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Archive for June 4th, 2016

Ankles and the Apocalypse II

(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 31st, 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 26th, 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 19th, 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 26th.  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.

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