Six Weeks - It's Magical!

The physio has been saying to me "the magic date is 6 weeks." She doesn't really know why but she maintains that 6 weeks post-surgery seems to be a big milestone for people like me with a spinal fusion. Well guess what? I think she's right. I walked into her rooms this week and she said just two words: "New man". She felt that I looked different, was walking much better and overall looked like I was making big progress. I felt the same.

Today is 42 days post-op. I've walked 28.8 kilometres for the week, not including local jaunts and coincidental stuff around the house and up and down stairs. I still feel like my back aches a lot, I still have right buttock pain but it all feels much more controllable.

Immediately after surgery my weight started a slow but steady decline as I had reduced appetite and was increasing exercise. That decline had stopped, and indeed somehow in week 5 I put on 500 grams, much to my disgust. However the weight loss has resumed this week and I'm feeling good for it.

The remaining issue is sitting, I can't do that for very long at all and somehow I need to do that in order to return to work. Six weeks was always the target date for return to work. That's not going to happen but there's nothing I can do about that!

I also had an unexpected experience on Friday. I attended the funeral of a fellow pilot, killed in an air crash recently. I couldn't sit down for that long, so I stood for a bit over an hour. Standing still for an hour, however, reproduced an old back problem that I hadn't experienced for at least 10 years and which is not associated with the levels that I've had surgery on! Go figure that one!!

So in summary a really good week. Next target is to start to get off the last 2 painkillers that I'm on.

Day 35...Progress?

This has been a much smoother week. I got some good advice at the beginning of the week and it has paid off with a smoother, though not trouble free week.

The good advice was delivered by a slightly exasperated friend who's "in the business" - that is he's closely involved in these sorts of operations. His advice was simple: "you need to treat yourself like you've been in a major car accident with multiple injuries and you are now in the recovery phase". I think he and those around me felt like I was behaving as if I was recovering from a stubbed toe, and having the same expectations of myself. That really was the big issue - my expectations of myself.

So, taking that advice on board I've had a better week, particularly emotionally. Not perfect by any means, but certainly vastly improved. I've also continued to demonstrate to myself the things that I can't do yet. The main thing is sitting. The more I sit, the more pain I get and the longer it lasts. I also get pain if I walk too far and so I've limited that as well. Having said that I did 22.5 km for the week and a rather epic 5.5 km in one shot yesterday. That was a mistake!

I've also ditched the anti-spasmodic drug this week, with no apparent negative effect. So now it's just two tablets a day. That feels like an achievement in itself!

As for the sitting problem, I'm trialling a Bambach Saddle Seat, at the suggestion of my ever supportive physio. The verdict is very much open on this still. I like the position, but it causes soreness in my inner thighs and if I sit long enough an ache in my lower back. However it has doubled my capacity to sit, from around 5-10 minutes pain free to around 20-25 minutes pain free.

I am seriously keen to hear from others who might have had a lumbar fusion and have direct experience of this chair. Please leave your experiences in the comments.

So the summary is: a much better week/ However the team at work will just have to wait. I'm not ready to start working today guys and it's going to be some weeks yet in my view!

Day 28...time ticks slowly

This has been a remarkably tough week. I think the biggest issue has been a huge gap between what I think I should be able to do and what I can do. I've walked 25.7 km, not including incidental walking - across the road, round the house, etc. That includes one day where I didn't walk at all, except around the house. My biggest walking day was yesterday where I did two walks totalling 7.1 km. I ended the day feeling OK, except for a persistent dull ache in the base of my spine and general aching and stiffness.

For me the tough thing is to remember that 4 weeks ago I couldn't walk 300 metres without sitting down 3 times (and still arriving a pale, shaking mess) and that it's been over 3 years since I've been able to walk 7 km in a day. So that's got to be progress of a massive scale.

Nevertheless I've absolutely been through the emotional wringer. Half way through my long walk yesterday I stopped for lunch and found myself sitting eating my lunch with tears streaming down my face, wondering how the hell I was ever going to walk home from there and whether the pain and slowness were ever going to improve. God knows what the other patrons thought! Anyway walk home I did.

The problem is that I then feel an overwhelming need for sleep. So I slept for a couple of hours before my next walk. This was supposed to be a short walk before dinner. I bumped into a couple of friends and spent some time chatting with them about their plans for a new house. It was a great end to the day and improved my mood no end. So from the deepest downs to a reasonable up. No doubt it won't be the last time that happens, but I am surprised at how emotionally labile I am.

The key stopper for me at the moment is sitting down. Basically I can't, except for very short periods. I do sit sometimes for longer periods (like writing this post) but the suffering that results is directly proportional to the length of time spent sitting. The optimal maximum seems to be about 5 minutes. Not much hope of a return to work any time soon at that rate.

My mental target for return to work has always been 6 weeks post-op. At the moment I can't see myself being able to front up to work in 2 weeks' time. We'll see.

I also desperately want to get into the pool, however there is one little area of the suture line that is healing by secondary intention and I'm not game to get into some foetid pool until that is completely settled.

For those who've had to put up with my intensely unhappy behaviour this week, in person, on the phone or on Twitter, my apologies. I hope I stop behaving like that soon. I'm trying. thanks for all your support.

Day 21...where am I up to?

For those of you still hanging in here, and more importantly perhaps for those of you considering an operation like this, here's a day 21 round up.

First some background. I caused injury to the L5-S1 level of my spine a long time ago when I ruptured the disc. I had a difficult period straight after the injury but since then things have travelled on OK. In 1991 I lost sensation in the front of my right thigh and at the same time I developed an intermittent deep nagging pain in the centre of the front of my right thigh. Those are all things that you learn to live with.

Over about the last 5 years I've developed intermittent bouts of lower back and buttock pain which have become progressively worse. They took up two forms. The first was a nagging pain of varying intensity which at its worst left me flat out on the floor unable to do anything. The other, more troubling, was pain in my buttocks legs and feet which got worse on standing. Towards the end 5 minutes was too long to stand and I couldn't walk either for more than a few metres. That meant that it was time for action.

