OS appointment - December 18th

I had another appointment with my orthopedic surgeon last week Friday. This was the first appointment since I started doing "the turns". I was curious to see if the slack had actually been turned out of my frame yet. While I had been watching the tube part of my fixator lowly inch itself along, less than a millimeter a day, I hadn't actually started to notice anything different about my pin sites - no new scabs or scar tissue, no pain or discomfort aside from the same old, same old. In fact, I would argue that aside from the odd moment of stinging here and there and the pain I was having around my bottom pin, the pain overall was decreasing steadily.

The day of the appointment I got a call from the fracture clinic saying that I could come in anytime I wanted to. I won't blog about it now because I already did on Friday before heading out to my appointment.

Mum and I made it to the hospital in good time. There was hardly any traffic and the driving conditions were good. Many people have been complaining about the weather; no snow yet and it looks like it will be quite warm on Christmas. People want snow! This is Canada for Pete's sake. Truth be told though, as much as I like snow I hope we get as little as possible this year. What with the crutches and external fixator, I do not need the added risk of injury that slippery, wet, icy conditions bring, or the difficulty of crutching through a meter of snow...

The drive up to the hospital was pleasant and I caught a picture of a transport truck that I found quite funny.

I know that Fluke is the name of the company that owns the truck, but I didn't read it that way. When my eyes scanned over the phrase, my brain interpreted as "If we deliver your stuff on time, it's only by accident". After all, the word fluke is synonymous with chance or a stroke of luck.

Obviously I like word puns.

Mum and I were checked in at the reception desk at the fracture clinic around 1:15pm. We hope, since we had been told to come in whenever we wanted to, that we wouldn't have to sit in the waiting room for several hours before being seen as usual. This was not the case. So I had plenty of time to people watch. As usual, the people waiting looked miserable. Except this time it was worse than miserable. People just looked depressed. There I was, tinsel on my fixator, dressed in a skirt and nice shirt because heck, I was happy to get out of the house, and everyone else looked discouraged and downhearted. I know well enough that a broken bone can have a pretty sizable impact on a person's life. But come on... seeing everyone so miserable was a bit much. I know that I can't tell the extent of a person's injury just by looking at them. Nobody can. But given everything I have overheard over the last four years while I sat in the fracture clinic, I know that a lot of people also have injuries that heal pretty quickly or are, in fact, not that serious. As a nursing student as well, I know that health care professionals put up with a lot of stupid stuff, patients who are completely worked up about something ultimately insignificant. Anyways... I just don't understand why the people always look so unhappy at the fracture clinic. Perhaps my own history has changed how I see things. Of course I am going to see a broken wrist ad insignificant when it comes to my own situation, but to the person with the broken wrist it is still a pretty big deal.

One thing that stuck out to me while in the waiting room on Friday - there was another patient with an external fixator, the same as mine, just red (they are colour coded by size) and on his thigh. Mum suggested that I go over and talk with the guy, but I wasn't sure. I have never seen someone outside of a hospital bed so doped up on pain medication. In the end, I didn't speak with him, but it was nice, almost comforting, to see another person with an external fixator. I know that other people have one and see pictures of them all the time on the online support group I am part of, but it is different to see in person.

As usual, I had x rays before being called back to a "room" in the clinic itself. By room I mean three walled area with a curtain where the fourth wall should be in a row of several other "rooms" across from another row of them on the opposite wall. Basically you can hear everything that is said between a patient and the doctor with the illusion of privacy. I hope the people sitting there today where impressed with what they heard my surgeon and I talk about!

There is, as expected, a logical order in which my surgeon sees his patients. The people with earlier patients get seen first. That logic didn't apply to me. I saw my surgeon walking past my little cubby (for lack of a better word). He walked past, back tracked, stuck his head round the curtain, and then came to see me instead of where ever he was going. Having a fixator does pay off! I think my surgeon was just excited to get to see my x rays (and if things were going in the right direction, and that is why he got the receptionist to call me and tell me that I could come in whenever I wanted to).

He eagerly pulled up my x rays and explained what was going on. Here are the x rays.

Side view

Front view

They clearly show that the external fixator is working and moving the "loose" (as in it's not actually connected to my or the rest of my bone at the moment) piece of bone down my leg and the IM nail. This is good. It means all the slack is gone and things are going as planned despite me not feeling the pins track through my skin.

