Me and My IM Nail (Part 8) – 3 years on

by Jake McMillan

<<< Me and My IM Nail (Part 7) – 2 Years on

Three years ago I broke my tibia (see X-ray above) and fibula and the brand new term IM Nail (Intramedullary Nail or Rod) was introduced into my life … and my leg. Three years on I can still remember the pain, thankfully I don’t have that any more. Since the accident I’ve been blogging about my recovery as there was so little  information about it on the internet.

Unfortunately, three years later, there still seems to be very little information out there. However! One positive has been all the people who have taken the time to get in touch with me and comment on this blog to share their experiences of going through the recovery as well. A massive thank you to all who have commented and especially those who have said kind things as I really did not expect anyone to read my long posts about limping and pictures of scars and hairy legs.

For those who are not aware or have not yet filled it in, I have put together a short survey and will produce and share the findings with everyone. I’m just waiting until there are a 100 responses, with 80 people having filled it in so far (at the time of writing).

Scars and bruising
Over the three years the scars and bruising have gone down, but have not completely disappeared. Being a hairy-legged man helps cover them up.

So, three years post operation how is my leg doing generally?
It’s very similar to being a normal leg, it just has niggles. For example, if I leave it in one position it feels stiff/sore and kneeling on it is not comfortable (but is a bit better compared to a year ago I feel). There are some days it feels better than others, but generally speaking I can walk about, run and dance as badly as I ever did.

I am still cautious when it is raining and slippery, as if I expect my leg to cause a problem and always feel relieved when it is perfectly fine. I was in Singapore in March last year and I was wandering around, exploring after it had been raining and on a slippery stone I managed to fall straight down to the ground on my bad leg. It was just a case of poor grip, but I was so happy that I hadn’t hurt my leg or broken or bent my IM Nail I actually forgot the embarrassment of falling over in front of lots of people.

I haven’t done a lot of sports or exercise this last year but that has nothing to do with my IM Nail, it is been more me not making the time and effort to do it. I fully aim to do much more this year (we all say that don’t we?).

Last Sunday, I went to Richmond to meet some friends and I did so with some trepidation as it was a repeat of the exact same activities I did three years ago that ended up with me breaking my leg on my way home at Clapham Junction Station. I’ve been to the station and walked through the underpass (where I actually fell over and broke my leg) many times before so it should not really have been a big deal.

However, a friend made a joke over Facebook that they would break my other leg. They did not mean or intend any malice by this, just making a joke, but I did not take it in my normal good humour and realised that breaking my leg, the operation and its recovery was still a big deal. Apart from the pain and discomfort of the main recovery period, I was self-employed and it meant I couldn’t fulfil a contract that January or go for one the following month. I almost went bankrupt and barely managed to get by. My attitude remained positive, but it was a really tough time that I would not want to go through again.

In Clapham Junction Station Underpass

As I walked through the underpass at Clapham Junction station last weekend I remembered the time laying on the ground 3 years ago whilst my friends decided that I actually did need medical attention (I had told them to leave me and I would hobble home to bed). I hoped I would not have a similar fate that evening. I am pleased to report that on my journey home I had completely and utterly forgotten about the accident and that it completely escaped my mind. Although, to give full disclosure, I had realised I was totally desperate for the loo and that was utmost on my mind. Nevertheless, although it’s something I still think about, the whole incident is very much in the past and the ongoing niggles of my leg don’t affect my life or bother me that much.

Will I have the IM Nail removed?
I have given this some thought and have still not yet arranged an appointment with a consultant to discuss this. I will do this as would like to know more information and will, of course, share it here. I would like to remove the IM Nail as would prefer it not to be in my leg, I think most people feel this way, but the question is whether it is worth the risk of further complications and pain. It does worry me what happens if I have another accident, how the metal might cause more damage, but then I cannot predict how bad that accident would be anyway? Some have had very successful removals and I know others where it has not given the desired result and caused further pain and problems. As I don’t get much discomfort and it doesn’t really prevent me from doing anything I think a consultant would say there is not enough justification to do it.

Sharing Your Experiences
Please keep doing this, I will continue to keep updating this blog and it really does help others to hear about as well as give support to others going through the same or very similar experience.

Thank you again to everyone who has contributed to the blog and wishing you all the very best with your recovery!

Jake

IM Nail Removal – Your Experiences

It’s been 2 years since I had an operation to have an IM Nail inserted into my left leg, and although I don’t get really get any pain, just niggles here and there, I have been pondering whether to have it removed? Having the metal in my leg does not stop me doing anything but feel maybe I have become a little reluctant to put myself into situations that might damage the leg. Also, there is a concern if I had another accident, there is no way to predict how the metal in my leg would react? Would it help or make the situation worse?

