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March « 2010 « Tamsin Lewis's Blog


Archive for March, 2010

Surgery in A Modern World – and other musings.

Tuesday, March 16th, 2010

What an exciting weekend it has been for some of my fellow Team TBB mates!

Congrats to Amy for a superb result. Amy looks like a machine,
swims like i can only imagine… and is one helluva trooper.
Much respect girl for a great performance.
Wongstar – you are just nails… we can all learn from you.
Maki – I imagine Maki smashing her way through the
water.. creating a tidal wave in her wake but all the while with a devilish grin on her face…  you have to be seriously pleased with 4th – brilliant.
Congrats too to the boys!

Abu Dhabi I watched very closely…as I was meant
to be there… choosing not to dwell too much on the negativity..
I put my misfortune aside and watched as awesome athlete  and fellow Brit Julie Dibens produced another stellar performace.

Caroline, Bek and Teresa -
- my heart goes out to you all – supastars! It was hot out
there.! Special thoughts were with Bek who went out
there and did her job, despite the preceding
weeks of adversity… again inspiring stuff.

The race brought up a little suprise for me as I saw an
athlete – Carrie Lester come up fifth.
Carrie won her age-group at The World Champs
in Sept at the same time as I won mine (25-29v.
30-34) so I was stunned to see someone to whom I
was so competitively close.. do so well over the
longer distance event. definitely provided food
for thought.

So my update…

well… as per previous blog.. went to see top shoulder doc/surgeon at St Thomas’ Hospital in London for
re- xraying and clinical opinion on my beleagured collar-bone.

We talked – at length… the pro’s and the cons
of surgery versus leaving it.
techincal speak is :
conservative v. interventional approach.
i.e to slice or not to slice…
to plate and pin or to sit and sling.


well… firstly. I’ve been through medical school.
I’ve seen many an operation and been held in awe
at the technical expertise with which some surgeons
deftly manoerve their way around our bodies’
web of nerves, blood vessels, sinew, muscle and adipose (fat). However, I have also had to run out of
operating theatres’ on a few occasions.. as I
feel a swell of nausea rise up ready to enduce
vomitus. Now the particular type of operations
to enduce such a pallid state are those of the orthopaedic variety. A vivid memory of the dilated pupils and crazed grin of an orthopaedic surgeon
as he drilled into some poor chaps’ femur (thigh bone)… blood spurting… smearing the surgeons’ glasses with droplet upon droplet of haematogenous material… and the smell.. human flesh and drills not a olfactory delight

so the gist is – orthopaedics in my mind is well…
a bit butch for me… A Bit hit and miss… all that drilling and hammering and nailing and filing…

soooo… If I was going to choose to have any
operation – any in the whole world – having an orthopod (as we other medics term them) involved is the last thing on my wish list…

ok – so if I ever had to choose between heart surgery and repair of a fractured clavicle… then I perhaps would reconsider … but you get my chain of thought.

of course (and Mum if you’re reading this.. sorry)_
I didnt tell any of the above to my dear mum so has now undergone two hips replacements – both ultimately very successful… but she did have them done privately and a fair amount of sedative was required to get her to the operating table…

ok, where was I… all that thinking about blood and gore distracted me…


oh yes – decisions – well… I go and fracture my
clavicle in an abnormal way… none of this bog standard collar bone breaking for little me…
nope….  I go and do myself a Tami special – better known in medical speak as a displaced and comminuted lateral third fracture… which, as the research.. and apparently clinical practice  show, are LESS likely to heal on their own… so conservative treatment – i/e to sling… is less effective and the chances of non-union (in surgeon speak) is much higher… as high as 60% of me being left with a non-union (i.e the two ends of the fracture not coming together…which could potentially affect shoulder function in the future… which is unlikely to bother most folk much – but if you are required to blast through 20-30k of swimming per week… not ideal…)


anyway.. the surgeon tells me to go away and think about it… at the end of the day he doesnt want to push me into an operation that I dont want to do… and all that blood and gore hammering and nailing stuff obviously doesnt come risk free…

loook… this is what it (the plate) may look like in-situ..  (if offended by blood, look away now….) the arrows pointing at the nerves that must be avoided – or else would end up with a numb nipple = bad result.


Option 1 – Surgery – Plate and Pin.
Pros’ – guaranteed (almost) union of the fracture site.

Risks of Surgery – potential vascular damage, nerve damage (see yellow arrows above), infection, scar… uncomfortable plate position.

