the thin line between optimism and delusion…

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.

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Remember that time I thought my foot was broken, and then it wasn’t broken, and I had unexplained ankle pain for about a year before anyone could tell me what was wrong, and then one of the doctors decided he knew what was wrong, and they took out the extra bone in my foot and got mostly better and I did fun things???  Well, as of January 2015, I was pretty much back where I was in January 2013, just with a more complicated treatment history.

I had ankle surgery in October 2013, and in Spring 2014, once I started running and working out again, I played two tennis matches because my tennis team needed someone to play.  I did okay for not having played in a year and a half, but I didn’t feel great about it, and I figured I would sit out the summer and be all well and rested for fall tennis. I ran about ten miles a week in June and July, and did yoga a couple of times a week.  I had some tweaks of pain on occasion, but I was thrilled by this level of activity, as a year previously I had basically resigned myself to the fact that I might never run more than a mile again.

In August 2014, I decided I was ready to start playing tennis again.  I even took a couple clinics.  Being out on the courts felt good, even though I was still a little leery of my foot.  The last week of September, I ran three miles on Monday, took a tennis clinic on Wednesday, and played my first tennis match of the season on Thursday.  My tennis opponent made swift work of me, and ours was the only match that was finished by the time it started raining.  I was relieved that it was over, because I didn’t feel good about my ankle, but I didn’t feel any worse than I did during the spring matches, and I figured it was all in my head.

Friday, Saturday, Sunday are normal days.  Sunday night, I get a hankering for Jestine’s.  Jestine’s is just over a half mile from my house, and if I don’t want it bad enough to walk a mile for it, I probably don’t deserve it.   Plus, it always tastes so much better, and Briscoe likes to walk.  Briscoe and I happily and successfully make it to Jestine’s and almost back to the house with no trouble.  Half a block from my house, mid step, my ankle locked up and each step resulted in blinding pain.  If I had been more than half a block from my house, I would have required rescuing.  As it was, I hobbled home in near tears, and stumbled up my stairs, collapsing on the couch in the worst pain in recent memory.  I dug through my medicine cabinet and found some pain killers from my surgery, but when I woke up the next day I was still in pretty serious pain.  I dug out the ole trusty walking CAM boot, and tried not to scream in frustration.

I made an appointment with my Augusta surgeon, and with the ankle guy at MUSC.  Augusta Surgeon could see me Friday, MUSC said I was in luck, that their Ankle guy could see me December 15th. Augusta Surgeon was completely nonplussed by my regression.  He said that it’s not uncommon for scar tissue to break up about a year after surgery, and that I should wear the boot until I didn’t need to anymore, and call him back in six weeks if it was still painful.  I went back five weeks later and he fitted me with a lace up brace, and ordered an MRI.  I had an MRI thanksgiving week. The MRI showed some swelling and inflammation of my FHL and PTT tendon, but nothing was torn or broken.  I went back to Augusta Surgeon the week after the MRI, and he told me I should just be patient, that inflammation like this can take 3-4 months to heal, and that I should try to take it easy until January.  He said he felt sure it would be better by January.  I asked him what would happen if it wasn’t better by January.  He said that if it wasn’t better by January, it meant there was something else wrong with the ankle that the MRI didn’t show.  Great.

I was able to transition from the CAM boot to a lace up brace.  Before I knew it, it was December 15, and I was able to see the MUSC ankle guy.  I was told that most people wait six months to see the MUSC ankle guy, and I was lucky I only had to wait 2.5 months.  Dr. MUSC said that he wanted to review my MRI with his radiologist and that he would contact me after he came up with a treatment plan.  Dr. MUSC’s PA called me on December 31, and asked if I could come in that morning for an ankle injection.  Dr. MUSC said that he believed that there was something wrong with my FHL tendon, but that his radiologist disagreed.  Dr. MUSC injected my posterior tibial tendon sheath with ropivocaine.  This was an interesting experience, as the doctor took x-rays with this x-ray arm thing while he was injecting my foot.  I was instructed to go out and do whatever I would normally do that day.

“Normally” is such an interesting thing.  What is normal?  Seeing as it was New Year’s Eve, I wore heels.  I had not worn heels in months.  The injection made my foot feel infinitely better, and I was able to wear heels all night NYE, and I was able to go to two yoga classes the next week – on Monday and on Friday. I was at about 70% for the yoga classes, but I was so happy to be active, I had forgotten how much I enjoyed working out and how much I had missed it.  I returned to MUSC on Monday, January 12, 2015, and Dr. MUSC injected my ankle joint with ropivocaine, to see if injecting the ankle joint would also result in improvement.  The actual injection did not hurt, but a few hours after the injection, the pain increased drastically.  By Tuesday morning, I was unable to walk.  Dr. MUSC said he performed hundreds of injections a year, and that he could not remember the last time an injection had increased a patient’s pain.

It is my belief that I further injured my ankle wearing heels and going to the two yoga classes, and that the ankle injection just happened to be at the same time. I was prescribed mobic and ultram, but I only took the ultram at night because it made me feel weird. The pain was severe enough the second and third week of January that Dr. MUSC put me in a hard walking cast for three weeks.

Dr. MUSC took my cast off on February 22, 2015, and told me that he was not confident enough about my diagnosis to operate, and he referred me to OrthoCarolina for another opinion.  I had to wait until March 22 for an appointment, and the pain forced me to continue wearing the boot.

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