Sunday, 20 July 2014

4 of 40 ... 1/10th of the way!

How to manage this rehabilitation?

Well, there is some similarities between this and training for a major event or project managing a construction job!

Both of my Consultants have said 40 weeks before the femur will be back to full strength, as it was before the accident and I can do what I was prior ... running, cycling, mountain biking, skiing, hiking.

40 weeks, hence 4 of 40, today marks the end of the fourth week!

40 weeks is an end date or when the event would be or when I would hand the keys over on the construction job! A point to aim for and allows for a time line to be drawn!

Along the way there will be way points and benchmarks to be set.

Phase One - was the hospital as detailed in my previous blog

Phase Two - started when I got home and will last until the 4th August when I return to hospital for x-rays and a visit to the consultant.

The primary goal during this phase was to settle down into home and create a routine for both myself and Chris, learning what I could do by myself and what I needed help with. To get back into a regular sleep pattern, as sleep is a key factor in allowing the body to repair, unfortunately in hospitals they like to check on you every couple of hours! This has set the foundation of how the next few weeks will go.

Already I/we are seeing progress, it has got easier to get in or out of bed, the same with the car. My confidence has grown with using the crutches ... I think I have passed my Learners Licence!

Physically, I have had the balance of the stitches removed from the leg and the wound has healed well,

 I have been able to cut out the pain killers, I see a small improvement in strength, that I can now lift the lower leg by itself, the swelling has reduced, but is still reasonable around the knee. I can now get a pair of jeans on ... oh something so normal felt great! Flexion of the lower leg is about sixty degrees and needs to improve.

These are all small steps, which create benchmarks to measure future progress against!

Of course there are set back backs and frustrations, but having those benchmarks reinforce the progress which tempers the frustrations

The flexion and confidence of getting around is what I am working on, until the 4th the Phase Three starts ...

All going well, the talk around Phase Three is to introduce some weight bearing to the leg, start some physiotherapy and some form of exercise, and possibly start back at work for a few hours a day with it ramping up.

Meanwhile a big thanks to those who have called in, emailed, texted or phoned ... it means a lot ... THANKS!

Saturday, 5 July 2014

The aftermath ...

It certainly puts your mind at ease, when you get rolled into the Emergency ward of a hospital and a full team of experts swings into action!

Of course the drugs helped ... morphine and entonox ... the thigh was still spasming! Meanwhile my cycle kit was being cut off me and was prepped to go in for a xray.

In for one, but couldn't get my good side, so it was back for a second with the ED Consultant Saskia keeping the tension on my leg reducing the spasms. Got a good picture the second time to confirm that I had a spiral fracture to the femur just below the head of it ...

A discussion was held to either operate immediately or to wait for the morning ... morning with a full team in the operating theatre was decided!

A very disrupted night was spent, hourly observations, thigh spasms, morning couldn't come soon enough!

I headed into theatre about 7.30 in the morning waking back in my room about 1pm. Now sporting the most customized piece of cycle bling in my leg, inserted by two most expensive tradies out there ... my surgeons (Chris and Darre)! I now have a titanium rod screwed to the top and bottom femur. Something not readily available at your local bike shop!

Sunrise from my hospital window in Rotorua

Unfortunately, I had developed Compartment Syndrome in the thigh. Compartment Syndrome is where there is a build up of toxins in the quadricep muscles and that they had to do a Fasciotomy. That is to split the thigh open (like you would butterfly a leg of lamb to bbq) to take the pressure of the muscles and then they flushed me with fluids (a drip and plenty to drink) to minimise the build up of toxins in the kidneys. there is a marker (CKm) in the blood to measure this build up it sitting at 1800 and it needed to be below 400 to close the leg up! This finally happened on the Saturday morning.

Now I had 3 incisions, 26 staples and 24 stitches holding my leg together and a drain running out of my leg.

Meals were always a surprise nothing like their description!

Saturday morning passed under a general aneasthetic but was looking forward to Chris arriving that evening, it was bloody good to see her, Sunday my very good friends, John and Mair made the trip over from Hamilton giving a good boost to my moral.

It was now that there was talk about getting me back to Christchurch. 

Swelling difference between the knees

Progress was made, negotiation with Christchurch Hospital to take me was successful, they organised the NZ Flying Doctors to pick me up on Tuesday afternoon, I was loaded into their Beechcraft King Air C90B for the 90 minute flight to Christchurch. I could not stop smiling once I saw the Canterbury Plains!

A HUGE THANKS to all the staff of the Orthopedic, Surgical and Emergency units at Rotorua Hospital, you are fantastic!!!

Two days in Ward 19, with friends visiting life was starting to get more positive, talk turned to me being released home ... 

Thursday 3rd of July, once Chris finished work, we headed home, stepping outside the hospital towards the car the emotions took over, I became a bit of a happy blubling idiot ... this was a call to close for me!

I have covered some miles solo, in some wilderness areas ... someone was looking over my shoulder for when and where this happened.

