WANDERING AROUND B.C.

POST # 24 Well I've earned the title of wanderer again this week for sure, and maybe I should re-title the blog "The Crutching Wanderer" but that would only be suitable for the short term as I hope to be off these things at the first opportunity. But for now the crutching will continue. One week ago I woke up early back at Luanne's farm in order to drive to Creston to meet the 7am Greyhound departure bound for Vancouver, a 14 plus hour journey. Thankfully, a young lad who had been sitting in the very last row, agreed to give up the space for the stranger with the broken leg. This last row is a mixed blessing. It offers a little more space in order to stretch out, which in my current condition makes my life a little bit more comfortable. In addition to that, it is right next to the on-board washroom (toilet, dunny, restroom, bog, bano,etc.) which makes it easy to get to and from. The disadvantage is the smell which permeates the surrounding seating area. I can't really say that it is a bad smell, but it's always present, and after a few hours it does become rather obnoxious. The odour is created by the blue liquid which sloshes around in the bottom of the toilet. Also in the bottom of this toilet I happened to notice an empty Budweiser beer can floating there. Perhaps the person who deposited it, had had enough of the smell, and decided that maybe drinking a beer might help deaden his/her senses. In any event, I chose this seat for the advantages it offered my leg, so this small inconvenience of odour was something I could tolerate for the journey. Thankfully the day dawned a sunny one, and soon after leaving Creston the bus climbed up the Kootenay Pass (elevation 1775m, 5823ft) one of the highest mountain passes in Canada. This pass gets it's fair share of snow which can result in its closure, however on the day we went over, it was clear sailing all the way to Salmo, our first stop. From Salmo we passed through Nelson, then Castlegar and later in the morning Grand Forks, where this whole broken leg affair began. It felt both strange yet familiar to be back in Grand Forks, and with the limited time I had, I wanted to make two phone calls, one to Dorothy and the other to Bev and Brian, to say one final thank you to all of them. Alas the phone wouldn't accept my quarters for whatever reason and with only a ten minute stop it was soon time to re-board and continue the journey. We rolled through Greenwood, Midway, Rock Creek and arrived at 2:20pm in Kelowna for our longest stopover of the trip, 40 minutes. An old friend Brian Stainsby lives there, and so I called and as a result we had a short visit prior to my departure. When he arrived at the depot, I yelled out,"Did you bring me a Vegemite sandwich?" which I knew would get his attention, due to our Aussie connection from the past. It was great to see him and I was so glad that I made the effort to call and that Brian had made the bigger effort to come by. Kelowna and West Kelowna at least along the highway has become one long strip mall as far as I could tell, and it went on and on and on. I do wonder how well all of these car-centric cities that we have created in North America are going to cope in our rapidly approaching energy starved future, and I am becoming more and more convinced that the smaller communities will fare much better than the larger towns and cities. But at the moment though, at least on the surface, it all looks so normal and functional and I imagine most people don't even give this a passing thought during their busy work week. Onward we road through the dry interior countryside arriving at our next stop of Merritt. I only mention this stop because of what happened to me upon re-boarding the bus. The steps on a Greyhound bus are rather high, but by this point I thought that I had a pretty good system for hoisting myself up them. This time, when I was perched on the second step and beginning my move up, I caught my toe on the edge of the higher step, lost my balance and for a moment my right leg almost stepped down in an effort to recover from losing my balance. Fortunately for me I managed to prevent this from happening by having a very solid grip on the handrails by my side. I can only imagine what pain and damage might have come about if I had landed on my right leg. This time I was lucky and I got to learn another