Bone Isotope scan!

Well, today was the day of my bone isotope scan.
I was a little nervous, but grateful that after this scan i would know for sure what needed to be done to me!
The bus dropped me at the private clinic where i was to have my scan and i headed up to the doctor...sorry, correction...nuclear physician's office, for my scan.
I was asked to lie down and they injected me with the substance in my right arm. It was luckily only a needle full and didnt hurt too much.
I was asked to return in a couple of hours, so i headed off for sum breakfast down the road.
When i returned, i lay down in a machine not dissimilar to an MRI machine.
I lay still while the machine slowly spun around me and took images of my lower body.
The whole procedure took about an hour, and then i was on my way.
Or so i thought.
I had the bus drivers number to call when i was done, so i gave him a call and he said that he was on the road back to where i had come from, 2h away, and that he would get another bus or ambulance to pick me up.
After 3 more phone calls over the next couple of hours, he eventually returned back to pick me up 3h after my original call!
Then i was off to the provincial hospital to get my file. They had to phone up to the orthopaedic section to let them know i was coming as it was already so late in the day.
When i got upstairs, i sat and waited another 2 hours before the specialist i had been seeing all along came walking up to me with another man. He introduced us, and he turned out to be the head of the orthopaedic department.
We went into the consultation area and he pulled out my scan results and put them up on the xray viewing machine.
The scan showed up that there was still action around the fracture sites, which meant that the bones were still healing. He told me that bones can continue to heal for up to 2 years, so based on the scan, he would not recommend another op before that period is up. This would only be in October next year. And obviously only if the bones still weren't grown back together by then.
The other area of the scan which was just a big blotch of activity was the knee!
He said that this indicated that the knee was extremely unhappy, which is why i am experiencing a lot of pain in that area.
He said that until they go in and see what is the matter they would not be able to do anything about it.
So, with my knee scope already booked in for March (thank God, as the new date had it not already been booked earlier, due to demand, was only in May!), all that was left to do was strengthen the quad muscles as much as possible before the op.
He told me that normally he would want the affected legs quad muscle to be 120% of the good leg's strength. At the moment i can just about lift my leg straight form a bent position, but i am sure i could lift more were it not for the pain in my knee.
He said that it was a bit of a catch 22 i was in as i needed to exercise the quad muscle even though the exercise meant hurting my knee!
We also checked my blood tests and they were perfect. He said that he had never seen an infection reading as low as mine. Everything was great.
So, basically what needs to happen is that over the next 3 months up to the 5th March, i need to work on my atrophied quad muscle as much as possible in order to get it ready for the op which will immobilize it again for possibly another month or more.
I have done a bit of research online and have found that an electric muscle stimulator might be very helpful for my quad muscle as it could exercise the muscle without the need for me bending my knee.
I have found one online and am in the process of ordering it.
So, another visit to the hospital and another different diagnosis!
At least this one is based on the scan, and not some doctors hearsay.
Apparently the recovery period after the scan is 3-4 months, so this would mean that all things going well, i will be walking by June/July 2013...
But i wont know for sure what the outcome will be before the scope in March. I am still very optimistic that the scope will rectify the problems with my knee, and that come the middle of next year i will finally take my first steps!

Round & round we go...!

