And the author of a guide for recovery from ankle surgery contacted me after finding my articles. You can read their guide here:
http://blog.garymoller.com/2015/01/first-aid-treatment-for-severe-ankle.html
Showing posts with label ankle rehabilitation. Show all posts
Showing posts with label ankle rehabilitation. Show all posts
Saturday, March 14, 2015
Progress and exercises following my severe ankle injury
Saturday, February 28, 2015
An astonishing example of a successful programme to minimise postoperative scarring
Seven weeks ago my ankle was sliced and diced with enough metal and screws inserted to hold down a Wellington roof! One of my concerns was excessive scar formation, not just to the skin, but to the tissues such as the ligaments and tendons.
Scar is necessary for knitting together damaged structures and providing a scaffold for healthy new tissue to grow. Scar formation is essential; but there is a Goldilocks zone - not to much and not too little - just right! Too much and you end up with thickened, ugly tissue that has ongoing strictures and adhesions that limit function. Scar tissue tends to shrink and harden over the year or so following injury and this can further bind down joints and tendons.
Post-operation, if the tissues swell too much, and the wound may open a little, stretching the stitches. This is a frequent issue. The end result can be a broad, purple scar which can be quite unsightly. My main concerns about visible scar are not cosmetic but to ensure that I restore to 100% strength and function. This includes ensuring "healthy" scar and its timely removal once its job has been done. This might sound like a fanciful goal that we have no influence over; but we actually do. We know well the way scar is formed and modified over time and how this can be influenced by balancing minerals such as zinc and copper, the role of vitamin C in collagen formation and we now have systemic enzymes that soften scar and remove old scar. Amazing and exciting!
I began a programme of supplementing with special nutraceuticals that help to regulate scar formation and for aiding the removal of old scar and replacement with healthy new tissue. I also took a number of things to control inflammation without interfering with healing. The other thing I did for several weeks while in the plaster cast is keep my leg elevated most of the time other than when hopping from A to B.
Did it work? Here are some photos of the scarring at 6.5 weeks. You be the judge.
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| Spot the scar: Its a long slice along the medial malleolus of the tibia where the surgeon peeled the flesh back to insert some expensive hardware. |
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| Can you see the scar over the ankle joint where the surgeon opened me up to reduce the dislocation and to insert some hardware? Remind yourself that these are just 6 weeks old. |
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| More visible than the other scars, this one is over where the most hardware was inserted to repair the shattered fibula. Not bad eh? |
Previous articles:
http://blog.garymoller.com/2015/01/first-aid-treatment-for-severe-ankle.html
http://blog.garymoller.com/2015/01/my-ankle-fracture-dislocation-two-weeks.html
http://blog.garymoller.com/2015/02/sleep-deprivation-following-severe-leg.html
http://blog.garymoller.com/2015/02/my-ankle-fracture-six-weeks-on.html
http://blog.garymoller.com/2015/01/my-ankle-fracture-dislocation-two-weeks.html
http://blog.garymoller.com/2015/02/sleep-deprivation-following-severe-leg.html
http://blog.garymoller.com/2015/02/my-ankle-fracture-six-weeks-on.html
Monday, February 23, 2015
My ankle fracture-dislocation: week seven - getting moving
Its Monday morning, just coming into five days after having the plaster removed, and I must admit to feeling shattered right now. This is because of the chronic lack of sleep, constant pain and possibly because I have been shifting a lot of stagnant fluid about and this can cause flu-like symptoms.
The foot hurts constantly, the skin is very sensitive and any pressure on the ankle is almost unbearable, especially when trying to sleep. I have not had a full night of sleep for seven weeks now. It makes no difference whether I take painkillers or not. The best I can do is put the headphones on and listen to some music while I lie in bed tossing and turning. Having said this, rest assured that I am in good spirits and delighted with the progress being made.
I think my next update will be about resuming exercise and improving strength and mobility of the leg.
http://blog.garymoller.com/2015/01/my-ankle-fracture-dislocation-two-weeks.html
http://blog.garymoller.com/2015/02/sleep-deprivation-following-severe-leg.html
http://blog.garymoller.com/2015/02/my-ankle-fracture-six-weeks-on.html
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The foot hurts constantly, the skin is very sensitive and any pressure on the ankle is almost unbearable, especially when trying to sleep. I have not had a full night of sleep for seven weeks now. It makes no difference whether I take painkillers or not. The best I can do is put the headphones on and listen to some music while I lie in bed tossing and turning. Having said this, rest assured that I am in good spirits and delighted with the progress being made.