The symptoms were caused by stenosis of the neural foramina at L5-S1. That means that where the spinal nerves exited the spinal column through a gap, called the neural foramen, they were being crushed. This was happening because the facet joints at L5-S1 were slowly collapsing leaving an ever smaller gap for the spinal nerves to exit. Those are the nerves that control parts of your legs and that's why I had troubles.

My surgery was minimalist. I had a laminectomy, where the laminae - bits of bone behind the spinal column - were removed. The facet joints were also removed and four pedicle screws were inserted - one on each side of each vertebra through an area of tough bone called the pedicle. Then the nerve root on the right hand side was gently moved aside and a piece of plastic (PEEK in fact) called a fusion cage was slipped in between the two vertebrae. The idea was to re-establish the gap which used to be held open by the disc. Saying that the fusion cage was "slipped in" makes it sound easier than it was. Quite a bit of force was needed to re-establish the original gap and to get the cage where it was supposed to be. The cage was packed full of munched up bone that had been removed from my spine and the space behind the cage was also packed full of the same bone. This bone will grow and fuse the two vertebrae together.

Then a rod was placed vertically between the pedicle screws on each side of my spine and finally a cross piece was placed between the rods and the job was finished, but for closing the muscle and skin layers.

When I woke up I was totally pain free at the incision line and on the left side of my back and in my left leg. All the pain I'd been suffering on that left side had gone and has never returned. On the right hand side I had localised pain, muscle spasm and some intermittent leg pain. That has remained, though it's improving.

So to day 21. Here's the situation:

• Walk 5 km;
• Shower and dress myself;
• Sit for up to 10 minutes without too much discomfort and longer with significantly more discomfort;
• I can get in and out of bed and roll over with no external assistance;
• I've been able to manage flights of 20 stairs since day 3 - up and down - unaided;
• I can stand for long periods of time, basically pain free;
• I can lay for long periods so long as it's absolutely flat.

Not bad considering where I've come from. Now to the bad bits:

• I'm still on 2 long-acting opioid pain killers per day plus 1 anti-spasmodic for the spasm in my right buttock. Can't see when I'll be off those, but on the other hand I've weened myself off a bucket load of other stuff already;
• I don't drive because of the drugs I'm on - personal choice;
• I don't know whether my right side will ever get better than it is now and that's not great;
• I'm a bit depressed - people work and do their own thing and I'm left either walking (slowly) or lying down. Movies are all crap, I've read all the decent books I can find and I've listened to my whole music collection I think!
• I'm frustrated out of my brain! I can't sit so I can't work and I can't travel. I feel like I'm in limbo.

The bottom line is I'd probably do it again in a flash, even though the outcome is far from clear. Next week, I'm hoping one last little area on the suture line will be healed and I'll be able to hit the pool. That'll be a new distraction for all of 2.5 minutes, but a new distraction nevertheless!

Two steps forward, one back...

It's day 18 from surgery. Since last weekend I've done another couple of long walks but I've finally had to admit that it's probably not the best thing I could be doing. Finally yesterday, after "good" advice from a range of sources, I took a day off and didn't walk at all. I did the normal walk around the house, read, get food, but that's about it. I did two other things though: I stopped taking all of the short acting opiate painkillers, leaving only two sustained released drugs and something for muscle spasm; and I slept.

I couldn't believe how much I slept, 2 hours, some food, then another 2 hours, then dinner and some TV and then off to bed and slept for 7 hours straight. My body must have wanted to tell me something! I also didn't get bad withdrawals from the painkillers. I'd been expecting worse, all I really got was feeling slightly hypersensitive and grumpy. Some who know me well would say "what's new about that?"!

Today I hit the road again with a small 2km walk and after talking to the physio I'm going to try and stick to a smaller number of shorter walks - around the 2km length rather than a 5-6km out and back marathon.

My surgical scar has one little area that's not quite healed, so I'm hanging out for that to sort itself out. Once that's healed I can do some deep water walking. I'm so bored at the moment that even a small change like that is something to really look forward to.

What's particularly wearing is that I can either walk, stand or lie flat. I can only sit for very short periods and I really suffer if I try and sit for longer. No trips in the car to speak of, no going out to lunch with someone (I tried and suffered afterwards). So life's pretty boring.

Still I should stop bitching. The signs for the long term outcome are pretty good and I managed through some contortions to put my own socks on today. Big win! Don't ask me how!!

Things will no doubt improve as I'm able to do more. Till then I'm like a caged lion!

Hey and thanks for all the support and suggestions on Twitter - you're champs, thank you!

Walking, walking

I'm used to walking at a pace that competes with the best of them. I guess that's at least 5.5 - 6km/h. Right now I'm only able to keep up about 2km/h. So that gives me plenty of time to sight see and smell the roses. I expect that speed will climb quite quickly but it's fast enough for now.

The surgeon had asked that I start off slowly and then build up to a reasonable walking distance each day. I'm not sure what that means exactly. I got out of hospital on Monday and managed to do a 1.0km walk that day, which seemed quite puny to me. That was in addition to all of the coincidental walking around the house and a visit to the super market. The next day was a little more at about 1.2km.

Then I stretched my legs and walked 1.7km the next day followed by a 2.0km day on the Thursday and a 2.1km day on the Friday.

All of this taught me two things: firstly I can't do speed just at the moment - I've still got a little bit of a drug load on board so I'm particularly careful crossing roads and checking where I put my feet. The second is much more galling: the run-up to the surgery was pretty rough, to the point that I couldn't really walk at all - 150 metres saw me out. Add to that a week in hospital, even though I did wear out quite a bit of the carpet walking after the surgery, and you end up with somebody who's seriously out of shape. I'm trying to put that right, but it's galling to raise a sweat just ambling somewhere at 2km/h!