lesson. With each step, one has to concentrate on what one is doing. Not to do so, will surely end in grief. The Coquihalla Pass was next on the journey, and I was amazed at the amount of fresh avalanches that had tumbled down the mountain sides, turning hundreds of trees into so many match sticks. We humans think that we are so smart and powerful, and then all it takes is to view the power of nature, and we are humbled back into place. Arriving next at Chilliwack I got off the bus for a stretch and right away I noticed the different smell to the air. Even this far out in the valley, a hint of ocean air wafted in the breeze. Next stop, Langley, and then on to Coquitlam. As we passed through the soul destroying sprawl of industrial parks and suburbia we came to the Port Mann bridge and up until this point we had moved along at a relatively decent pace. This all changed once we approached the bridge. The current twinning of the bridge, part of the government's "Gateway" project caused such a traffic jam, that the Gateway project should be called the parking lot project, as we crawled along at a snail's pace. I am sure that at times I could have got out and moved along faster on my crutches than the bus was going. Expanding roads is what we seem to do in North America when the current roads become clogged. And the current roads were an expansion of older roads which had become clogged many years ago. So it's not too difficult to work out where this is going. Maybe in the years ahead some politician is going to be blabbing on about the fact that "the old Gateway project is outdated, and we need more road expansion", but what I think is more likely is that these expanded roads and bridges will become big white elephants. Time will tell. Eventually we made it to Coquitlam terminal, for a brief stop en route to our final destination of Vancouver. As we rolled along first avenue in East Vancouver, my mind thought back to last summer when I was housesitting the dogs Einstein and Snoop. It already seemed like a lifetime ago. But the memories of that housesit are still very sweet. Considering the traffic jam that we had to endure we only arrived about 20 minutes behind schedule getting into Vancouver at close to 9:30 pm. My niece Nicole and her boyfriend Dan were there to meet me and take me back to their condo in downtown Vancouver. It was somewhat of a roll reversal for Nicole and I as I think that the last time we were both at the bus depot, was to put her on a bus. Now the former jet setting uncle had switched to the bus, while Nicole had just arrived back to Vancouver from S.E.Asia. My week in Vancouver was filled up with visits with friends and relatives, and in addition to that I even ventured out on my longest crutch journey to date, going from downtown Vancouver over to the Aquabus dock at Yaletown in order to catch up with Congo Bob and the rest of the Aquabus crew just to say hi and enjoy their company. Yesterday, I departed Vancouver in order to head over to Victoria where I now sit writing this blog at my latest housesit gig. I arrived late yesterday afternoon, and the only difficult part of the bus/skytrain/ferry journey, was my struggle to board the number 17 bus in Vancouver. Due to a heavy backpack, getting up into the bus proved to be a challenge, and while I struggled, the bus driver waited impatiently for me to board. I guess not everyone has patience for a person struggling on crutches. Perhaps he was just having a bad day. The rest of the journey was a breeze, and now I have 5 precious weeks here with two lovely indoor only cats named Tai, a siamese and Maggie a persian. At the moment Maggie is under observation by the vet with some test results due back any day now. In the meantime they will have me around full time to care for their every need. After less than a day, I am already working out the best way to move around my new digs, and this will get easier as time passes. It's shaping up to be a very relaxed time, and I am looking forward to being here during my recovery period. I am very grateful to the owners Phyllis and Ken for trusting me to take care of their place and the kitty kats in spite of my injured leg, and I feel confident that all will go well. So let's get started then with this first week of cat r and r shall we? Next blog will be May 7th. all the best, Paul The Thoughtful Wanderer

