(12 March 2001)
A Wounded Bird in a Surgical Steel Cage
Wow, been a long time since I last wrote. But then again, not much has happened and I have been able to do other things than mope at the keyboard.
The debate during the winter was over whether to do a closing type or an opening type osteotomy. In a closing type osteotomy, the surgeon would cut a wedge of bone out of my shin, bend it onto the straight and drive in a couple of staples to hold it that way. This would straighten my leg but would not lengthen it - this is an issue since my left leg is at least ¾" shorter than my right, and if it is not corrected I will have more problems besides those caused by walking on one edge of my kneecap (as I am currently doing with the crooked leg). An opening type osteotomy would see the surgeon opening up my leg, stuffing new bone obtained from my hip into my shin to pad it out onto the straight, and fixing it with pins. This could lengthen my leg as well as straighten it.
However, an osteotomy is a major surgical intervention, in a place where I have already had three such, and the blood supply to my leg is still not all that it could be. I sought the advice of another orthopedic surgeon in town, who told me bluntly (and I appreciated his candour) that if an osteotomy was done and we had the twin situations of the bone not joining up and a post-operative infection, both risks because of the diminished blood supply, then there would be a 50/50 chance of my losing my leg below the knee. Yikes.
He then suggested an alternative called the "Ilizarov Procedure." This was invented during World War Two by a Russian orthopedic surgeon of the same name, who worked on many many broken and crushed limbs. Basically, how this works is that they would break my leg, insert a number of short steel rods, a bit like bicycle spokes, into my shinbone above and below the original fracture site at right angles to the bone. The heads of these short rods will be attached to longer steel rods running along the long axis of my shin, and the heads of these longer rods will be attached to two metal rings. It looks a bit like a birdcage with spikes sticking inward into my leg.
The advantage of this procedure is not only that it works well to revise the problem with my leg, but also that it is a much less invasive operation than an osteotomy. There is only one surgeon in town who can do this thing (not the one I went to see), and as luck would have it he examined me at ICBC’s behest last summer. This has made me more hopeful and I hope there won’t be too much of a wait to see him and find out just what exactly is involved.
In game/designing/writing news, in 2000 I did development work on two Joe Miranda games (Indochina War and Asia Crossroads), edited twelve issues of Strategist, and put together a game called Algeria (on the 1954-62 war, the first ever designed in any language on the conflict) which came out through the Microgame Design Group at the end of 2000. (We had to change the name due to the Alberta Provincial Government getting upset over our use of the term "co-op".) I’ve also just finished work on Plan Crimson, an adaptation of the Freikorps system at a lower level that covers a hypothetical US invasion of Canada in the 1930s, that will also come out through MDG. All this prevented me from writing more articles in 2000, so the pipeline is empty now. I need to get back into that end of things; lots of ideas.
4 April 2001
A Welcome Break, But Not The One I Gotta Get
On the weekend of April 1 I took a quick visit down to Seattle to see the Residents, a group I have been wanting to see for almost 20 years. Saw them at the Experience Music Project near the Seattle Centre, a building that looks like an enormous lump of chewed tinfoil. But the concert was great.
I found out some more information on Ilizarov etc.. Here is a picture of an Ilizarov apparatus as applied to a tibia. I found many, many pictures other people had posted to their own websites of their own apparatus, but I will spare your sensibilities until I get some pix of my own!
Once the apparatus is in, every 6-8 hours I have to adjust it a turn here, a turn there, so that my leg is both lengthened and straightened, and see the surgeon every few weeks to see how it is going. It’s very much like truing a bicycle wheel by adjusting the spokes. Maximum bone growth in a healthy man is up to 1 mm a day so I may be adjusting this for at least one month, and wearing it for another two or three months after that to support the bone while it hardens.
I’ve also spent some time in the last few months getting some counselling for the various mental/emotional difficulties I’ve been having the past year and more. It seems that a lot of what’s been going on is related to the chronic pain of my injury (haven’t had normal sleep in over two years), but this can be dealt with. It feels good to be doing something active about this as well. There is also at least one Internet support group for "fixators" as well, featuring people who have had some truly horrific things happen to them.
