Here are a couple of pictures of myself before the accident.
On the left I've just finished a training session at my local
gym and the other is touring in Spain on my old FJ 1200. As
you can see I'm in pretty good shape and in fact doctor's
told me that this is probably why I survived the impact.
I decided to go shopping locally. I was approximately twenty
minutes from home - just a few miles - when the accident happened.
I don't remember anything about the accident. (It was later
explained to me that four vehicles were involved. I had hit
the back of a car hard enough to literally leave the outline
of my body on the car.) The next thing I remember is waking
up in a side room at Broomfield Hospital, Chelmsford. I was
only vaguely aware at that time that I had injuries to my
left arm and leg.
My Injuries:
Head Injury-Lacerated liver-Ruptured kidney-Abdominal haematoma-Disintegrated
left wrist Disintegrated left tibia-Broken left ankle-Broken
ribs-Pancreatitis developed while in hospital.
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I
had also sustained internal injuries which were life-threatening.
It was in A & E that internal bleeding was discovered.
Vital organs had been damaged. I survived only because I had
a strong mid-section. The fact that I survived at all was
due largely to my general fitness and weight training regime
spanning many years.
Decisions
had to be made regarding amputation at this stage. Fortunately
for me the Consultant in charge decided that due to my good
physical condition it was worthwhile trying to save the leg.
He called in his team, and the long procedure to put me back
together had begun. Following initial operations, I was closely
monitored in intensive care.
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The internal injuries were left to see if they could possibly
resolve themselves to avoid more surgery. The external injuries
were initially treated with a plate fixing my ankle - an external
hybrid fixator on my leg and another external fixator on my
left arm to pin the wrist.
As I recall, I had many operations in those first weeks and
some of the pictures on this page show my 'gradual' recovery
in those early weeks. From complete bed rest - where I had
no comprehension of what was going on - to being helped to
sit out in a chair for a few minutes each day. Finally - I
was allowed outside for the first time in two and a half months.
I still had a long way to go but my recovery had begun.
I
will never forget the overwhelming feeling of how lucky I
was to be alive
During
this time in hospital I developed methicillin-resistant Staphylococcus
aureus M.R.S.A and it was decided to give me an injectible
anti - biotic called Vancomycin. The anti - biotic was administered
very slowly. Then, after a few moments, I felt severe burning
sensations in my hands and feet. The injection was stopped
immediately because I had developed an anaphylactic reaction
to the drug. Several nurses came into the room to assist and
a doctor was called to administer adrenaline injections. Eventually
I recovered, but was then given oral anti - biotics. That
regime was to continue for the next eighteen months.
Prior to my eventual discharge after three months - the fixator
on my left wrist was removed. The bone had mended but my wrist
and hand were left badly shaped and with little movement or
feeling. (Further treatment would not be attempted until 2002.)
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Following discharge from hospital the plan was for me to return
in a few weeks to have a bone graft operation. This should
encourage new bone growth. The 'healing' process was going
to take a long time and to illustrate just how serious my
leg had been damaged - one of the Registrar's told me that
it was as if a grenade had gone off inside my leg.
I
went back to hospital for the operation. Some bone was taken
from my left hip and transplanted into the damaged area of
the left leg. This was a routine operation and in theory should
promote growth in my damaged leg. I returned home and visited
the consultant on a weekly basis.
I
did have problems with persistent infections and periodically
went back into hospital so that my progress could be monitored.
Infections slow down or halt the healing process and so continuing
with the anti-biotics was crucial. I had to have weekly blood
tests due to the strength of the drugs which could, if not
monitored, exacerbate the kidney damage I had already sustained.
Many
weeks later it was decided that the external fixator could
be replaced with a full length cast-brace. The brace is joined
at the knee joint with external hinges to allow 'normal' movement.
This allows weight bearing to begin whilst at the same time
supporting the leg.
It
was at this time that serious problems began to develope with
my leg.
Continuous
infections in the bone itself meant that I had to undergo
operations to remove infected areas. One such procedure was
to remove the earlier bone graft material because it had 'died'.
The infected ends of the tibia bone had to be 'tidied' up.
This would mean the loss of about 25mm to the overall length
of the leg. The next procedure was to have another external
fixator fitted. This time it was to be an 'Orthofix' (see
picture above),and an internal fixing plate. This was because
the cast brace wasn't able to support my leg sufficiently
and when I tried to bear weight, the leg moved sideways at
the injury site. This had the effect of 'shearing' away any
bone that was trying to form.
Next
Operation
In
the ongoing process of trying to prevent amputation of my
leg, a decision was made to try a second bone graft operation.
This
was somewhat different to the first bone graft where 'granules'
of bone were inserted - this time a complete section of bone
would be used. Another important difference would be that
this 'complete' section of bone would be transplanted with
its own blood supply.
The
procedure was to take a section of bone from my right fibula
- complete with an integral blood supply, and this would be
grafted into my damaged leg. The body should incorporate this
material into the damaged area and begin the process of regeneration
at the injury site.
The
operation was a very long process - approximately 10 hours.
The operation was carried out jointly by orthopaedics and
plastics.
I
had an internal fixation plate fitted during this process
and another plaster cast brace fitted shortly afterwards.
