abductor set - Lie on one side and raise your upper leg (It was incredibly liberating when I realised just how much mobility I still had in my bad leg. My quads were limited, but everything else could still function very well. Abductors have been the most helpful, particularly in getting into and out of cars.


Static quad - sit upright with legs out in front of you. With your good leg, press the back of your knee joint into the floor. Now try to repeat that with your bad leg. You should see your kneecap moving upwards as the quad muscle comes into play. You can play around with this exercise. Try engaging the muscle and holding, or doing a set of reps where you engage then release.

0-70 in 10 seconds

I reset my brace!

Since my operation I've had:
weeks 1-2 leg locked in extension
Weeks 2-4 knee flexion limited from 0-30 degrees.

Now, my brace is set to allow movement from 0-70 degrees for the next 2 weeks. After that.....well, that all depends on what my 6 week follow-up appointment brings and how the fixation looks on my 6 week xray. I'm really hopeful that at this point they will say it's ok for me to start working in the pool.

So my knee had been allowed no more than 30 degrees of flexion for the past month. It's still very swollen, the joint isn't really recognisable as a knee yet. The swelling extends around the whole circumference of the joint so the tendons along the back of my knee joint are barely palpable. I knew the swelling would limit my knee movement.

With the brace set at 30, the movement felt quite free and I thought that once the brace was set higher the extra flexion would come fairly easily. But it really didn't! As soon as I tried to flex, my knee pretty much just stopped at 40 degrees. It's a weird sensation, it wasn't exactly pain that stopped it, it just stopped, like something was blocking the joint. I've spent the day gradually easing the joint through the extra degrees of flexion, which has been painful. I've probably overdone it a little, as the joint is feeling pretty hot and tender now. But I can now flex from 0-50 quite freely. The extra 20 degrees require me to ease into it and work at it. I'm going to give it a rest for the evening now and try some ice on the joint to ease this swelling and heat.

As another exciting distraction I got another new bit of static exercise kit today in the form of a hand bike. It sits on the table and you turn the pedals with your arms. I worked out on it for 20 minutes (limited as my shoulders and wrists are suffering a bit from my crutches) and I managed to work up a bit of a sweat!

Next blog will be more details of my current workout sessions for anyone who's interested on how to exercise whilst sitting on your arse!!

Victories:
Not being despondent when my knee didn't instantly flex to 70 degrees, but working the joint slowly until it did.
Being sensible enough to know when to give it a rest.

70 degrees of freedom

Again, the feeling like being a toddler on Christmas eve...
Thursday is the day I get to set my brace from 30 to 70 degrees of flexion.
'Progress!!' my mind screams, and I feel one step closer to running the moors again!

I need something like this this week.. It's spring. Autumn and spring are my favourite times of year to run. The changing weather and with it the changing trails give me a feeling of joy, peace, happiness and makes my soul feel open to the world. It's one of the very few times that I feel part of anything, like I belong to the earth.

So, the recent change in weather, the lengthening evenings, the sprouting plants, the buzz coming up through the earth...and being unable to run on it...it's driving me mad! Like a terrible itch that I just can't scratch, or a glass of water that is just out of my reach!  So far I've been trying to deal with this by burying my head in the sand, keeping the curtains closed, ignoring the sunshine and cursing the singing birds every morning. My weekly alcohol intake has definitely increased as I try to numb the call of the trails.

I've been trying to scratch the itch with my evening workout regime. I've got some pretty good sessions going now, with the help of Jason as a sparring partner. Getting my heart rate up a little and breaking out into a light sweat, it does make me feel a little better and takes my mind off my loss.

But, nothing replaces the trail.
So yesterday I went for a walk. Well, a hop. Off-road. And it was.....well, it was wonderful. I put my long-distance playlist on my MP3 player (lots of hypnotic music. Gregorian chant, Byrd, Tallis, John Tavener and Arvo Paart.). I left the road through our village and I went up one of the trails and through the fields. I got stuck in the mud, I sat on a gate and watched the birds, I washed my crutches in the stream.
And so I discovered that I can find peace and contentment, even when I'm not running. I can even get a fleeting sense of the meditative state that I feel during an ultra. It's a very, very valuable lesson to learn

Always there for me. 

Stuck-in-the-mud

Now, to 70 degrees of flexion, and whatever the next stage of my recovery brings!

Victories:
Learning that I can find at the very least a shadow of my running contentment by being in the right environment, at the right time, with the right music and the right frame of mind.

