Archive for June 11th, 2016

Ankles and the Apocalypse III

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!

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