Recovery, Rehab, and Thoughts on the ER

Allow me to preface this post with an apology.  It's very possible I'm in a bit of a Percocet and Toradol haze.  As my editor isn't available at this moment, there might be a typo or disjointed sentence (or 4) floating around somewhere.

It's day 3 after my ankle surgery.  I have to admit it's not as bad as I thought it would be.  Granted, when the nerve block on my lower leg wore off the other night I was popping Percocet like they were Chicklets.  But it's manageable.  I'm not all smiles and full of cheer, to be sure, but I'm experiencing pretty much exactly what was explained to me.

There's pain and discomfort of course, and I do have periods of time where the discomfort is a bit troubling.  But I'm finding a groove, so to speak, in getting around the house and am getting the hang of navigating the kitchen with a cast and crutches.  Sleep is fitful, but depending on what meds I'm taking I nap enough through the day and 4-5 hours of sleep at night is about all I can muster. 

I really don't have room to complain too much.....really, I don't.  I'm very fortunate to be able to run, swim, and cycle - and compete in triathlons.  As a dear friend said to me yesterday, if this is the worst sports injury that I've had, then I should consider myself lucky.  If all goes well I'll be starting physical therapy in the next 2 to 3 weeks, and then it's just a question of how hard am I willing to work in conjunction with the healing process.

My wife JL has been great.  She makes sure that I have water, fruit, snacks, laptop, etc all ready to go on the coffee table in the living room before she heads to work.  She's been keeping an eye on me since the incident happened a week ago, and without her here at home I would have been in a spot of trouble for the first few days.  But I think a corner has been turned and the healing process is underway.  I'm now looking forward to getting the hard cast off and getting PT started.

I'd like to jump back a bit, and comment on our observations on the ER, the Orthopedist, and the care that was given throughout this wonderfully fun past handful of days. 

I'll start by saying that everyone in the ER was great.  We were checked in quickly, and I think we might have waited 10 minutes in the waiting area before being brought back into triage.  There was a bit of aloofness (for lack of a better word) at the beginning.  Not that the physicians assistant and the resident docs weren't friendly, competent, and direct.  But there wasn't any real urgency in moving things along as fast as I would have liked, or thought they should have been.  But I'll touch on that in just a moment.

The on-call Orthopedist for the ER was at her practice at the time, so we saw her there on the way home.  The next day I met with the Chief of foot and ankle surgery - with a sports medicine background - for that practice.  Both were great.  Very informative, and very to the point.  If we asked questions, they listened and gave answers.  This isn't to say there wasn't a little of the usual "quickness" in their answers, but follow-up queries were accepted without being talked over.  They both wanted to understand what my expectations were, and explained very clearly the time lines and process for recovery both with and without surgery.  Once it was decided that surgery was required, the Orthopedic surgeon rang me up and told me exactly what he was going to do and again listened to all my questions.

The day of surgery was very business-like.  I think that sums it up best.  The nurses in the prep area were all business and didn't mess around.  My attempts at joking with them fell mostly flat.   My surgeon, the Anesthesiologist, and physicians assistants were actually very upbeat, direct, and offered suggestions and input during the planning process for the day.  I was put at ease by their attitude.  No complaints at all.  I will say, however, that an improvement in communications while I was in the recovery room would have been helpful.  There were a few gaps where more information and communication to both my wife and I would have been helpful on a number of fronts.  In the end, nothing major.  If that's the biggest complaint we have for the day then so be it!

So, as I said, there was kind of a strange vibe going on in the ER when we first arrived.  I was in a hell of a lot of pain, and there was just a bit of a lackadaisical approach with the people we spoke with.  I just felt that, while competent and being thorough, nobody seemed to think things were all that bad. they kept talking about a 'bad sprain' in my ankle and that I'd 'be fine'.

It was shortly after the radiology results came back that we had our little epiphany (well, JL did - I wasn't thinking much at all at this point).  As soon as word got around the ER that I had one, possibly two fractures, the physician assistants, nurses, and ER docs who all saw me from the beginning (saying that it could be a bad sprain) all started to circle back and, with great surprise, state "...it's broken?  Wow, you really did it up right!" or "...oh my god, you broke you leg?"  We think, and this is just a guess, that they see so many weekend-warriors come in with sprains and muscle pulls that it was just assumed that I was another type-A, 40-something out trying to relive his childhood.  But when word got around that I really did screw things up, their tune changed a bit.  We could be reading into things, but in hindsight their attitude did go from somewhat aloof and indifferent to enthused and attentive.

Don't get me wrong - I'm absolutely not knocking the nurses, PA's and doc's that were in the ER.  They were great.  And I'm sure that, if I had been in their shoes, I would have had the same initial attitude:  Some knucklehead 40+ year old out running in 20 degree, icy, miserable, weather?  Really?

Plates, Screws, and Bone Sutures. Oh My

Yesterday was quite the day.  Surgery day on my ankle.  Looking back on it now, it was quite the surreal experience.

