Fusion Blog

Command Centre
What To Do

Three months of lying around with my foot in the air seems, at first blush, to be a total write-off of my summer.

But it's a longterm investment in walking without pain that I am eager to make.Thinking some more about it, I realize that this is a unique little patch in my life - a time when I won't be required to do much more than brush my own teeth.

I feel strongly that life is precious and I am not prepared to write off even one moment of what I've been given. What then, to do with these three months?

First ...organize my environment to minimize frustration by maximizing capacity for independence. Then, put together some projects that will bring me to the end of this patch exceedingly pleased with what I've done ...and not bored for even one minute.

My surgery is an ankle fusion - to rehabilitate an ankle shattered twenty years ago in an accident. While some details will differ, the strategies suggested here are adaptable to recuperations from other surgeries.

Preparing your Environment

Frustration comes of feeling helpless. Organize your environment so that you can meet your own needs as much as possible.

Where I live the Red Cross offers an equipment loans service. I was able to get everything I needed free-of-charge. That said, every single piece of paper they gave me had painstakingly detailed directions for donations and the walls of the equipment depot are papered in donations appeals ...fair enough.

If you don’t have this option, most equipment is available for rent from medical supply stores or for sale. Home renovation/hardward stores, for example, sell toilet frames and grab bars.

Equipment Options

Wheelchair, Crutches, Walker, Roll-A-Bout
For getting around in tight spaces you will need a walker or crutches. The basic difference is that crutches are two-legged and walkers are four-legged. During the first week after surgery I was unstable and had poor balance. The walker was a better choice to start with. Later, especially once I was able to start putting a little weight on the fused ankle, the crutches worked better. Roll-a-bout

People with really good upper body strength like crutches. Those with not so much (most women) can develop serious pain in their arms and shoulders.Try them out. Practice. Develop some skills while you're still pretending.

The Roll-A-Bout is an American invention and available through the company’s website. www.roll-a-about.comThe cost is $499US. They are expensive but they look real nifty and users report high satisfaction. The principle is basically that of resting your knee on the shelf and “walking” rather than hopping so it is much easier on the good leg. Especially when the “good” leg isn’t so good anymore.

I found a used one for sale on ebay but dropped out when bidding went past $350 US. The company also rents them so this might be a reasonable option.

Another possibility is a device called an iWalkFree. This is a kind of stilt device. It looks a little harder to master but I don't see why you couldn't steady yourself with a cane until you get the hang of it. You can see it at www.healthchecksystems.com/i_walk_free.htm

walkerMy husband hammered together his own version - affixing a plywood shelf to a walker. I rested my knee on the shelf as I "walked" and pushed. I wouldn't want to do a walkathon on one of these, but it worked pretty well around the house.

Other people report pushing themselves around by resting their knee on an office chair with arms then kind of pushing and scooting along. Give it a try but remember you have no brakes so stay away from hills!

Wheelchairs can be useful in your home if you clear the obstructions (like coffee tables) out of the way. For me, the most important function of the wheelchair was the wheels it provided to get me back into the outside world. A lightweight, collapsable model will fit in the trunk of most cars. When choosing one, also check out the width, tire-to-tire. The smaller models will fit through internal doorways - important if you want to use it in the house. Final tip: you will need a leg extension to keep that ankle UP.

Bath Benches
These are plastic chairs or benches with holes in the seat, facilitating showering. They come in all kinds of configurations, from four-legged chairs with backs to benches that fit across a bathtub. You need to look at your best bathing options then choose a bench that will make it easiest for you.

Yes, a plastic lawn chair will work too ...but plastic lawn chairs are light weight and when you are hopping on one foot you will need things to grab onto and a light-weight, unstable lawn chair isn’t a good choice.

Grab Bars
I wish every bathroom had grab bars built into the showers and toilet areas. But they don’t and it may be difficult for your handyman to find the studs needed to firmly affix them. But if possible, yes, have grab bars installed. The more solid things you have to grab onto as you lift yourself in/out of shower and on/off toilet, the better. Home improvement stores sell them in a variety of sizes and finishes.

Toilet Frames
To attach this to your toilet, you remove the seat, then screw the frame between the toilet and the seat. This gives you a stable “frame” around the toilet to assist you in getting up and down on one leg. I’ve seen these at Home Depot for $39 US.

Whether or not you need a toilet frame, will be determined by what else you have around your toilet (like grab bars or counters) to grab onto when you are lifting yourself up and down on one leg. As well, how strong that “good leg” is. When I first injured my ankle I was only 32 and it never occurred to me to look for assistive devices. My ankle fusion occurred at age 54, when my good leg now has an arthritic knee and I will take all the help I can get.

Prepare Ahead

While you are still able-bodied, simulate a casted ankle and work out how you are going to do things ...like toileting, showering, eating and carrying on activities that you enjoy. I wrapped and taped several big bulky towels around my leg and used crutches while I hopped around the house getting in and out of showers and so on. It’s an important exercise because you won’t know what works till you try it and it’s easier to find out something doesn’t work when it’s just a towel around your leg and not a cast.