Things you shouldn't say to an injured runner - warning, sense of humour failure!

Below are a selection of comments I've had from a few *less than* thoughtful people since this happened (none of whom are at all likely to be people who would read this blog which is why I'm happy to publish them!)

In each case what I really wanted to do was to pull the person inside my mind and let them feel my pain and loss at not being able to run, and the effect their comment has had on my psyche. Or maybe to invite them to witness me sobbing uncontrollably during my designated 'sadness' times. Then maybe just think a little.


1. 'It's the worst patella fracture I've ever seen. This is going to really affect your running.'
This statement comes under the headings 'blunt' 'thoughtless' and 'stating the bloody obvious'. Yes, my entire knee is going to function differently. And you think that will impact on my ability to run? Wow, you frickin' genius.

2. 'At least you'll lose that terrible gaunt runner physique, and become more womanly.'
So I'm going to be unable to run, AND I'll get fat? Double whammy saying this to a runner who used to be anorexic!

3. 'All that training and you won't be able to compete this year'
Yes, I had realised that, but thanks SO much for reminding me.

4. 'Well that's your cardiovascular fitness out of the window. No amount of weight training can maintain that without your running'
And my resting heart rate used to be 45 and is currently 70. How about you give me another kick while I'm down?

5. 'Hey, tried running yet' - followed by a wink and a laugh
No. No I haven't. I'm not weight bearing, my knee is only flexed to a max of 30 degrees, and I know that it's going to be another 4-6 months before I can even contemplate this. But, hey, GREAT joke!! What do you mean, 'sense of humour failure'?!

Each of these comments has elicited the same response from me. 'Yes, it is terrible. But it could have been worse, I could have cracked my skull open or snapped my neck'.

In short, we runners are a physically tough but sometimes emotionally sensitive breed, and sometimes, just sometimes, it's better to think about the impact of what you're saying on a delicate and endorphin-deficient mental state.
Rant over.

Short and SWEET!

Oh by all the Gods, I just managed my first straight leg raise!!
And then managed 2 more!!!!

It's the little things that are now a massive deal to me!
I'm going to have a beer to celebrate!

Quads-r-us!

The beginning of the end of the beginning

Delayed publication due to police investigation.
This is a long blog, documenting my recent accident. I've written in detail.

Over the Christmas period I had suffered from a depressive episode, which had really taken its toll on every part of my life. It also resulted in me having to cancel my plans to travel to Sierra Leone, as I was not in any fit mental state to manage such a major change. I had to come to terms with how my plans would have to change. I was still able to run, but I was getting very little joy out of it because of the exhaustion that comes with depression and I knew I was doing it more to preserve my little remaining sanity. Endorphin chasing to take the edge of the misery. By the middle of January I was more settled on some new medication and was starting to feel small tendrils of hope pushing up through the mud. I had plans for courses to go on,  races I wanted to do, aims to get selected to the GB trail team again and a bit of traveling I might manage if my mental state continued to improve.

On 20th of January I fell whilst training on the coastpath, splitting my knee open on a rock. The cut went right down to the bone and needed suturing, and the knee itself was very swollen and painful. Dad told me that I wouldn't be running for a couple of weeks at least. I limped around in a bad mood for days, snapping at family, whinging about how I was going to get fat. By day 9 I tried to go for a run, got 3 steps and was stopped by the pain. Huh. Well, at least now the wound was closed I could swim. And with the AoA a definite no-go, I was pretty confident I would heal in time for Transgrancanaria in March, which was my first A-list race of the year. I could not wait to hit those mountains!

