Travels in Tuscany driving from Firenze to val d’orcia in our Citroen C3.

May 11 2023.

The trauma

Sunset came and we rushed to join the multiple photographers gathering at the entrance to the property.

We set out a bottle of wine to drink on our return.
Little did we know that fate was to prevent us ever opening that bottle of chianti Classico rosso.

We drove to the gate.

The ground was wet.

I had a new pair of Geoxx sandals.

They had no grip.

I was rushing up the slope on the side of the road.

Sunset was coming and the glorious view that I had wanted to see was imminent.

I came down the small hill with my canon camera in my left hand hoping to assist my wife to climb up.

AND IT HAPPENED.

It was 8 pm exactly.

MY RIGHT FOOT SLIPPED FORWARD, AND I FELL HEAVILY WITH MY RIGHT KNEE BENT / flexed AT THE KNEE.

The pain was severe but the shuddering of my quadriceps muscle and the distorted knee with the patellar displaced down and outwards made an almost grotesque appearance of deformity.

I tried to stand up and pushed the patella into place and collapsed unable to stand with an intense shuddering aim from the ruptured quadriceps tendon AND COMPLETE INSTABILITY.

I KNEW WHAT HAD HAPPENED.

The tendon was ruptured at the quadriceps of the right knee.

The holiday was over.

We had to go home.

I said to linda, “we are going home, get the luggage”

She said “oh no David!”

And with that we phoned Francesca who was in Asciano the neighboring town.

Some other people helped me to the car.

All muddy, I got into the passenger seat.

Leg extended in intense pain.

The muscle in the thigh was shuddering with any movement with intense spasm.

Francesca arrived and helped linda check out and retrieve the luggage.

She advised we get to hospital in sienna.

And so it was …I never saw that famous sunset.

I never drank the wine which we left on that windowsill.

The holiday was over.

We drove to sienna, by which time it was dark. Country roads.

Google map assisted us.

On the way I phoned Dr Engela my favorite orthopedic surgeon, colleague in Cape Town.

I told him i had ruptured my quadriceps muscle.

He said it was either surgery in Italy or return to Cape Town.

Surgery was advisable within 14 days.

I resolved to get to sienna and have the leg plastered in extension and failing that a splint and to get back home for surgery in my own hospital, constantiaberg mediclinic in Cape Town.

We drove to sienna and with great difficulty tried to find the emergency department of sienna university hospital.

We parked at the from entrance whereupon a wheelchair was provided and I waited in triage to be seen.

At the emergency unit we were helped with a wheel chair, directed to wear a mask,  and after a short wait went to triage and filled in the required forms and were sent to wait for the doc.
After two hrs we were directed by the casualty doctor, who believed my diagnosis, with a cursory examination, to a dark passage, outside a foreboding door warning of Covid risks etc.

The hospital was unable to provide me either a caste or a splint or brace, but the doc suggested we get one at an orthotist in Sienna in the morning.

We checked into the Sheraton Four points hotel at 2 am and a kind concierge from the Cameroon, at the hotel brought me from the car using a luggage trolley.

We made our way to a ground floor room.

On the way I saw umbrellas in a bucket at the entrance.

At the room I lay on the bed and sent Linda to get the umbrellas and fashioned a third world splint with the two umbrellas anchored to my shoe and strapped on each side of the leg with belts and a luggage strap

The reception staff phoned around to different suppliers to find a knee brace in stock for purchase.

And so, in that fashion we could go by taxi to a pharmacy, which sold a reasonable, full length knee brace.

We purchased the closest brace to the recommended brace.

And we taxied back to the hotel, said our thanks and goodbyes and checked out.

It was now off to Firenze to drop the car and fly out.

The evacuation

The drive back was crazy.

Me in the passenger seat as navigator and Linda driving through a rain and hail storm, to get to the car hire drop off, which by miracle I had saved on Google map as a favourite so we could navigate their as directly as possible.

On the route, I booked business class tickets from Florence to Amsterdam.

Cost was no issue … we were desperate to get back and the only way to fly with an outstretched leg was in business class.

Once we dropped the car, we waited an hour for the taxi and booked into a hotel near the airport aiming to fly out first thing to Amsterdam.