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| This is my foot three days after having the plaster off. Very stiff, weak, sore and swollen - bearing in mind that I my ankles are normally very skinny. |
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Now, how's that for a spectacular and delightful reduction in swelling! You will note, as well, that there is a little muscle coming back already. This photo was taken yesterday. This spectacular improvement has been achieved by:
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| Today is definitely a rest day, keeping the leg elevated and compressed. I'm going to avoid any stress on it. It is telling me that it needs a break from any weight bearing and other stresses today. Hot bath and gentle massage will be about the lot. The leg still hurts and the constant lack of sleep means I still need to rest and nap often during the day. While this may seem an idyllic way to spend one's time, I can tell you that I am well and truly over it. I have been hanging around the house for seven weeks apart from a couple of excursions downtown and the occasional hop around the suburbs on crutches. All that aside, it was a nasty injury and I am truly delighted with my progress; but still eager to get back on my bike - oh - and back to full and unimpeded work. Those are not far off. |
Previous articles:
http://blog.garymoller.com/2015/01/first-aid-treatment-for-severe-ankle.htmlhttp://blog.garymoller.com/2015/01/my-ankle-fracture-dislocation-two-weeks.html
http://blog.garymoller.com/2015/02/sleep-deprivation-following-severe-leg.html
http://blog.garymoller.com/2015/02/my-ankle-fracture-six-weeks-on.html
Friday, February 20, 2015
My ankle fracture six weeks on
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The original damage: enough hardware to secure a Wellington roof. Praises be to the surgeon and his team for doing a wonderful job of screwing me back together. If I was in a 3rd World country I would probably now be on a street corner with a foot facing the wrong way and holding up a begging bowl.
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Plaster coming off - thank goodness! But in for a quite a shock.... My days of leisure are now coming to an end...
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Is there more to meet the eye than the expected? There sure is...
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Oh dear - and I thought I had small ankles! The foot is very swollen, sore and with little range of motion. It feels like it is detached from the leg which is a most disconcerting feeling. While not unexpected, the severity after 6 weeks is still surprising.
The good news is that the follow up xrays show the bones are very nicely knitted. The surgeon has done well.
The nutrition and other strategies to ensure good healing must have also helped - no harm for sure.
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Anyone feel like mushrooms for dinner? The result of six weeks in a sweaty cast in the middle of a historic heat wave. The sight and the smell were quite shock. Very smelly and not at all pleasant to look at.
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My partner, Alofa, was given the unenviable job of thoroughly washing the foot before the long taxi drive home. The windows were kept open - phew!
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My ankle a few days later. Swollen and painful.
The 7th to 8th week will be devoted to getting the swelling under control along with carefully increasing the range of movement. Right now, the foot is still very sore and feels like it is about to fall off. Range of movement is very limited and crutches are required to get around. Sleep is fitful even with painkillers.
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Note the calf muscle loss as compared to the very muscular and toned right leg. Swelling is being steadily reduced by the use of compression bandaging from the toes to the top of the calf (It is important that compression for swelling covers the entire limb part and not just the swollen region). The leg is also elevated at all times other than walking (shuffling). I'm in no hurry to push the walking - "One small step for Gary....", if you get the drift.
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Leg elevated while typing this article using a special leg support on loan from ACC. While its a little awkward, the benefit is improving hamstring flexibility. I'm also getting effleurage massage once a day, with coconut oil, to shift the fluid out of the leg. It is interesting that I have felt a little ill over the last two days. I wonder if this is due to the increase in toxic fluids now being shifted into the circulation. This may be the cause of the flu-like symptoms. I have stepped up liver support.
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Related articles:
http://blog.garymoller.com/2015/01/first-aid-treatment-for-severe-ankle.html
http://blog.garymoller.com/2015/01/my-ankle-fracture-dislocation-two-weeks.html
http://blog.garymoller.com/2015/02/sleep-deprivation-following-severe-leg.html
http://blog.garymoller.com/2015/02/my-ankle-fracture-six-weeks-on.html
Monday, January 26, 2015
My ankle fracture-dislocation two weeks on: Healing, detoxification, fatigue, dangerous drugs interactions and circulation issues
Two weeks have passed since I tried to rip my foot off and, for the first time at ten days, I have been able to inspect the surgeon's handy work. Please read my earlier article here:
Things have actually gone very well, although there have been a few issues, such as a very unpleasant and rather frightening drugs interaction, which I will discuss later.