My 5km jaunt yesterday left me pretty sore and sorry for myself so today I may slacken off a bit. We'll see. I can't see a trans-continental jaunt in my near future though - sorry Forrest Gump!

How do you do that?

So out of the ward, down in the lift, across the road and we're at the car. I'm not allowed to bend at the waist, I'm not allowed to twist and I'm not supposed to sit with my knees higher than my hips. So how do I get into the car seat? Well gingerly for a start...I got the car door open as far as it would go and sat on the edge of the seat facing outwards. Of course all modern cars have seat bolsters designed to retain you as you circuit the Nurburgring at 200+ km/h. All very useful in that situation but for my purposes a pain in the arse. Once perched on said seat bolster I then pivoted my legs into the car, after having somehow got my head inside without bending, twisting or doing any of the other forbidden things. The result, if done well is a simple pain-free entry into the car. The alternative is, well let's call it a mess. It works well though, so well, that a friend still uses it 17 years after his operation.

The ride home wasn't as bad as I thought it would be. The surgical site and my back are remarkably impervious to bumps and jolts. I'm simply not troubled by most of what a modern road can throw up.

Of far more importance was the problem of getting on top of drug management. I arrived home in possession of 7 different drugs, each with their own raison d'etre, timetable and regime. Up to that point I'd been rattling back about 20-25 tablets a day, not to mention various potions designed to keep the trains running in the face of the constipatory forces of the other 7 drugs. A spreadsheet was the only answer. Each drug, it's maximum daily dose, suggested dose and timing was set out in the spreadsheet and off we went on the magical mystery tour.

Quite quickly it became apparent that firstly my requirement for pain relief was falling and that the spreadsheet was allowing me to target my drug use to periods of need. Monday the intake fell to 15 tablets, Tuesday it was down to 10 tablets and by Wednesday it was down to 6 tablets.

Two things became apparent at that point: firstly my pain wasn't quite under control and so I was wasting my time a bit. Secondly I was having bouts of what turned out to be withdrawal. Shakes, shivers, sweats, anxiety...as I weaned myself down from the high levels of drugs.

Thursday the total number of tablets is back up to about 9 and that seems, for the time being to be the right balance. I'm hoping that I can carve into that further over the weekend.

The other thing that has to be tackled is my rehab programme. This can best be described as the modified Forrest Gump programme. Instead of "run Forrest, run" it's a case of "walk CA, walk". Basically the idea is to start off slowly and to build up to several kilometres a day over a period of weeks. Of course me, being me, the idea became fixed in my head that if small walks were good, then big walks were better. I'm currently paying the price for that as well!!

Overall though, this surgery is a miracle so far. The only thing I can't do for myself is to put my socks on. I can't work that one out yet. I can do anything else I've tried so far with some ingenuity including picking things up off the floor. That involves squatting, down on one knee, down on both knees, pick up the object and then the reverse the process. Stairs are no problem, though they're treated with due respect and driving is out of the question. I'm carrying too much of a drug load to want to be out on the roads at the moment, though from a purely physical point of view I think I would be capable of it, without the drugs.

More to come as I explore the niceties of a recovery as opposed to mere functionality.

The path to the exit...

What wasn't so great was that my right hand side, which had been largely pain free before surgery was now painful. It was as if I had swapped the pain from the left to the right hand sides! The explanation was pretty simple: I'm a big bloke and in order to get access to the various bits of my spine and to place the screws and the fusion cage it was necessary to use a fair amount of force, including retractors and a "scissor jack" style distractor to re-establish the old disc space. This led to some substantial bruising and perhaps some bleeding. I suspect that the "handedness" of the surgeon who inserted the cage from the right hand side also had something to do with it.

The upshot of all of that was that it was hard to get and maintain pain control. I kept getting muscle spasm in the right buttock and that is a vicious circle - more spasm = more pain = more spasm. At about the same time the line in the back of my left hand got knocked out by a clumsy movement and an attempt to re-establish a line in my right hand was unsuccessful. That left me without access to morphine. The whole situation culminated in me sitting on the edge of my bed in tears at midnight one night unable to cope with the pain. A phone call or two and a sharp increase in pain control medication got the situation back under control. In retrospect that was the nadir, life improved quickly from there.

Days three and four saw the return of the torturers (the lovely physios)! They had me out walking again, firstly with the frame then without, then climbing three "mock stairs" then out to the fire stairs for a scary unaided climb up and down one flight of them. At the end of that process they declared that they were finished with me and I was fine to go home!

Friday also saw me off to the X-Ray department for a quick picture to ensure that everything was where it should be. Only two things were holding me back now: pain control and the delicate matter of "opening my bowels". To put it bluntly you can't go home until you can control your pain successfully and until you've demonstrated your ability to have a crap! Opiate pain medication is not helpful in achieving the second of those goals!

As far as pain control was concerned I was getting about 2 hours between bouts of medication. My nights consisted of two hours sleep, some medication, half an hour's walking the circuit of the ward and another couple of hours sleep before the cycle started all over again. I could shower myself, dry myself, dress myself. The drain and catheter had been removed. I just wasn't really on top of the pain and it was now 7 days since I'd had a crap. Finally on Sunday night it all came together and on Monday morning - 7 days exactly after I'd entered the place I was kicked shakily out onto the street.

Working Back Through the Intervening Days

So what happened after coming out of surgery and leaving hospital on day 7? Well quite a lot really.

I vaguely remember this insistent voice in recovery saying "what's your pain now dear?". The scale is 1 (no pain) to 10 (unbearable pain, worst you've ever felt). I remember answering "7" every time. It sounded like a good number in my semi-conscious state. The unexpected result was that I arrived on the ward from recovery with 40mg of morphine on board and quite quickly accumulated another 4mg. Life was pretty painless at that stage!!

