the thin line between optimism and delusion…

Happy Georgia Florida everyone, I will be in Athens this weekend packing furiously to move into my new house next week.  Come visit me.  To everyone traveling to the coast, be safe, check your tires, take a fleece and some real shoes, the high is 89 tomorrow in Jacksonville, but the low on Saturday is 52, aka “freezing” on the coast.  

Cover of the excellent card Becky and Nan gave me.

Monday update: I wrote this Saturday. My ability to walk in the boot has increased significantly since then, and the pain is tolerable.  I have a long way to go, but every day is an improvement. 

Waking up from anesthesia is weird. Your eyes are closed, and you know you want to open your eyes and wake up, but it’s like you forgot how to wake up and you need to remember how to wake up before you can wake up.  You also feel like there is something very important you need to remember and tell someone, but you can’t remember what it was or who you were supposed to tell.  You lie there for a few minutes, thinking about how your eyes are closed, aware of the things going on in the room, listening to the people around you, looking at the back of your eye lids.  After a while, you become aware of other things, like, whatever body part has been manhandled and cut up while you were out.  The need to wake up generally becomes more pressing at that point, because most of the time you realize that you need something urgently.  Like after my appendectomy, when I woke up DYING of thirst, like someone had scrapped the inside of my throat with a blunt object, and I thought if I couldn’t have something to drink I really might die.

On this particular occasion, I had a pressing desire to wake up because the lower part of my right leg was on fire. It felt like my right leg was being partially scalded and burned, but I couldn’t move it.  Eventually I was able to regain consciousness enough to get the attention of a nurse, who told me that the heat was from the splint they had just placed around my leg.  He wanted to know if it was warm or if it was painful.  I said it was painful. (I wanted to say, it’s hot AF, take it off!)  He said he would get me some Demerol.  Upon reflection, it’s interesting that the hot splint was painful, considering the nerve blocks.  Let’s talk about the nerve blocks.  Listen, I’ve had nerve blocks before, I had a nerve block for both of my prior ankle surgeries, and I figured this one couldn’t be a lot different.  I was very wrong.  Pre and post op they told me numerous times that I should “enjoy” the nerve block while it lasted.

Y’all, this nerve block was legit. I could not feel or move my leg from mid-thigh down.  The hot ass splint weighed about a gazillion pounds (I think it got lighter once it dried).  If I thought REALLY hard, I could make my big toe twitch for a second.  If I wanted to move my leg, I had to pick it up with both hands and move it.  Crutches were a bit of a problem, because I couldn’t operate any of the muscles in my knee.  Kate drove me straight back to Augusta after the surgery. I’m really glad we made the trip while I couldn’t feel my leg, and while I was still semi-conscious, but my decision making skills were definitely blunted.  On the way out of town, we stopped at Chick-fil-a, and I destroyed a combo #1.  Upon reflection, I realized that I was in the backseat of a car, post anesthesia, and that I might regret overeating fried foods.  Luckily, the nice people at the surgery center had sent me home with Phenergan.

Once home, Kate had to hold my dead leg while I crawled up the front steps. While I had the nerve block, I only required half doses of the Percocet about every five hours, combined with some Benadryl and Phenergan as needed.  The nerve block wore off about 4 am Friday morning.  I woke up, and my first thought was, OMG! My leg is working again! I can pick it up and…AGGGGGGHHHHHHHHH.

Needless to say, I did not go back to sleep that night, and I spent the next several days in a bit of stupor.  Narcotics make me insanely itchy, and I really cannot tolerate Percocet without Benadryl, and I don’t know about y’all, but Benadryl makes me real sleepy.  When I wasn’t passing out mid sentence, I was eating baked spaghetti and pound cake.  Does anyone need a pound cake recipe? I have a really great one.

Pound cake is really great with peaches and ice cream.

I caught up on some television.  I finally finished Billions, which I enjoyed immensely.  The passing out midsentence made my usual hour long drama difficult, and I started watching sitcoms, like Brooklyn 99 and Unbreakable Kimmy Schmitt.

I could only tolerate the Percocet for a couple days, and the doctor called me in a tramadol prescription, which is much easier to tolerate, at least for me. Kate got me a scooter, and even though Trav said I got the wrong scooter, I’ve been able to take it out on the road and see what it can do.  Here’s a video.