Risk of anaesthesi
a – gulp – it scares me more than most things that we medics STILL dont know how anaesthetics work… which equals guess work in my head… which equals fear of the unknown…= out of control = more fear = avoidance. only only if forced
(ok maybe if someone offered me the chance of surgical implantation of Halle Berry’s breasts I may reconsider…perhaps..;)

Option 2:
Conservative/Sling Management.

Pro’s – NO BLOOD AND GORE SURGERY (see above)
Cons – Non-Union = Pain = submaximal shoulder function = pants swimming.

I will only know for sure if I choose option 2 – whether all has healed (as in united) at around 10-12 weeks.

So… (god I’m going on).. if i dont get the butchers to operate now… then i’m gonna have to sit tight till week 12 to see whether nature has done its job. If it has Wooppeeee! If it hasnt it means a potentially much more difficult operation and further training setback.

OK… so all the umming and aahing and crises aside.. the surgeon – Mr R said he really thought I should have the operation and my chances of getting back to swimming would be expediated under Option 1. So I cut my losses and give myself up to his expert opinion… and on Friday (12th March) I allowed myself to be prodded and labelled and prepped for the op.

op-fat(good gracious… I asked them to photograph my good side! – eejits)

Nerves were flying everywhere… by blood pressure was that of an 80 year old fat, diabetic smoker but non concordingly my heart rate was setting off alarms being so darn slow (yay a reminder that i’m an athlete!)

So picture this… i’m in the anaesthetic room, drip in hand sharing some friendly but nervous chat with the anaesthetist (with whom funnily enough I used to see at the student bar – I even remembered that he was a hockey player ;) … when Mr R bursts in profusely apologising… ‘Tamsin, Tamsin… so sorry to keep you waiting, there has been a bit of a … ummm… problem..’
me – ‘Oh?’

goes on to tell me that the plate they had ordered in to nail into my poor C-bone (had to be the best platinum variety if they were ever gonna come close to inserted a foreign body into me…) had had its sterile packaging tampered with.. as in it had a hole in -m non sterile = not useable.

And a backup plan – err… didnt exist.. 1 non sterile plate = no operation.

Sigh…. giggle…smile… was this fate?

So I get dressed again and then Mr R, still red-aced from all the chasing around trying to find another plate tells me he is sorry again and can fit me in on tues…

fine… Can I go and get a Burger King and pint of Stella now please? (just kidding – i rarely pollute my intestines with such rubbish… promise ;)

So since Friday, I have had time to think and have had my Xrays reviewed by other specialists- many of whom sit on the fence and say – ‘Tamsin, we just dont know which way this one is going to go… but chances are it COULD heal fine on its own…’

Long story through my obsessive ruminations over the weekend … which became remarkabley clearer when I embarked on my first run in three weeks…

The sun was shining it was – for the UK – warmer than it had been since last October – a balmy 11 degrees… and I decided that I felt comfortable enough to run. and I ran… and ran … and felt like I could go on and on. Ok so I wasnt running at a world-breaker pace… but all felt good… so 2hrs 5 minutes later… I though prob time to call it a day… just in case.

wonderful… Its at times like this when I remember how lucky I am to have caught the Tri-Bug and decided to get fit… running is a great clarifier.

Sunday night – wee bit of pain… bit like a grating really… but nothing crazy. monday morning – I trot into see Mr R again and say – Sir I reaaaaally dont want to have this operation – can we give Option 2 – (conservative Mx) a shot? another long talk about pro’s and cons – another two surgeons’ come into examine me… I even let a few nurses and medical students in to have a poke … the more the merrier..

He tells me – aaaagain… its down to me..

So thats it folks – my decision NOT to operate on my collar bone is based on my female intuition and instinct – bloody waste of time those 6 years at med school eh?

Onwards and Upwards…

so now – Rehab… I’ve done the Priory (in a professional capacity)- kicked the Diet Coke/Chewing Gum/Red Wine/Massage addiction… now for my bones….

amy-winehouse-rehab-ur-doin-it-rongLets get it right!

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Back in Blighty

Monday, March 8th, 2010

My last 10 days in Thailand – had been a little more relaxed than the rest of my fellow Team TBB mates.  Enforced rest was upon me… and it was not for once welcomed.

