Monday, 14 April 2008

Daily Living - Progress Report (2)

So 2 weeks down and after some ups and downs I am still progressing. The community physiotherapist visited this morning and I was able to report a couple of things.

First I had experimented using elbow crutches albeit nervously and with my wife walking in front of me in case of any stumble. I did this without my right foot touching down at all but do not want to repeat it by myself until told its OK by the Physio. I also managed to make it half way out of the front door to collect post using the zimmer frame but had not tried to negotiate the half step to get me down to the level of outside.

Second I had become increasingly aware that while the swelling in my upper leg was receding nicely and was now soft the same could not be said of my lower leg. Having a history of superficial thrombo phlebitis in both lower legs I was beginning to worry about this and made extra efforts to rotate my right foot while seated. Unfortunately this served to exacerbate a painful right ankle. I mentioned my concern to the district nurse who visited on Thursday to change dressings and remove an additional suture I had felt an inch or two below the dressing for the incision. This suture was removed and the entire area redressed. Having used a heparin based cream called Hirudoid in the past to help "dissolve" away the blood that might have been clotting in my leg I said to the nurse I was running out and asked if this could be added to my prescription. She examined the leg and agreed although swollen and reddish it was not hot to the touch. It would however need to be watched carefully. She agreed to sort out the prescription even though she had not come across Hirudiod before but thought it might be useful for other patients in the future. I have in the past been readmitted to hospital following a hip operation for a similar condition - so wanted to avoid this if possible. In the event the pain in my right ankle was so great that my wife and I decided I should stay in bed to rest it. So an early night on Saturday was followed by all of Sunday in bed. Not only did the pain go but the swelling below my knee also began to resolve. I could make out the shape of a calf and when I "shook a leg" parts of it wobbled convincingly enough to believe that the bed rest was working. My wife and decided therefore that in addition to using Hirudoid and doing foot rotation exercises I should plan on a couple of hours of bed rest during the day until the swelling disappeared completely.

I explained all this to the physiotherapist who was booked to attend on a weekly basis. We discussed realistic goals such as getting out of the front door to use the mobility scooter around the garden, and possibly using elbow crutches and finally getting into my car albeit with someone else driving. I demonstrated my prowess with the zimmer frame and was shown a couple of exercises I could do while seated to develop muscles in my upper leg.

We could get much further however because of uncertainty about the extent to which I was expected to weight bear. The hospital referral letter to the community physiotherapy service had a one line description along the lines "1st stage hip revision - to gradually weight bear" I mentioned the concern expressed by the Senior Registrar about not weight bearing given the extent of bone loss and cement used. After a while we agreed I would email the Consultant's secretary to seek clarification and ask for a copy of any advice to go to the community physiotherapist.

Once we have this clarification she can plan a sensible programme for me for the next few months. In the meantime she agreed I should use the power chair rather than the zimmer frame but should include some use of the frame up and down the corridor to maintain strength in my arms which would be useful for when I do progress to using elbow crutches.

The then unabated swelling below my knee had concerned my wife who wondered what she would come home to after work on Friday. We both experienced a welling up of the frustrations about my current state that had up to then been kept beneath the surface. This taking stock caused me to see myself as others do and degenerated into self pity and loathing as well as a fuller acceptance of the millstone I had become to my wife limiting what she could do and dragging her down too. Of course this is a common problem for sufferers and carers alike and is unavoidable. We have however come through that - for the time being at least - and continue to soldier on together in the hope of better times ahead.

So with that in mind I must now make ready for a couple hours bed rest and foot exercises to continue the progress.

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