This article covers what I have been doing post-surgery to facilitate a quick and uncomplicated recovery, including pain management. First of all, let's take a look at what can be seen at 10 days post-injury when the plaster has been removed so that the stitches can be taken out and another cast is fitted for a further four weeks:
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| Some swelling as to be expected; but minimal signs of bleeding which confirms that my immediate first aid measures worked. Refer to my earlier article here. Bleeding into tissue, dead cells and swelling all compromise healing, so the less - the better for there to be a quick and uncomplicated recovery. |
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| Excellent wound healing. No excess inflammation at all. I have been taking special supplements to help regulate inflammation and to help the body dissolve and excrete dead tissue and blood clots. These need to be removed before healing can happen in earnest. |
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| Dead blood in the foot and some discoloration from the surgical disinfectant; but not too much detritus to worry about. |
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| I've seen worse looking ankle sprains, so I'm delighted with how things are looking. |
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| Not pretty; but I am delighted that there is some promising movement in the joints: A little plantar flexion, dorsiflexion, pronation and supination. I'm off to a good start! Enough of that - its back into plaster for that leg. |
Managing Post-surgical pain and swelling
When joints, bones and soft tissue are violently disrupted, such as happened to my left foot, blood vessels are ruptured (thankfully only capillaries, low pressure veins and not high pressure arteries). If this is not bad enough the trauma is compounded by the hours of surgery to realign the broken bones and displaced joints. This involves quite a lot of hacking, wrenching and screwing which is all additional trauma.
Blood continues to be pumped to the foot (thankfully!); however, the blood flow back to the heart is compromised due to the damage to the peripheral veins and capillaries. Similar damage has been done to the tiny lymphatic drainage vessels and this will be seen as swelling of the foot. Being immobilised in a cast makes the circulation problem worse because the muscle pump effect of muscular contraction and relaxation is no longer available to pump blood and lymph fluid back to the heart. The consequence is the foot will go purple and blow up like a balloon if it is not constantly elevated.
Constant fatigue, swelling and throbbing of the foot have been the main problems I have been having to deal with and I have found it most unpleasant and requires constant lying down, now causing an unpleasant rash on my lower back.
If you visualise the extent of the damage done to the bone and soft tissues around the narrow collar of my ankle, you'll appreciate just how badly the circulation through my foot has been compromised. How much? 10%? 20%? I have no idea other than to say that it feels like a whole lot!
This means regrowing a whole lot of tiny blood vessels. I am helping this along by taking a mix of supplements that enhance circulation, support tissue healing, break down dead tissue, including fibrin and support liver and kidney with handling the toxic load.
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| Example of almost instant unpleasant swelling and stagnation of blood flow if the leg is not elevated |
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| Leg elevated: dark, deoxygenated venous blood drains out of the leg quite quickly and the feeling of pressure is relieved. Note the very healthy tomato plants in the background. I am very proud of them (I have very little to occupy my mind right now!) |
Pain Management
I have been reluctant to take much in the way of pain medication. This is because I need some pain feedback to tell me when to change position and when to raise my leg. Pain is your friend unless it becomes so intense as to cause suffering and debilitation.
The two pain medications that I have been taking is Tramadol and paracetamol. Initially this was at the minimal rate of just one of each in the morning and the same again at bedtime. By Day Ten I had reduced this to one of each at bedtime only.
The problem with these drugs is they are tough on the liver and kidneys and I need these organs to be working at 100% to clear the dead tissue from my body without compromise. Paracetamol has a number of serious complications, including asthma, skin reactions and liver failure. Tramadol is a narcotic-like drug and can be highly addictive. It is also toxic to the liver and kidneys. So, while I have been taking some up till now, it is very little only as much as is needed to make life bearable. As of today, I do not think I will need any more drugs from now on for pain management or sleep.
I have also been soaking in a large, hot bath with a handful or two of Epsom Salts in the water to help relax the muscles. The bath brings about profuse sweating like in a sauna. Sweating is an effective way of ridding the body of metabolic toxins, while bypassing the liver and kidney. Its easy to prop the cast on the side of the tub and getting out is a good workout for the upper body.