I also had various tubes and lines in place. A venous line into the back of my left hand, put there by Charles when he anaesthetised me and now being used for the Patient Controlled Analgesia (PCA). This is a marvellous device that delivers 2mg of morphine every time you press the button, limited to 1 press every 5 minutes and 95mg total over some time period which I never worked out.

I also had an arterial line in my left wrist, which soon came out leaving a big bruise; a drain from the wound on my back and an in-dwelling catheter in my bladder to remove the need to get up to go to the loo; and finally a further "spare" venous line in the crook of my left elbow.

The wound was dressed with a waterproof dressing which was in turn covered with a heavy "cushioned" dressing of something like rubber or neoprene. I never suffered the slightest pain from the suture line, however all tapes and adhesives give me some degree of inflammatory reaction so that was an issue from time to time.

Bruising after removal of the arterial line from my wrist

The first 24 hours focused on keeping pain relief up and helping me learn to turn with assistance from the nurses. I was allowed no water or food whatsoever until bowel sounds returned just the occasional wipe around my mouth and gums with a dampened swab. Once small bowel sounds returned I was allowed crushed ice to suck. What we were all waiting for was a full-blown fart! A sign that my gut was again working. Apparently surgery on the spine can cause your gut to go into a sulk. Taking food or drink in that situation leads to nausea, vomiting and other dire consequences so crushed ice it was. Finally about 50 hours after my last food I finally produced the requisite fart and was allowed to begin a light diet.

About 30 hours after I returned from surgery I was encouraged to hoik myself out of bed and into a vertical position. This involved edging towards the edge of the bed in lateral recumbency and then pushing up with my arms as I swung my feet to the ground. That happened all in one motion and got me to a sitting position with the minimum of twisting and very little pain. From there it was simply a case of using a small walking frame and what remained of my wasted thigh muscles to rise like Lazarus to my feet. The first thing I noticed was that my left side, that had been so painful pre-op, was now completely pain free.

That ws a huge milestone getting to my feet again and taking a few small steps.

7 Days On

Pedicle screws, rods, cross link and the radio-opaque markers in the fusion cage (from the back)

Pedicle screws from the side showing the hardware at the back and the radio-opaque markers in the fusion cage.

Last Monday morning, bright and early at the hospital for all the clerkly things to happen, then to be weighed, have blood taken, an ECG done and finally to meet Charles, the anaesthetist - and coincidentally the guy who was going to be keeping me alive for the next few hours. After those formalities and me grilling Charles, it was off to the holding bay. This is a little area just outside theatre and was the last walk I was to make for a few days. I was placed on a trolley with a big sign "Pre Warm". I was placed under a large bubble cell blanket that was in turn connected to a hot air blower. The idea being that I was going to be in a cold environment for the next few hours so I might as well get as warm as possible.

Next on the list of visitors was Tim, the surgical assistant. Tim was a friend of a friend so a nice chat helped to bust my mounting anxiety.

Finally Peter the surgeon came along for a chat and I was wheeled in for Charles to weave his magic. The next thing I recall was Peter telling me that he'd just rung my wife and that all had gone well.

Operative time was a very quick 140 minutes - we'd all been expecting 180 to 220 minutes, so that boded well.

During the operation Peter had removed the laminae from between the L5 and S1 vertebrae, together with the facet joints; cleaned out the intervertebral space; and inserted a fusion cage and finally placed 4 pedicle screws, two rods and a cross link. As well he had opened up what remained of the neural foramina on both sides to give a clear path for the nerves to exit.

So far, so good and I was off to the ward.

D-Day the early morning

Alarm went at 5:00am, I have to be at the hospital at 6:30. Currently making coffee for others! I'm hungry, thirsty and dying for a cup of coffee...and I can't have anything.

That saying "ignorance is bliss" has got a lot going for it. I think if I didn't know what was at stake here I might have had a decent night's sleep. Instead I tossed and turned and worried.

Soon it will be off to the hospital and I'll talk to you on the other side. Wish me luck.

D-Day minus 1

Tomorrow's the day. I'm having a single level spinal fusion - L5-S1 - with inter-body fusion cage, pedicle screws and rods. Doesn't sound too bad when you say it quickly.

For years I've had back problems firstly with a ruptured disc at this level and then as time has passed the facet joints have collapsed and I've developed stenosis of the neural foramen, particularly on the left side. In plain language that means that the nerves that run down my leg are being trapped and squashed.

Over the past 3 years or so it's become increasingly difficult to stand - 5 minutes is generally too long now, and increasingly difficult to walk. A couple of weeks ago it got to the stage that I had to sit and re-gather myself 3 times whilst walking a single city block. It makes life pretty limited. Going to the art gallery is out of the question, travelling is a problem if you have to queue at the airport or walk to your departure gate. About 2 weeks ago I went to listen to the MSO. It was all I could do to cope with the queue and get to my seat - a real feat of endurance that left me pale and shaking.

So to surgery. The problem with something like this is that no matter how intolerable the chronic pain and reduced function is, the prospect of surgery is not nice, not nice at all. You know that there are risks, anaesthetic risks, surgical risks... and you know that you are going to face a period of acute pain, rather than the chronic pain you have been facing. You are going to be in the hands of others, dependent on their care and skill. Not to mention minor indignities and inconveniences.

I'm supposed to be first on the list tomorrow morning - around 7:00am - and I'm told that it will take 3-4 hours for the procedure, followed by a week or so in hospital and 6 weeks off work. I'll try to keep this blog up-to-date, no doubt for the first couple of days it will be entirely unattended, but as soon as I can I'll give you some details.

That fetish

I'm feeling a little confessional this morning so I thought I'd tell you about one of my fetishes. It's about bags, I can't help myself, I just like bags. I know I'm not alone and I bet a fair number of you also share this fetish in one form or another.