Also when I entered the Kiwi Brevet one of the charities I donated to, was the West Coast Canterbury Air Rescue Trust ... the operators of the NZ Flying Doctors ... paying it forward!

The other useful item I was wearing was a Road ID bracelet which had all my important details on it, well worthwhile!

End of Phase One!

 I had not shaved for the time I was in hospital so signalling the end of Phase One and the start of Phase Two a bit of a tidy up!

Phase Two started at home - The next four and half weeks is to adapt around home on crutches and not place any weight on my left foot, the stitches will come out this week. the Physio has given me some small exercises to do, trying to increase the flexion-extension of my knee. My leg is not in a cast so it does have own mind and spasms occasionally ... not pleasant

Phase Three will be the following six weeks introducing some weight bearing on the left leg and will increase the rehab around the muscles

Overall, I have been told it will be a total of forty weeks (9 months) before the femur has healed to where it has the same strength as it had before the accident.

Warning: Below are some photos ... some are graphic ... if you don't like graphic  photos don't look! They get more graphic the further down you go.

Bruising on the hamstrings

Bandaging on the thigh

Staples on the knee incision

The three incisions

The Fasciotomy

Friday, 4 July 2014

Shit Happens!

Picking from the last blog ... Fatigue creeps up on you, it accumulates! You acclimatize to it, it becomes normal. Some stress is good but you can have to much stress is not healthy. One of the issues was my blood pressure had been steadily rising, well its has dropped about 25-30 points with getting away.

So basically we had eliminated causes by taking some time off, having health checks, recovering from the Brevet was hampered by work stress.

Going forward the goal will be to keep a better balance ...

Monday 23rd June 4 pm

I meet Matt at the Waipa entrance to the Redwoods Mountain Bike Park ... I love this place ... some of the best designed and cared for trails in the world!

Now I hadn't seen Matt for 14 years, so there was a bit of chin wagging to be had, and during that time we had been through some similar experiences some good, some not so!

Initially I was going to have a rest day, but it didn't take much for me to say yes and ride.

We headed out, cruising, chatting, nothing hugely technical ... well within my technical riding ability. We had ridden around a few trails then taken the forest road up to Tokorangi over looking Rotorua, just on twilight, we flicked on our lights and started to head down back to the car maybe twenty minutes away ... down Tokorangi track Matt was ahead of me ... when we came to the start of Turkish Delight ... the track broadened and it  looked like there was two tracks and I could see Matt's lights ahead of me ... I slowed down as I skipped across  some tree roots ... suddenly my front wheel slid sideways of the root and down I went ... right onto the root, rotating as I went ... ending up lying in the foetal position with my left leg on top.

Matt had heard me go down ... now when shit happens like this ... it great to have mates like Matt, Matt's background is similar to mine, many years as an Outdoor Instructor, experience with Search and Rescue and an ex Ski Patroller. Matt soon started to assess the situation, with my thigh misshapen and swelling quickly, we both knew the seriousness of the situation! It was 5.30 pm.

Matt jumped on his trusty stead and rode out to the car, calling 111 for an ambulance advising them of the seriousness of the situation, on the way back a couple of other mountain bikers to help out directing the Paramedics up to us.

Lying there in the dark, on the forest floor, my thigh was spasming, causing the pain levels to shoot through the roof, but as I laid there I thought of the Soldiers who had fought through the World Wars and drew strength on that if they could survive so could I! I was on the edge of a small city with a modern hospital with in it and excellent rescue services on the way here.

It was about 20 odd minutes before Matt was back and was joined by Murray and Malcom who were mountain bikers, 20 minutes later St John Ambulance Paramedics Arthur and Michelle turned up, time 6.20ish.

A full assessment was made, I spoke with Christine on the phone to let her know what shit had gone down! Mean while the Rotorua Fire Service had turned up. The next step was to straighten the leg and splint it ready to be carried out!

Arthur advised me to think pleasant things, as he administrated some Ketermine (aka Special K, aka Horse tranquilliser, which is also hallucinogenic), they did do the straightening and splinting of the leg placing me into the stretcher, meanwhile I emptied my lungs screaming like a Banshee! All I could see and think ... was how pretty all the torch lights were reflecting on the underneath of the tree ferns a kaleidoscope of colour's ... man this shit was good stuff ... talk about tripping out!

The muscle which was brought in to carry me out headed of a trip of about 25 minutes to the ambulance, thanks boys great job,then into town to the Emergency Department at Rotorua Hospital  ... time 8 pm!

A big THANKS to ST JOHNS AMBULANCE, NZ FIRE SERVICE, Matt Bennett, Murray and Malcolm and anyone else who helped out that evening.

For the last six months the writing had been on the wall ...

For the last six months the writing has been on the wall … The three years prior to that It has been flat out working to help get Christchurch repaired and rebuilt often long hours and stressful interactions. What was decidedly exciting about the project is at the beginning it was unprecedented, there was so many learning outcomes to happen, the shakes continued, the project got larger and more complex. With few true firm guidelines we operated long hours ... It was exciting time, the first year was an adrenalin rush, it was exciting! 

