the Schedule - Overruled

The Schedule said I had to do three hours on the mountain bike on Saturday. My Daughter said I had to take her to the Lough Shore. My Daughter won.

I loaded her and her brother into the bike trailer, Granda borrowed my marin, and we took the scenic route down along the river, through the castle gardens and down to the shore; ate ice cream, watched the pirate ship race, saw a demonstration rescue by Lough Neagh Rescue and lay in the sunshine.

I couldn't help but notice a girl in the crowd with her arm in a sling and a plaster cast all the way up to her shoulder looking awkward holding a wee baby. That wrist surgery's never far from my mind these days.

Martin does a lot of his training with weights on his ankles. Personally I don't see the logic in this, because the weight's balanced - so when you have to pull one weight up, the other's pushing down, cancelling out the effort. Pulling a five year old and a three year old behind you in a trailer, on the other hand, now that's a definite training enhancement.

The problem is that my straight line cycling fitness isn't my biggest worry. I really need to improve my off-road skill, so tomorrow I'm heading down to the Mournes for an overnighter, taking my new £10 Lidl lightweight tent, sleeping in my as-yet-not-used Scottish Silkworm sleeping bag liner, and cooking on... I'm not sure which of my too-many stoves I'll take.

I wonder where my compass is.

hard decision

I made a hard choice this week. The padwork in kung fu hurts, and not in a good way. I can't punch hard because on the impact I can feel the bones in my wrist crunch. Another problem I found is that my wrist's limited range of motion means I can't even be a decent sparring partner.

I've given it up.

It's a pity because it was a good way to get an hour's workout into the week, and the circuits were challenging, and I could feel my body getting used to it.

On the bright side, the nights are getting shorter, so there's more opportunity to ride.

I've a bit of a hamstring niggle after Monday's effort, so tomorrow's cross training will be mostly upper body work.

fits like a glove

Yet another appointment for my wrist, this time with an occupational therapist to make a 'gauntlet'.

Ali Hunter is the OT extraordinaire. She asked all the usual questions, then she actually measured my range of movement and grip strength. She's the first person to have done it properly with all the tools, and even I was surprised at how bad my right wrist is. I was certain, even though it's sore, that my right hand was significantly stronger than my left; turns out it's quite a bit weaker.

The aim of the gauntlet is to take the weight off my ulna (and therefore my TFCC) when I'm riding.

Ali then took a sheet of thermoplastic, cut it to size, melted it (at 65○C apparently) in an electric frying pan like my mum used for cooking in the caravan.
She'd been thinking quite a bit about how best to make a splint specifically to wear while riding the bike, so she cut a tiny hole in one end and draped it all over my arm, with my thumb through the hole. She held it in place, with my wrist at the angle I usually hold it while riding, and the end of the splint along the palm where the handlebar will sit.
The plastic cooled in shape and Ali took it and did some cutting, cleaning up and added some padding in a very fetching pink colour. I just don't understand why medical companies think bright pink makes things invisible. I even looked it up online thinking it was just that Ali only had one colour. Nope, it's called Hapla Fleecy web, and it only comes in 'flesh' colour. Let me tell you, medical experts, if your flesh is that colour you need to go and see a doctor quick smart. It's never going to be invisible, so they could at least make it a less embarrassing colour.
With a couple more minor adjustments, she added Velcro straps and away I went.

It's very comfortable and it does hold my wrist firm while I'm riding. Haven't tried it on singletrack yet, but bunny hopping up and down kerbs last night at 25mph I was able to pretty much forget I was wearing it.

Result!

Mr Swain, the orthopaedic hand surgeon, phoned me at home last night with the results of my MRI scan.
The bad news is that I've got a perforated TFCC, a ganglion and a perforation in my scaphoid cartilage.
Since I've got no pain on the radius (thumb) side of my wrist, we can ignore the scaphoid 'problem'.
The ganglion and the TFCC issues would be solved (probably - there's no certainties with wrist surgery) with ulnar shortening. That's the operation where they break my arm and bolt it together again. It's supposed to be really really painful, but then after you recover from the surgery the odds are very good that everything will be near normal.

The good news is that he agreed to let me just get on with the training until I can't stand it any more, and do the operation then. That might be never, but somehow I think I'll throw in the towel within a year if it stays as bad as it's been lately.

what's on my mind?

Saw a girl today with her arm in plaster. I wonder if she had her ulna shortened. Nah, probably just slipped on the ice.

clever mummy

Alex had an idea.
I could use an exercise bike to work on my fitness.

hospital gowns with missing ties

I caught the bus up to the clinic this morning and got directed through to the MRI department.
I forgot to bring my insurance details, but that wasn't a problem - just phone them through when you get back to work.

"Have you had brain surgery, heart surgery, eye surgery...?

have you ever had a job working with a metal grinder?