On 30/1/16 I went for my first swim. 3.5K later and my knee was feeling a lot looser and I was feeling a lot more optimistic! I spent lunchtime cleaning my road bike and then late in the afternoon I decided to give my knee a try on the bike. Setting off up the hill from home I felt a little stiff, but my knee handled the rotational movement well and so I carried on down through Horrabridge towards Tavistock, planning to do a loop of the town and head home again.
I worked hard down the hill from Grenofen as it was raining and I didn't want to get cold by just coasting. I wasn't thinking about anything in particular.
What happened next happened so quickly, but the time involved also seemed to become stretched out. I saw a car pulling across the road into my path, turning off the far lane into the car park of Lidl. Directly into my path. Seemingly moving so slowly. In my mind, I knew I was going to hit it. I was cycling down the road with no reason to stop, and had not been slowing for any reason as I had right of way, I was probably doing between 15-20mph, and now, here was this car, in my path. I thought briefly about what I could possibly do to avoid this. But these thoughts were fleeting, I think I screamed 'No No No' and in my head I was just thinking 'NOT now, this CAN'T be happening.  Everything is just starting to get better'
I don't remember impacting the side of the car, rolling over the bonnet, cracking the windscreen on my way. I don't remember landing on the road on the far side of the car. What I do remember next is intense pain in my right knee and an overwhelming feeling of despair at what, even at the point, I knew were going to be serious injuries. I started crying uncontrollably, screaming and screaming, rolling around in pain (I never understood that phrase before...I do now) while people tried to calm me down and protect my C-spine. I remember hearing a lot of screaming children and people trying to get my details off me while I continued to scream and cry and shout that I just wanted Jason. My knee was in so much pain and I felt it would be more comfortable if I flexed it, but couldn't move it. Wave after wave of despair and fear washed continued to wash over me, and I started to shake uncontrollably. Someone told me everything was going to be ok,  and i just sobbed back 'why this now? Everything was just starting to get better'. When the ambulance arrived I was scooped off the ground into the back, and given entonox for my pain. The paramedics put all the heaters available on, but I was still shaking violently and the Entonox did little for the pain, but did make me hyperventilate. As we reached Derriford I came close to passing out.
In resus I was met by one of the ED consultants 'Hi, I'm Higgy, I'm one of the ED consultants'. I responded it 'Hi, I'm Sarah one of the medical SHOs' at which point he recognised who I was. Jason arrived and I began to calm a little, partly due to the bolus of morphine that I'd been given on arrival. I stopped sobbing and tried to think 'ok, it'll be fine, I'll look stupid because all this is just going to be bruising'. Higgy examined me, cleared my C-spine, my thorax and pelvis. He checked out my left knee, which had a gaping open wound over it. Asked me to straight leg raise, which I could with no problem. Checked my right knee, minor abrasions to the knee surface, asked me to straight leg raise.....and I couldn't. He poked around my kneecap for a bit and then said 'you've broken your patella'.
5 minutes later he had to ask me to try to calm down. The waves of despair and fear were back, and this time they were a tsunami. I knew the implications of a patella fracture for a runner. I went for imaging, and when he had reviewed that he had more bad news. It wasn't a simple fracture. It was smashed into lots of bits. Pretty soon after that I was seen by Mr Stitson the orthopaedic consultant who painted a doom-and-gloom picture of the extent of comminution, difficulty of fixation, potential need for a partial patellaectomy and uncertain long term function. I asked if I would be able to compete again in the future, but all he could tell me was 'we'll just have to wait and see'. The draw-back of having done 8 months of orthopaedics is I have a good understanding of what was going on in my knee and why they were being so pessimistic. I spent the rest of the evening trying to think of the positives; I'm young, I'm very fit, I don't smoke, I have no other health issues, it's not an open fracture and my bone-stock will be good due to the impact exercise I do.
So, Saturday evening left me lying in bed, waiting for my operation on sunday morning, and trying to come to terms with how quickly my identity had changed, and just how different 2016 was going to be compared to what I had planned out. No TGC. No world championship trials. No race to the stones/race to the King double, and no West Highland way. And, most of all, no opportunity to represent my country at the sport I love the most.
Maybe I will still get these chances in the future. Maybe it will only be as a finisher and not a winner. Maybe it won't happen at all.
In the words of  Mr Stitson, "We'll just have to wait and see."

Punching fate square in the face

Well, it's been 3 weeks since my accident. Actually, it's really been 2 and a half, but I'm counting it from the dates of my fracture clinic appointments.
I always like to have things to look forward to and focus on, it keeps me going when my mood drops. Before this happened I had some major points of focus in the coming few months, and my plan was this:

Interview for CMT in February
Transgrancanaria in March.
Skiing holiday over Easter
Expedition medicine course end of March
Hoka Highland Fling for the GB trail team trial at the end of April
MRCP exam in May
West Highland Way race in June
Race-to-the-stones and Race-to-the-king double over the summer (I had free places courtesy of Threshold events)
Spartathalon
I was planning on applying for Less-than-full-time training when I get my CMT position so that I could manage my running around work.