The dogs have been keeping me company, but they suck at bringing me drinks and snacks. Yesterday, I had my two week follow up appointment, and I got the splint off, which was absolutely amazing.  My foot looks better and worse than expected, in my opinion.  The bruising looks better than my previous surgeries, but that might be because I’m two weeks out.  The stitches are dissolvable, and the big incision is all woomped up funny. Here, I will show you – but just in case people are squeamish, I will put all the ankle photos at the bottom, so scroll down or don’t.  I don’t think it’s too bad, but I know some people don’t like to see stitches.
The resident said my ankle looked great, that I should work on my range of motion, and then I should start physical therapy in two weeks, and then two weeks after that I might be able to transition into walking in normal shoes. I got a new walking boot, and this one is significantly different from my previous walking boot.  They gave me a copy of my operative report, and I was surprised to find out that I now have two titanium suture anchors in my medial malleolus and attached to my deltoid ligament – specifically one was attached to the tibionavicular and one was attached to the “spring” ligament.  This is apparently called a deltoid ligament reconstruction, which was done to correct an anteromedial rotatory instability.

I think the spring ligament is the horizonal one to the right of the navicular bone, right below the deltoid – in the middle, not at the very bottom.

This link might be a better photo.  I also had a CAM lesion on my talus and a kissing lesion on my tibia, which were “saucerized”, which you should not google image search.  They also debrided a “large central osteophyte of the tibia.”  Google says osteophyte means bone spur.  Despite my extensive research, I’m still not entirely clear about the difference between a CAM lesion and an osteophyte, but I think a CAM lesion is a type of osteophyte.

I’m fascinated at how much more extensive the repair on the front of my ankle was, compared to the repair required on the back of my ankle in my previous surgery. It makes me wonder how long I’ve had these problems.  The only major injury I’ve ever suffered to my right ankle was a horrific ankle sprain my junior year of high school, more than 19 years ago.  The good news is that the surgical note says my ankle joint looked good, and that I didn’t have any full cartilage lesions or arthritis, which is encouraging.

My ankle is extraordinarily stiff, which has thus far inhibited my walking, but I think it is better today than it was yesterday, and hopefully, will be better tonight than this morning. The pain from this surgery has been exponentially more severe and lasted a lot longer than either of my previous surgeries.  My entire body hurts from being on crutches and climbing up stairs in a seated position.  Since about Monday, I’ve only required the occasional half a tramadol when I’ve been up on it too much.  Even more helpful than the pain medications has been keeping my foot elevated.  When my foot is down on the ground, it turns blue frighteningly quickly, but I can tell this is slowly getting better.

The atrophy to my leg is much more extensive than I was expecting, I was really hoping that the fact I was active and not in a boot before my surgery was going to translate into less atrophy.  I was hoping I would be able to immediately concentrate on rehabbing my ankle and not spend a lot of time on rebuilding my calf and thigh.  In just two weeks, my calf has wasted away.

The nurse who cut off my cast asked me if I needed a refill on my pain medication, and I told her I didn’t think I did, unless she thought my foot was going to be a lot more painful once I started walking. She laughed and said, “You know it, I will get you a refill prescription just in case.” I did not find this particularly reassuring, but so far, walking is quite painful.  Last night I was able to take a bath with my newly liberated foot, and let me tell you, it was glorious.  GLORIOUS.

Sad right leg.

My family has been great during this whole process. They’ve brought me ice packs, coffee, meals, snacks, wine, filled up my water bottles, taken care of my dog, washed my clothes, run errands for me, watched TV with me, and been generally entertaining.  My dad and I watched the first season of House of Cards.  I watched most of the first season years ago when it first came out, but then I lost interest, and I’ve enjoyed catching back up.  We’ve watched Dr. Blake Mysteries and Father Brown. I ordered T5 a tent and that has been great fun for all.

Family being entertaining

I’ve been watching Unreal and Happy Valley on my own. Happy Valley might be the most enjoyably depressing television show I’ve ever seen.  I can’t explain it, the things that happen to the people on this show are horrible, it’s gruesome and bleak, with substance abuse and mental health issues, rape, murder, infidelity, blackmail, kidnapping, family estrangement, stalking – but somehow I really enjoy watching it, and I really like the characters and the stories.  It is baffling.  You should definitely watch it.  Unreal is also pretty dark, but entertaining.

Speaking of dark, here are the ankle photos!

(disclaimer – this is a long drawn out explanation of a poorly defined, chronic problem. It is very far from the most interesting thing I’ve ever written.