So, today was meant to be the fitting of my orthotics.
So i thought.
It was another long day, but at the end of it, i hope, a faint light at the end of this tunnel?
It all started with collecting my file and heading up to see the orthopaedic section.
Wednesdays are crazy days at the hospital! About double the number of people i have been used to on a thursday.
Eventually my name was called and i headed in to see the guys for my fitment.
The first thing the doc said to me was to ask me why i was wearing a knee brace?
I replied that it was for lateral support for a torn LCL ligament. He asked when the accident was, and i told him, 14 months ago. He shook his head. Then he asked me how long i have been walking for. I told him i haven't been able to put any weight on my left foot for the entire 14 months because of the pain.
He was astonished.
He said that this was impossible. I should have been walking after 6 months!
He asked me to get up on the bed and take off the knee brace.
He preceded to push and pull and twist my knee in all directions, causing a helluva lot of pain! I am pretty sure the other side of town could hear my screams!
He tested the knee for lateral laxity in the MCL and LCL ligaments, and told me that they were normal. The LCL was a little lax, but this was still acceptable.
So, what this basically meant was that the LCL ligament was ok. It had repaired itself over time. The problem lay elsewhere...!
He told me that often he would get people come see him complaining of knee pain, and the result of the pain was the hip or somewhere else.
He said pain transferal to the knee was a common thing.
He asked his colleague to come in and make sure of his findings, and he went thru the same procedure of twisting and pushing and pulling!
More screams of pain!
He was amazed at how much pain i was in from even the slightest touch.
He immediately booked me in downstairs for a full set of xrays from head to toe.
So off i hobbled down to radiology.
2h later i was sat back with the othro guy and we were looking over the xrays...
Neck - perfect.
Spine - pristine.
Hip - brilliant. Very happy with the fracture healing. Perfectly mended.
Femur - erm....not great...possibly a non-union...!
Knee - looks fine.
Tibia - wow...what an ugly job! Possibly a bone infection as well!!
Lovely news!!
So, what it all boils down to is that my femur may not be grown back together where it was repaired, which could be resulting in pain when the leg is limp and the muscles arent supporting it, which seems about right.
Also, the tibia bone didn't look very healthy. It wasn't nice and white and solid. It was looking a bit like a piece of cheese! A bit mottled! Not good at all!
And the repair job on the tibia apparently was not good either!
I was sent for blood tests to ascertain whether or not i had an infection to the tibia, and was told that he wants to operate on the tibia again. He would need to open up the knee again and move it over, bang the nail out, clean out the infection (if there is one), ream the inside of the tibia, and then insert a new nail down the shaft of the bone.
The femur would need to be done in the same way if a non-union was found! They would need to cut my hip area open again, bang the old nail out, ream the bone, and insert a new nail.
I am booked in for wednesday next week for a bone isotope scan, where they inject a mildly radioactive substance into you intravenously, and a couple of hours later, once the substance has distributed itself throughout your body, you are gamma scanned for abnormalities.
Basically though, it will tell if there are any problems with the bones, including non-union and infection.
Based on this scan and on my blood test, i may have to undergo surgery to both the femur and tibia fractures all over again!
I will know for sure on wednesday what the prognosis is, so will update again then...
I cant believe that the specialist i have been seeing until now could have missed this?!
Thank God the guy i saw today knows what the hell he is doing!
So, after 10 months of wondering why i am not walking yet, i now may find myself under the knife again for a complete do over of the original op 14 months ago!
Not exactly the news anyone would want to hear, but i consider it a step in the right direction (excuse the pun) nonetheless!
Here's hoping for positive news next week...

Ligament Tears, Orthotics & Scoping!

To say it was a fantastic visit to the hospital today would maybe be a bit of an exaggeration.
I suppose that i can say that i walked away at the end of the day with good news, but still not completely over the moon just yet...
The day started with the customary trip to the physio first, and he told me that i needed to add a few more exercises to my routine now.
I spoke to him about the instability in my knee, and that, after some research online, i thought that it may be related to the tear of the LCL that i sustained.
I asked him if there were any exercises that i could do to strengthen the LCL, but he explained that the LCL is a ligament made up of fibrous tissue, and therefore it cannot be strengthened like a muscle can.
The only way to fix it would be to strengthen the other muscles in the leg, notably the quad muscle, in order to take the strain off of the LCL and let it repair itself over time.
These kind of tears (mine was a Grade II, a severe tear, but the ligament still intact) can take years to completely repair themselves, as they grow back very slowly.
I also asked him about the difference in my leg length, which has been a bit of a worry of mine as well.
He got out the tape measure and measured from the tip of the hip joint, to the inside of the ankle, in a straight line. He did this both sides, and told me that i have a difference of 3cm. 2cm is the accepted difference, and anything over that would necessitate getting orthotics so as not to mess up the spine, hips and knees in normal walking posture.
He told me to chat to the orthopaedic specialist about this as well.
He also told me that it was possible that a knee brace might help in the lateral instability that i was feeling in my knee.
Then it was off to the ortho specialist to see what he had to say.
Unfortunately it was a pretty busy day and i could not see the guy i normally see, so it was a new doctor today.
I explained what the story was, and he took a look at my file.
He sat me on the bed and also did the leg length measurement, and told me that he would book me in to the orthotics clinic they held every 3 months at the hospital, and that they would custom make me some inserts for my shoes.
I told him that i was experiencing some popping and grating noises in my knee whilst i was doing my exercises, and he told me that he would have to do arthroscopic surgery in order to ascertain what the problem was. More than likely it was due to the tear of my meniscus though.
In the MRI i had, it was indicated that i had a small medial meniscus (the schock absorber material under your kneecap) tear.
He said that they would do keyhole surgery, and drill 2 small holes in my knee, 1 on either side of the knee.
They would insert a camera in the one side and the tools in the other side.
I will have to stay over for 2 days, as there is apparently a lot of bleeding involved wit this type of surgery, and they can only release me when the bleeding subsides to an acceptable level.
I asked him about the LCL tear, and he said that even if it was a level III, which is a complete rupture of the ligament, they do not do the surgical repair on the national health system. I would have to have it done privately!
He said that even professional rugby players have recovered from severe tears to the LCL by strengthening to the quad muscle to such a level that it takes over the function of the LCL and lets the ligament repair itself.
So the diagnosis for recovering from the pain i find myself in, and being able to walk again, is to strengthen my quad muscle to super strength.
I asked him how long he would expect this to take, bearing in mind that i can only just lift my leg from bent to straight at the moment. 6 months minimum was the answer!
Some more prescriptions of pain killers and anti inflamatories, and i was on my way again.
The orthotics clinic is booked in for the 5th December, and the next available date for the keyhole surgery is the 5th March.
So until then, its gonna be the usual exercises, with the new ones added by the physio, and a lot of quad exercising.
On a personal note, it was disappointing to be told that i will have to exercise for at least another 6 months before i can hope to be walking again, but if i look at the positive in my visit, i will be getting inserts for my shoe that will make the walking process better, i will also be getting surgery to repair the tear to my meniscus, and i now know exactly what i need to do in order to relieve the pain to the lateral part of my knee.
So, like i said, all in all, today was a pretty good day....!  8)