By miracle, I was able to pay in, to change our scheduled Amsterdam Cape Town tickets, and pre-book seating.

I tried to book KLM Amsterdam Cape Town business class tickets, but the flight was full.

And there they were… two tickets in economy behind the bulkhead. A miracle.

Booked!

One more disaster awaited us.

The hotel in Florence graciously gave us a room with a disability bathroom.

I was still covered in mud, from the fall.

I undressed and got in the shower, with the splint on.

The shower had a seat attached to the wall.

I sat on the seat and undid and removed the splint.

And as I sat on the seat, naked with my knee extended, the seat collapsed off the wall and I went crashing to the ground. I hit my head very heavily, in the left parietal area and lost consciousness.

Linda thought I was dead.

After a minute, I regained consciousness and my leg was at right angles and I was bleeding from the head wound and I was weak and numb in my left arm, semi paralysed in my arm and hand.

Linda was saying “I can’t do this anymore”

Anyway.. I was concussed and it took a few minutes to gain my senses and we stopped the bleeding using bathroom towels.

Blood everywhere.

It was just beyond imagination.

My head and neck was sore.

The bleeding stopped and the arm improved.

I did a full neurological examination, noting power recovery over an hour.

Sensory function returned over two hours.

I resolved to continue with the evacuation and not to go into hospital.

I decided not to take anticoagulants, preferring a leg thrombosis over a brain haemorrhage.

You can’t make this shit up.

By morning the arm was good and no headache and we proceeded to check out and get by taxi to the airport.

We limped in with the brace and KLM provided a wheel chair.

They were fantastic and from that point on we were safe.

Checked through and wheeled into business class lounge and then fetched and wheeled to the gate and onto the plane via a lift straight onto the plane.

Fantastic service!!!!

Equally on arrival at schipol airport a wheel chair took us to a taxi rank as I booked into the ibis airport hotel.

Staff at the Ibis were singularly unfriendly and unhelpful.

There we used a luggage trolley to assist us to the room, and the next morning, we used the trolley to get us to checkout and took a taxi to the airport, and again had a wheel chair assistance to the plane.

The KLM staff were fantastic.

I was taken to my seat in a portable wheel chair.

Staff assisted us to the bulkhead seat which had fantastic legroom.

I was able to keep my leg up and had my hand luggage to rest the leg on.

It was the perfect trip.

All credit to KLM and their staff, from the doors of Florence airport to the arrival halls of Cape Town airport.

KLM has a loyal customer forever!!

We arrived 930pm in Cape Town and were assisted by wheel chair through passport control and customs to our waiting transport .

After that it was home for ten minutes to see the dogs and then straight to Constantiaberg hospital for admission at 11pm 14 May 2023, and straight to the Orthopedic ward C, with surgery scheduled at 6am Monday morning 15 May 2023.

Peri operative

The pain before surgery was minimal.

The anaesthetist Clive Nussbaum gave me a spinal anaesthetic and the ward and theatre staff were amazing.

My surgeon, Deon Engela, examined me just before surgery and agreed with my assessment, and he proceeded to arthroscopy, to check the internal soft tissue and ligaments of the knee, and then repaired the ruptured quadriceps with double row sutures plus used patella bone anchors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8556666/

Before I knew it I was back in the ward and all seemed perfect.

The anaesthetic was flawless.

The surgery uncomplicated.

One must note, that at first, with the trauma there was no pain, other than spasm of the ruptured quads, which was prevented  by keeping extension, via splinting pending surgery.

However post op, pain was explosive. I was on targinact and oxynorm opiates, for four days.

At day 2 it was too sore to get out of bed.

At about 3 days the physio took me for a walk with crutches with my caste. It was a deal breaker. Conquered my fear of getting up, although it was still damn sore.

At day 3, I went home.

Moderate severe pain especially slinging my leg up using the other leg/ foot to support it as I swung it up.

Stopped the opiates by day 5 as I also didn’t want to get habituated.

Stopped all pain killers at day 7.

I avoided any anti inflammatory and only took analgesia pain killers in that time.

Local pain at the wound site lasted about 10 days like a moderate pulling sensation of the sutures in there, and at the patellar region.