The most effective pain management is elevation which I am having to maintain constantly for now.
This has worked quite well and I am noticing improvements each day, although the warm nights have made sleeping comfortable almost impossible with a heavy, sweaty cast on my leg. In fact, I have been so restless at night it has been almost to the point of despair. Last night I seriously thought of cutting the cast off. I so want to move my ankle. But that will have to wait another four weeks. I am so over it!
A potentially dangerous incident of drug interaction
Two nights ago my partner, Alofa, arrived home later than usual from doing the weekly groceries. She had purchased half a dozen craft beer and handed me a bottle which I enjoyed very much. About an hour later I went to bed, thinking nothing of as I swallowed a Tramadol capsule. About half an hour all hell broke loose: I began to twitch and fidget uncontrollably, scratching my scalp face and body. My body was burning hot and I was becoming almost uncontrollably anxious. My pulse was raised about 20 beats above rest. I figured I was having a reaction to the combination of Tramadol and alcohol, although both were small amounts. I hopped to my office where I hooked up my blood pressure, pulse and temperature equipment and waited. Squirming and scratching. It did occur to me that I would have to get the ambulance if things got any worse! However, my vital signs were okay, so I resolved to wait it out.
By about 1.30pm I was beginning to settle and was able to return to bed shortly after for the reminder of what was a less than pleasant night.
Although I was aware of the danger of mixing narcotics with alcohol, including convulsions and death, I got well and truly caught out. Brain fade. The lessons I have taken from this distressing brush with drugs interactions is to be extremely vigilant by keeping the brain in gear at all times and that it is best not to take any drugs, or the least possible. Its just far too easy to make a mistake. In my case, I am so thankful that I took only one Tramadol and not 2, 3 or 4!
Post-injury fatigue
Two weeks have passed and all I still feel like doing is lying back, dozing off and sleeping. This is because I need to. There has been a huge amount of damage to my leg - twice, if you think of it - once from the accident itself and then a second insult from what added up to almost half a day of surgery. Over the ensuing days and weeks, toxins are flooding into the circulation where the liver then works like a huge filter to pull them out, neutralise their toxicity and then excrete the end products through the kidneys and the bile. The initial toxic load is from a mix of medications and the contents of cells that were destroyed during the accident and surgery or shortly thereafter.
Clotted blood that fills the injury site must be dissolved and removed from the injury site for healing to happen. Tissue that survived the initial insults of injury and surgery may be stressed and die from the combination of being surrounded by toxic dead cells and their contents, smothered by congealed blood and poor oxygenation due to blood vessel damage. Much of this secondary damage can be avoided by flooding the body with a mix of powerful anti-oxidants and ensuring that there is minimal pooling of blood and swelling. I have had these measures in place from the very beginning and they are working well, by the way.
The end result of this toxic overload is fatigue, fatigue, fatigue - and bad breath! I feel similar to a person who has hepatitis, Tapanui Flu, glandular fever or post-viral fatigue syndrome. The management of these is to focus on supporting enhancing liver function with a mix of various herbs and supplements such as milk thistle, lipoic acid, a multi mineral salt and even good old vitamin C! Sweating daily and drinking plenty of fluid are also most beneficial.
Most important is my body is telling me to rest. I am tired and for good reasons that are not to be ignored or circumvented. Sure, I would like to get exercising and back to work today but I would be foolish to do so. My body needs rest for the time-being and that is what I am doing. Exercise and working are tiring and keeping the leg elevated all the time is impossible, so healing and recovery will be compromised and may delay a full return to work and sport.
I know I have a tough job ahead of me to regain full function of my left foot. I agree with the surgeon that arthritis is a high possibility, given the extent of the damage. I do want to resume my quest to win the world mountain bike champs in 2016 and I do want to go for some age group running events later. For this to happen, patient rehabilitation is the name of the game. Patience is the key!
My next article will deal with resuming exercise gradually and safely while still hobbled in plaster. I am just about ready to go.