There is, however, even better news. Something is happening that, given my surgeon's reaction when he saw it, is not something that was expected to happen yet. As the pieces of bone are slowly moved apart a tiny bit twice a day, the bone is tempted to heal itself. Cells start to bridge the gap between the ends of bone. These cells do not automatically equal new bone. Instead, they form cartilage, the precursor to bone. The hope is, obviously, that this has been happening as I do "the turns". What was not expected, however, was for this to already be visible on my x rays.

On the image below, I have circled an incredibly tiny little white fuzzy cloud that showed up on the x ray in the gap at the top of my tibia. My surgeon wasn't expecting this cloudy spot to show up this soon. What it tells us is that the bone transport is actually working! Of course this is still only one very tiny spot. I still have months to go before I am finished doing "the turns" and the loose piece of tibia connects to the bottom part that is attached to my ankle. Many things can still go wrong and slow down or completely stop the bone growth. But this is by far the best news I have received health wise since we suspected the bone infection had returned in October 2014, well over a year ago. I couldn't have asked for a better Christmas present and hope that 2016 will be a year full of healing and nice new health bone.

According to my surgeon, it will take six to nine month for the cloudy spot to look anything like the solid healthy bone in these x rays. So there is still a long road ahead, but we have started out on a good note.

We also talked about pain. My surgeon said that his patients are usually pretty stoned throughout the time they are making adjustments to their fixators. He was surprised when I told him I was hardly in any pain at all (I only take a long acting pain medication to help me get comfortable and sleep at night). He said maybe I will get lucky and be pain free. There was one explanation he gave that could perhaps explain the lack of pain. Usually bone transports got the other way, from the top up. As a result, the moving portion of bone moves against the muscles, stretching them and ultimately causing pain. Given where the infected section of my tibia was, the normal way of doing things wasn't possible for me, so we are doing a reverse bone transport. This means that the bone is moving downwards, the way muscles are set up. Fingers crossed this means I will only experience minimal pain.

On a side note, he asked me about the ringing in my ears. This is a side effect of the IV Vancomycin I was on for eight weeks during the summer. He asked because spoke with another doctor who wanted to prescribe it to a patient willy-nilly. When he heard that, he thought of me and ringing it caused in my ears (a health are professional's unique experiences with patients become part of his/her working knowledge, so they easily recall things depending on a situation. This is the kind of thing that only experience and not a medical textbook can teach). Given that, he thinks twice about prescribing it unless absolutely necessary. I am glad that what I have been through might help someone else who might be prescribed this medication. As for myself, the ringing comes and goes. It is worse at night when it can be pretty maddening. I miss things being quite, although it is not bad when there is background noise on. My surgeon said it could take up to a year for it to go away.

After all was said and done, I gave my doctor a box of Merci chocolates to share among the staff. He did amazing work on my leg (with more tome come), and his staff have been fantastic, so with Christmas coming I thought it would be a nice way to say thank you. As a nursing student I was taught that patient's cannot give gifts to individual staff members (and said staff member can't accept a personal gift), but patients can give a gift to the entire staff of a floor or clinic. He said he was going to start nibbling on them right away. That is what I love about him, he is not snobbish or stuck up like other surgeon's I have seen. Yes, he is a doctor and probably makes a lot of money, but he is really down to earth and genuinely a nice person.

Before leaving, as mum took pictures of my x rays and I made to get of the stretcher, one of the ortho technicians came over, wished me a merry Christmas, and gave me a big hug! How nice is that? As I have said before, the staff are fantastic and they truly make appointments, which are usually quite stressful, enjoyable and more relaxing.

On the way out we made an appointment for January 8th, three weeks away. My surgeon said that he had set up an impromptu clinic day on Wednesday December 30th. His clinic days are usually on Fridays, but I think he has too many patients to miss a week (Friday is New Year's day so the clinic will be closed). He told me that I could show up without an appointment if I had any concerns.

And that was the appointment. Best news ever! Well, not ever... that will be when I can walk normally again and get back to nursing school. But definitely the best news I have had in a very long time. After falling in the 1% where things go wrong for so many years, it was about time I fell in the 99% where things go right. Not that having an external fixator is common, in fact is it pretty rare, but things with the fixator are going well. I was smiling for the rest of the day.

And just because, here is my leg the day of the appointment. Despite a few small hiccups when part of the incision opened up a bit (treated with steri-strips), things are healing well!

And me... looking good! Still smiling on Sunday =)