At one month now this pain is gone completely.

But I get a dull ache, when I stand a few hours at work, and this relieves when I lie and elevate the leg.

I joined the quadriceps rupture repair group on Facebook.

There are 900 people going through this trauma on the group.

The support and advice is immeasurable.

We will win this battle and the Facebook  group has been a great help to share experiences.

2 weeks

1 month

My update from the trenches.

So it’s been a month since our premature return from Italy with the trauma, and surgery for the quadriceps rupture, and I’m still in a caste from thigh to heel on my right leg with the knee at about  range 0 to 15 degrees largely because my muscles have wasted and I can almost out my hand into the back of the caste and scratch behind the back of my knee.

I was off work for two weeks and went back for about three to four hours a day, for the last two weeks.

At the end of the shortened work day, the leg is heavy and feels achy so I have to come back and lie on the bed and elevate the leg.

I get quite exhausted.

I’m on blood thinners - xarelto 10 mg daily to prevent clots.

I’m taking occasional paracetamol and Celebrex for pain.

I’m doing as much muscle exercise as I can - which isnt much as I’m severely limited.

Sleep is a real problem as I try to sleep with the leg up a bit on a continental pillow and I reflexly toss side to side, and my back is now aching more than my leg from kicking the duvet cover back as it’s winter and cold when uncovered.

It’s a mess.

I go up and down stairs with crutches.  But on the level in the office and at home, I walk without crutches

I shower with a layer of cling wrap and then a green rubbish bag taped to the leg to waterproof the leg.

Not to mention going to the loo which is like Rudolph Nureyev in the ballet!!!

It’s a real pain.

I am really house and work office bound and life isn’t fun.

Above all I have 6-9 months to go and it’s not a happy time.

At the end of this month, the caste will be replaced by a knee brace, with a hinge that is progressively allowed more bend until I can get 120 degrees and weight bare over the next 6 months.

And most serious is the fear of falling and re rupture, when it’s all done and it gets worse the second time.

My real fear.

The concussion issue is done… my head and strength and feeling in my arms is good and back to normal.

Thank goodness for Twitter.

I took on the insurance company which was evasive and refusing any refunds from the trip … another story.

Bottom line I’ve received appropriate refunds for our expenses and losses.

Small compensation for the disability and hardship I’m going through.

PPS aren’t paying appropriately for the illness time off yet and that’s another issue.

Thank goodness for Linda, she’s been amazing.

Couldn’t do this without her.

At the end of the day .. I’m going back to Italy to our dream place.

The light will shine again.

I can still dream of Italy and val d’orcia.

We will, in the words of General Douglas MacArthur  to the Philippines…  we will return.

June 20 cast off, and brace on.

D day.

35 days since surgery.

Caste came off today.

Hinge brace on.

Set 20 degrees.

I’ve been doing quads exercises for last 3 weeks so not much muscle wasting.

But quite insecure in the leg … more from fear if anything.

Brace seems so flimsy compared to the caste.

Physio to start this week.

Quads exercises then set the range to 10 degrees below pain on flexion threshold aiming to increase each week vs my confidence.

Showering will be interesting… as I intend to sit in a chair for the right leg.

Thursday 22 June.

Right side quads rupture 11 May, Surgery 15 May.

Cast off on Tuesday 20 June.

Brace on with some adjustments on Wednesday.

Physio started yesterday afternoon.

She made a few logical observations.

1: I’ve been doing flexion and quads straight leg raising exercises, myself.

2: I have tended to neglect exercises of the hamstrings and glutes.

3: I have neglected to do exercises of the normal side.

Therefore session focussed on hamstrings to prevent hyper extensions and help weight bearing balance.

Will be getting two sessions a week for three weeks then weekly for a few weeks.

Progress report 5-6 weeks out.

Getting 30-40 degrees leg bend. Working on my quads and hamstrings.

Walking without crutches in the house and at the office.

Crutches for long distance and stairs.

Physio started last week.

Trying to do some stretches.

Got on the bike doing ups and down to stretch within pain limits.

6 weeks and today was my second physio session.

Different exercises introduced.

