7 weeks post op - Fainting in the plaster room!!
God, I feel like such a sissy!
Turned up at plaster room today for the fortnightly plaster change and foot repositioning. Feeling happy that this will be the last plaster and I’m rounding the bend into the home straight (of the plaster stage at least). Remember I’m on the UK NHS stone-age track where they still think the best plan is to have you NWB in hard cast for 9 weeks!
Then suddenly I’m surprised - “If we can get your foot to 90 degrees we can put you in a walking cast,” says the nice lady. This was unexpected - cool! She doesn’t mean a boot or anything, don’t get too excited, just a hard cast set so you can put your foot down. So they cut off the old cast and, oh dear oh dear oh dear . What a sad sight emerges blinking into the light. Surely to God that’s not my leg? Yes, apparently it is. I could weep with despair (but I don’t - stiff upper lip ). I console myself that winter is coming - all long trousers and boots and thick socks.Very, very thick socks.
So then I have a few minutes to give it a little wiggle, which feels okay, but very feeble. The muscle which runs alongside the shin-bone is just non-existent. The other plaster room lady arrives and they stick a prop/frame under my knee like usual and then we have the routine battle of trying to get my leg to just relax and it really doesn’t want to - less than ever this time. After weeks of nothing, suddenly Mr.Leg is expected to crank into a new position and he says “Foxtrot Oscar!”
We all really want to get my foot to 90 degrees but it soon becomes apparent that it isn’t going to go. They are pushing my foot up and it isn’t exactly hurting but it very tight everywhere and my ankle joint feels just solid, especially at the front bizarrely. Lady no.2 is battling to push the foot into the right position and my leg is refusing to let her. I’m trying so hard to relax and breath and go floppy, when suddenly my ears start to buzz and I feel very faint indeed (I never faint - I’m made of girders). They quickly drop down the back of the couch/table and I lie back which helps the faint feeling and the leg relaxing. Don’t know why I was sitting up in the first place. Eventually the new plaster is on, but we haven’t achieved the magic 90, so it’s another NWB cast. I’m not too gutted because it’s not like I was expecting a walking cast anyway.
We are off to Paris for a 1 night stay next Tuesday and, in an effort to be helpful, the ladies have fitted me in for an extra appointment next Monday to try to get the little bit of extra push so I can have a walking cast. This is very nice of them, but at the moment I think I’ll cancel it, for two reasons. Firstly, I don’t really want to go on a plane in a brand new cast which always feels tight at first so any in-flight swelling, however minimal, really has nowhere to go, and anyway the airline policy says that casts under 48 hours old should be split (although I suppose that could be done as soon as it has set hard). Secondly, I’ve been NWB for so long I am very strong and proficient on the crutches. As and when I’m suddenly allowed to walk a bit, albeit in a hard cast, I probably should not be bounding up and down the boulevards of Paris, but pottering carefully at home. Better the devil you know and all that. But I’ll mull it over in the next couple of days. Of course, if I was in a lovely air-cast boot like my friends states-side none of this would be much of an issue (grumble, grump, mumble).
Despite today not being a total success, I’m still due to come out of cast altogether in 2 weeks. I’ve been told to turn up with 2 shoes, plus heel lifts for the injured side. Blimey! No mention of physios or anything, just my new bezzy mates in the plaster room.
This process is a bit like climbing a mountain - you battle up a steep slope to what you think is the summit, but just as you get there you see it’s not the summit at all, and there’s a whole load more mountain to come. About time somebody installed a nice cable-car on this damn mountain! Preferably one with an on-board bar!
Love to all,
Smoley
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Hi Smoley,
Good to see you’re managing to keep your sense of humour.
The human body’s a wonderful thing. I had no pain when I had my rupture, but nearly passed out a few minutes later - brain blocking the pain signals or just shock?
I think it would take a few days to get used to weight-bearing on the injured side whatever it’s encased in - certainly did for me when out of the cast. I’d think I was standing up straight but the Wii Balance Board said no.