First let me set your mind at rest, it's not a fetish for black garbage bags (go and google that one) nor is it a fetish for handbags. I confine my fetish to functional bags - a bag to carry my stuff to work or to carry around a camera or two. David Alan Harvey, of National Geographic fame, has a serious camera bag fetish. It puts my mild obsession to shame.

Years ago with me it used to be highly functional bags made of all sorts of high tech fibres, designed to stop a speeding bullet at ten paces and protect your camera from anything the world could throw at it. In the mid 1980s I remember buying a Tenba camera bag for, what was in those days, large sum. It was a great bag, not too deep, decent dividers, various pockets and padding. All in all a great bag, including its nondescript grey colour. The problem was it was made, I think, of an early version of Cordura and it wore its way through any fabric it rested against. Your clothes didn't stand a chance. A couple of years ago I dragged this same bag out of its resting place because I had a use for it. Unfortunately the waterproofing in the bag consisted of some sort of coating on the inside of the Cordura. This coating had parted company and disintegrated into a fine dust - the kind that is designed to penetrate - and stick to - every part of a camera or lens. That was sad because it was a good bag, nobody seems to make those shallow, minimalist sorts of bags any more.

More recently my fetish turned to Crumpler bags, first a Fux Deluxe messenger bag, then a variety of computer bags and most recently a computer knapsack. Whilst I really like the look and feel of an elderly, grubby, Crumpler messenger bag, they don't grab me like some other bags. Nor do they quite cut it in the "perfect work bag" stakes.

Now we come to my most recent fetish. Maybe it's something about the ageing process - mine not the bag's - but as I've got older I've come to value the qualities of "old fashioned" materials over the latest high tech carbon nano particle gadget bag. Enter bags by Billingham and others.

The thing about Billingham bags is that they're made of very old fashioned stuff - laminated canvas, cotton webbing and leather. They shouldn't really be effective camera bags...but they are.

Now the next problem with bag fetishes is size - I always seem to think I need a bigger bag than I do. My first Billingham bag was a 555, I can load more kit into that bag than I can lift! In fact I can't work out why I bought that bag. It's so big that nobody in their right mind would try to carry it. I use it as a container to lug stuff around in but I don't try to walk anywhere with it.

My next Billingham bag I decided was going to be a sensible size. I had to be able to carry it when it was full and it had to sit comfortably. "Buy a Hadley" they all said to me at the shop when I told them what I wanted. I tried the Hadley and decided it was too small. I tried the 225 - a great little bag - and decided it was too small. You can see where this is leading can't you?

I ended up with a 335, this is also a great bag, but you can never use the words "small" or "little" in the same sentence. You could take this bag away with you to Outer Mongolia for 6 months and carry enough gear for a professional assignment. A great bag...just not what I intended to buy.

Meanwhile my back's been getting creakier and my bags appear to be getting heavier. So off we go in the search for another bag. I've got to the stage that I don't tell my beloved that I'm bag shopping and I sneak the new purchases into the house hoping they won't be noticed. She's a very tolerant woman but my bag fetish is a bit much for her!

This time I went straight after the good advice bag - a Billingham Hadley Pro. It's a small looking bag but it takes a surprising amount of stuff. I can fit a Leica M, a couple of lenses, notebook, keys, passes, "first aid kit", pens, wallet, MacBook and various other cords, chargers, earphones and stuff. It doesn't weigh too much and it sits comfortably on my shoulder. When I went to buy it, they only had black. I didn't want a black bag, but I wanted a bag. So I bought the black one. It's actually turned out to be an inspired choice. It blends in and it doesn't look like I'm straight out of the British Raj. I just hope that it doesn't overheat in the summer.

Interestingly the bag tags didn't tell me what the material is, however on the Billingham site it says that black bags with nickel plated fittings are made of their new, synthetic, FibreNyte material. If it is, it's a great copy of canvas - it looks and feels just like their canvas.

Oops I realise in this exploration of my fetish I haven't told you about the important sub-branch - Pelican cases...never mind another day.

For those who are interested I'll work up some piccies of various bags to add later.

Ears yet again!

Day 14 is drawing to a close. I've just had my first 24 hours pain free and that is a bit of a revelation. I'm hopeful that it's all plain sailing from here. I was surprised at how painful the procedure was and how long the pain persisted. Since about day 10 the pain has reduced and my reliance on painkillers has also reduced. If there was one thing I hadn't counted on it was the pain - ears are clearly sensitive!

The other unexpected thing was the infection. I suspect that suture removal at the beginning of day 4, may have resulted in the infection. By day 6 I had a substantial infection and that ultimately needed both oral and then IV antibiotics. I finished the course of antibiotics on the morning of day 13 and the infection had certainly cleared up.

Now whilst the ear is tender to the touch it is vastly improved and the outcome looks pretty good as you can judge.

Day 6, two days after the sutures came out

Day 14, well on its way to looking like any other ear

The one outstanding issue is loss of sensation. I've got a large area that runs up the back of my ear and over the top at the centre that has no sensation. As well the area inside the auricle above the graft is also without sensation and of course the graft itself has no sensation. I'm told that this will resolve but it is certainly unexpected and mildly unpleasant.

So really that's the story! The surgeon says I'll get improvement in the look of the graft over then next 2 to 4 months. I'm pretty happy with how it's looking now. When the last bits of serous scab resolve and the surface of the skin renews over the next few days it will look almost indistinguishable from the rest of the ear.

I spoke too soon

Not long after my last post, my ear began to get sore and tense, with some drainage. Saturday afternoon, AFL Grand Final replay day...not a great day to have problems. Nevertheless I toddled off to the Emergency Department at the local hospital. The doctor had a look and called the surgeon. Very quickly I found myself with a drip in my arm running in a dose of IV antibiotics. Next, a short trip across town and I found myself being admitted to hospital for more IV antibiotics, a dressing and observation.

Great care from everyone but not what I planned for Saturday night.