The physio liked my use of the bike pushes and pulls.

At 45 degrees to point of tenderness.

Brace set for 45 degrees.

Physio concentrating on hamstrings and flexion stretch.

The final goal is to get knee flexion at >120 degrees.

That seems an insurmountable task at the moment.

Measure of improvement is that I can weight bare and walk (with brace on) with confidence that I can hold the leg straight.

I basically shower myself using another brace with leg straight. Then sit, hold leg straight, remove the backup brace and wash the leg.

Then apply aqueous cream.

Dry myself sitting down.

Then put on the proper brace and get out.

People would not believe the difficulties for basics like shower and toilet.

But as they say… a man’s gotta do what a man’s gotta do.

But I couldn’t do it all without Linda.

She continues to be amazing, patient, understanding and I will always be grateful for her love and care.

Week 7 post op.

Physio doing hamstrings and stretches.

At 60 degrees.

Able to weight bare on the leg.

Can climb the stairs with crutch at hand as a precaution.

Balance improving.

Actually went onto the park outside our house and did a bit of chipping golf balls with the help of the brace.

What a liberty moment.

Update Week 7 post total Right side quads rupture

At 60 degrees of bend.

Saw my surgeon.

Happy.

Said the muscle looked like a mop on each side but happy with result and progress.

Walking without a crutch.

Stairs one at a time with crutch at hand.

Did a bit of chipping on the field opposite from my house. But looked like a penguin when I walked.

Knee mild throbbing and still swollen.

Suture site fine.

Surgeon says I can ditch the brace at end of month and he says I should be at 90.

I think 90 is likely but the brace will remain on because of my PTSD (post traumatic stress disorder)

Exercises continue.

Physio didn’t add any and mainly massaged the quad and calf this time.

Must say that after work, where I stand most of the day I’m quite tired and glad to lie down flat, a bit.

July 17 9 weeks

At 9 weeks and had a significant problem related to aggressive flexion exercises at the hip and extensions at the knee

Concerning problem occurred with pain and lot of knee swelling with heat, and a suspicion of lateral partial  re-tear.

At 9 weeks and only aggravating issue was knee extension exercise.

Seeing the surgeon and cooling off the exercises until more clarity.

Plus taking anti-inflammatory meds a few days .

Was at 80 degrees now at 60.

Hoping nothing serious that conservative management can’t sort out

Had an ultrasound prior to see the surgeon.

Ultrasound shows tendon looks intact.

The knee was full of fluid.

Possibly had a bleed into the knee

The surgeon is seeing me tomorrow, but it looks positive that conservative approach is required and surgery looks off the table.

My biggest fear is re- rupture, and I am somewhat reassured as of this evening.

To complicate issues our power to our house is completely off power, irrespective of with and without Eskom power.

Electricians tomorrow to the rescue.

Poor Linda my wife, is taking all the pressure … like a hero.

July 19 At 91/2 weeks.

So after the temporary setback .. I saw my surgeon who said I have to bite the bullet and stretch the leg … even with pain, not withstanding.

I’ve stopped the blood thinner meds be taking some Celebrex one a daily news

So bite the bullet and now at 90 degrees.

Damn it’s sore.

He wants me stretching just beyond the pain limit for two minutes and do repeats frequently in the day

July 21

Big decision. 91/2 weeks post op.

The brace is to go within the home.

I might use it with stairs and at work.

Been quite restrictive and I’ve noticed my calves wasting.

One tends to walk leg too straight.

I’m not doing enough hamstring and calf exercises.

Today I started heel stretch knee bends.

Sitting on a chair.

Bend the knee then move the buttock forward to limit of knee pain then tiny bit more and hold for two minutes.

Then do it again at limit plus a little and hold 30 seconds.

Repeat X 3

Repeat X 3 per day.

It does hurt, but it’s the only answer.

Tonight I’m at 100 degrees.

Started to walk without the brace and had a normal shower without a knee support.

Planning can begin for our return trip to val d’orcia next year

Sunday July 23 10 weeks since surgery

Milestone tonight.

Drove a car for first time in 10 weeks since the surgery.

Took brace off and feeling confident.

Who knows … golf next month?

