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@Fixed&Broken
I'm starting to think about this, I'm just cautious about making things worse which is why I've avoided it so far. Even if it was just so I could do a few gentle miles on the loop where I'd not have to worry about traffic and have big grass banks to aim for if it all goes wrong. If I just swap my levers over so I've got a rear brake it should be enough to stop me OK as I'm hardly going to be sprinting and it's fairly flat. I've been looking at lowering the gearing anyway so that I can do climbs without having to get out of the saddle and fatter tyres to take the edge of road surfaces. I'm also looking at swimming as an option. While I can't really pull with my arms I could at least do some fitness work with a float. I'll have a chat with the consultant hopefully next week and see what they say.