I am someone who likes to work from targets and action plans. That said, I have found the last 4 weeks post surgery really tough, because everyone told me to take it easy and that I needed to give it time for everything to heal to a point where it was safe to move forwards with rehab. Waiting indefinitely is not a strong point of mine!
Vascular outpatients follow up
I had my follow up appointment with the vascular outpatients last week. 3 weeks had passed by since my last surgery: we were looking to see if the graft was still holding.
Yep, the graft is still working well, but there is a blood clot below the graft at my ankle. Collateral blood flow created as a response to the clot is still delivering oxygenated blood to my foot, but there is only 50% of the normal blood flow.
For that reason, I am still getting hypoxic pain in my calf (pain in the muscle created by insufficient oxygen to the muscle, similar to the pain you get when you are exercising in the anaerobic heart rate zone, but with none of the associated effort!) Only time and gradually increasing the exercise in the leg will improve that. I will not know for at least 12 months, whether the function will be sufficient to avoid another conversation about below the knee amputation.
Wound healing progress
the left lower leg incision and the speed at which this heals determines everything from here on. This incision, as you know, has taken the longest to heal because of where it is and because it was opened up 4 times in quick succession. Today, after almost a month, the pico (surface vacuum) dressing was finally taken off because it looks like the wound has finally healed enough (just) to stop it from leaking lymphatic fluid. It is still really early in the healing process – it is ONLY JUST closed over so I still need to be really careful, not spend too much time on my feet and keep the leg elevated as much as possible. The district nurse is coming out aain in 2 days to assess it and see how it looks. We are hoping that the new dressing stays dry, which will signal that the incision has stayed closed after the vacuum dressing was taken off. all the other incisions are pretty much healed, I just have two small dressings in other places, but nothing major enough to stop me from swimming, if they were the only ones that I had. Sadly, the left leg still isn’t waterproof quite yet.
Physio and the plan from here
It has been really tough working my way through the last month without a clear plan or any idea when I will be fit enough to return to work. Everything rides on this left lower leg incision.
I had my first physiotherapy appt today. I finally feel like I have a clear plan of what needs to be done next.
Firstly
All my incisions need to be fully healed to the point where they no longer need dressings covering them. Once I am at that point, I can start to make a plan for a phased return to work, a return to the pool, and most exciting of all, a very gradual return to cycling. Until I get to that point, I cannot plan anything in real terms.
Meanwhile….
Physio wise, I now have a basic strength program and have been told to gradually increase my walking, starting with very short distances (50m or so), stopping before the pain is so excruciating that I need to sit down. This will involve some concentration and self awareness because I am so used to being in a constant pain state, stopping before that will take practice. But, the theory behind it is that I will be able to recover quickly and get up and walk the same distance again. If I push it too far, that will ruin this plan and any further walks will be worse, in both distance and pain. This has to be my focus and will be a fine balance with doing enough, but not too much, and still spending enough time with foot elevated.
Then…
When the incision is healed and I can swim, I will also be able to ride on a stationary bike. That alone is soooo exciting, it has been over 3 months since I was able to ride my bike, longer by far than the time I was off the bike post knee replacement.
Returning to work
This will be long and much slower than I ever imagined. Once the incisions are healed I can start planning a gradual phased return to work, starting with some personal training. But at first I may not be able stand up for long, and will have to adapt a lt of how I deliver things with clients. Massage is looking like it will be a lot further away and a much much more gradual return that I ever imagined. I am finding that very hard to deal with. But, massage has a lot of physical demands, I need to have strengthened the calf to a point where I can use it for long enough for it to not get hypoxic, before I can even entertain trying to massage. even then it will have to start with short appointments that are very spaced out.
Thankful for being self employed?
Imagine for a moment, being faced with this mammoth rehab mountain, after the horror ride through multiple emergency surgeries and then being faced with the fact that you may not be back to full speed at work full time for an indefinite, indeterminable amount of time. For some, this could indeed mean losing your job. So, the fact that not only am I self employed, but that the business is in a position where I can leave staff in charge and adapt my work to behind the scenes admin only, makes me feel quite thankful, compared to what I could have been facing – possible redundancy.
Don’t get me wrong, the business could really do with me being there, but equally, I am acutely aware of what could be at stake here… like a leg, for example.
Sensible reflections
A lot of people have been concerned about my usual gun-ho approach to rehab. I am more than acutely aware of the seriousness of the situation I find myself in, have been very careful of what I am doing and have sought expert advice at every stage.
never before has an entire limb been at risk, if I don’t do things correctly.
Truthfully, it will probably be as long as 12 months from now before I will know if this will work – and whether I will get to keep both feet.
Wish me luck.
Melanie Magowan 