F U C D

POST # 23
"Foot up, crutch down, foot up, crutch down." FUCD. Since last Wednesday this has now become my new safety mantra. Wednesday was my transition day. Up to that point I had the use of crutches, a wheelchair, a walker, a toilet seat extension with handles, and finally a shower chair. But all of this equipment has now gone back to the hospital, and the crutches that I have are courtesy of my friends from Calgary, Bob and Susan.
The FUCD part of the story has to do with going up and down stairs. It may seem like a logical sequence, but so far each time I am faced with this new little challenge, I have to stop and think about which goes first. To do it the other way around can only mean pain in the long run, so up to this point I have been successful. The most difficult steps so far were the four steps to board the Greyhound from Grand Forks to Creston. The first step is a little plastic one that is placed on the ground in front of the bus entry, and from there it is one big step up, followed by 3 smaller ones. Only when I exited the bus in Creston, did I notice that there were handrails to use. The rails made going down the steps much easier indeed. Once back on level ground, it is just a matter of concentrating on each step forward, as well as not being in a rush. So far I have had a few close calls, and it usually results from a lack of just THINKING, before acting. Like just a few moments ago. I hobbled over to the kitchen to get a paper towel and when I grabbed for the towel, the whole roll fell out of the dispenser which caused me to lose my balance and almost fall over. I got lucky and arrested the fall in time, but it just helps to prove to me that I have to really concentrate anytime I am standing up or moving from one place to the next.
So let's see, what's been happening since my last blog? Well I guess the biggest change is that I have now completed my housesit in Grand Forks, as the owners Bev and Brian and their daughter Ellie arrived home last Tuesday. We had the opportunity to have a visit for a couple of hours and then they drove me to town where I spent my last night in "the Forks" at my friend Dorothy's house. On Wednesday, Dorothy drove me around town to get a few things done, like another trip to the pharmacy to get some additional pain killers, and we also had the time to do a drive around town which I really enjoyed.
Before long it was time to go, and after a final goodbye to Dorothy, I hopped up the stairs of the bus and headed out for the four and a half hour ride to Creston, where my friend Luanne was waiting to collect me and drive me back home to her farm about 40kms or so north of Creston.
And it is here at the farm I have been ever since. We arrived in the dark and the next morning I was treated to the most spectacular view looking west across Kootenay Lake with a backdrop of snowcapped mountains. This will be my last rural retreat for a while, as once I leave here, it's back to the concrete and glass jungle of Vancouver for about a week, which I imagine will be an assault on my senses, with the extra noise, extra light, and extra smog, as well as the concentration of people. But Vancouver will only being a stopping over point and it will offer me the chance to catch up with friends during my stay.
My time here at the farm has been very relaxing and Luanne and I always have plenty of things to talk about so the time just flies right on by. I certainly hope to make another trip out here in the future, when I once again have two working legs, so that I can help out with some of the farm chores. The farm also comes complete with Mr. Tugwell Boots the dog, and Sam the cat, which help to add to the warmth of the place.
I am writing this blog on the day before I normally post, as tomorrow will be a very early start and what with me spending over 14 hours tomorrow on the bus, by the time I arrive in Vancouver, I don't think I will be feeling very creative. So the plan is to write today, and then just turn on the computer just before leaving tomorrow morning (April 21st) so that I can hit the "post" key, so that the blog will appear on the appointed date.
Tomorrow my niece Laura will turn 39 which makes me see that I am getting older, faster than I expected, and also tomorrow, my dear friend, Dr. Phillip Law would have turned exactly 100, but unfortunately he only made it to 98. But hey, 98 is a good run in anyone's books and Phil packed a hell of a lot of living into his 98 years. He continues to be an inspiration to me.
The last thing to note for this blog, is that as of yesterday, I only took my pain medication once during the entire day, as opposed to four times. This is a great leap forward, and I can now see the day very soon, when I can throw the rest of the pills away and let my system get back to something resembling normal. Slowly but surely the healing process continues, and I feel that I am now over the worst of things. My focus going forward is to make sure of just one thing, and that is, DON'T STEP DOWN ON YOUR RIGHT FOOT, PAUL. And of course, FUCD, foot up, crutch down.
So now it's on to face the city for a while.

Until next time,
all the best from

Paul
The Thoughtful Wanderer

AND NOW FOR SOMETHING COMPLETELY TECHNICAL

POST # 22

So when I woke up this morning thinking about all the various things that I could write about today, I decided that I should try and finish off this leg saga and what better way to do that than to describe the operation from the doctor's point of view.
So while I was off in "la la" land, she and her team with all their years of experience began the process of attempting to return my leg to something that resembles normal. The details that now follow are the doctor's words of what was done during the 4.5 hour operation on March 20, 2012. I've read the report a few times now, and the more one reads it, the more it makes sense. So here goes....