I am going to see the consultant and run through the options and risks as although it seems having the IM Nail removed is far less traumatic than having it put in, it would mean having a general anaesthetic and being on crutches again for a few weeks. There is always a possibility of complications with a procedure like this and if I’m basically fine now, then maybe it’s not worth the risk?

There is very little on the internet about the recovery from IM Nail insertions and even less about the recovery and process of having them removed. A few people have very kindly shared their experiences on this blog, but may not be easy to find as are hidden in comments way down the page. So, I thought I would make some links to the comments to make it easier to find and perhaps encourage others to share their experiences too.

Carl
Carl had his IM Nail removed in August 2012. He has very kindly shared his experiences, including photos, here.

Nick
Nick had his IM Nail removed in Feb 2011 and was very kind enough to provide several updates  with a lot of detail of what happened:
1st Update
2nd Update
3rd Update (May 2011)
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Andrew
Andrew had his IM Nail removed just over 10 years ago.

Emily
Emily had her IM Nail removed in April 2011 as her consultant said the nail was a little too long and was damaging tissue:
1st Update (Just after removal)
2nd Update (Dec 2011)

Becs
Becs has an IM Nail in both tibias and after 15 years had them both removed in April 2012. You can read  the reasons she gave to the doctors to persuade them to remove the nails and her experience of recovery 3 weeks after the removal by clicking here.

Caz
Caz had her IM Nail removed after 3 years in August 2012. The doctors did not seem too keen for her to do it, but after one night in hospital she was back home and her knee pain has gone.

Also, please read the comments made below.

If you have had your IM Nail removed or are about to, it would be great for the rest of us to read about your experiences as there really isn’t much information about this and it is so useful and supportive for others to read.

Jake McMillan

Me and My IM Nail (Part 7) – 2 Years On

<<< Me and My IM Nail (Part 6) – 1 Year after the accident

Me and My IM Nail (Part 8) – 3 Years after the accident >>>

Wow! It is hard to believe it has been two whole years since I broke my tibia and fibula at Clapham Junction Station and had an operation to put an intramedullary nail (IM Nail) into my left leg in January 2010. Getting to this point now seemed like a lifetime away shortly after the accident as I only let myself concentrate on short term goals. I took things a month at a time and 6mths seemed too far away to think about, let alone two years. However, here I am and happy to report things are good!

Before getting to specifics, I would like to say a massive thanks to everyone who has contributed to this blog, not just for some of the nice things said, but especially to those who have shared their own experiences.  I started writing about my own experience as there wasn’t (and still isn’t) very much on the interweb about IM Nail recovery and what to expect. It has been very helpful and reassuring to me and to everyone else that others are going through similar problems, worries and issues. Please do keep adding and updating your own experiences as well as any handy tips as lots of people have got in touch to say how useful it is to read them all.

Right, a few people have asked me some questions of how the leg is 2 years on, so I will answer those:

Does the leg feel like a normal leg now?
Almost, but not quite. If you have broken your leg to such an extent that you need an IM Nail inserted, then your leg is never going to be quite the same again. You have to accept that having a large bit of metal in it means that it is not a normal leg any more. Two years on and it feels normal most of the time, but not all the time. For the first 6mths and year of recovery you will be very aware when walking that one of your leg feels noticeably different. However, as time goes by, it starts to feel less and less different to the extent that you don’t think about it much, but you are still aware of it. Don’t be disheartened into thinking you can’t do the things you did before, as you can, you will just be much more aware and careful with your leg. Doing the physio and exercising the leg can actually make it stronger than it was before the IM Nail.

Do you still get pain?
No, I wouldn’t describe it as pain, but I get niggles from time to time. For example, yesterday I had a few niggles just below the knee whilst in Central London. I’ve been ill with a fever and been stuck in bed so it was the first time I had walked anywhere in a few days. I had to sit in an uncomfortable chair for an hour or so and when I got up and had to start carrying/moving stuff around I noticed the niggle. No great pain, just small blasts of it feeling sore and a bit weird. It didn’t prevent me from walking around or doing what I was doing.

Have the scars gone?
Nope, they have faded a bit, but not a lot. As you can see below there is still an annoying brown/bruise type mark where the tibia broke. I had hoped that this would have gone away as it’s nowhere near as sexy as an operation scar. Oh, and apologies about the hairy legs!

Will you have the IM Nail taken out?
It’s definitely something I am considering doing, but because I don’t get lots of pain, just niggles, it is not a priority. I am going to organise a visit with the consultant to see what the options are and review the risks.

Have you had any other issues?
Two months ago (November), I had a problem with a shin splint type pain in my bad leg so had to rest it for a few weeks. Shin splints are caused by muscle imbalances in the legs and I think because I hadn’t been keeping up my exercising (I cancelled my gym membership a few months beforehand) this caused this issue.