It’s looking possible.

Monday July 24

Driving to work.

Brace off.

Dressed in long trousers.

The shorts are no more!

Pushing the flexion exercises at the knee and easily get 100 degrees

Walking upstairs with caution, pushing up on the right leg.

The work continues.

I have informed my golf four ball that I am anticipating return to golf mid august 2023.

 The wasting of the right leg is quite striking.

August 2  At 11 weeks post op.

Progress continues.

Physio has me doing squats, steps and now some weights.

I am driving and chipping on the field opposite the house.

Walking on uneven surface for about an hour.

I am going to start golf next week.

15 August 2023 - three months post op

Today is the three month anniversary of my surgery for right quads rupture.

Have been walking well, but take some strain climbing stairs and slight hesitance on down stairs requiring a hand on the side rail.

But I’m at 120 degrees.

Back at work fully without a problem.

Can walk on the level no problem.

Can do a stationary cycle but I’m so exhausted after work that I’m lazy to exercise.

I will have to change that.

This weekend I do my first 18 hole golf at my golf course in Cape Town, Royal cape.

Looking forward to it.

Will take a cart though, first few weeks.

I feel very stable on the leg.

There is hope.

Had my last physio session a week ago.

Technically my surgeon has discharged me weeks ago.

So it’s time and exercise that I need moving forward.

Thanks to my surgeon Dr Deon Engela.

Thanks to my Physio Gabieba Martin.

Thanks to my wife Linda.

Thanks to the quadriceps tendon rupture repair Facebook group.

I’m very happy with my hope for my future potential return to normality.

PS I’m buying a hiking stick to use when I do outdoor activity and hiking, plus for my eventual return to val d’orcia Tuscany Italy, where it all began

My progress since August 2023 was progressively better and better.

Golf with walking the course strengthened the leg.

Exercises included quads exercises and stationary cycle.

Minimal pain other than a sensitive area in front of the patella where the knee capsule, the retinaculum was sutured.

The muscles are very wasted.

Bought my physio a great pair of sketchers shoes as a parting gift.

She wanted me to go to a biokinetist.

I confess I was lazy and it never got done.

September 2023.

The leg has full flexion and no pain.

A bit unsteady going down stairs.

Getting out and walking without the walking sticks I bought.

End of November 2023.

Now able to travel and went to Johannesburg to visit my children and grandchildren.

Took the hiking  sticks which were unused.

Looks like I gained some weight with the reduced exercise.

Pretty normal now

Off to Greyton with family for a weekend.

Did a fair amount of walking.

Used one hiking stick.

No problems.

December 2023.

May 7 2024 almost at the one year

Three days from the anniversary of my fall in Italy.

Many things to be grateful for.

My wife linda.

My family.

My surgeon and health care team.

My physio.

The quadriceps tendon rupture recovery group on Facebook.

My golf buddies.

My medical colleagues .

My friends.

And a special thanks to my maker G-d Hashem, above who looked after me to survive the injuries , including  the tendon rupture and the head injury and the paralysis of my left arm and allowed me to get where I am today.

May 11 2024

Our “survival lunch” after golf with my golf buddies, Brian and Pam Burnett, Raymond Gamble and Johnny and Tesse May went to La Grotto italian restaurant to celebrate 1 year of what was the most terrible injury and recovery thereafter.

A toast to life and  health.

At the end of the day, i didnt see that sunset.

But Linda took a single picture as we were driving from the gate to the apartment.

Thats all i have...the only picture of the sunset that changed my life. 

In June I’m taking the whole family on holiday to Mauritius to celebrate with them.

The survival holiday.

You don’t know what’s ahead.

Do not take health for granted.

Appreciate everything around you.

Life consists of whom you meet along the way.

Your health is your wealth and time are your assets.

When you are dead, you are dead a long time.

You live every day but you die only once.

Live!

Appreciate the simple things, possessions are stuff and at the end don’t matter.

In May / June 2025 I shall return to Italy and hopefully to the place it all started in val d’orcia at agriturismo Baccoleno.

See you there !!!

The final entry is the group photo at La Grotto Italian restaurant with my golf buddies, exactly 1 year after the fall that changed my life.