My current list of focus points is as follows:

25th of Feb - DonJoy brace gets set to 70 degrees of flexion!!
10th of March - 6 week fracture clinic appointment when I find out if I can start doing aqua-jogging and swimming!!!!
Thankfully I still have MRCP exam to focus on, and I have managed to postpone my CMT interview until March (it was originally due 1 week after the accident, and I was just in too much pain to manage). I may even make it to the May edition of the expedition medicine course so thankfully that isn't out of the window.
Maybe I'll even manage a 10km race at the end of the year.....

Funny how your plans can change so quickly. In the few seconds it took me to smash my knee I have managed to lose a whole years worth of plans, which were mainly focused around competition. I'm finding it a challenge not to dwell on this, and trying so hard to focus on my new goals and plans. In an attempt to manage this, I have set aside 15 minutes each day when I am allowed to sit, feel despair, cry and dwell on my losses. It sometimes spills over at other times, but it does help to have that designated time of misery.

So, back to the present.
I'm feeling so much better, physically. But I'm drastically limited by the fact that I can't put any weight through this leg. I was allowed back to work this week, which was wonderful, it was so nice to be doing something positive. It has been a bit strange having to repeat the story over and over as people ask me what I've done, and I have found it difficult when people have asked how it will affect my running. But I think it has also served to help me see my purpose beyond running. I love my job, and it was so good to be back.

Now I'm getting more mobile I'm desperately trying to find ways to maintain some kind of fitness. It is extremely challenging! My upper-body strength was pretty good before hand, but I'm now having to use my arms and torso to do any form of exercise, and so I'm finding my weak points very quickly! Our front room is starting to resemble some sort of mini-gym as I buy gadgets that I can use to help with fitness. I'm also lucky to have my own personal boxing coach (I knew Jason's Krav Maga lessons would come in useful one day, I just always assumed it would be to beat off muggers in the rough end of Plymouth!). I have also discovered that I can sit on my bike on the turbo trainer and pedal with one leg (thanks to Kirsten for that stroke of genius!). I'm still a little limited with this due to the pain in my 'good' knee which, although not broken, still took a heck of a smack.
So, my evening workout is currently something like this:
10-15 minutes on the turbo trainer (low intensity as I'm cycling with one leg)
10 minute push-up set on the Swiss ball
15 minute abdominal set (sit-ups, crunches, oblique sit ups)
15 minute boxing set with Jason (this is the only work out I can currently do which gets my heart rate elevated much. Basically, I lie on the floor, Jase stands over me with the pads, and I do sets of jabs, hooks and elbow strikes as dictated by him. It is exhausting, and brings me out in a sweat. I love it!!)
10 minutes bicep/tricep/shoulder/lat work with dumbells.
5 minute isometric quad exercises.

In short, I'm going to end up resembling Popeye. But, it gives me daily focus and a tiny endorphin hit, and so until the 10th of March, this will have to suffice.
If anyone who has read this would like more detail on how to do the exercise set I'm using, please drop me a line!


Take that, fate! Stand still while I punch you repeatedly in the face!! 

Victories:
Managing my sadness in a controlled manner
Finding ways to maintain some core fitness
Reconfirming to myself how much I love my job.

Brace brace baby!

My 2 week fracture clinic arrived! Well, it wasn't quite 2 weeks to be honest, it was 11 days. But the op note said, and I quote:

Ahem-hem: 'Convert from back-slab to brace at 2 weeks. Brace set at 0-30 degrees for 2 weeks.'

Oh, thank god. This back-slab was REALLY starting to hurt me. All the padding underneath had slipped down, and it was now just bare POP rubbing against my skin, and more importantly, against my frickin' surgical clips, OUCH! Add to that the fact that it now smelt a lot like how I imagine a dead badger left out in the sun for a week would smell. I could not wait to be rid of the damn thing!

I woke up on Thursday morning feeling like a child on Christmas day. My fracture clinic appointment wasn't until 16:10, so I had to spend the day amusing myself whilst I mentally bounced off the walls in excitement. When the time came to go to my appointment I nearly rocked up with my own pair of scissors!

I was waiting outside clinic and was met by Kirsten, one of the lovely people I know from my time in the T&O department. Kirsten is awesome, like a cross between a big sister, a mate and a partner in crime. It was so good to see her and the other lovely people in fracture clinic. I do feel lucky to be under the care of a department where I used to work, and in a hospital where I know so many people. while I sat waiting I must have got 'Hello, what on earth are you doing here?' from about 6 different members of staff, from consultants to porters. It really is like a big (slightly dysfunctional) family!