ITB Treatment...

For any of you reading this who might be wondering what exactly those stretches and strengthening exercises are for the ITB, i attach a copy of them below. I hope you can read it ok?

1 week into my new program, and i am happy to report that no new delayed muscle pain has arrived!
However my knee remains painful to lateral movements and weight bearing.
I have noticed muscles appearing in the Vastus Lateralis area, the lateral side of the lower quad muscle. This muscle seems larger from doing the Figure 4 exercise to strengthen the Hip Abductors and Lateral Rotators.
It is a hectic schedule of physio, as i have added in hamstring strengthening, quad stretches, Vastus Medialis strengthening, calf exercises, and ankle/achilles stretching as well as the exercises listed.
The entire session takes me about an hour to get through, and i have set myself a program of doing mornings, after lunch, and again before bed in the evenings.
A 6 day exercise week, and a sunday to rest.
I'll report back how things are going in a week or so.
Good luck to all of you in the same boat. Not much fun, but there is always light at the end of the tunnel...eventually...
;)

Physio physio and more physio...

The last month of rest started off frustratingly, as the injection that i was given did nothing to relieve the pain, and the sensitivity i was experiencing was exactly the same as before.

In fact, i didn't notice any improvement until 3 weeks after my last visit!

Slowly i started to feel as though my leg was a bit more stable and my knee a bit more "solid".

The pain was still there, but at least not with every little movement!

I did try and do a few strengthening exercises towards the end of last month. Literally only 5 minutes or so.

2 days later i was in agony with muscle pain!

My quads were SO sore, and even standing up or sitting down was extremely painful.

2 days on and i awoke to a pain free quad! Very strange indeed!

So, last thursday my next appointment with the hospital arrived.

Just for interest sake, wednesday was the 1 year anniversary of my accident!

I caught the bus through, and by the time i had collected my file from reception (a 3h queue), it was time for my physio appointment.

I spoke to my physio about feeling a bit stronger, and also about the quad pain i had experienced.

Apparently it is called delayed onset muscle pain. Appears around 24h after doing strenuous exercise and lasts for about 48h!

He told me that he had just done a course and in the course they discussed ITBS!

He printed me out some sheets from his course explaining ITBS and also exercises for it.

I was surprised to find out that ITBS is not a repetitive strain injury as previously thought, but is caused by other muscles acting or not acting on the ITB.

Your Gluteus Maximus and Minimus and various other muscle groups influence how your ITB is stretched by acting on it depending on how strong they are. If one or more of these muscles are weaker, then the pulling forces are incorrect and create pain in the anterior part of the knee.

The remedy is to strengthen all of the muscles associated with the ITB to the correct degree, and the pain should go away.

On the memo were 3 exercises on stretching and strengthening the Gluteus Maximus, Hip Adductors and Hip Abductors.

Apparently doing these exercises 4 times a day, 6 days a week, for 6 weeks, is considered the minimum time period to strengthen them all sufficiently to relieve the pain.

I asked him to make a rough estimate of how long he thinks it will take me to walk again. He said a conservative estimate would be 6 months!

So, armed with this information, i headed off to the orthopaedic specialist to see what he had to say.

We discussed the injection and he decided against giving me another.

He said that another month of rest for my knee was to be had, but told me that various areas of my leg were very weak and needed strengthening.

My ankle also had nowhere near enough range of motion in it for walking, so i was given stretching for my achilles tendon as well.

He told me to do all my stretches and strengthening and return in a month to see where we are at.

So, now its down to me to get busy with a LOT of exercises to try and sort my knee out.

There have been times in the last year where i have been adamant that i needed another operation to fix the pain in my knee, and there have been times where i have gottten angry and cycled my ass off to try get there quicker. But all, to no avail.

I have now kinda made peace with the fact that a lot of hard work is necessary on my behalf to physio myself back to health.

I (hopefully) now have a list of exercises that if i stick to, will give me some relief and hopefully get me walking again.

The next month will be a telling one...