Dealing with the stress of fixation.

As those of you who have been following my story will have noticed, I have mentioned a sudden attack of depression in July 1999. This occurred 'out of the blue' one day after a very simple thing just seemed to drive me over the top.
This has led me to consider the overall effect of fixation and orthopaedic surgery and the depression that mau occur as a result.
Prior to my accident I was a volunteer counsellor mostly to do with companion animal (pet) bereavement. Although my studies also encompassed managerial and general counselling.
I had considered that, following the accident, I had the situation 'in hand'.
In the months immediately after the event, I probably bored the pants off all and sundry who would listen. Everyone knew the story of the incident. And I had cried many times. Anger, fear, frustration, all the emotions had been involved. I lost my partner due to the stress that the acident put me under. Following this I decided that I really needed to utilise the services of a counsellor, to try to exhorsise my ghosts.
This I did, to good effect, admittedly combined with chemical assistance (Prozac), and had assumed that, since ceasing the sessions, I was still doing OK.
I had felt alright. I was sleeping alright. But apparently, in hindsight, I was showing signs that were worrying my friends. Mostly it was because I was too 'up' all the time. I very rarely got a bad day unless the leg hurt, and that was very rarely.
However after everything went awry in May 1999, I started to notice specific changes in myself.
After discharge from hospital and returning home, I began to be increasingly aware that time wasn't doing what it was supposed to.
This bit may seem strange but it's very difficult to explain. The only person I've met who understands it is a friend of mine who spent some time in a coma in intensive care. She knows exactly what I mean by inference, but she can't express it any better either.
I became aware that the passage of time was becoming distorted. The progress of a day from morning through to night was generally unaffected although some days raced by whilst other crawled. Fairly normal really. However the passage of days, weeks and months was somewhat misty, distorted, unreal even.
I would speak to someone on the phone, certain that I hadn't spoken to them for weeks, only to find out that I'd spoken to them the previous day. Similarly people I hadn't spoken to for ages, I was sure I had only just spoken with.
This description does not clarify the situation really, the closest true analogy I can make is that it is like the Bill Murray film 'Groundhog Day. In this film everyday is the same, events repeat, only he is aware of the anomally.
This situation becomes extremely worrying and confusing.
I could not explain this to anyone and get it to make sense, only my friend, mentioned before understood, and she could not improve on the description.

The effects on time are understandable in some ways as many things take much longer than they did before. Washing, showering, getting dressed, making food; all take considerably longer due to the awkwardness of standing, sitting and moving that comes with wearing a frame. Consequently, or so I believe, because I've spent years taking only fifteen minutes for my daily shower and dressing, my brain is still, even now, in this mindset. Consequently I 'lose' time as I cannot get to grips with the fact that it actually takes me around an hour now to do the same routine. Even though I know this fact, for some reason the brain does not seem to accept it, and carries on trying to relate the old time scale to the new.
I feel that this apparent failure to accept my situation at a mental level, is probably the cause of my depression. I am, in effect, turning my back on the situation and hoping it will just go away.
Of course, it doesn't. I also am aware that I am unable to interact with outside events in the same way I used to. For example, my Mother is seriously ill. Her health has deteriorated recently following a stroke she had several years ago. My father has, since that time been her sole carer. Prior to the accident, I would visit them regularly. They live on the South Coast of England, some60 miles from me. Now with the frame on, unable to drive and uncomfortable being a passenger, this distance may as well be to Mars.
And now, as she has been hospitalised again and is also infected with MRSA, I have been advised both by Kings College Hospital and the Conquest Hospital that I should, under no cirumstances even consider trying to go. Having had MRSA twice, I would not consider risking a third infection. But of course all this sort of things adds to the stress.

I know this page sort of rambles and gets no where but, it was meant to really. So, getting to the point, I would suggest that any fixator wearers, especially those living alone, try to make reasoned observations about their mental health. If not, ask your friends and get them to be truthful!
Don't bottle up emotions, it helps no one.
If you feel like crying, screaming, shouting then do it. It's better out than in. Watch out for signs of aggoraphobia (Fear of going out) it can happen quite suddenly. Without warning you may find that you're making excuses not to go out even to places that you may have recently visited whilst in your fixator.
Try to be aware of things which once were no problem but now become 'Ah don't matter I'll do it tomorrow!'. This is a bad sign because tomorrow sometimes doesn't come for several days!. Don't be too proud to ask for help. If you don't ask you won't get. My local social services were totally unaware of my situation until very recently as I had taken a single 'you won't qualify' as gospel. I am now awaiting quite a long list of possible help schemes including washing services, housework, transport, occupational therapy and others. If you're offered counselling or psychiatric help, take it. Remember there is the scary possibility that you're not really fully aware of your own situation. I have now been placed on an increased dose of Prozac and am awaiting a visit from the community psychiatric nurse. I'm not scared by these occurrences, I am more bothered that I constantly told myself I was OK when I really knew that I was not.

DON'T KID YOURSELF,
YOU MAY NEED MORE THAN JUST PHYSICAL HELP.
CHECK IT OUT BEFORE YOU DISMISS IT!
STRESS CAN CREEP UP UNANNOUNCED,
AND IT WON'T HELP YOUR PHYSICAL HEALING EITHER!