OPERATIVE NOTE

The patient was brought to the operating room and attempts were made to administer the spinal anesthetic and this was aborted to a general anesthetic. He received Ancef preoperatively. The carbon bar and the joints from the external fixator were removed, but the Schanz pins and the calcaneus cuneiforms and proximal tibia were left in situ. The leg and the Schanz pins were then prepped and draped free in sterile fashion. A thigh tourniquet was inflated to 300mmHg. An anteromedial incision was made starting just lateral to the subcutaneous border of the tibia extending down to the joint surface and then making a 60-degree turn towards the distal medial malleolus. This is extended to the medial side of the tibialis anterior and down to the pariosteum. This is extended down towards the level of the joint. The capsule was then opened at the level of the sagittal fracture. Next the joint was evaluated. There was a very large Volkmann fragment on the posterolateral aspect and a significantly smaller Chaput fracture fragment anteriorly. There was a large area approximately 1 cm x 1-1/2 cm of articular cartilage with some associated cancellous gone that was free in the joint. There was a medial malleolar fragment. Starting with the Volkmann posterolateral fragment, a K-wire was transiently placed into this fragment as was an osteotome and with distraction placed across the Schanz pins using a femoral distractor as well as pressure placed on the heel to invert the heel. This fracture fragment was reduced on the talar dome. It was secured by K-wires passed through the fibula subcutaneously into that Volkmann fragment. Once this was reduced onto the talar dome, the free fragment could be reduced onto the talar dome as well and held transiently with some K-wires through the medial malleolus into that fracture fragment. The Chaput fracture fragment was then reduced onto the Volkmann fragment. A one-third tubular plate was used as an antiglide plate initially just to hold it in position and then this was later exchanged for an anterolateral locking plate for the distal tibia. On the medial side, there was a large butterfly fragment and prior to doing the definitive internal fixation, this could be easily secured with two interfragmentary screws. This allowed the medial column to be reduced onto this secured shaft column. The medial malleolus was then secured and held transiently with some K-wires into the medial talus. The fracture fragments were then held transiently this way and the anterolateral plate was secured to the anterolateral tibia. A bicortal nonlocking screw was placed to lag the plate to the bone. Through the two lateral screw holes in the distal arm of the plate and under fluoroscopic guidance two lateral screws were placed and these were partially threaded cancellus nonlocking screws. These allowed the Volkmann fragment to be compressed under fluoroscopic guidance to the Chaput fragment and this completely reduced those fragments. It could be seen from the fluoroscopy that the free articular fragment was still elevated and by placing a reduction tool through the hole in the metaphysis this could be reduced back onto the bone and was secured with a partially threaded interfragmentary screw placed obliquely across the joint. Two more locking screws were placed into the distal end of the anterolateral locking plated and then three more proximal screws were placed, two of which were locking after all of the nonlocking screws were placed. The medial column still needed support to prevent it from going into a varus position. A one-third tubular locking plate from the small fragment set was then slightly contoured to the medial column. It was then secured and two locking screws were placed into the medial fragment and then three screws proximally into the arm of the plate. X-rays were taken and this was an anatomic reduction of a very complex pilon fracture. The loose cancellous bone that was removed from the joint initially was then packed into the metaphyseal region and this was further reinforced with some Allomatrix bone graft with some bone chips. The wounds were then irrigated. Attempts were made to close the fascia over the tibia and this was not possible. There was a bit too much swelling. Therefore a careful closure with some tension was performed using a 2-0 Vicryl for the subcutaneous layer and interrupted 2-0 Prolene sutures along the skin flap. Once the new incision was closed, the Schanz pins were removed and left open. A dry sterile dressing was applied and then a posterior splint.

Postoperative plans are to keep the foot strictly elevated for a week or two to allow the precarious skin with the incision to heal. If there are any concerns about dehiscence, then a VAC will be applied. The patient is to be strictly nonweightbearing for 12 weeks, but after the wound has healed at three weeks and the sutures are to stay in for 3 weeks, then he can start doing some gentle range of motion of is ankle.



So that's it then, the broken leg repaired in doctor speak. I have read the report now quite a few times, and each time I read it, it makes a bit more sense to me. But I doubt that it is of as much interest to the reader as it is to me. But now it's recorded in one more location, so if I ever need to relive the operation, I can always come back to blog #22 and refresh my memory.