I can’t emphasize this enough – organizing your environment ahead of time will make your life soooo much less frustrating. Start by looking at what’s all in those drawers in the bathroom and move all the stuff you never use out of the way.

Basket One
Put the things you need into a drawer or basket that you can easily reach ...your toothbrush, toothpaste, deodorant, moisturizer etc. Make sure you have enough of these things to last past the end of 12 weeks. Husbands are hopeless at finding the right moisturizer and if you think you'll solve this by giving him the old container to take to the store ...they will have changed the packaging. Save your marriage - lay in a supply of all your regular products.

Basket Two
Into a second basket put the things you need occasionally ....nail clippers file, tweezers, razor, moustache bleach ..whatever :) Husbands are equally useless at finding these kinds of things so think through everything you might possibly need over the next 12 weeks and make sure it is there.

Where are you going to sit while you tidy up? I remembered a solid old wooden pub chair I had downstairs and it was perfect. It was heavy and not easy to tip, had wrap around arms to grab onto. It was perfect, both for sitting on to clean up and dressing. I also found that by placing my knee on it and grabbing the arms I could “walk” across the room to get in and out of the shower.

I reasoned that if I was going to be cleaning up in the bathroom each morning/night it would be easier all around if my underwear and nightwear were in the bathroom already. I cleared out a cupboard under the sink and this worked great.

What else?
Have a good supply of garbage bags and tape for showering.
Have a supply of clean towels where you can reach them.
Move the garbage can where you can reach it.
Locate a laundry hamper close enough to slam dunk the dirty clothes.

When I broke my ankle at 32 I must have been a lot stronger because I remember lifting myself in and out of the bathtub, resting my casted leg on the tub edge. That doesn’t work for me these days.

During this recuperation I had two options: the bathtub in the guest bath or the corner shower in the ensuite. Many people prefer the bathtub because they can place a shower bench across the tub, then sitting on the edge, lift their injured leg while they swivel into the tub. This wouldn’t work in my house because the tub has sliding glass doors.

The corner shower was a better option for me. I placed a shower chair inside, and a solid wooden chair with arms just outside, facing the shower opening. I was able to sit on the wooden chair, then step into the shower with my good foot, swivel and sit on the shower chair. My casted leg then lifted up and rested on the chair outside. I pulled the shower doors closed around the leg sticking out.

All of this took a few tries to figure out ...while my leg was wrapped in towels. The first time I tried it with a casted leg it went off perfect.

Tips on Showering

Wrap and tape a towel around the top of the cast first – to absorb any leakage that comes through from the top of the bag. Then wrap a big ‘ole plastic garbage bag around that, taping at the top. Overlap the tape onto your skin a few turns so that you have as good a seal as possible. Keep a pair of scissors handy so that you can remove it all easily later. Masking tape worked well for me.

A hand-held shower head is essential.

Ensure soap, shampoo, and long-handled brush are reachable inside the shower stall.

Assemble clean clothes, towels, etc in reach.


What are you going to wear?
If you are a woman, dresses are a good choice for the first weeks. There is simply a lot less to pull up and down. When you are balancing over the toilet on one leg and the other is going boom-da-boom with pain, you will appreciate this.

I bought some cheap ($9.97) t-shirt style night-dresses from Sears. They look like $9.97 but they are very comfortable and have the added advantage of discouraging anyone’s passing fantasies about what all this horizontal lying about might be putting me in the mood for.

The other suggestion was shorts ...and this works better for men. Big, floppy, wide-legged shorts. I also found capris made out of t-shirt material to be very comfortable and easy to get over the boot.

After the initial post-surgical weeks I was moved from a cast/bandage to a removable surgical boot that I could take off for showering - bliss. The nurse at the clinic gave me a generous roll of what I can only think to call "sleeving". This is an elasticized cotton tubing that I pulled up over my leg before putting the boot back on. I cut this into 18 inch lengths and it worked perfectly as a lightweight "sock" between me and the boot.

Where are your clothes?
Test out and choose the clothes you are going to wear during those non-weight-bearing weeks, then gather them together in an accessible place. Choose a drawer or cupboard that is enroute to the bathroom where you’ll be washing up. Eliminate extra steps because it’s just not that easy to hop into the closet for a clean pair of shorts then back over to the other side of the room for a clean shirt then back out to the bathroom to wash and dress. Make it easy on yourself. Organize your environment.

Location of Recuperation

Location One – Bedroom

Some doctor’s want their post-fusion patients flat on their backs for the first two weeks. In any event you will be spending a fair amount of time in first days in bed, so prepare that environment.

Clear out bedside table and make sure meds, waterbottle, tissues, lozenges etc are at hand.

Have a reading lamp that you can read by and an interesting book of short items (short stories, humour, essays, magazines) ready. Your attention span won’t be great in the first post-op days. This is the time for People magazine, not War and Peace.

Have a commode near the bed for the first weeks. Keeping some water in the commode keeps it fresher. Placing an old mat under the commode makes sense.

Have a light blanket where you can reach it – temps vary as you recuperate.