Any words of advice or encouragement?
Yes, absolutely. Although the above has focussed on issues I have had, I feel my leg is really good right now and I am happy with it. Although doctors tell us that it takes 6mths to recover, it is actually longer than this. We will still get pain and soreness for much longer even though we can be very active on our leg. Be patient with any pain, it should subside eventually. If you are still getting a lot of pain after a year then definitely go back to discuss with your consultants. Even when the leg is feeling good a year after the operation, do keep up some of the physio. I still do the standing on tip toes on my bad leg from time to time (sets of 15).

Can I get in touch with someone who posted a comment as it seems they experienced what I am going through now?
Potentially yes, this has happened already. I will get in touch with the person and ask if they are happy for you to contact them.  Please send me an email: jake.t.mcmillan@gmail.com

Please share your experiences! It really is useful for others to hear about what you have gone through. Also, if you have any questions or worries, then maybe others have an answer.

Jake McMillan

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<<< Me and My IM Nail (Part 6) – 1 Year after the accident

Me and My IM Nail (Part 8) – 3 Years after the accident >>>

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Me and My IM Nail Part 5 – 6mths since the Op

<< Me and My IM Nail Part 4 (5mths on)

Me and My IM Nail Part 6 (1 year on) >>

In January 2010 I broke my left tibia and fibula and had an operation to have an Intramedullary Nail (IM Nail) inserted. The doctor at the time told me, I thought rather vaguely at the time, it would be “6 months before you could do the things you want to do”.

It’s now been 6 months since the operation and I can confirm the doctor was right. I can do the things I want to do, but the leg does not feel like it is completely normal and back to full strength and capability. This is not the end of recovery; there is still some progress to be made.

The leg is really starting to feel like a normal leg. I have finally lost my limp and this was confirmed by my physio and friends are very impressed with how easily I’m walking about.

Me with a couple of friends as I am stretchered away from Clapham Junction where I had the accident

I started jogging 2 weeks ago. Not on the treadmill, but proper jogging in my local park, Clapham Common. I just did 10mins and it was at a very slow pace. When I finished I felt so elated to have been able to do this and my leg felt fine as I walked home.

My physio recommended, after hearing of my initial 10mins run, to do 3 runs of 10mins every other day (to give the leg time to rest) to see if the leg was able to cope without any problems and then to slowly build it up from there.

I didn’t quite follow her instructions and have increased each run by 2.5mins and yesterday did a 20mins jog. I’m a lot slower than I used to be, at the moment, and it takes me 11mins to reach a marker I used to do in 10mins. I’m really quite unfit as have not been to the gym in ages, but in a way this is good as if I was fitter I would be tempted to run for longer and maybe push the leg too hard too soon.

My visit to the physio last week ended up being my last visit, touch wood, as she gave me the all clear. I still have physio exercises to do:

• 3 sets of standing on tip toes 15 times on my bad leg and once this is quite easy, to start hopping
• One-legged (on bad leg) lunges or rather lowering my body through bending my left knee
• Using the wobble cushion (see below)

My physio recommended buying a wobble cushion as she said the receptors in your ankle basically go to sleep when they aren’t being used for some time and standing on a wobble cushion helps wake them up and will prevent you from falling over when on uneven ground. This type of rehabilitation is sometimes referred to as proprioception or proprioceptive re-education.

Firstly, you stand with both feet on the cushion and try to maintain your balance. Hopefully you will find this quite easy. To make it harder, try closing your eyes whilst doing it. It’s amazing how much you rely on your eyes for balance. With your eyes closed it just the receptors in your ankle giving information to your brain about how to stay balanced. Then try it with one leg (the bad one) on the cushion and then with your eyes closed.

I still have my scars and bruise from the accident and kneeling on my left leg is not really an easy thing or comfortable thing to do. A friend of mine who went through the same thing just over 18mths ago thought perhaps he would not be able to kneel properly ever again and then gradually he was able to.

Walking down stairs is easy but I am still very aware of my leg’s limitations and it doesn’t feel quite natural.

As it is 6mths since the operation I thought it might be useful to reflect on the recovery period so far.

I feel I worked really hard and put a lot of effort in the first 3-4 months, but after that either my will or energy seemed to diminish. Once I was basically able to move about (although with a limp), work and socialise I stopped trying so hard. It wasn’t a conscious decision, it just sort of happened that way.

I think I was really trying hard to beat the 6mths recovery time and when I realised I wasn’t able to, particularly when the physio told me I shouldn’t start running yet, I lost some of my motivation. But this could be a good thing in a way as I know others who have pushed themselves too hard and that has ultimately led to a delay in their recovery.

However, I am pleased to report to anyone else who is or about to go through the same thing that after 6 months I really do feel quite good and, as the doctor told me, I can do all the things I want to do.