I've had a great week and the highlight has been a visit from my friend Jay from Kamloops as well as my friend Bob from Calgary. Having a cat named Bob has caused a bit of confusion at times but we've all muddled through. It's been wonderful to have both of them here, and they have been a big help to me for which I am very grateful indeed. Jay left yesterday, and Bob drove me to Trail yesterday so that I could have my final visit with the doctor.
Soon Bob too will be heading home, and then next week I will be on the road again, as the owners return from their vacation next Tuesday. By this time next week I will be close to Vancouver where I will spend a few days, enroute to Victoria where I will begin my next pet/house sit.
My time spent here in the Grand Forks area has been memorable on many fronts, but I suppose the lasting memory will be the whole story surrounding the breaking of my leg.
I'll just chalk it up as yet another adventure on the road of life, and try to learn some lessons from this that I can use in the future. Some lessons are tougher than others, and this one has certainly made an impact on me.
But now it's time to move on, and with each day gain more strength, so that by June I will be able to finally put some weight on my right leg, and try to get my life back to being a bit more normal.
Next Saturday, I may be on the road which may or may not cause a delay in writing my blog, however I will do my best to get something written for all of you out there who have taken the time to keep up to date with the adventures of the Thoughtful Wanderer.

The journey continues.

Paul
The Thoughtful Wanderer

A DAY IN THE LIFE OF PINK FLAMINGO PAUL

POST # 21

I guess that for most of us, our day begins probably sometime after 6am or later depending on our work schedule or our daily routine. However, since my little accident which took place more than a month ago, my day begins much closer to the official start of each new day at 12:01am. So for those of you who have been wondering just how I pass the day lately, I'll try to explain in a bit more detail.
Now even though my pain level has reduced significantly over time to the point where the pain itself doesn't disturb my sleep, what causes me to begin my day so early is primarily because I still am under doctor's orders to keep my leg elevated when I go to bed. In order to accomplish this, I have to lay on my back with my right leg up on a pillow, which is certainly not my normal way to sleep. It's usually lights out by 10pm and I do manage to drift off for a couple of hours give or take, but sooner or later, sleep fails me and I'm left alone with my thoughts, but certainly not alone, as Sadie the dog is stretched out on the floor beside my bed protecting me from all the bad guys, and Bob the cat has found the perfect spot, as close as possible, curled up right next to my head. I have to put in earplugs otherwise I would get no sleep at all, because Bob wins the award for purring, both in loudness and in frequency. While the three of us are encamped in the bedroom, Blueberry the cat is nowhere to be seen, however I have noticed her during the day on the couch just outside my bedroom, and I think that's where she spends the night. She wants to be close to the action, but not too close.
Each night is different from the next, but in general it's little bite sized portions of sleep, followed by more lengthy stretches of being awake. And during the times that I am awake, I read, or pet Bob and Sadie, or often times, I just lay there thinking. It's an activity that I enjoy doing, and it distracts me from the current sleepless situation I find myself in. This makes the time feel more useful and I always have a pen and paper next to the bed, in order to capture any important thoughts that may drift into my head. Experience has taught me that if they aren't written down right then and there, the thoughts go into some sort of black hole in the brain, usually never to be retrieved.
Eventually the night passes, and I am ready to get up anytime after 5am. Of course the earlier the better as far as the animals are concerned, because they have breakfast on their minds.
I dress, by sitting on the edge of the bed, and this has become much easier as the days go by. Then with a strategically placed footstool by the side of the bed, I ease my butt down onto it, and from there to the floor, and with the use of my two hands, my one good leg and my rear end, I proceed to crawl crab like across the floor to the steps, and then one step at a time I descend the 16 stairs to the second level of the house, which is where I will spend most of the remainder of my day. Near the bottom I look down and say good morning to Mr. Bumbles the toad, who usually seems to be relaxing in his water dish, a morning swim as it were.
My wheelchair awaits me at the bottom of the stairs, and I have perfected a simple movement which propels me from the stair, to the wheelchair in one fluid motion. It wasn't that way at the start, but soon enough, one learns how to maximize each movement and in addition to that, you learn where to place various items so that they are easy to grab onto when required.