My April 2015 FHL repair surgery was a breeze. Before the surgery, I had been in a walking boot  continuously since the first week of January, and I also spent about six weeks of Fall 2014 in the boot.  Because my tendon was torn, I literally could not walk without the boot.  After surgery, my foot was bandaged; I was given a surgical shoe and pain meds, and instructed to start weight bearing immediately.  I took the pain meds for a few days, with great pain control, and after a week I was back at work.  I started physical therapy in mid-June, and I was dismayed to realize how much my right leg had atrophied.  My right leg was visibly smaller than my left leg, and disturbingly weak.  It wasn’t just the ankle, it was my calf, my knee, my thigh, and my hip.  I felt like I’d had a minor stroke on my lower right side.  Keep in mind, I stayed fairly active, even in the boot.  I couldn’t work out, but I still went about my every day life without any lifestyle modifications.  The severity of the atrophy and the loss of strength came a shock.

At the end of July, I spent a week with my family at Lake Rabun. My dad and I hiked down and out of the Tallulah Gorge on day, and Christy came up from the ATL for a couple nights, and we went on a fun hike.  On the way back to Augusta that Sunday, we stopped at Ingles, in Elberton.  While in the store, my ankle locked up, with blinding pain.  I limped back to the car, and had a panic attack the rest of the way home.  Something else was wrong, I knew it.  This was like the pain I had the previous summer.  I emailed the doctor, and spent the rest of the day icing my ankle with a tramadol and a very bad mood.  The doctor told me to take it easy for a few days and relax.  It did feel better after a couple of days, but it made me realize I shouldn’t push it.  In physical therapy, we spent a lot of time trying to get my ankle to bend right again.  I had very limited dorsiflexion, and myself and my physical therapist were convinced being in the boot for so long had resulted in stiffness.

Thanks to my Nike running app on my iphone, I can go back and see that I ran one mile in just under eleven minutes on June 2, 2015. I ran 2 miles on July 2, 2015, in just under 22 minutes.  As a reference, I’ve always run about a 10 minute mile, more like 9.5 if I’m in good shape, so this was sort of slow, but I was just happy to be there.  On August 10, 2015, I ran 3.1 miles in 33 ½ minutes, and after than I ran between 2.5-3 miles at about an 11 minutes pace about twice a week for the rest of the fall.  I also went back to yoga, but to shorter, less intense classes, strategically spaced out.  In October, I started going to Spin classes.  With the exception of fairly painful episode of DOMS in my right thigh lasting most of a Thursday afternoon (apparently my physical therapy had done an excellent job reconstructing my right calf, with a less thorough rehab of my right thigh), and a weird hip twinge that wouldn’t seem to go away, I was feeling good.  I was running steps, and running hills when I was home in Augusta, and I convinced my dad to buy me spin shoes for Christmas, as an added motivation to keep going to spin.  Charlotte doctor said my hip pain was piriformis syndrome and gave me some stretches.  I was still working on bending my ankle, but my range of motion had definitely improved, after a ton of physical therapy and continued stretching.

Spinning made a huge difference with my cardio, and I was back running at a pace right under ten minutes a mile by November. I went for a long run in Augusta over Thanksgiving, with a bunch of steps and hills, and I felt like I was doing something I shouldn’t be doing, and then I thought I was being paranoid.  It was six months after my surgery, and it felt like the time to start pushing myself, and stop being scared of getting hurt again.  To be clear, by a long run with a lot of stairs and hills, I mean, three miles in thirty minutes, not like, ten miles in an hour.  I had some good runs in December, but in between Christmas and Thanksgiving, my ankle got very stiff.  I attributed this to my triumphant return to high heels, but it was serious enough that I decided not to run for a couple weeks.  I went to Kona on the big island of Hawaii in mid-January, for Pete and Tara’s wedding, and I couldn’t resist going for a run along Ali’i Drive, followed by coffee and scones on the water. I made it two miles.  I haven’t run since.  I kept going to spin class, but that eventually became too much, and I dropped down to going to half of a spin class.  Eventually I was limited to riding the bike on my own for no more than 20 minutes.

I had an MRI in February, which showed some mild tendinopathy and joint effusion, but nothing interesting. The first appointment I could get with the Charlotte doctor was the end of March, so he sent me to physical therapy in the meantime, because my ankle range of motion continued to decrease.  Remember in middle school and high school, in gym class or basketball practice, when you would stand facing the wall, with your hands on the wall, with one foot slightly forward the other, and bend your knee towards the wall to stretch your calf? I couldn’t do that.  My ankle wouldn’t bend, and my heel would come off the ground.  Bassam and Justin at Physical Rehab were great – they spent a lot of time trying to make my ankle bend, with some success.  When my ankle started bending again, it hurt, A LOT.