Sticking with trousers myself at the moment - definitely with you on the cable car idea!
Enjoy Paris,
Sam
Thanks Sam,
The frustrating part of today’s experience is that I’m sure that if I could have had a bit more time to give it a gentle massage or a nice warm foot bath to loosen things up, 90 degrees would probably have been no problem.
Is there lots you can do on the Wii board? Suppose it depends on your physiotherapist - if they are into it then they’ll weave it in to your programme. Hubby is Mr.Gadget - any excuse to buy a new gizmo!
I’m already trying to put a little weight through the bad foot, not standing on it as such, but pressing it a little while sitting, or using both legs to push myself around on the wheely chair. Just to remind my foot what it feels like - v. tingly!
Smoley
The Wii board also reminds me of simple things I can’t do yet - like up on my toes without support for the skijump. But my physio was quite supportive of me trying things like the hulahoop, ski slalom, football heading and step as well as the balance tests to see how I’m distributing the weight.
In my last cast I would push down with my heel to get used to working that - amazing how hard it is afterwards to get the right muscles to respond and do what you think you’re trying to get them to do.
Oops, school pickup time - bye!
Hi Smoley,
I’ll drink to the cable car idea!
My NHS experience is similar to yours in that at each cast change I suffered severe pain as the foot was pushed up due to the tightness of the AT.
Once you do go partial & full weight bearing it will slow you down, albeit for a hopefully short time.
For travelling I am sure that they could get you into a boot before you go, great progress but possibly still NWB to start. If you don’t make the boot they can bi-valve the cast to release any pressure in the event of emergency. When I went on holiday recently my airline insisted that I get a letter from my GP stating that I needed crutches to allow travel, however having got the letter nobody asked to see it (15 quid well spent!).
I hope you can go to Paris, it would be great for lifting the spirits. If you go to Charles De Galle airport, enjoy the navigation at the terminal - only the French could design it!!!!
Hey you have some quite sadistic nurses there over in Britain? My hospital is blessed with 2 very gentle male technicians in the ortho clinic
I am sure once you are out of the cast your ankle will start to feel less stiff after a nice hot bath.
Do not be sad for not having the walking cast - if you are very proficient with the crutches you are right it is better not to experiment in uncharted territories.
Hope your cast and crutches will bring the better out from those French waiters and you will get loads of extra spoiling on your little vacation!
Oh Smoley,
I feel just wretched hearing about how you’re getting treated w/the NHS (although I just reread the beginning of your first post and am surprised that you had surgery the next day). How they can expect an immobilized ankle to suddenly be OK w/being placed at 90 degrees is beyond me! I think the only reason that I got to 90 after two weeks is because I had my splint changed after 1 week, putting my foot in less of a plantar-flexed position. Fortunately, you have a razor-sharp wit and seem to be bearing this better than the vast majority.
Cheers, Ron
PS- “bezzy mates”?
Ron - thanks for your reply. I hope I haven’t painted a bleak picture of the NHS because it isn’t all that bad! The ladies in the plaster room are great, it was my leg that wouldn’t co-operate! They just wanted to make life a bit easier. Each time the plaster gets changed (fortnightly) they move the foot round a bit more, it just didn’t want to make the final few critical degrees. I’m sure that after a warm bath and a bit of a rub it will loosen massively. They take a very gradual approach to bringing the foot round so it doesn’t heal too long.
I have questioned the 9 weeks in hard cast approach, and although I’m still not convinced, it seems to boil down to 2 main reasons: First, it works! Sew the tendon back together and immobilise it and it will fix. The unfortunate side-effects (muscle atrophy etc) can be dealt with later. Secondly, patient compliance. If you are in a hard cast so you can’t put your foot down then you aren’t going to do anything daft. Give the patient something they can remove and they may be tempted to do so. This aspect makes me a bit cross because I would do exactly as I was told. However, I have read plenty of posts on this site which confess to doing things outside doctors orders, so perhaps they have a point!