It was felt that this combination would support my leg sufficiently
enough for healing to take place.
As
the weeks passed things didn't really improve. I continued
to have problems with various infections and so maintained
a high dosage of anti - biotics. My leg unfortunately, continued
to move laterally under slight pressure and thus prevented
any chance of new bone forming.
During
Christmas 2000 I developed a high temperature and became feverish.
I went back into the Broomfield Hospital. My condition was
considered serious and so intravenous anti - biotics were
administered. After a week of this and after many swabs had
been taken - the result was that I had M.R.S.A again.
Once
I had stabilised and my temperature began to return to normal,
it was time for hard decisions to be made.
The
consultant who had worked so hard for over a year now had
to tell me that the leg wasn't healing and that there was
nothing else that he could do - I must now consider losing
the leg and prepare for an artificial limb. Obviously this
was devastating news and something that I just hadn't contemplated
during the past year. We decided that I should go home and
return the following Monday for a full and frank discussion.
Monday
came and the consultant repeated what was said before. But
he had been condsidering all the options and told me that
there was a surgeon at the Norfolk and Norwich hospital who
specialised in this type of trauma and used a technique known
as the 'Ilizarov Method'. This is a special type of fixator
which holds the limb in line laterally but is designed to
allow longitudinal compression - allowing weight bearing to
take place which is fundamental to bone healing. I couldn't
wait. He would contact the other consultant immediately.
I
was overwhelmed when later that same afternoon I received
a telephone call from the Norfolk & Norwich Hospital.
It had been arranged for me to see him at 9:00 am the next
morning.
I
was examined by the consultant following x-rays and removal
of the plaster cast. I was nervous because I knew that this
was my last chance. Everything hinged on the consultant's
assessment of my injury and how I would respond to an Ilizarov
being fitted to my leg.
After
a long and detailed consultation the result was that he would
attempt to fit a frame. But, I had to agree that if the operation
wasn't sucessful, I would have to agree to an amputation.
I agreed without hesitation and travelled home to await the
call to go in for the operation.
The
operation to fit the Ilizarov frame was sucessful as you can
see by the pictures above - please click to enlarge. There
were several 'stages' to go through before the work on my
leg would be completed.
The
25 degree tilt of the tibial bone above the injury had to
be corrected.
The gap between the bone ends would have to be compressed
together to 'fuse' the bone ends together and stimulate new
bone material to grow filling out the damaged area.
In 2002 the frame will be reinstated to correct the curvature
of the lower leg. This is pronounced and causes hyperextension
of my knee joint. (The joint tries to bend the wrong way when
weight is applied.)
In 2002 the final procedure will be to lengthen the leg.
The
adjustments are carried out by turning adjusters on the frame
1.0 mm each day (4x 0.25). This allows the body to gradually
adapt to the changes until the completion of each procedure.
This is a painful experience but worth tolerating to achieve
the necessary amount of djustments at each stage of the corrective
procedure.
I
returned to the Norfolk & Norwich Hospital each week so
that a progress assessment could be made. Any necessary changes
to the geometry of the frame were carried out during these
visits - the daily 1.0 mm adjustments I did at home each day.
I
made good progress with the adjustments and maintained strict
hygiene of the frame and the pinsites. I even began to walk
with the aid of crutches and do gentle cycling on my indoor
trainer. I adapted the left pedal to accommodate the width
of the Ilizarov frame and the 50 mm difference between the
length of my two legs. (25mm following a 'tidy up' of the
bone ends and 25 mm following compression with the Ilizarov.)
The
previous 14 months of inactivity had resulted in a substantial
loss of lean body mass. X rays showed also that my other bones
were decalcifying through lack of weight bearing exercise.
Having
the Ilizarov fitted was like giving me my life back again.
As I said above - I could now begin walking again - with the
use of crutches - do some gentle indoor cycling and some weight
training exercises for my upper body. This was a real turnaround!
I
did still have M.R.S.A and the pin sites were painful, but
slowly the bone did begin to form new 'callous' and I could
at last begin to feel positive about my leg and my future,
thanks to the Ilizarov frame.
In
the summer I took part in the orthopaedic walk which is organised
nationally and raises money for orthopaedic research and the
hospitals.
In
September after wearing the frame for nine months - it was
removed to 'rest' my leg. Another Ilizarov will be fitted
early in 2002 to begin the lengthening procedure.
Update
20 July 2002.
Unfortunately
my optimism regarding the planning and execution of the work
to my leg was unfounded. Time has now run out for the frame
to fitted and the leg lengthening process to be completed
in time for my departure to Siberia scheduled to begin in
January 2003.
The
frame will need to be on for at least five months so even
if the frame was to be fitted today it will still be on until
the end of December this year. I couldn't then set off in
January to cycle 10,000 miles to Siberia and back and expect
my leg to survive. I have therefore decided to complete my
preparations this year and leave as planned in January 2003
wearing the shoe that I have developed to make up the difference
between the length of my two legs which is more than 2 inches.
This
is disappointing because the challenge is hard enough anyway
without any additional complications. Still, looking at the
bigger picture, the main task is to complete the challenge
and raise lots of money for orthopaedic research and that
is what I am focusing on.
Treatments and Operations
Update 2002
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