I headed up to Phuket to a ‘fancy’ private hospital to get my C-bone reXRAYed and to seek advice from an ortho specialist there.  Well he spoke English, so that was a start… and I must admit was pretty impressed by the facilities at Bangkok Phuket hospital.  Meets international standards for private hospitalisation and I spied a fair few westerners wandering around with their drips … and began to guess which cut price operative procedures they’d jetted to the sunny side for. I spotted at least three boob jobs, two possible knee ops… and one lady who i think had pushed caution to the wind and gone for face/boob/tummy/knee/hip op… it wasnt pretty!

So getting the word from the surgeon that he didn’t think my need for an op to repair my beleagured collar bone was imminent – he tightened my figure of eight ‘brace’ – put me in a sling and sent me on my way.  The next four nights were spent in ’5 star Freddy’ accomodation.  I started off at The JW Marriot Resort and Spa in Phuket. … but decided after a few hours there… that it really wasnt my cup of tea…. beautiful – yes…. but far too generic – like you could be anywhere in the world in a similar place – no real authenicity.  Then it came to the steak dinner with some rather stunning Sauvignon Blanc – absolutely delicious (and not a chilli in sight!)… but then the bill came and I realised that spending $50 on dinner a night was definitely not feasible – given my now status as an (otherwise unemployed) professional athlete.

So i kicked up a wee bit of a fuss and asked for my money back – and moved – to a place up the coast where I had stayed some 5 years ago.  Secluded and serene, feet away from the Andaman Sea.  just the place for some down time.  Now those of you who think enforced rest means no exercise – well not really.  Brett had given me the ok to get on the bike in the gym – so I was there 48 hours after the accident… sitting up on the bike pushing some high gears.. trying to keep some strength in my wee legs.

I’m no good at being on the other side of the fence – i.e a patient, and often am pretty pants at taking my own advice to take it easy. But its all in perspective… i didnt do anything stupid – but lying around waiting for my bone to heal – isnt my style.  There is a fair bit of evidence to suggest that bone healing post fracture is enhanced by a diet rich in vitamin C and Calcium and Vit D.  Well I have eaten by body weight in fruit almost daily since my time in Thailand so my ascorbic acid levels were constantly topped up…. and of course the effects of sunlight on the skin increases Vitamin D levels… so that just leaves the Calcium… so added a bit of extra dairy to my daily intake… every little bit helps ;)   So we’ll see.

Tomorrow will be 2 weeks post accident and its time for another XRay and a consultation with a renowned Shoulder and sSports medicine specialist.  He will give me the final say on whether he thinks an operation is necessary.  I have in pretty firmly in my head that an op is not the way forward but I have to think about my return to function – and long term its gonna be swimming which will be the hardest to get back to… so i want my c-bone in tip top shape!

The last few days I came back from Phuket to Krabi… saying goodbye en route to Brett at the airport ….   my heart sank a little driving up to our team base… and little sadness that I couldn’t join the others in their sessions.  Took me 10 minutes of feeling sorry for myself before I thought of a new challenge which could keep me occupied and the muscle fibres active… the climb up to the Temple on top of the mountain.  1226 steps. Easy I thought… and then I started to climb and noticed some people coming back down…. they looked shattered. One said to me – she couldnt do – too steep and she was scared of heights… hmm one wonders why she started… but hey at least she tried..

Then I realised – whoah – these steps are steeep.. almost vertical … and I smiled. like a challenge me .. so I started my stopwatch… and 15 minutes and a l o t of sweat and heavy breathing .. later I was at the top.  What a view!   My camera didnt really do it justuce… but could see for miles -a total 360 degree panorama… The Big Buddha was kinda cool too…   my mind quickly snapped back to the climb… and I was off down again, only to come back up for the second time … and then the third.   The other toursists struggling up the steps thought I was mad but hey… we all are us triathletes ;)

I must admit – the next day I could barely walk down the stairs!

The girls had brought me back a turbo from Singers… a fair bit of encrusted rust – but hey it worked so game on.

Sad to leave Thailand and the peeps… especially as was just getting to know James and Scottie.. Donna was sad to see me leave at first but quickly got over this when I bestowed on her all my products I couldnt carry back home… and my ‘home comforts’ like rugs and pillows that i’d bought to make the room a bit more comfy..  she felt like she’d been to a jumble sale!

So now i’m back in the cold but suprisingly bright London.. 0 degrees is no fun – but if the sun’s out all becomes a bit more bearable.  another turbo session and lots of sleep and i’m feeling a bit more alive…  lets see what the specialist says tomorrow ..but he may have a bit of a fight on his side if he wants to get his knife into me ;)

The Steps upKrabi SunsetThe Top of The MountainDe Big BuddhaThe ViewThe Monkeys