So, into fracture clinic. I can't describe the moment of ecstasy when they took the backslab off! I can only imagine what it is like for people who have to be in cast for 6 weeks!! The surgical clips came out. (a quick note, I'd been warned about this by loads of people...'oh, it really hurts, really stings when the clips come out'. It really doesn't! Out of around 20 clips, maybe 2 of them stung a bit. So, if you ever have to have surgical clips out, don't sweat it. You may well find it completely painless!)
The wound was looking good, and the 2 ortho SpRs who were running clinic (one of whom I know as a runner and one of the nicest surgeons you could hope to meet!) were happy with the wound and so happy for me to be fitted up with the Donjoy brace.

Donjoy brace with hinge set from 0-30 degrees of flexion

"Sad wounded pixie" face. Used in an attempt to look pathetic so people do stuff for me/give me free stuff.

Brace time. The clinic physiotherapist fitted me with the brace. As it went on, all I could think was 'oh my god, I look like a Borg, this is COOL! Mis-spent youth). She then told me that my quad strength was non-existent.

I'm sorry, what? I think anyone who knows me would know why this would ruffle my feathers slightly. I told her that I was a long distance and mountain runner, and my quads were my best feature. Her answer was that, as soon as the patella fracture occurred the quads would have lost strength, and now 2 weeks down the line, they would need building up from scratch. Fair enough. I asked how, and she described the static quads exercises that I had already been doing. I told her that I was already doing those. Her answer was 'fine, then carry on'. I said that I was a competitive runner and that I was keen to keep my overall strength as much as possible during the rehab period. She just shrugged and told me to do the exercises. I asked how often, she shrugged again and said 'until it hurts'. I asked if there was anything else I could do to maintain base fitness while I was TWB only. She said no. I asked when I would be able to start swimming. She said not for another month and even then I probably wouldn't be able to swim, it would just be aqua-jogging.

Basically, this girl really pissed on my enthusiasm.

I left fracture clinic feeling like the whole thing was a massive anti-climax. I spent the evening in a really bad mood, and the brace was hurting like hell. I have 30 degree flexion now, but suddenly it seems like an age until I will be trying to ease back to normal function. I know that it is early days, and I know that I have progressed so much even in the short time since the accident. But in the space of 24 hours my mood has dipped from positive and enthusiastic to so negative that I could barely be bothered to get out of bed the following day.

Reflecting on all of this, I know I set myself up for a fall. I was so excited and fixated on the cast coming off I didn't think about the other side. But the whole experience was made so much worse by the negativity and thoughtlessness of one member of staff. All I can do is take it as another lesson for myself for my own practice. Negativity is sometimes a necessary thing in communication with patients but it HAS to be tempered with a balance of positivity and empathy, or you do more damage than good.

Victories:
Cast coming off and my body having dealt nicely with the surgical wound.
Reflecting on the situation and working out how I can put the lesson into my own practice.

Not for the faint hearted

Just a warning before you read this...it contains details which will not be at all surprising to anyone of a medical background, but may be slightly shocking to those that aren't.
I'm going to talk about my bowels.
Yes, I am.

Since the accident, I'd been using quite a lot of opiate analgaesia to manage the pain. This started with a lovely dose of IV morphine from the guys in resus, and continued with frequent doses of Oramorph and Tramadol when I got up to the ward (I was initially given codeine, but it had no effect on the pain. Interestingly my dad also reports no analgaesic response to codeine. A quick tutorial, codeine is a pro-drug and only becomes active when it converted to morphine by your body. Around 6-10% of the population have an abnormally functioning gene for, and therefore have reduced levels of the enzyme that converts the pro-drug, and so for them codeine has limited effect as an analgaesic. I'm assuming both my dad and I fall into this group)

When I got home from the hospital I was using 20-30mg of oramorph every 4 hours. The pain was so bad I felt like I wanted to use more, but having never had opiate analgaesia before in my life I was worried about how my body would handle such high doses anyway, and I was concerned about becoming tolerant to the effects and therefore being left with pain that didn't respond to the drug. I was also prescribed tramadol, but knew that there was a risk of interactions between that and my regular antidepressants so I didn't want to use too much of that.