My appointment in Charlotte was March 31^st, the Thursday before the Masters, and my main goal was coming up with a plan that would let me walk around the course all week without having to wear the boot.  Dr. Davis evaluated my ankle for about five seconds, and sent me for x-rays, weight bearing, with my knee bent.  He said I had a cam lesion bone spur in the front of my ankle, causing anterior impingement, which was interesting, since my previous two surgeries had been to correct problems in the back of my ankle causing posterior impingement.  He said he had no idea why this was happening, gave me a cortisone injection, told me to give 3-5 days to kick in, and call him when it started hurting again.  He told me to stop going to physical therapy.

I don’t think I was aware of how bad a cortisone shot could hurt, but since I’d driven myself to Charlotte, I didn’t have time to wallow in the pain. I stopped at Bojangles before leaving Charlotte, because I was aware of how hungry a cortisone shot can make you (and because I felt like I deserved it) and I drove back to Augusta.  The next day, I went to the ATL to meet Philippa for the High Museum Wine Auction.  The auction was a blast, and my foot held up well, but I didn’t notice any real effects of the injection.  My ankle hurt on Monday and Tuesday of the Masters, but in a tolerable fashion.  The funny thing about my ankle pain was that it took 2-3 days to really start hurting after I overdid it, so I was expecting to wake up any morning of the Masters in debilitating pain.  To my surprise, I made the whole week on two feet with no boot!

Clearly the cortisone shot made a big difference, but about a week after the Masters the pain started to return. It’s amazing how quickly you can forget what real pain feels like once it goes away.  The cortisone shot let me continue to go to spinning and kept my activities of daily living intact, but I still couldn’t bend my ankle, and I felt like my activity level was decreasing while my pain was increasing in very small increments every day.  I talked to Dr. Davis on the phone about two weeks after the Masters, and he said he thought I needed surgery.  Surgery was scheduled for May 26^th, and I had every intention of riding the bike and staying active right up until that point. The first week of May, I did something weird to my hip riding the bike, and I realized I was overcompensating because of my ankle didn’t bend right, and I decided if I couldn’t ride the bike without hurting something else, I shouldn’t ride the bike.  In the week that followed this decision, whatever remnant of the cortisone shot that was still helping wore off rapidly and completely.  Clearly I had grossly underestimated the value of the cortisone shot, but at least this new found severity of symptoms helped erase any doubts I had that surgery was a necessary course of action.

I went back to Charlotte on May 19^th, for a pre-op visit, and Dr. Davis said he felt confident he could fix the problem.  I told him I was happy someone was willing to at least try to fix the problem, and that I had low expectations, because any improvement would be appreciated.  The surgery was May 26^th.  The morning of the surgery, they had me sign a piece of paper that said Dr. Davis was going to perform an anterior ankle arthroscopy with possible tibia/talus saucerization, whatever that means.  Once I had my surgical gown and cap on, Dr. Davis stopped by to draw on my foot.  He told me he was going to make sure he fixed everything this time, because he did not want to see me back there. The anesthesiologist stopped by and told me he was going to give me a nerve block in three of the nerves in my leg – with an injection on the outside of my knee, and another one on the inside of my thigh.  Then they wheeled me back to another room so the anesthesiologist could use the ultrasound to find my nerves.  They also gave me 2 mg of versed, and about ten minutes after that, they gave me another 2 mg.  I remember them telling me I would go back to the first room after the nerve block, but I don’t remember the nerve block, and the next thing I remember is waking up.

Jack is aiding in my recovery efforts.

Hello, Friends.  Here I am, back at my parents house, convalescing after ankle surgery #3 last Thursday, May 26, 2016.  I’m in a splint, non-weight bearing, until at least June 10th, when I get the splint off and get my new walking boot, which I will be enjoying for the rest of June and part of July. Until June 10th, it’s me, my crutches, and the scooter against the world.

Briscoe is enjoying swimming in the pool with Bobby and Jack, but she is unsure about the scooter.

In the eighth grade, we read Alas, Babylon and Lord of the Flies. These books taught me that in the event that I became stranded on a desert island or the apocalypse, I would quickly, if not immediately, be a burden and liability to those around me.  Why? Because I was blind without my contacts or glasses.  My contacts would only last so long and let’s face it, my glasses would get broken. Even with my contacts or glasses, I would suck at boar hunting and crab spearing, these visual aids did nothing for my impaired depth perception.