Hopefully this will start to run smoothly sometime or other!!

The ear update!

Today is day 8 and all of a sudden over the last 24 hours things have improved. I'd really got myself into a little black hole with the unrelenting pain. All from such a little procedure!

After the sutures were taken out on Tuesday the ear seemed to get worse not better. I was getting a lot of serous exudate from the graft site and it was very painful and swollen. On Thursday morning things started to get a bit mucky. It wasn't readily apparent that I had an infection but I took myself off to the doctor. His view was that it was infected and that this was also the reason it was a bit swollen and sore. He prescribed antibiotics and within 8 hours life had taken on a whole new meaning!!

It's amazing how release from a bit of misery makes you feel so much more positive and happy.

I'm now looking for a hat to "shut the door after the horse has bolted" as it were. I want something that I can wear with a suit or casually to protect my ears and face in summer without looking more like an idiot than I do now! Any suggestions?

Ears and things...

Where's your hat? Stay out of the sun! I can remember my mother's refrain from childhood. I was a very fair skinned kid and sunscreens were really not available when I was young. Consequently I was regularly burnt and on odd occasions I developed sunburn blisters - unpleasant and painful.

As I've got older I've become increasingly obsessive about sun protection - hats, screen, sunglasses, long sleeves...The problem of course is that the damage is done. All that childhood exposure is now revealing itself in the way of solar keratoses, and various bits and bumps. The dermatologist removes them or freezes them off and I go away for another 6 months.

About 12 months ago I became aware of an area on the face of my ear that developed a small crust and wouldn't heal. The dermatologist gave it a blast with liquid nitrogen but it reappeared. A biopsy revealed a Basal Cell Carcinoma (BCC). These things are slow growing but can be difficult to completely remove. I was referred to a plastic surgeon. He said "you'll be surprised how extensive this is". I wasn't! By now it had stretched from inside the antihelix across the face of the ear and up to very close to the ridge of the helix. The decision was that it had to be surgically removed and a full thickness skin graft used to cover the defect caused by the removal.

The ear in question with the graft in place - day 5

The surgery was scheduled as a day procedure. When the time came I was placed on my back on the operating table and the anaesthetist gave me a sedative and a short acting narcotic painkiller through a canula, whilst the surgeon infiltrated my ear with local. I was aware of what was going on but the drugs prevented me from feeling the pain as the local was injected and made me happy to just lie there.

The procedure involved removing the neoplastic tissue and a 2mm margin around it. Then a full thickness graft was harvested from the groove behind the same ear. I could feel the pressure of the cutting, snipping and pulling as the graft was harvested. Then the graft was trimmed for size and sutured in place with lots of interrupted sutures using nylon. I chatted briefly to the surgeon while the graft was sutured in place.

Once that was done the ear and surrounding hair were cleaned up, the drapes removed and then I shifted myself from the table to the trolley to go back to recovery and then after a couple of hours off home.

My ear was numb from the local. As that wore off later in the evening the pain began. Initially the pain was from the donor site for the graft. It was closed with dissolving sutures and because it was quite tight it was very painful. It was reasonably easy to control the pain with Nurofen (ibuprofen) and Panadeine Forte (paracetamol and codeine). However I required regular pain relief every 4 to 6 hours and sleeping was a real problem. I could only sleep on one side and moving hurt - it's amazing how and where your face and neck muscles are interconnected!

The surgery was latish on Friday afternoon. The weekend required regular painkillers but it wasn't too bad. However the pain got worse not better! I removed the dressing on Monday morning as directed and showered as normal before going off to work. My ear was swollen and sore with areas of numbness where nerves had been compromised. The graft looked like something out of a horror movie and there was some bruising and tenderness in various areas. Enough to frighten small children and squeamish adults!

Monday was a big day and I was glad to get home after work for a nap. The pain on Monday night was worse and I spent a fair part of the night awake as I waited for various doses of painkillers to kick in. Part of the pain seemed to be from the swelling and part from the increasingly tight sutures. Early on Tuesday morning the surgeon took the sutures out which was a bit of an ordeal and left me pale and sweating. He cleaned up the graft and declared himself happy. He put a vaseline gauze and a simple dressing in place for 24 hours. After that he directed a daily soak and cleaning of the graft with saline followed by a smear of petroleum jelly to keep the graft moist and supple. I'm to see him in 16 days.

I managed almost a full day at work on Tuesday, despite feeling shaky and looking pale, I had lots that needed doing - the surgery having coincided with a critical stage in a big project. Finally in the late afternoon I had to give in to the pain and go home. Tuesday night was bad from the point of view of pain control. I woke on Wednesday morning, after limited sleep, feeling pretty crappy. I finally gave in to the inevitable and took the day off work. I hope that will let me get on top of the cycle of pain and sleeplessness.

I'm left feeling that I cannot for the life of me understand why people would undergo this sort of pain for cosmetic reasons. In my case the BCC had to be removed before it spread further. However I can't understand why people have facelifts, boob jobs etc. It's just too painful!

Secondly all I can say is: if you are young then please take care of your skin. This kind of procedure is painful, costly and despite the skill of the surgeon, it will never look like it did before.

The anti-Craigslist campaign and other stupidities

It may not be a big thing on this side of the globe, but in the US there is a major campaign against Craigslist. Broadly the campaigners claim that Craigslist provides a way for criminals to pimp and traffic young women for sex. By inference it appears that they believe that Craigslist does nothing to stop this trade, that it is widespread within Craiglist's listings and that the company is venal. We now have young women's advocacy organisations rejecting donations from Craiglist.

Meanwhile the Attorneys General of 20 States in the US have run a campaign to force Craigslist to close its Adult Services section. Note that it appears that there is no legal reason for Craigslist to do that. One assumes that if even one of those Attorneys General had the legal means to do so they would have taken action in the courts to force Craigslist to take action, Instead we have a campaign that has sought to harness public opinion against Craigslist.