More related articles:
Wednesday, January 21, 2015
First aid treatment for a severe ankle injury (updated 16 Feb 2015)
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| The author's ankle following a severe fracture-dislocation |
Latest update here:
http://blog.garymoller.com/2015/01/my-ankle-fracture-dislocation-two-weeks.htmlHow it all happened
Several days ago I was practice riding the course for Round 2 of the New Zealand Mountain Bike Championships, to be held on Mt Victoria here in Wellington this coming Sunday. I was in great form, handling the steep declines, scary drop-offs and brutally steep climbs. I was confident of an age group podium finish. But this was not to be and my plans to contest the World Championships later in the year were about to be dashed.
It all came apart as I crested the summit of the biggest climb and entered a gentle left hand turn. My front tyre slid on a patch of pine needles, which was not a problem as I expertly planted my left foot to correct the skid. Problem was that the bike and body kept gracefully sliding while the foot stayed where it was planted! (Pine needles can act like fine needle bearings when on top of dry clay). I had violently ripped my foot off my ankle, shattering the bones and ripping ligaments in the process. Needless to say, the pain was beyond description.
Despite the agony, being a naturally positive person and a blatant opportunist, I realised this was the perfect scenario for an article on the practical application of emergency sports medicine. (I wrote the original ACC guidelines for Ice, Compression and Elevation (I.C.E) back in 1979 and had been thinking of doing a personal update about now). So, my first request of the cyclist who came across me lying on the trail was to call the ambulance; the second was to have him take photos.
Let me explain why first aid is so important in cases like fractures and dislocations of limbs.
Let me explain why first aid is so important in cases like fractures and dislocations of limbs.
Bleeding is enemy of treatment and recovery!
When there is severe trauma to a limb, in this case, the ankle, there is immediate and profuse bleeding into the joint and tissues from the ruptured blood vessels. If this is allowed to happen the blood and swelling can be so much that surgery must be delayed, often for weeks, because of the mess inside and also because it is impossible to stitch flesh and skin, if an incision is made such as to put in a plate and screws to stabilise a fracture. Also, the earliest stages of healing involves the removal of congealed blood and debris from the site of injury. The more blood in the wrong places, the longer the recovery and increased risk of complications such as blood clots.
Yes, the laying down of new tissue to replace the damaged tissue can not commence in earnest until this process of clearing the building site of debris is complete. If there is a lot of congealed blood, healing will be delayed - slowed down by weeks. So you will gather why it is essential to minimise the bleeding and swelling right from the moment of injury.
Yes, the laying down of new tissue to replace the damaged tissue can not commence in earnest until this process of clearing the building site of debris is complete. If there is a lot of congealed blood, healing will be delayed - slowed down by weeks. So you will gather why it is essential to minimise the bleeding and swelling right from the moment of injury.
How to stop bleeding and swelling
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| Notice the crooked left ankle. Immediate elevation after falling to prevent bleeding into the joint. I am writhing in pain and making a lot of noise while having a great ab workout. |
Elevate, elevate, elevate
The next time you cut your finger do this: Raise the cut finger above your head. It will stop bleeding. This is because the heart is designed to pump blood no higher than the top of your skull, although I would swear there are many people where the blood flow stops at about neck height! So, the first and only action necessary to stop bleeding and swelling post injury is to raise the damaged limb as high as you can comfortably do so. Do not bother with ice and only add compression if it is convenient to do so. In my case, I did not add compression because we had nothing suitable until the paramedics arrived an hour or so after the accident.
Rest, rest, rest
Clotting of blood to seal off ruptured blood vessels is well underway by about seven to 10 minutes; however it is necessary to keep the limb elevated and motionless for the best part of an hour to ensure the blood vessels are sealed. Anything other than gentle movement over the ensuing 36 or so hours may induce further bleeding, so the priority over the first 3-4 days is rest, elevation and immobilisation.
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| Thank goodness the bike's okay. You may be wondering why I have not had someone prop my leg up on my bike. well, I felt I needed the extra workout and, besides, these photos were taken immediately after the accident. Getting the photos was the first priority. My foot was propped up later. |
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| After an hour of lying there I was thinking that this was really good ab work! Nice shot of my flash bike, by the way. Thank goodness you can't hear what I am saying! |
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| One very crooked left foot but note the lack of swelling. The shoes are lightweight Northwave brand - I can highly recommend them for grip. |
As an aside, while lying in that spot for over an hour, the best part of a dozen people walked past. At times I was alone while the two very helpful and caring cyclists, Jodi and Hamish, went searching for the paramedics who had gotten lost. What astonished me was the number of people who walked past without even asking if I needed help, one even almost stepped over my head to get past, while I noticed another walker avoided me altogether by taking an off-track diversion! Only a few asked if I was okay and one did stop and insisted on constructing a platform out of some branches so I could keep my leg raised - thank you. On the positive side, the ones who helped, or offered assistance, more than offset those strange and uncaring people.