I'm now on an increased dosage of Prozac (40mg/day). I must admit to being so laid back now that I'm nearly horizontal!.
I'm not too sure about this at the moment, but I'm still in the bedding in phase with the new dosage so I'll see how it goes.

Pierre Filion in Canada, who is translating a lot of this site into French for speakers of that language has sent me a passage about his feelings to do with stress. I've included it below in both French and Pierre's own English translation. Thank you Pierre!

FRANÇAIS

La santé mentale n`est pas à négliger: il est possible que le porteur du fixateur externe Ilizarov connaisse des modifications majeures dans sa vie quotidienne. Après l`hospitalisation, il peut se sentir angoissé à cause du changement de l`image de soi, déprimé, découragé par la durée du traitement; il faut donc trouver des moyens pour contrôler et exprimer ses émotions: relaxation, exercices, lecture, musique, informatique, etc. Il serait avantageux, pour tous les porteurs, que chaque centre hospitalier dont le département d`orthopédie est spécialisé dans la mise en place du fixateur Ilizarov crée un groupe d`entraide leur permettant de se rencontrer à des périodes prédéterminées pour échanger sur leur vécu quotidien, partager des trucs, se supporter mutuellement. Ces rencontres, avec des exercices dirigés par un physiothérapeute, pourraient se dérouler en présence du chirurgien pour les conseils d`ordre médical et d`un psychiatre pour les conseils au niveau de la santé mentale. On pourrait aussi avoir comme invités spéciaux des individus qui ont vécu l`expérience Ilizarov et qui jouissent maintenant d`une complète mobilité: ceci serait réellement encourageant, stimulant. La création d`un tel groupe d`entraide sortirait le porteur d`un fixateur de la solitude générée par ce type de traitement de longue durée. Enfin, si ce type de service n`est pas offert par votre centre hospitalier, il ne faut pas hésiter à consulter les personnes-ressources de votre Centre local de services communautaires lorsque vous sentirer le découragement vous envahir. N`ayez crainte de déranger, ces gens ne demandent qu`à vous aider.

Il est vraiment essentiel de se prémunir contre les effets nocils créés par une trop longue solitude et aussi par le lourd sentiment de dépendance dans lequel nous plonge cette longue convalescence. Nous recevons beaucoup de visiteurs pendant les premières semaines de notre convalescence mais si elle dure trop longtemps...et nous devenons gênés de toujours demander les choses ou les services qu`il nous est impossible de nous procurer nous-mêmes. L`hiver québécois étant ce qu`il est, nous sommes presqu`automatiquement confinés à la maison. Les tempêtes de neige, la glace noire, le vent, le verglas et le froid ne font pas bon ménage avec la marche en béquilles. L`été nous permet beaucoup plus d`activités extérieures comme la plage, la piscine, la pêche, les fêtes familiales, etc. À nous de choisir et d`en profiter !

La vie avec un fixateur externe Ilizarov n`est pas nécessairement drôle, je le sais. Je sais aussi cependant que cet appareil me permettra sans doute de mener une vie normale plus tard, de marcher comme tout le monde; c`est pourquoi je fais tous les efforts pour profiter des beaux aspects de la vie. Cette galerie de photos sert à illustrer qu`on peut tout de même s`offrir de très bons moments un peu partout si on veut vraiment bien s`organiser pour s`en sortir de la facon la plus agréable possible.

ENGLISH

We must not neglect mental health; it is possible that the Ilizarov frame wearer knows major changes in his daily life. After being in hospital, he can feel anxious due to the change of his own image, depressed, discouraged by the length of the traitment: we must find ways to control and manifest our emotions with relaxation, exercices, reading, music, computer science, etc. It would be profitable, for all wearers, that every hospital having an orthopeadic department specialised in Ilizarov frame creates a support group allowing the wearers to meet at regular dates in order to exchange about their daily life, to share tricks, to support mutually. These meetings, with exercices leaded by a physiotherapist, should take place with the surgeon for the medical advices and with a psychiatrist for the advices in mental health. We should have as special guests people who lived the Ilizarov experience and have now a full mobility: that would be really conforting, stimulating. The setting up of such a support group should take the wearer out of the loneliness generated by that kind of long-lasting treatment. At last, if that service is not offered by our hospital, we must not hesitate to consult with the specialist of our community center when we feel discouragement is coming. Do not be afraid to bother them, they are there to help us.

It is really essential to protect ourselves against the harmful effects created by a too long loneliness and also by the heavy feeling of dependence in which this long convalescence throws us. We receive many visitors during the first weeks of our convalescence but if it lasts too long...and we become embarassed to always ask for the things and for the services we cannot get by ourselves due to the frame. The Quebec Winter being what it is, we are almost automatically confine in the house, most of the time alone. The snow storms, the black ice, the wind, the frozen rain storms and the cold do not get along with crutches. The Summer allows us many activities: the beach, the swimming pool, fishing, family parties, etc. We only have to choose and enjoy it.

The life with an Ilizarov external fixator is not necessary funny, I know it. But I also know that this fixator will allow me to spend an normal life later, to walk like everybody; that is why I make every efforts to enjoy the nice views of the life. This pictures gallery shows that it is possible, anyway, to have very good moments everywhere if we really want to get organized in order to take over in the most pleasant way.


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