It appears to me that we have the modern day version of the lynch mob chasing Craigslist and without sound reason.

The argument used is that Craigslist and other websites provide the ideal place for criminals to traffic young women, and that they are used by those people in that way. The anti-Craiglist lobby argues that the problem is huge. This quote (and the others to follow) is from a CNN news report:

"Nobody knows what the real numbers are," said Ernie Allen, the NCMEC's (National Center for Missing and Exploited Children) chief executive. "I'm also confident that the internet has changed the dynamic of this whole problem. We're finding an astounding number of kids being sold for sex on the internet."

Allen said the best source of information on the number of underage girls being trafficked online are websites themselves. While online classified giant Craigslist shut down its "adult services" pages in early September, other sites like Backpage.com are filling the vacuum left behind, he said. And while there are clues in the way the ads are written, only a small fraction of them get referred to law enforcement or organizations like the NCMEC.

Let's be clear before we go any further that we all know that even one exploited child is one too many. That's something that I feel very strongly about. Equally I feel that in this case the advocates, and as we will later see, the law enforcement organisations are engaged in a massive stupidity. Bluntly they have forgotten that their job is to catch (or advocate for the right action against) the criminals who exploit children and instead have embarked on a campaign without evidence against Criagslist. My message to the NCMEC and all of the law enforcement agencies is this: If the problem is as large as you claim then you are simply lazy and not very good at your jobs. You are not doing your job, rather you are seeking to blame an easy target. When you have driven Craigslist from business you will not have made one single ounce of difference to one single exploited child. Not a single bit of difference.

The first sentence of the quote above gives us a guide to what is going on here. "Nobody knows what the real numbers are". That is the standard line used when there is no evidence. However that's not going to stop him or others. What that really means is that these people don't have a shred of evidence but they're still hell bent on their lynch mob tactics with respect to Craigslist.

Further on in that same report we get this:

"It's an outrageous thing to say, but one of our goals is to move these operators into some other illicit enterprise -- to get them out of the trafficking of human beings and into some other illegal business," Allen [CEO of the NCMEC] said.

Yes it is an outrageous thing to say. He's talking about the people that he claims are pimping young girls via sites like Craigslist. Similarly we have this:

In Atlanta, Georgia, one of the country's busiest prostitution markets due to its position as a highway and air travel hub, police and prosecutors witnessed the effect of the internet on the business of prostitution firsthand.

Fulton County District Attorney Paul Howard told CNN that eight years ago, law enforcement began a serious crackdown on the pimps that control most underage victims, until the pimps vanished.

"At that time, we saw a number of underage girls standing on street corners, and they were usually standing there because a pimp had placed them there," Howard said. "After we started our crackdown, we began to notice that the numbers became fewer and fewer, and we were wondering, 'What's going on?'

"What we found is that there was a wholesale transformation from young girls standing on the streets to those same young girls being sold through Craigslist and other internet vendors," Howard said. "That has put us in a terrible position, because much of the illegal sex activity now goes on almost undetected by the police. The numbers we believe remain the same, but what has happened is that they are now out of sight."

So when was the last time we heard about the need for law enforcement to move with the times? These guys are still stuck in a 1960s time warp. The world has moved on guys and the way you need to catch criminals has changed. Why is it that your definition of law enforcement is to run campaigns against legitimate businesses? Why are you too lazy to work out how to enforce the law with respect to the real criminals: the people who place the ads.

By all means if, in the course of doing your job, you arrive at evidence that Craigslist is breaking the law then prosecute them. They have no right to special treatment. But at the moment what's happening is that the law enforcement establishment is targeting Craigslist and allowing the real criminals to go on exploiting women unchecked. That's a shameful situation.

This campaign has moved to the point of mob hysteria is some quarters. A search of Twitter will turn up reams of increasingly bizarre posts lauding the campaign against Craigslist.

What really makes me angry is that all this effort is misdirected. Direct the energy to smart, effective law enforcement. Catch these people and imprison them. At the moment all this campaign is doing is diverting energy from the real actions that will help the young people who are being exploited. That's shameful.

PS: sorry about the formatting in this post...sometimes Blogger defeats me!

iPhone 4 - Ho, hum

The title says it all really. We wanted another iPhone and it seemed pointless to get a 3Gs when the next model had already been released and the price point for a 3Gs was not that attractive compared to the price of the 4.

If you care about design, this is a nice looking piece of technology. The problem however is that it's too thin. If you have big hands then you'll like the old 3Gs better probably. It had a bulge on the back that fitted nicely into your palm and altogether it felt better to hold and use. What is good about the 4 is that it doesn't have the "slippery" character of the 3Gs - the tendency to slide off things and to be slippery in your hand. It's about a draw in my view: the iPhone 4 is designed to sit on a flat surface more than anything else!

If you're using a 3Gs with the latest iOS then you won't actually notice a lot different with the iPhone 4. Yes granted the phone is slightly, and I mean only slightly, quicker. It's not an "oh wow" thing though. It is just a tiny bit more responsive.

The screen on the 4 is however gorgeous. Indeed the screen is the one stand out on this phone. Without the new screen I'd say it was simply a nice revision of an existing product. But this new screen is very luscious. The retina display makes the task of using a small screen just that much easier and it looks delightful. I can't speak for all iPhone 4s but mine certainly has a greenish yellow cast to the screen. It reminds me of the 1980s Nikkor ED lenses. They had a very similar cast and it added a brightness and spark to photos taken with them. I can't tell whether the screen is supposed to have this cast, as mine does, but if it is supposed to be there then I bet it's about making the screen appear as good as it possibly can. The cast is strong enough that it is just barely acceptable. Whites certainly ain't white!

Speaking of colour casts the camera on the 4 is shocking under tungsten or fluorescent light. It simply doesn't know what white balance is. In daylight the camera produces nice photos, but under artificial light it's simply a shocker.