A pillow was folded and fastened around the ankle and foot by the paramedics. Bear this in mind if you ever need to stabilise a fractured or dislocated limb. The soft pillow method is more comfortable and safer way to stabilise a fracture for transport than trying to fashion a splint.
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| Three fractures and dislocations |
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| I didn't quite succeed in ripping my foot off my leg, but made a good attempt at it. |
Pain is your friend - not your enemy
Right from the moment the paramedics arrived I was offered pain relief. I refused all but the minimum. Why? Because:
- Pain exists because it is my feedback system telling me when to back off or to stop. Without pain, the so-called hand will remain on the hot plate with untold damage being done. Pain is my friend. So...
- While moving about I did not want the pain to be dulled to the point where I might inadvertently cause more damage.
- Pain has guided my rehabilitation from Day One, telling me when it is time to stop and put the leg up for a rest. It also tells me when to shift position, thus avoiding pressure damage to the wounds.
- Pain medication, such as Voltaren, is renowned for the damage it can cause to the digestive tract and to the liver. I was aware from the moment of the injury that a healthy digestion and strong liver were going to be essential for a quick and full recovery. Bear in mind, as well, that the liver was about to have to deal with various potent drugs such as the general anaesthetic, pain medication and antibiotics during and after surgery - and also the detritus of dead tissue over several weeks.
Pain and fatigue tell you when to back off
and when to have a break
So, yes, I did take pain medication but very little indeed as compared to most. So long as I got a reasonable sleep, I did not mind some pain. I was careful not to incapacitate this life-saving feedback system. The pain was terrible at times, but I kept reminding myself that "Pain is in the head" - not completely true but a good line to keep repeating while in pain! I think, as well, that the extreme athletic conditioning I have done over the years has endowed a good pain tolerance.
Swelling is your enemy
When I arrived at the hospital the orthopaedic registrar advised that surgery may have to be delayed because of swelling (he could not see the ankle other than from the xrays because of the bandaging). I responded by saying that there was minimal swelling. He was sceptical. Fortunately, I was right; there was minimal swelling and I was the first patient to enter the operating theatre the following morning. My first aid action had paid huge dividends by preventing any delays in surgery.
Good first aid buys you recovery time
During the two days of postoperative recovery in hospital, I had a very interesting man lying in the bed next to me to keep me company (I should be more careful about how I said that - he was in the bed in the adjacent cubicle). He had fallen off some scaffolding and suffered a nasty fracture to his heel and severe bruising to the backside and a tailbone fracture. While it was not as serious as my injuries, he was going to have to wait for about three weeks for the swelling in his ankle to go down before they could operate. In contrast, by being right on the ball with the first aid from the second of my injury happening, I had reduced my recovery time by at least three weeks.
The surgery
Because I had dislocations that could not be reduced under local anaesthetic (two excruciating attempts were made), surgery was quite urgent meaning that I was first in line in the morning (my injury was late Saturday and, by the time I had gone through accident and emergency and had the initial exams, it was late at night). I went under at 8 am Sunday and was out around midday, which was surprisingly long but indicative of the care of the orthopaedic surgeon, Mr Mark Sherwood, and his team. I have the feeling that a good job was done. However, I must say I was still a little shocked at the amount of metal that was required to put my leg back together. I had made a real mess of my ankle.
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| My quest to win the world champs has just become a whole lot harder. It is easy to understand from the xrays why there can be no weight bearing for several weeks. There are enough screws to hold down a Wellington roof. |
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| Oh dear! even more metal. What a mess and no wonder the surgery took so long. |
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| A welcome recovery cuppa along with some oxygen. One very sore leg. |
In praise of emergency medicine
Readers will know that I can be very critical of the direction of modern medicine when it comes to dealing with many of the diseases associated with ageing, lifestyle and nutrition. Readers will also be aware that I praise emergency medicine. There is no better time in history than now, to be run over by a large bus, or to fall off a bike. Medicine's ability to resuscitate and repair a broken body is mind-boggling. Its impressive. I had no hesitation at all to undergo the surgery (I also had no choice!). By the way, New Zealand has an excellent reputation when it comes to orthopaedics.