I was interested to see how my body handled the new experience of opiates. With the first few doses in the hospital I felt quite swimmy and sleepy, but not in a particularly comfortable way. They also left me feeling just on the edge of losing control of my body, which is an experience I hated. This was particularly noticeable with the fentanyl I was given prior to anaesthetic. I've heard the anaesthetists describe the midazolam/fentanyl bolus used as induction like 'getting a large G&T', implying that it is a pleasant experience. I've also spoken to other people who have loved the feeling induced by these drugs. Not me. I hated that feeling on being right on the edge of consciousness.

Luckily I didn't seem to be prone to the nausea that opiates can cause in some people. I did seem to become massively sensitive to electric light, and I found it really hard to be in brightly lit areas. Interestingly this didn't apply to daylight. My balance was really affected and I kept getting limb jerking which I'm pretty sure was due to the drugs.

And, the constipation. Oh yes, I knew opiates caused constipation, I've managed plenty of people in hospital who are suffering from this side effect. In my own practice I never prescribe any opiate analgaesia without an antiemetic and a laxative to go with it. I myself have never suffered from constipation before. I'm active, I have a good diet, I eat lots of fibre. I'd never had to worry about not having a bowel movement.  But now, I was bed-bound, I was not eating anything much, I was dehydrated and I was taking regular oramorph. And I was, stupidly, not pro-active in preventing it.
On Wednesday (4 days since my last bowel movement) I started taking regular laxatives. I wasn't in any discomfort, but I was worried about how this might progress. On Friday, still no bowel movement, I was feeling quite 'heavy' and I added a second type of laxative to the first. On Saturday I sent Jason out to buy suppositories. Later that day I managed to finally go (without the suppositiories). It was intensely painful, exhausting and something I hope never to have to experience again.

Last resort.....

So, there you have it. Of all the side effects of drugs I have experienced, this is definitely the worst. It is comforting to know that you can take medications to correct the problem, but I will NEVER underestimate the distress that constipation is causing one of my patients ever again.

Victories:
Opening my bowels!!
Realising that this experience will definitely make me a better doctor

TeaTriumph!

Apologies for my rapid fire blogging, but I'm keen to log these early days one by one. As time goes on, I will stop recording every tiny achievement and focus on the big ones. Unfortunetely, for now, the tiny achievements are the big ones, so each is getting recorded.

Friday, I woke up with a stinking headache and feeling really sick. But, as I waggled my foot up and down, I realised only very modest pain in my knee. I took 2 paracetamol, and that was it. I felt no need for anything heavier, at least not for my knee. I could do with some dynamite for my head, but opiates weren't going to be the solution there. I knew what the problem was. Dehydration.

Every night, several times during the night I would wake drenched in sweat. And this would also happen if I slept during the day. Couple that with my initial reluctance to drink to much because it hurt so much to get up to pee, and my heavy use of painkillers to deal with the knee pain. I essentially had a hangover. I really couldn't be bothered to get out of bed and wash. I was also very tearful for some reason. But I didn't want to head down the slippery slope of self-neglect, so I forced myself to get up, and washed myself whilst sobbing uncontrollably into the sink. I drank a litre of water and I went back to bed and slept until 1pm. Woke up, cried some more, took a couple more paracetamol, desk some more water and went back to sleep. I woke again at 3:30, still feeling crap. My plan for today had been to make my first journey downstairs by myself while Jason was at school still. We'd left the jug-and-bucket downstairs because there was still no way I could manage going up by myself. This was progress, and I wasn't going to miss out on it just for a headache and some tears.

Right, I could do this. My aim: get downstairs, make a cup of tea and sit myself on the sofa with tea and a biscuit. Simples.

Step 1: All the pillows and cushions upstairs needed to be downstairs for me to rest my leg on them. So, I threw them all to the top of the stairs, and then threw them all down the stairs. I also threw my phone, tablet, oramorph (just in case) and grabby-device down.
Step 2: get myself downstairs. Very very slowly and constantly re-checking myself
step 3: throw all the stuff from the bottom of the stairs firstly to the doorway of the living room, and from there into  the living room beside the sofa
Step 4: Arrange the sofa so I could sit on it with my leg up.
Step 5: Make tea.
Step 6: get tea from kitchen to living room. (This is the bit I'm proudest of). Line up a series of chairs between the kettle and the sofa. Transfer tea a chair at a time until you reach the sofa. Transfer tea from final chair to the living room table. BOOM! Tea in place!
Step 7: Arrange myself on the sofa.
Step 8: sit back with tea and biscuit, feeling smug!
Victories;
Working through the tears and despair and making my journey downstairs
My success making tea and getting it to the sofa even though I'm not known for my common sense.
A whole day with no opiate analgaesia

hopping into the unknown

My first few days since the accident is now time served. I say served, because it feels like I am serving a sentence for some terrible crime. At times I have felt so low that I have considered this to be the case. This accident is somehow divine retribution punishing me for being such a terrible person. In less dramatic terms, I've had more bad days than good days.