Now for the real cruncher: It doesn't keep the proper time! How hard is that? If you set the time to automatic it is always slow. Please don't give me rubbish about cell towers and carrier software. When sat alongside a 3Gs, using the same tower, it is always, always slow, as it is compared to a MacBook using a time server or any other item of timekeeping equipment. This and the camera and the screen colour cast, taken together, represent my biggest beef with this phone. It isn't ready for real life. Apple need to fix this NOW.

Other issues and problems with the iPhone 4 for me are:

• In iTunes it repeatedly throws errors saying that it requires backups to be encrypted. I don't want my backups encrypted but iTunes with iPhone 4 won't backup at all for me without encryption turned on. When I turn encryption on that's it - I can find no way to turn it off again! What's that about? Also the whole issue of encryption passwords is buggy. I really don't know what my encryption password is because of some aberrant behaviour around setting and changing passwords. That is very bad in my view and requires an early fix from Apple. (iTunes 10.0 (67))
• iPhone 4/iTunes 10 reject perfectly good provisioning profiles for beta software. I have one that's good for another month and it simply won't install the software.
• The home button occasionally does nothing...that feels really buggy;
• Battery life is NOT better than my old 3Gs. I used to barely get a working day from the 3Gs and I barely get a working day from the 4. That means say 6:00am to 6:00pm - it will often shut down on the way home. I religiously charge it to 100% every night but it simply doesn't last the distance. I use it all day every day at work with both private email accounts and several Exchange accounts as well as shared calendars. That's the way my life is and I suspect that's why the battery life is so poor. It isn't good enough though. I find myself obsessing about making sure I have a charger and USB cable everywhere I go. Not terribly useful;
• Now this issue isn't an Apple issue but it really, really bugs me: On the 3Gs I had a great silicone case. It had, in addition to a cover for the back, a piece that covered the home button and a similar piece at the top and was thick enough to provide some grip and protection to the iPhone. The silicone cases I've seen for the iPhone 4 and the one I have are, in a word, useless. They are these little soft skinny things that seem more like a little black dress than a working item. They give the phone no protection, they come off when you pick up the phone or pull it out of your pocket. They seem designed only to show off the iPhone 4 in all its anorexic, super model skinniness. These are working tools not fashion accessories. Can't some manufacturer give us a decent silicone case that stays on and protects the phone? It's not that hard...you did it for the iPhone 3 so you know how.

So overall a pleasant upgrade to the iPhone but nothing startling and with some unresolved problems. I haven't had the death grip problem but its country reception is worse than the iPhone 3Gs.

The resolution of the election

There's been a lot going on, so these are just some random thoughts about the (non) election which, whilst indecisive, I believe is all to the good. Already we've seen Tony Abbott in his true colours, first refusing to submit his policies to Treasury for costing and then, inevitably having to agree to do so. Why didn't he just agree in the first place? He looked very silly behaving the way he did: result shot in foot with own gun!

Julia Gillard on the other hand is desperate about this: she wants to "win" this election so badly she can taste it. By that I mean that she wants to be able to form a government. If I was her I wouldn't want to be the shortest lived Australian PM. It also appears that she isn't sleeping very well - she looks tired and drawn.

What we are seeing, despite the missteps from Abbott, is that both sides realise that this is the end of their picnic. They can no longer behave like they have been and expect the Australian public to cop it. I hope the independents keep whoever forms government on their toes. In this regard we want no backsliding.

The other thing we want no more of is Julie Bishop's heckling from the sidelines. As a deputy leader of a major party she has a very limited repertoire and none of it is either very useful or very flattering. My view is that she would do her party a great deal of good by learning a new repertoire that had some positives in it, which focused on what her party was going to deliver and how, and which stopped with the bagging of all and sundry. Enough already from you Julie.

Now to the "independents", Katter, Oakeshott, Windsor, Wilkie and Crook. This is where it gets interesting. The first three are tending to hunt as a pack, Wilkie has said he wants none of that and Crook has simply said that whilst he's a National he won't be on the coalition benches. Whilst Alby Schultz might claim that Crook has "done a deal with the ALP" I think we can be pretty certain that Crook won't help the ALP form government. There's the matter of the mining tax. Julia Gillard is in the position where she can't win on that: if she drops it Crook might well support her but a great big chunk of Australia will say "they've done it again, first the ETS now this". That would be pretty terminal in terms of public trust in the ALP. On the other hand Crook is on the record as saying he can't support the tax.

Andrew Wilkie may well be the first to show his hand, and maybe as early as today. Adam Bandt has already shot his bolt, saying very early on that he would support Labor. So the next cab off the rank is Wilkie. Ordinarily I would expect him to support Labor - that represents a win-win for him. He will keep the Labor voters happy in his seat and he will be able to exert independent leverage therefore keeping his own voters happy. However I suspect it is not that simple. Andrew has moments when he appears to be a zealot of the purest type. That being the case he won't do what appears logical to you or me. Watch this space.

As for the other three, whilst Bob Katter points out that the three state electorates within his seat all vote Labor and that his vote is personal rather than party aligned, I nevertheless believe that it will be hard for him to align with Labor. More importantly he is appearing to act as a bloc with the other two independents. Whilst he might want to align with Labor I think that Oakeshott may well be the stumbling block.

My guess, and that's all it is, is that we'll end up with a coalition government supported by the bloc of three. Please note Julie Bishop that has nothing to do with who got the greatest two party preferred vote or any other measure - all that's irrelevant. The only thing that matters is who can go to the Governor General and form a government and who can survive on the floor of the house. But I'm sure you don't get that - you show no public signs of doing so.

The next few days will tell and it will be interesting. What will be perhaps more interesting is whether, in the longer term, the independents and Adam Bandt can move beyond a pork barrelling mentality to understand that they have obligations to the whole of Australia and that they will be badly punished if they don't live up to them.