Even though the surgery site will be casted or booted, the blankets may feel like they are weighting it down. Create a “tent” for your ankle by making a table out of a cardboard box or adapting one of those devices people used to use for abdominal exercises – anything to get the blankets off your ankle.

Have several thick pillows available for elevating ankle. I found it easier to sleep with both legs/ankles elevated. Otherwise my pelvis was torqued and woke up with aching back.

Have a heating pad and hot water bottle available for easing pain and sore muscles.

I got a sore back from lying around so much – twisting a towel and placing it under the small of the back offered some lumbar support and alleviated that quite a bit.

Location Two – Command Centre

When you are not in bed, where are you going to recuperate?

At the time of my original injury, 20 years ago, I just happened to have an old La-Z-Boy recliner in my house. I lived in that thing. Preparing for this surgery I headed right out and found another one. Your personal budget dictates where you get his but you can get used one for peanuts. Look for good lumbar support and good lift of the foot pedestal – you need to get that ankle UP.

I called mine the “Command Centre” and friends quickly came to call me “Commander of the Universe” as I literally cruised the universe on my WIFI equipped laptop.

Tips for the Command Centre

Equip your house with WIFI (wireless internet) and beg or borrow a laptop if Carolyn in the Command Centreyou don’t have one. Hours and hours of fun and amusement at your fingertips – never mind the ability to command the universe!

Have phone and list of phone numbers at hand.

If you have a mate or minder on the property, get a couple of those walkie talkies so that you can stay in communication while they clean the gutters or build a new deck. I sneakily gave husband a set for his birthday – they are what every man wants, trust me. Little did he know I was thinking ahead to my surgery. They are great – with a range of 14 km he stays in touch, even on his morning run.

Ensure you can see and control television from the command centre – that means YOU have the remote!

Have a basket with your meds and comfort items in reach.

Line up a series of plastic containers within reach of the chair – each with different projects or activities in it.

Transporting What You Need

You cannot carry open liquids on crutches ...but you can carry closed cans and bottles and thermoses and bags.

If you organize your kitchen so that things you like and need are within reach, you can hop in here, put what you want into your carry bag and hop back to the command centre. I also have a light sweater that I wear a lot – it just happens to have big stretchy pockets. I can put an awful lot in those pockets! Another survivor mentioned that she bought a painters apron and used the big pockets to transport things around with her.

If you are going to be on your own a lot, think about putting a small cooler next to your command centre. In the morning your helper can stock it with a sandwich, fruit, drinks, etc. They can fill a big thermos with coffee or tea and you are set.

What Are You Going to Do With Yourself All Day?

This is where the rubber hits the road folks..... you can either look at this 6-12 weeks as the most incredible gift or you can whinge on endlessly about how bored and frustrated you are because daytime TV is really boring.

Think about it – 6-12 weeks with no responsibilities beyond brushing your teeth. This is an opportunity for some major accomplishments. To come out the end of this experience not only walking without pain, but with some new skills, tools, hobbies .....

Here are some ideas...

Organize that pile of family photos.

Scrapbook your kids lives.

Take an online or correspondence course ...accounting, languages, genealogy, start a degree, software programs....

Learn the in and outs of that software program you learned just enough of to manage and promised yourself you'd master later.

Learn how to design a website (it’s all on the internet) and make a personal, professional, or family website.

Write your personal and/or family history. Don’t worry about how good/bad a writer you are. Just get the facts down. You will be sitting there all day so get on the phone to the old aunties and uncles and ask questions.

Trace your family genealogy. Everything you need is on your lap.

Learn to play an instrument. As I write this I have both a guitar and a harmonica beside me. I learned how to play the guitar years ago so re-learning that skill is on my “to do” list for this recuperation. The harmonica and the “How To” book was a gift on my 40th birthday. That was some time back. It’s now or never. What have you alway wanted to play. There are instrument rentals and how-to books at music stores everywhere.

Read “all” of an author. At the same time, read the biography of the author and learn about what influenced them. Talk to your local librarian. You will be their dream come true. Trust me. They will organize the books for you ...ready for your helper to pick up and return in lots of 2-3 books at a time.

Watch all of the movies you've never had time to see, especially the ones that were made before you were born. Go to your local video store and make a list, then your helper can pick them up as you need them.

Buy an MP3 or IPOD or some such device and amuse yourself learning how to use it, then going to the music site and downloading the specific songs you love. Believe, this takes times ...there are thousands and thousands of clips to listen to. But you’ll be grateful you did it in years to come when you have personally designed playlists at your fingertips.

Write that great novel. I have to confess this is always something I thought I’d do given a little free time ...well, it’s not happening. But maybe you have better ideas than I do!

So ..there’s a few ideas. Come up with your own then set everything up in advance, putting all your "project materials" into plastic containers that you can access from the command centre.

Life is precious. We cannot, any of us, afford to blow off even one moment of our lives. The idea of blowing off 6-12 weeks of one's life is obscene. We’ll never ever get them back again. So enjoy....

Carolyn Usher