My first day at home jason got me up at 5.30 and got me downstairs and onto the sofa. Since he had to work all day and there was no way I could manage the stairs by myself due to pain, we had come up with the plan of keeping me downstairs so I had access to the TV, and setting me up on the sofa with everything i need in terms of food and drink for the day, with handy living room based jug-and-bucket for when I needed to pee. (The other not being an issue due to the large quantities of opiates currently holding up my bowel). I spent most of the day asleep, woken only by pain and the need for more Oramorph. I had no desire to eat or watch TV. I know I was phoned a few times by friends and relatives to check I was ok and wish me well, which was lovely. The details are hazy. I do remember a call from my parents (currently out of the country), and my dad spent some time reassuring me that everything i was experiencing was to be expected. I also called the South West deanery to try to postpone my CMT interview that was due to be in 1 weeks time. They were less than helpful. You'd think that breaking your leg would be a good enough reason to postpone an interview....not according to South West Deanery. At this point in time i was too tired to argue with them. At the end of the day jason came home and tried to make me eat, but I wasn't interested. Not at all normal for me. He got me back upstairs and helped me wash. I did feel a lot brighter after this, and it made me to realise how important it would be to look after myself through all this. We decided that i would be better off in bed the next day with the jug-and-bucket in my room in case I struggled to get to the bathroom (the Oramorph was making me very dizzy and my walking balance was terrible).

I was still needing a lot of analgesia at this point, and before I went to bed I had taken 100mg tramadol and 20mg Oramorph. 2 hours after falling asleep, I woke up screaming. Jason came rushing into the room. I'm still not entirely sure what happened, but I think I must have just jerked my leg in my sleep. The subsequent pain was unbelievable, and i had nightmarish visions of having pulled the fixation apart. Jase gave me another 20mg of Oramorph and I sobbed in pain until the drugs kicked in and I half-slept, half-passed out.

Wednesday I woke late, Jason had already gone to work. I decided to try and get myself to the bathroom, and while I was there I managed to wash my upper body myself. The rest of the day was spent in bed, drifting in and out of sleep, and trying to respond to all of the lovely messages that had been sent to me. I also gently started to try some static muscle exercises, but pain pretty soon put a stop to that. When jason got home he helped me downstairs onto the sofa before he went out to running club. While he was out, the pain in my leg started to get worse and worse and I began to feel sick and shivery. I loaded up on Oramorph and then the next thing I knew jason was home. Well, at least I knew I wasn't becoming tolerant to the opiates! I was too spaced out and wobbly to manage a wash so he put me straight to bed. 2 hours later I woke up practically swimming in my own sweat. This had been happening every night since the surgery, but now in combination with the symptoms I'd had that evening,  I became terrified that an infection was setting in. Dad called me the next morning and reassured me that the fevers were normal post fracture for several days.  I knew this, and I also knew that infection was not a likely complication at this early stage,  but it was so nice to hear it from someone else, least of all someone with as much experience as my dad. It's funny how you ignore your own knowledge in the process of catastrophising. I know how it can be difficult to come from a medical family, but by the Gods it is also a real blessing and I know how lucky I am to have dad there with his years of experience, ready to talk me through every tiny irrational fear that pops into my head. He makes me want to be a better doctor.

Thursday morning I felt a bit brighter. I also felt pretty disgusting and my bedclothes were all damp from me sweating so much. I couldn't bear the thought of lying feeling so skanky all day. I was feeling pretty determined, and the pain was well controlled. So, I got to the bathroom, washed myself, washed my hair, put on clean pjs, stripped the bed and put fresh bedding on. It took me frikkin' AGES and by the end I was exhausted, but mission accomplished!. I crawled back into my squeaky clean bed and slept for the rest of the day. Jase came home late because of a parents evening, got me downstairs,  I managed a whole plate of pasta and then went back to bed. That night I slept right through until 9am.

Victories:
Having a full wash with jason helping, and a couple of days later progressing to a full wash by myself.
Managing to change the bed sheets by myself.
Managing a bowl of Musli and snacks of fresh and dried fruit every day.
Being proactive in trying to change the date of my CMT interview

Grabby-device. Also useful for sexually harassing strangers from a slight distance.