Rehabilitation has already begun
Two days were spent in hospital recovering from the operation which appears to have gone well. The surgeon has advised that I will be in plaster with no weight bearing for at least 6 weeks after which there will be an initial period of recovering movement in the ankle which will be stiff and sore. He advised that full recovery may take as long as 18 months and there's a high probability that I will suffer osteoarthritis later. Looking at the damage I would tend to agree with this advice, the duration and long term prognosis. It makes for a good challenge.
My rehabilitation goals are to make a 100% recovery, that there will be no long term limitations from arthritis and to win the World Masters 60+ Mountain Bike Championships in 2016.
What am I doing to make these a reality?
What am I doing to make these a reality?
Stage One: Rest and Repair
The first six weeks is all about giving plenty of time for the body to repair the damaged structures to the extent there will be sufficient stability in the bones for weight bearing. Much damage has been done to the left foot and ankle and there is nothing to be achieved by pushing it. In addition, I have suffered general physical and emotional trauma the magnitude of which can easily be discounted: I need time to recover. I am playing a long game - no quick fixes. No arthritis later on. I will be guided by pain, swelling, intuition and the advice of specialists as to how hard I push things. Rest assured the process will be careful and conservative.
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| While this may appear an idyllic way to pass the work days, rest assured that the novelty is quickly wearing off! This reclining position facilitates venous and lymphatic drainage of the leg and I'll be doing this for the best part of the next six weeks, while gradually introducing some active rehabilitation in between. |
Nutrition to expedite healing
An aspect of recovery from trauma, including surgery, that is usually overlooked is nutrition. There are three aspects that need to be dealt with:
- Reducing secondary tissue damage from oxidative stress from the toxins released by dead and dying tissue. This is principally done by flooding the body with a mix of super antioxidants such as Algotene.
- Assisting the eliminative processes, principally the liver and kidneys, with expelling the detritus and toxins resulting from the trauma, surgery and medications.
- Supplying the nutritional building blocks for bone, ligament, cartilage, muscle and new blood vessels.
I began taking these the day after the surgery by adding the following to my diet:
- AST Serracor and AST Peptizyme which are a mix of revolutionary systemic enzymes that boost metabolism, improve circulation as well as dissolving and removing cellular debris, including actively dissolving fibrin (blood clots). One of the enzymes, serrapeptase, dissolves old scar tissue, creating cellular spaces for new tissue to be laid down. Amazing!
- Allergy Research Group Tocomin which is a rich formulation of mixed tocotrienols (members of the vitamin E family) which have novel bone-building properties as well as being powerful antioxidants, anti-inflammatory and circulation promoting. I have used this for the successful reversal of osteopaenia and healing of stress fractures.
- InterClinical Laboratories Reparen which is calcium phosphate monobasic. Calcium phosphate monobasic is concentrated at the site of tissue healing, particularly of bone, tendons and cartilage, as well as muscle. It is particularly valuable for bone healing. I have used Reparen for years for helping recovery from soft and bony injuries such as stress fractures.
- InterClinical Laboratories Algotene. Algotene is a remarkable marine phytoplankton which is adapted to survive in the harshest UV radiation found on planet Earth. Taking algotene helps to protect my DNA from radiation damage. I have had far too many xrays lately and more are to come. Algotene also happens to be an internal sunscreen, allowing me to spend more time out in the sun generating bone-building natural vitamin D. Algotene is a powerful anti oxidant.
- I am also taking quite high doses of vitamin C with echinacea to aid tissue healing.
- I am also taking the potent Naturopaths Own Probiotic and Immune Repair powder for the next month or so because I had three infusions of powerful antibiotics while in hospital.
Is this nutritional overkill?
My answer is "of course not!
When we are young we can eat almost any kind of rubbish and pretty much get away with it. As we get older what we eat becomes more and more important. As ageing sets in and nutrient deficiencies become more accentuated, healing and health in general become more and more compromised. Much of what we consider to be the uncontrollable consequences of ageing are, in fact, controllable nutritional factors, many of which can be slowed and even reversed. Slow and incomplete healing is the most obvious of these controllable factors.
High quality nutritional products are not cheap to buy. Actually they are very cheap, really, if you were to take away the billions of dollars of subsidies given to non-nutritional treatments such as patent medicines.