I’m very lucky because I’m an at-home-mum but my children are both school age (I’m hoping to get some work I can do from home soon, but the recession is stalling things) and my husband was made redundant in the summer (okay, that’s not lucky but at least he’s around to help out).
Being in cast does mean a lot of time at home,but I have tried to make the time productive and it has passed without too much difficulty.
It’s the next stage that is going to be tough!
Thanks so much for all your support,
Smoley
PS - Bezzy mates = best friends!
Dear Ron - just thought you should know that being described as ‘razor sharp wit’ has kept me smiling all morning! Thankyou!
Lee - yes, I thought as much. My intuition never fails! And, do you know, I think I can feel some razzle dazzle happy vibes buzzing through the ether! Or through the Dartford Crossing, that being the most direct route from Kent to Essex!
Smoley (aka Dr Smols - like that too!)
Smoley, I just read your comment on Graham’s page (figured I’d comment here rather than continue the hijacking of his page). So, this ortho consultant that you referenced is the one that you are surprising in Paris? Is he always that overbearing and paternalistic? I’m not completely serious, but come on. I certainly haven’t read the ortho research, but he doesn’t believe it because of small sample size? And I couldn’t let his cracks about our system go unchallenged. Yes, we have a (somewhat) consumer-driven system here, but we also have a wicked legal system. Any surgeon who caved in to patient wishes against defensible practice would find himself/herself writing a lot of checks. Has your friend ever practiced or trained in the US? or is he basing his caricature of our system on what the talking heads on the telly say? He sounds to me like someone who is completely set in his ways and if anyone does anything differently then it must be for reasons that aren’t worth considering. Ugh. Sorry to rant, but I couldn’t let his comments go without a rebuttal. Ron
Ron, Graham, Chris, everyone!
Didn’t intend to open a can of worms - feelings have been running a bit high! First, in defence of my ortho friend: he’s a great guy and one of the best in the business when it comes to hip replacements, but like most senior doctors (”emminent surgeon” is the phrase used here) he does have a level of ‘certainty’ in his own professional opinion. I suppose it is something you must have as a consultant to maintain the confidence of your patients and the junior docs and nurses working under you. Consultants in the UK generally work both NHS and privately, so someone paying a fortune for private would have exactly the same man for the same op - just less waiting around, a private room and better foood!
It must drive surgeons a bit mad when, after years of training and experience, people like me who have been bashing on the internet for a couple of days start questioning their approach and throwing research papers at them!
That said, if I was in this situation again I would push harder for the boot route. My injury and op were within 24 hours of each other and by the time I’d read all the research and learned from all the people on this blog, I suppose I was on a bit of a conveyor belt. Of course we should all be given the time we need to discuss/learn/make an informed decision, but when you’ve got a waiting room full of people all needing seeing to, is it practical? And an ATR isn’t life and death. A good friend has just been diagnosed with breast cancer and that gets a totally different approach - all the time you need to discuss stuff, your own specialist nurse to talk to etc.
All health systems have their pros and cons. I take your point, Ron that the US legal system would pounce on any doc not doing his job properly. But UK doctors come under an enormous amount of scrutiny too - hospital league tables etc. My friend does have a great deal of respect for US doctors - at least he’s forever heading that way for international orthopaedic conferences!
I’m still confused by Chris’s comments that his hospital (which I have heard has a very good reputation) has made a deliberate decision away from boots and back to casts. Seems very retrograde, so would love to hear their reasoning.
I’m really starting to count down the hours now until my cast comes off. But I must admit I’m a bit nervous. What will I be able to do? How much weight will I be able to put on it? I know it is very atrophied, but how is that actually going to feel? Being in cast is frustrating, but it is simple. Now things get complicated!
We are all still friends aren’t we?
Smoley
Of course we’re all friends!
Many of us use this forum as a way to vent our frustrations with this injury. Some of us (me) just do the venting a little less directly. After reading my comment, I think, “wow, where did that come from?”. So, even if I do pop off on a topic that is only tangentially related, I’m glad I’m popping off with my typing fingers than kicking the dog, yelling at the kids, etc.