My new getaway method. 

little victories

So my blog has significantly changed in nature. I have written about the accident itself, but am not posting yet as the police are still involved.
This blog is now a diary of my recovery.  If it goes well, then hopefully it will be an inspiration to any other runners who find themselves with a similar injury.
At the end of each blog entry I am including a 'victory' section, to remind myself of positive things I have achieved at a difficult time.

This diary starts on the afternoon of 31/1/16 - one month into the shittest year of my life so far.  For the first time in my life I awoke from general anaesthetic. I don't really remember much of the rest of the day.  Mr Stitson, the surgeon who operated on me,  visited and told jason and I that they had managed to get relatively good fixation considering the degree of comminution. That night I went into a drug-induced sleep. I woke the next morning and immediately started crying as the realisation of how much my coming year had changed and the fear of never running again washed over me yet again.

I went through my Facebook and email messages again.  In honesty,  many of the ones I had read on the Sunday had been spirited away by the combination of residual anaesthetic and opiates. I had so many wonderful and kind messages, offers of help, reminders of how strong I am. I know so many wonderful people.  Reading these again gave me a bit of a boost. I was visited by Caroline and Lorraine from the rota office who brought me a load of fruit and goodies, and by Kenny from the medical directorate who brought me sweets and wished me well. Matron Sue also came to see me.  Sue is amazing.  She has so much energy and is always so kind and understanding.  I cried when i saw her, and that started her crying. All these wonderful people,  it was like being visited by family.

The postoperative instructions were that I was to remain in a full leg backslab non weight bearing for 2 weeks and that I could go home when I was able to mobile on crutches.  Andy, one of the physios I know from my ortho days, came to see me teach me how to use crutches . He and the ward SHO looked through my op note,  looked serious and did the medical equivalent of sucking air in through their teeth like a mechanic with a car that was going to cost a load to fix. "Small defect in the articular surface " i heard one of them say. Thanks guys. Because pessimism was what i really needed right now. That's the trouble with being a medic in this situation. You know what all the little details mean and tend to focus on the worst potential outcome.

Andy walked me up the ward and checked out that I could use the stairs.  I got back to my bed,  sweating like a horse but fairly comfortable from a pain point of view. I then stupidly decided to take my new crutches out for a spin around the hospital,  not realising quite how much anaesthetic was still  going round in my system and how much the femoral nerve block the anaesthetist had put in was still numbing the pain. I got to the Drs post room,  picked up some mail I was expecting, went to the rota office to say hi to Caroline and Lorraine who had visited me earlier in the day.  At that stage I started to feel pretty strange, sweaty and the pain in my leg was becoming quite prevalent. I headed back up to the ward,  and made it just before I thought I was about to pass out.  I spent the following 2 hours absolutely sparko on my bed and when I woke I had to seriously ramp up the amount of painkillers I was taking.

Jason came to pick me up later that afternoon. The wonderful staff of Shaugh ward wished me well, and Larissa teased me to go easy on the Oramorph.  and Andy from the discharge team wheeled me down to the exit.  His progress was slowed as we passed lots of people I knew who all wanted to ask what had happened and then to wish me well.

When I got home Jase got me settled on the sofa.  The police were visiting that evening to take a statement so my plan was to wait downstairs until they had been and then head upstairs to bed. The pain in my leg was really starting to become difficult to manage and I was maxed out on the painkillers. When it came to getting upstairs I was in tears, every tiny jolt sent pain screaming through my whole leg. In the end I had to go up backwards on my arse while jason held my leg up off the ground.

The next issue was using the toilet.  I had succeeded in this on the ward,  but now,  with all the nerve block gone from my anaesthetic, I simply couldn't manage the pain involved in sitting on the toilet. In the end I came up with the solution of peeing into a jug while standing. Genius.

Jase helped me into bed,  and balanced my leg up on a pile consisting of all the cushions and pillows in the house.  Damn,  I was missing the adjustable hospital bed. Even with it elevated and my next dose of Oramorph on board I was in agony,  and I cried myself to sleep while jason stroked my hair and told me that everything was going to be ok.

Victories:
Working through the toilet problem.
Getting over my embarrassment of peeing with another person on the room. It's just another bodily function, after all.

Full leg backslab on the right.  The bandaging over my left "good"knee is covering the wound that had to be debrided and sutured.