There would be little change out of $30,000 for the surgery and the time spent recuperating in hospital. Then there are the follow up consultations and likelihood of more surgery to remove one or more of the metal bits and pieces.
Then there is the lost time and productivity from my work.
And what's the cost of an arthritic ankle a few years from now? Maybe I can avoid this by investing now, including in my nutrition?
If, through spending a few hundred dollars on nutritional measures, my recovery is quickened by even a few weeks and the possibility of arthritis a little less than it might otherwise have been, then the payback is well worth the investment.
Besides, I am preparing for the World Champs in 2016 and it is said that
a great athlete is merely a very healthy person!
Postoperative fatigue and high blood pressure
Its three days since I was discharged from hospital. My blood pressure, at rest is usually around 110/70. It is varying between this and about 140/90. In addition, I am feeling very tired and could sleep all day and night. A further observation is that my urine is a brownish colour and I am feeling slightly nauseous at times. I'll explain what I think is going on:Blood pressure
When sitting or standing with my leg down, blood is pooling in the damaged leg. This is because the venous flow is compromised due to swelling, damage to the vascular bed and lack of the muscle pump since the leg is immobilised, whereas the arterial flow to the legs has not been disrupted. Pressure builds as this pooling happens and this shows as a rise in blood pressure as the heart works harder to try to circulate the blood through the squeeze point of the left leg. Raising the leg so that the blood begins to drain shows a steady reduction in blood pressure towards 110/70.It is possible, as well, that stress on the liver and kidneys will be pushing blood pressure up, however I think this is minimal in my case because blood pressure quickly returns to normal once elevation is resumed.
Fatigue, nausea and urine colour
The brown colour of the urine indicates that my body is now working hard to filter and remove the cell debris, including haemoglobin and myoglobin, which will be producing the brownish urine. These wastes are excreted via the urine and the bile and the less than healthy bile can upset the tummy and cause nausea. The circulating waste and the strain on the liver and kidneys, which are the principal organs of elimination, can cause the person to feel very tired.Managing these postoperative symptoms
I'm managing these symptoms first by lots of rest and elevation. You can't ignore the need for rest. Its essential during this initial stage of recovery.I'm supporting the processes of removing dead tissue with various supplements including antioxidants, vitamin C and systemic enzymes (refer to the earlier section about nutrition). I may also do some specific liver support such as adding milk thistle if things become more uncomfortable than they are.
I am also having a few tablespoons of apple cider vinegar in a large glass of lemon water a couple of times a day. The largest organ of your body is the skin and sweating can be used to aid the elimination of toxins. I would normally use a sauna for this, but am inducing a really good sweat by soaking in a large hot bath with a couple of handfuls of Epsom salts (magnesium sulphate) added to the water.
Stage Two: Resuming non-weight-bearing fitness work
I'll be writing about this in a few weeks, once I have had my follow up appointment with the orthopaedic surgeon, Mr Mark Sherwood, so please come back soon for the latest update. I don't want to get too far ahead of myself.
In the meantime, once I am over the initial shock of the accident and its aftermath, I'll be progressively working to maintain my hard-earned fitness and not to lose it. I've already worked out how to do this and its ready to roll (More about this soon).
The older we get the harder it is to regain a high level of fitness,
so it is best to never lose it
In the meantime, once I am over the initial shock of the accident and its aftermath, I'll be progressively working to maintain my hard-earned fitness and not to lose it. I've already worked out how to do this and its ready to roll (More about this soon).
 |
| Jodi from Burke's Cycles Kilbirnie, unpacking and testing the silent, super-duper CycleOps trainer. Wow - it comes with a lifetime warranty! I'll be commissioning this beauty in a few days time using a special single leg cycling kit supplied by NZ Cycling coach, Andy Reid. By the way, Jodi is the person, who, along with Hamish, came to my aid when I shattered my ankle. She earned the sale! |
Related articles:
http://blog.garymoller.com/2015/01/first-aid-treatment-for-severe-ankle.html
http://blog.garymoller.com/2015/01/my-ankle-fracture-dislocation-two-weeks.html
http://blog.garymoller.com/2015/02/sleep-deprivation-following-severe-leg.html
http://blog.garymoller.com/2015/02/my-ankle-fracture-six-weeks-on.html
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