New x-rays and appointment with my surgeon

This time last year, I was propped up with pillows in my bed, admiring how nice my legs appeared stretched out in front of me.

Two legs dressed in elephant pajamas. Pink toes peaking out at the ends. Two legs that looked absolutely normal under the covers. No pointy edges. No bulky bits. No tent of fabric sticking up in the air. Earlier that day, my external fixator was removed at the fracture clinic where my orthopedic surgeon works; a place I have become all to familiar with - I can stand outside the hospital and know exactly were things are: x-ray and imaging departments, fracture clinic, same day surgery, operating room, emergency, etcetera. I remember lying in bed that night and thinking how ordinary my body looked lying there. How comfortable I felt in my body sans the metal pins and bolts and rods that helped put me back together. How good it felt to look down and see just my body. Such a simple pleasure.

I also remember wondering where I would be a year from then. How long would it take to relearn to walk? How long would it take to get my body to obey the commands sent forth from my brain to place one foot in front of the other? How long to trade in my crutches and progress to a cane? How long to ditch that stick? How long before I would be able to walk without having to think about the act of walking? How long before my x-rays would look normal? How long before my surgeon would say to my that I am all better?

Those last few questions were the most important to me. How long before I could put this all behind me? Walk away, both literally and figuratively? I was never naive about the situation. After all the years and pain and surgeries, I was more than merely aware of the possibility that things might not go as planned or hoped. I wanted to balance those two things that have accompanied me throughout this entire ordeal: reality and hope. Reality for what might actually happen, how many different possibilities it might include; hope to get better and return to a normal life no matter how hopeless or unpleasant things felt.

Today marks a year. Twelve month. Fifty-two weeks. Three hundred sixty five days. Somewhere along the lines of 8760 hours. But that last one might be wrong. After all, I was never that good with leap years. It doesn't really matter anyways, other than point out that today marks a day from that day and all the thoughts had on it.

"Where am I today?" That is a very good question.

Today I had an appointment with my orthopedic surgeon. It was not intended to be exactly a year from having the fixator removed. My original appointment was scheduled from the fifth of may. I called my surgeon's office in early April actually hoping to get the appointment brought forward, but that was not possible. And then the hospital actually postponed it, rescheduling it for today. Exactly a year from fixator removal. Maybe it's more than coincidences that it worked out that way. Or maybe not. Once again, it doesn't really matter.

What matters is that I had x-rays and what those x-rays showed. Despite having had a year to heal post-fixator removal, my leg has not completely healed. The bone infection  never came back. That in itself is wonderful news. The new bone at the top of my tibia is absolutely beautiful. Mu surgeon says he can hardly distinguish it from my regular/normal/per-existing before external fixator and bone transport distraction osteogenesis re-grow my tibia bone. The new bone at the bottom of my tibia? That's not looking so hot. There is a gap at the front of my tibia that has yet to fill in. Thank you very much overly eager bone that prevented us from completing the bone transport and docking properly. I also have what is called a hypertrophic nonunion. In basic terms, this means that although my body has produced a sizeable chunk of new bone at either end of my tibia, that bone has failed to knit together and heal. In even simpler terms, it basically looks like I have a broken leg. My tibia is being held together by an IM nail, or intramedullary rod. It literally supports my entire weight when I stand on it because the two bits of my bone are connected by, well, nothing... just like a broken bone. Due to the nonunion, my weight is not distributed through my entire tibia as it ought to be; instead, the weight goes through the IM nail. As a result, my weight is not distributed in my lower leg as it ought to be and that in turn causes a hell of a lot of pain. Bone pain. Muscle pain. Tissue pain. Both mentally and physically exhausting.

Truth be told, this was actually good news. Not like actual good news of course. But good news given the circumstances. Seeing how much pain I was in, and the variety of types of pain throughout my leg that I thought could in no way possibly be connected, I thought there was something much worse going on in my leg. Is a nonunion good? No. Not really. But I was afraid that there might be in infection, bone may have splintered, I might have had another heterotopic ossification, etc., etc., etc.,  For any other person who as a regular plain old broken leg, having a nonunion is bad news. But after all the infections and pain and surgeries I have had, a nonunion isn't that bad. In my opinion, it's the lest bad of all the horrible things that could have happened to this leg. It's still bad, but only mildly bad in comparison to what I was fearing might be going on. So, in some regard, it's almost kind of a relief. A frustratingly painful one, but a relief non-the-less. And really, my surgeon says that this is a common problem after the external fixator boen transport distraction osteogenesis thing. Is it good? No. But it is common. It's not strange and rare and kind of a medical mystery like all the other leg related nonsense I have been through. This was a potential problem that my surgeon was aware of. It also has a straightforward(-ish), standard fix. Yay!

For now we are taking a wait and see approach. We are calling this what it is for now - a nonunion. After an entire year, the ends of my tibia have failed to heal together. No stages of healing as I learned about in nursing school: hematoma, inflammation and cellular proliferation, callus formation, consolidation, and remodeling. But I have many things on my side - young, healthy, don't smoke or drink, walks a lot to promote bone growth. My surgeon wants to give my leg more time what it ought to be doing. He believes it could take one to two years for my body to try to heal this on my own. So for now we will wait and see and I will come back to get x-rays to reassess the situation at the end of September. We all hope my body figures out what to do by then. On the other hand, my surgeon says there is only so much time before the bone will stop searching for somewhere to grow. At that point, this might need a surgical fix. The bone has already had a year to fully heal but that had not happened yet. How much longer will it continue to try to heal itself? Nobody really knows. So we reassess in September. If the nonunion doesn't resolve itself, we have several options, including bone graft or replacing the IM nail for a slightly smaller one so we can let the bone dynamize. In the meantime, I just continue to walk, and my leg continues to hurt every time I walk.

So, where am I? I'm not really sure. I ditched the crutches long ago, followed my cane at the end of February/beginning of March. My body knows how to put one foot in front of the other. I still think about every step, probably because it is so painful as a result of the nonunion and all my wight being put through the IM nail. I think it's safe to say that I wouldn't be thinking about ever single step if it was not painful. My x-rays still show some issues to be concerned about, meaning the aforementioned nonunion and the missing section of bone at the front of my tibia. I am still not entirely healed and I cannot put this behind me just yet. And most significantly, I am not yet sure if I have regained trust in my body's ability to heal itself and do what it out to be doing. I lost this trust a long time ago during my broken leg bone infection fiasco. Hopefully my tibia will be able to heal itself. I would very much like to regain trust in my body's ability to behave as a body should.

I think that sums everything up nicely. In the meantime, I will do my best to continue to live my life. My surgeon said I need to start living again and that there needs to be a balance between my actual life and the impact that my leg has on it. This balance may be difficult to find. I have completed my education to become a registered practical nurse. I write my certification exam in two weeks. I have a job as a casual nurse on an oncology unit at the local hospital waiting for me to start later in the summer. I am excitedly looking forward to my new carrier! On the other hand, twelve hours shifts will be very painful and pain is both mentally and physically exhausting. Hopefully being casual will help give me the breaks I need. At the end of this month, I will also have been in a  relationship with my boyfriend for a year. I am visiting him in the United Stated next month, he is coming to Canada several times in the summer, and we shall be taking our first vacation together in October. Life goes beyond what it has been the last few years with all the surgeries and appointments. Even with the nonunion and the possibility of more surgery in the future, I am confident that the end is getting nearer and that I will be able to walk away from all of this medical stuff one day. For now, I just have to be patient and hopeful a little while longer.