And now my day really begins. Now, not to go into too much detail, but depending on what my bladder is telling me, I sometimes make a bee line in the wheelchair to the bathroom in order to relieve myself, however if the matter isn't urgent, I wheel straight over to the doors that lead onto the deck, grab the ball throwing device with the ball in it, open the door, lock the wheelchair into place and with a quick flick of the wrist, I send the ball over the railing and down onto the road, with Sadie in rapid pursuit. She needs to get outside to do her business, so this initial throw is the most important one for her in the day.
While Sadie is outside, I push the wheelchair back and to the right, and with the help of a wooden spoon I reach down to push the button on the computer, in order to get it fired up for the day. For the next little while, Sadie and I play chase the ball, which gives me an opportunity to fully wake up and gives her some much needed exercise.
I now take a few minutes to gaze out the windows and marvel at the view that I am blessed with here. It's been a cool start to spring which has produced many mornings with a dusting of snow on the surrounding hills. I actually spend quite a lot of time each day just enjoying the view, and I am constantly thankful that the owners chose me to take care of their place.
I can't get too far into the morning without engaging in the animal feeding routine, as Sadie keeps giving me those "please feed me" looks and Bob and Blueberry are meowing up a storm.
It took me a few tries to get this routine perfected, but now it works very well and the animals are now use to the fact that I have to roll around in order to get breakfast ready for them. Roll to the fridge, extract catfood, and one piece of cheese. Roll backwards to the feeding area. With the use of a spatula, retrieve the two cats dishes from the floor. Proceed to dole out catfood and place back on the floor where Bob and Blueberry get tucked into breakfast. Next, place Sadie's pill in the cheese, and give that to her as an appetizer, followed by her morning scoop of kibble. While the animals are chowing down, roll back to the fridge, place the catfood back in the door, then wash hands, and put the kettle on the boil for coffee. While the water is on the boil, Sadie and I have time to spend playing throw the ball again, and soon after, I have my coffee in hand, as I roll across the room to the computer to check emails etc, while Blueberry, Bob, and Sadie are curled up on the rug and or couch, digesting their food.
During this period, I do my morning exercises which involves 200 stomach crunches and in addition to that and other stretching exercises, I do a bicycling motion in the air in order to at least keep some muscle tone in my bad leg.
Without going into too much more detail, as the readers have probably suffered through enough of that, suffice to say that my day revolves around moving from the computer, to the couch, the kitchen, or out on the deck depending on the weather. I spend ample time with Sadie and the ball, and the cats get plenty of opportunity to jump up on my lap while I am on the couch in order to have a snooze.
The pink flamingo reference in the title comes from the fact that when I am in the kitchen, preparing food, I have to stand on my one good leg, and the other day when I was doing this, I had an image of pink flamingos standing one legged, and I began to chuckle.
The day winds down and I am amazed at how fast it goes by. Boredom is something that I don't suffer from as there always seems to be something to focus my mind upon. I am reminded again about how Thoreau only wanted to work six weeks per year in order to leave ample time for reading, writing, walking, thinking, and observing nature. In my current situation I can accomplish all of these things with the exception of walking. Another Thoreau comment was, "My greatest skill has been to want little." With each passing day, I strive to live up to that maxim.
Before long the day has come to an end. The evening meal for the animals has long since past, and by around 9:30pm or so, I have gotten into my end of the day routine. The wheelchair is parked where it started the day, at the foot of the stairs, and with the same fluid motion that propelled me into it in the morning, I do the same movement in reverse, and bum my way up the stairs, into the bedroom, and up onto the bed where I settle in for the night. Sadie curls up beside me on the floor, and Bob usually arrives a few minutes later to take up his post near my head.
If I'm lucky, I get a few pages read before sleep overtakes me, and with my anti-purr earplugs installed, I switch out the light, count my blessings, and hopefully drift off into sleep for at least a while, until the whole process begins anew in a few hours time.
My days are full, and rewarding and at times I even forget momentarily that I have this thing called a broken leg. This current routine feels now normal to me, and I am happy.

More thoughts to follow in a weeks time.
Until then,

all the best,
Paul
The Thoughtful Wanderer