Fortunately working for Fletcher support was and is there with monthly Professional Supervision, to give us an outlet and discuss workload, issues, etc. One which was raised for me at Christmas time was burn out, the signs were showing working long hours, training for the Kiwi Brevet, juggling family commitments, thoughts about ongoing work once this project has finished.

The Christmas break came and went to quickly, riding the Otago Rail Trail, I struggled with staying warm on the cold wet day not usual for me, but is an indicator when you are fatigue staying warm is hard, on returning to Christchurch had a few days off training  then a 600 km training then it was back to work early.
February rolled around, I completed the Kiwi Brevet in my goals set pretty happy pretty exhausted, again on the fourth day I had got wet and hypothermic and ended up calling it a day after 90 kilometers, it took ages to warm up even after a big meal and hot shower but once the event had finished it was straight back into work, still plenty of families wanting, needing to get back into their homes, greater pressure from our client (EQC aka The Government) to have a higher completion rate with lower complaints.
Still in the weekend I would go for a ride  60 kms and be totally wasted the next day I was struggling to get over the fatigue from the Brevet … but was I … I also was not sleeping well often waking during the night for an hour or two thinking about work. We were checking out the body physically, went and saw the GP who referred me to the Cardiologists all the test said that I was doing great … some might say a fine specimen … some might not!

The resulting repairs from the earthquake has changed peoples conversations, go and sit in a CafĂ© and listen to the conversations … once it would have been discussions about the weather or the rugby but now it is all about “how is you house repair is going or not?” There is no escape from it!

Come the middle of June, another visit to the GP to discuss the ongoing issue, he said two weeks off work, get away from it all! Go and chill out
Work said give us your work phone and Ipad and off you go.

So I threw a few items into the car and headed to the North Island, taking a few toys with me, as sitting around doing nothing would really send me over the edge!
Into Wellington catch up with a friend over dinner … it was great to see Jo and how excited she is about her new job. The following day a drive through to Napier, stopping along the way to have a cuppa with some close friends Ralph and Sandra, then onto mum’s in Napier.

Chilling out in Napier, I had a couple of rides into the quiet country side, not quick, not hard, stopping for coffee, enjoying the sun, no meetings, no time schedules. Caught up with another old paddling buddy Steve, told a few lies, all the usual things, old mates do!
I had been eating well, sleeping superbly, life was starting to flow back into the body.
Still staying with family can be difficult, after all they are family!

So I shot through to Taupo, one of my favourite places in the world I have spent months of my life playing and at this time of year it is totally chilled out. Arriving I booked in to the Mountain View Motel  the owner Kunio Onishi is a keen mountain biker himself.

I spent the rest of the day chillin, drinking coffee walking cleaning gear, it was a beautiful day! I had not ridden my mountain bike out at the Craters of the Moon for 14 years and was keen to get back, so grabbing a map I sat down and looked at it … lets be sensible you don’t have to ride it all in one just aim for 60 -90 minutes!
Over the next two days I had two fantastic rides there not pushing myself along speed wise or testing my skill level, just good old fun. These tracks are well designed well graded, the soils drain superbly so can be ridden quickly after it has rained without tearing up the track. That evening I went to the pub to watch the Allblacks England test.
I decided to stay another night and catch up with friends Jo and Crunchy who live locally and have been on two of the Southern Alps Cycle tours  with me. Crunchy had ruptured his Achilles and is on the mend, hoping to be back for Novembers Tour, meanwhile Jo had been out road racing.

With Rotorua only an hour away and some of the best mountain biking in the world, still with four days to get back to Wellington to catch the ferry south again. I cruised the next day through to Rotovegas! 

Paying my respects to Huka Falls along the way … as you do being a paddler! There was a pretty good flow pouring through that morning it was sunny … I had just had nine nights of sleeping through all night, getting 9 to 10 hours of sleep a night.

Once in Rotorua, I check into the Alpin Motel  they have a good reputation with mountain bikers and are close to the tracks. Speaking with a paddling buddy we arranged to hook up for ride and catch up at 4pm once Matt finished work.

So at this point I am feeling generally fresh, starting to recover.
I was starting to think about next summer’s challenges, choosing some events which would be create a bit more balance.
My longer term goal is to ride the Length of New Zealand - Aoteraroa Brevet, when I turn 50 in 2016. So having some goals for 2015 and how that would help move towards 2016 was churning through my mind …

Option One was to go back and do the Kiwi Brevet in reverse.
Option Two was to do some triathlons there were three which are on my list to do … Rolf Prima Half Ironman  , The Marlborough Sounds Half Ironman and the Motutapu Xterra race.

The pros would be that option two would be less racing about 18 hours in total as opposed to 60 hours; quicker recovery because of the shorter racing volume; tri’s keep my whole body better aligned and tuned, the tri's would be a good freshening of the mind.
The cons would be going into the length of NZ Brevet with less experience.

This is where I had got to on Monday the 23 rd June 2014 ...