Eventually, I got my eyes lasered, and I can say without doubt that getting my eyes fixed was one of the greatest things that ever happened to me. Visually, I am now ready for the apocalypse.  I’m not sure if you’ve noticed, but the apocalypse has been a hot topic for most of my life.  There was a period of time when I gravitated toward dystopian literature, when the Hunger Games was first published and I had to convinced my tween cousins to read the novels, when Jennifer Lawrence was a tween somewhere in Kentucky.  After a while, the dystopia was difficult to escape.  A quick look at my Goodreads list reveals a distressing trend of nightmare wasteland settings, with heroes and heroines fighting through the jungles of what was once Chicago/Baltimore/Sacramento.  The last two straws were The Handmaid’s Tale and The Fifth Wave.  These books were HORRIBLE.  I can’t believe anyone thought the Handmaid’s Tale was worth publishing, much less recommending to others.

Around this time, I developed a chronic ankle problem. The only thing worse than imaging District 12 in the hunger games is imagining yourself as a young cripple in District 12.  I decided I would stop reading dystopian novels.  Except…a lot of novels don’t tell you they are going to deteriorate into a dystopian nightmare on page 450. Maybe I need to research the books I read, and maybe the problem is that most fantasy involves a dystopian lean, but as a PSA, novels with dystopian aspects you might pick up at the airport:  11/22/63; The Bone Clocks; 1Q84; The Circle; Night Film.

I enjoyed four glorious years of being ready and able for the apocalypse, but since 2012, my right ankle has replaced my vision as the top concern for why I won’t survive dystopia.  If you would like to read more about initial injury to first surgery, this post does a good recap from the initial injury in 2012 through March 2015, with links to the posts about the first surgery in October 2013 and the recovery.  Then you can read about my adventures with Ortho #4 and the second surgery here and here.

It’s interesting for me to go back and read these posts, because sometimes it hard to grasp how long I’ve had this problem, and how many doctors I’ve seen, and how many times I was told to “wait and see.” I’ve been reflecting on whether or not I could have handled this differently, if I could have been more aggressive in advocating for myself.  I’ve also been reflecting on how lucky I am that this problem manifested itself at a time when I was gainfully employed by the federal government in an extremely sedentary job, which has provided me with the best group medical healthcare available; the sick leave necessary to take the time off for my numerous surgeries, doctors appointments in cities 3 hours away, and extensive physical therapy; the ability to continue working despite my inability to ambulate effectively; and the sort of work that can be handed to a coworker during my absence without placing an enormous burden on myself or my coworker.  Plus, I’m not responsible for miniature humans!  While this has been a serious problem resulting in significant limitations in my activities of daily living and vocational restraints, I’ve been extremely lucky in my circumstances.  Next post, Surgery #3!

The backyard and rose are helping me through this tough time. 

Me: You never responded to my text message about the Canadian mystery crime novel I’m reading! Where the victim gets electrocuted at the community curling match on Boxing Day after the maple syrup pancake breakfast?! 

Robyn: I definitely thought I dreamed that, and that if you did send me that text that you made this novel up to pick on the Canadian. 

Me: I’m serious! Everyone got a new toque for Christmas! And I even knew what that word meant! It was a fun read. There was hockey and bacon and snow and art and tons of French words, it was awesome, you would love it. 

My long anticipated appointment at OrthoCarolina in Charlotte. was for 1:30 on Monday, March 23.  I was battling a cold and terrible allergies, and Susan-Elizabeth and crew stayed with me over the weekend.  I woke up Monday morning feeling terrible, but nothing was going to stop me from making my appointment in Charlotte.  I met my mom, Kate, in Columbia, and rode with her to Charlotte.  I left my insurance card, of course, but other than that, the visit went off without a hitch.  Dr. Hodges Davis met with me and watched me walk, and examined my ankle, testing the range of motion and the strength, and asking me questions.  Dr. Davis pulled up MRI and showed us the one slide that showed a tear in my Flexor Hallucis Longus Tendon, and that the tear would not have been visible during my previous surgery because of the location and the surgical approach.  Dr. Davis said that tendons tear like a rope frays, and that once it gets frayed, it will get stuck in the tendon sheath and not move correctly. Dr. Davis said that when my big toe seemed to get stuck, and when my ankle seemed to be stuck in a certain position, that it was actually the tendon tear getting stuck in the tendon sheath.

Dr. Davis said that he could fix the tear with arthroscopy, and that I would be in a boot for three weeks, and then I would be able to go back to my regular activities, with maybe a couple weeks of physical therapy.  This sounded too good to be true, but I was happy to have a doctor who was confident in what was wrong with me and in their ability to fix the problem.

I drove home from Charlotte pleased with the result of the visit, but generally not feeling very well.  When I got home, I had a fever of 102.2.  I spent the next three days in bed.  My surgery was scheduled for April 16.