24 September 2001
A Break-through! (sorry, guess these puns are getting repetitious)
I now have a date for surgery: 6 November, 2001. Saw the surgeon who will do it a couple of weeks ago, it has to be done in Vancouver. This date is far in advance of anything I had been led to believe - I was half expecting it would be in January/February 2002! So, even though the operation is subject to cancellation up to the very day it's to be done, there is a date to shoot for. I am told I will be convalescing at home for a few weeks, and then back to work but on crutches for a few months, then maybe a cane if things go all right. All told the thing will be on my leg about six months, so that by May I'll have a spring in my step and not in my tibia!
What else has gone on in the last few months? It was a busy summer, I spent lots of time with my son but had very little time off work per se, due to the change in government we are all being run off our feet. My summer vacation was a Friday-and-Monday thing, on the weekend of the Tuvan Independence Day party. A Japanese magazine is publishing one of my games (see gaming page for details). I have loads and loads of ideas for articles, game designs and art pieces but no time in which to do them (this is news?). And like that.
23 November 2001
Thy Rods and Thy Staph They Discomfort Me Greatly
Well, no hitches and I got into the hospital and operated on according to schedule. No problems with the anaesthetic this time, but hoo boy, this frame is bigger than I thought it would be! Pictures will be posted later when they are scanned.
There are eight bolts going into my leg, one thing like a bicycle spoke that goes through the top of my shinbone, and four rings about the size of the sprocket the pedals on your bike attach to. Looks somewhat like the picture below.
They didn't file off the heads of the bolts so I gashed my leg the first time I tried walking - wasn't used to giving that leg extra room. The Occupational Therapist there rigged me up with a foot sling made of thermoplastic, bungee cords and curtain hooks that attaches to the frame and helps me avoid getting dropfoot. She kindly used the spare bits of thermoplastic to mold over the heads of the bolts, so may pants and bedsheets aren't in ribbons.
I got out of hospital on Friday 9 November, was very tired when I got home and the next day my problems began. I woke up with an agonizing pain in my knee and it soon became apparent that I had an infection in the top two pin sites, nearest the knee. Constant Readuhs will remember that this injury is almost three years old, and I have to say, this was the worst pain I have had from it yet. By Monday I was on intravenous antibiotics, had to come back every 12 hours for a fresh bag, also was on Dilaudid (a painkiller 10 times stronger than morphine I'm told) for the pain and mass doses of oral antibiotics. Several times I had to wait three hours before they could get to me to give me a 25-minute IV - I would gladly have gone to a clinic or some other facility to avoid clogging up the emergency room at the hospital, but that is the only place I could go for IV antibiotics. Bacteriology found out that it was a penicillin-resistant strain of staph, this plus the promptness of the emergence of the infection make me think I probably caught it while I was in the hospital. I do hate to revise my opinon of a place after I've eaten there (the food was pretty good!), but it could happen to you too.
That took up all of the first week after the operation. My great fear is that the infection has gone into the bone, but things seem to be clearing up with continued doses of oral antibiotics and with luck I've dodged that. On Monday the 19th I went over to Vancouver to see the surgeon, and he seemed pleased with what was happening. I go to see him again on the 29th, and by then the straightening-out phase shoule be over and he will install some rods to start lengthening my leg, however much it might need. And then starts the consolidation phase: another four months or so, most of it on crutches, while my partly-broken leg settles down and strengthens. Let's hope there are no more infections, at least not major ones.
18 December 2001
Three Years and Ten Days That Shook My World
A few weeks later and the infection seems to be under control, but my leg is still swollen and sore. Last week the doctor took out the wire at the top of my knee, since it was still draining and was very uncomfortable - made it hard to sleep. So he just cut it on either side with his wire cutters - *spung*, *spung* - and zipped it out with his pliers. Who needs anaesthetic? I'm still hoping for a promotion to Tough Guy when this is all over.
On my previous visit to the clinic, the doctor took some digital photos that are very nice - I have reduced them in size but they are good shots of the frame:
So, Gizmo here will be part of me for the next three or four months, depending on how fast the new bone grows. Then I will be as good as Science can make me, though I kind of liked the way I was before. what has gone before - 2000