In January, now (as in July) seemed so far away and I didn’t want to think about all I had to go through to get there. Although the pain largely goes away, it is still sore and you are reminded of your leg problem pretty much the whole time, in every step you take, when you lie down, having a shower, etc. That is not the case anymore, thankfully. Yes, I am still quite often physically and psychologically aware of my leg’s limitations, but this seems to lessen by the day.

My advice to those recovering still remains the same, you should be very short sighted and set yourself small goals to achieve, try not to look a long way into the future.

Me and My IM Nail Part 6 (1 year on) >>

Me and my IM Nail Part 3 (4mths since the op)

<<< Me & my IM Nail Part 2 (3mths on)

Me & my IM Nail Part 4 (5mths on) >>>

Since the last update a month ago I don’t feel like I have made as much progress as I should have or maybe hoped for. When I was initially told there would be a 6 months recovery period, I really thought I would be able to beat that, but it seems I am exactly on track to meet that timeframe.

I’ve been a little disappointed with myself as there were a couple of weeks this month where I could have tried harder. Work and life meant I wasn’t able to get to the gym like I wanted to do, but even so I could have done more physio at home. However, reflecting on this now I realise I have been pushing consistently hard recovery-wise for over 3 months, so having 2 weeks where I wasn’t 100% focused on it was probably a good thing.

I won't be visiting here for another 4mths

I still have my limp, which I really hope would have gone by now, but it is much less pronounced than it was before and I can walk long distances (45mins plus) without it causing discomfort. So I know the limp is due to disappear soon, I just have to keep at the physio and going to the gym to build up the muscles.

Since the last update I have also been back to the hospital for another check up and the consultant is very happy with how I am healing with the IM nail. He even suggested I could probably start having a go on the treadmill. My physio has not suggested this so I was a bit sceptical but felt positive after the visit.

I hate waiting! It's normally over an hour for the X-Ray and then another hour for the consultant

I met up with a guy I work with from time to time who had broken his leg 18mths ago, but I didn’t realise he had an IM nail put in too. It was really good to quiz him about his experiences. The first thing you will be pleased to hear is that he is about to run a marathon in the next couple of weeks.

He is into his running and told me he pushed too hard when recovering and this actually set his whole recovery back by over a month. He was advised when able to start running again to start with 5mins and then to build it up one minute at a time. However, after a few goes he felt good and ignored the advice and ran a bit longer and then did a 40mins run but after that he couldn’t run again for a few days as it would be very painful and sore.

I went to the gym 3 times last week and felt good about that, particularly as last Monday I went on the treadmill to jog for the first time. That felt very weird! As you are not sure how your leg will perform. I took it very easy and did a 5mins jog at very slow speed. I was able to do it, which was good, but still ran with a bit of limp and was unsure whether that was right or not?

The observant of you will have noticed that the person above is not me ... I have better, but hairier legs

On Wednesday I jogged for 6mins at a slighter faster speed and then 7mins on Friday going slightly faster again. I haven’t felt any bad after effects from doing this and so can continue with confidence.

My physio gave me a new, stronger rubber sexual aid (Green) to continue with the ankle exercises which I have to be honest and say I have not really been doing, even though I do keep them near me when watching TV at home. The physio has also got me standing up and down on tip toes and standing on just my left leg (the bad one). I’ve been doing a lot of these as it is very easy to fit into normal life … whilst brushing teeth, making a cup of tea, waiting for a bus/train, etc.

Standing on one leg helps to build up strength and although I could do this before the physio asked me, I was very wobbly and it was hard to balance. Whereas now I can do it with my hands in my pockets without needing to put my arms out to balance. It’s not as good as my right leg, of course, and it still wobbles a bit (the muscles around the ankle and knee move about to maintain the stability of the leg).

Standing on tip toes is something  I’ve been able to do for ages, but a month ago I tried walking on tip toes and that was a very different story. I could barely manage it and it was similar to when I first started walking, or rather hobbling. A month later and I can now walk on tip toes better, but with a major limp.

The guy I worked with also recommended that I keep up with the rubber sex aids as when he was able to start running he gave up on the ankle exercises, but wished he’d continued.

I haven’t reached my goal of losing my limp, but have jogged on the treadmill for 7mins which is ahead of what I thought I would be doing. So I hope by the next update the limp will have gone and I will have jogged for at least 20mins on Clapham Common.

I also still have the bruise from where the tibia broke which I think is also a reminder that as much as you can push your physio and exercises, you can’t speed up how quickly your bone heals.

<<< Me and my IM Nail Part 1 (2mths since the op)

<<< Me & my IM Nail Part 2 (3mths on)

Me & my IM Nail Part 4 (5mths on) >>>