Are you wearing a pacemaker, hearing aid or drug infusion system...? "
The Radiographer looked at me as if I might actually be wearing a drug infusion system and just forgot about it.

then into a changing room "you can keep your T-shirt on, and boxer shorts and socks, but take off everything else."
At this point I'd like to point out that I don't like energy saving light bulbs, because my socks really did look the same colour when I put them on this morning.

The hospital gown (which contrary to popular opinion, is not open at the back) is supposed to tie with two ties at the side. Of course mine only had one. I improvised - Oh yes, I watch Gok Wan - and if I may say so myself, I made that gown look good.

Normally when I've seen these MRI scanners on the TV everybody looks pretty comfortable, lying flat on their back for what looks like a quick pass through the magic gateway. It wasn't quite like that. For a start it wasn't my brain they were scanning (keep the jokes to yourself) it was my arm, so I had to get my arm in the centre of the bed with my body hanging off the side. A bit awkward. Then I had to stay like that until she pushed the bed inside the machine - except of course the bed's a tight fit - so I had to hunch up a bit so I could actually fit inside half the Stargate tube. Uncomfortable.
So all hunched up, hanging off the side of the bed, squeezed into a smartie tube - I think I can just about hold this position for a few seconds. 25 MINUTES I was in there like that! and it might look high tech, but it sounds like you're sitting in the engine bay of a John Deere.
When she eventually let me out, I sat up and stretched my aching limbs. There was a blip and the radiographer looked worried. "power cut" she said. I didn't ask too many questions - If she didn't save the images she'll have to draw them with a pencil from memory, because I don't intend to repeat that experience in the near future.

The results should be available in about a week.

just got a phone call

MRI scan on Monday morning

So what did he say?

He sent me for an X-ray to check for ulnar variance. Normally the head of your ulna is a bit shorter than your radius. Mine's about 2mm longer. That increases the load placed on the ulna, but also allows the ulna to compress the TFCC Triangular FibroCartilage Complex. It is likely that my TFCC is torn or worn through. This can be confirmed with an MRI scan.

(That picture's not my x-ray, but it looks similar. I hope Oregon Uni don't mind me using this)

The solution?
IF that's the problem ... he'll slice open my arm, break the ulna, shave off a couple of millimetres of bone, and bolt it back together. I'd be in plaster for 6-8 weeks, but because I cycle and canoe he'd want me to take a bit longer recovery time. Maybe 10 weeks.

All very simple and matter of fact. He does it every day.
I don't do it every day, and I thought it was a sprained wrist.

Now with the NHS I'd expect the MRI scan to be in December 2012 and the surgery to be in August 2015 (OK so maybe a very slight exaggeration there) so I'd just do this ride as normal, but Mr. Swain mentioned that IF the MRI scan shows a tear the possible date for surgery could be as soon as THE BEGINNING OF FEBRUARY!!!!! Four Weeks! 30 Days! NEXT MONTH!!

I told him about our planned coast to coast. He was confident that IF it's torn, and IF he operates in February, it could be healed in plenty of time, even allowing for minor complications, but he very sensibly pointed out that missing 2-3 months of training could scupper me for the ride. Another option he offered would be to do the surgery after the ride, but IF it needs done I think I want it done and dusted and out of the way as soon as possible.

I think I do.

Now I just have to wait for the MRI scan.
It's not the coast to coast ride I'd intended for this blog, but you've got to admit that it is mildly exciting.

NOOOOOOOoooooooo!!!!!!!!!

Yesterday I saw an orthopædic hand specialist. I've had wrist pain for years. I went to A&E a long time ago and they checked it wasn't broken. "You've got a sprain of your triangular ligament" they said, gave me a splint to wear for two weeks and sent me home.

A sprain should get better, so although this didn't, I decided to give it a while, then I just got used to the discomfort, changed the way I do things a bit so I wouldn't have to turn my palm face up, or put pressure on that side of my wrist.

A month or so ago I sprained my thumb. It healed within two weeks and I realised that maybe the other side of my wrist shouldn't still be sore. So I did something about it.

I get health insurance through work, and this is my first time using it. For somebody used to the NHS, this is frighteningly fast.
I rang my GP two weeks ago. He recomended physio first. My first physio appointment was last Thursday - she tried some manipulation, laser treatment and ultrasound. I had another physio session on Monday (the one where I had to ride up the big hill) where she did the same, but then said "we're really only guessing what's wrong. You would be better seeing a surgeon who specialises in hands to get a proper diagnosis." Actually, unbeknown to me my GP had also written that on my notes as the next course of action. So I arranged an appointment with Mr. Swain at the Ulster Independent clinic. That was yesterday.

If I'd been going through the NHS I probably wouldn't have got referred to a physio in the first place, but if I had it'd be a 6 month wait before I saw one, then probably a month before my second appointment. Two years to see the specialist, and another year before anything was done.