We arrived at the hospital in the late morning for check-in / registration and waited around for about 90 minutes to be called up.  All the usual stuff here - some additional forms to fill out, gown on backwards, useless booties on the feet, IV put in, and another hour of waiting.  My Orthopedist came in, and we discussed what he was going to do:

An incision would be made on the outside of my left ankle - a plate would then be put on my fibula.  Two small incisions on the inside of my ankle would be made, where he would go in to thread bone sutures with the tibula from the plate.  He was, again, very upbeat and straightforward and told me in no minced words what the procedure entailed and what I could expect in the days to come.  We had another in-depth discussion around the topic of anesthesia and pain management.  While the Anesthesiologist hadn't yet arrived, my doc suggested, should it be offered (and he said it would be), that I get a spinal.  His rationale?  By doing this - and being numb from the waist down - it would require less sedative in the OR, and my recovery afterward would be easier as I would become awake and alert quicker.  I was a little apprehensive to be honest.  I can be a bit of a hamster at times like these.  More to the point, I'm sure it was more a mental fear of the unknown.

My wife Jerri Lynn was there with me as I was getting prepped.  While I was having these discussions with my Orthopedist, she could clearly see that I was getting a little overwhelmed.  We chatted a bit when everyone had come and gone and she talked me off the roof, so to speak. The reality of what was going on had really set in.  Everything had happened so fast over the past handful of days that, as I lay there, I was coming to grips with the fact that I was going to have a fairly significant procedure to fix a pretty significant injury.  All the fears that you can imagine were running through my head: What if it's worse than the doc thinks?  What if they can only do so much and my ankle will never be the same?  But, as I said, my awesome wife - always the voice of reason - kept me as cool and calm as she could.  She's a rock-star.

Anyway, it's all a haze from when I left the prep area to when I hit the OR.  They started doping me up in the prep area and I could feel it kick in pretty much immediately.  I remember getting the spinal in the OR (bizarre!) and then remember them start to put the tourniquet high up on my thigh - then that's it.  I drifted in and out at times, and they had a screen up so I couldn't really see what was going on (thank goodness).  I started to come around when they were finishing up the cast but only saw that for a moment or two.  I came to, officially, in the recovery room, and it was a bit disconcerting to not be able to move my legs at all.  They said it would take a couple of hours for the spinal to wear off - but in reality it took over 5! 

After about an hour in recovery, the "pain doc" who I met to discuss my earlier spinal, came by to do what my Orthopedist had suggested we do post-op.  Similar to the spinal, he was going to block the nerves in my lower left leg to allow for maximum comfort for the next 24 - 36 hours.  As I type this I still can't feel my ankle or foot, nor can I move my toes.  I have control of my left knee and the muscles above, but it's a tad weird.

My legs (well, right leg) finally began to tingle and come around shortly afterward.  I could start moving my toes and legs and was feeling okay.  But, in the interest of full disclosure, overall this was a bit of a humbling experience.  All the feelings and reactions that your body deals with as a spinal wears off can be odd and off-putting.  Even though all the nurses in the recovery room said that everything I was experiencing was completely normal and to be expected it was a very strange, and sometimes humiliating, 5 hours.  Finally, everything worked itself out, and I was discharged.  We started the day arriving at the hospital around 1030a ET and arrived home around 830p ET.  A long and crazy day.

I head back to the Orthopedist in two weeks to have the hard cast removed (originally one week, but now two....Hrmph) and then things speed up.  PT starting sometime in week three.  Swimming as soon as the surgical wounds heal (but no pushing off with the left leg for a while).  And cycling on the trainer (no resistance) in 3-4 weeks.  I'm told that my ankle will "blow up and be painful" through all this, of course, but the sooner I get back to strengthening things up the better.

So, I sit here on the couch - with my leg elevated up on pillows - trying to keep up with work.....sort of.  Mostly I'm surfing through bad daytime television programming, and managing discomfort from cast pressure points and pain from now returning feeling in my leg and ankle.  I have 4 prescription bottles lined up on the coffee table, along with a Sigg bottle of water, my mobile phone, iPad, MacBook, remote controls, Kindle, and - again in the interest of full disclosure - an apple core, a bag of nuts to munch on, an empty bowl of soup, and one very nosey cat.

Winter Running - The Aftermath

The Orthopedic Surgeon gave me a call yesterday (Saturday) around noon, after reviewing my MRI.  Monty, what's behind curtain number 2?

A torn deltoid ligament, a cracked / broken syndesmotic joint, and most likely damage to another ligament (I have which one written down somewhere, but I just can't remember everything he rattled off to me at the moment.)  Bottom line he said that it's very unstable, and he'd be very reluctant to start any physical therapy on that ankle for at least 6 weeks.  His words as I remember them: "I wouldn't want anyone cranking on that joint for a while".  So, his suggestion was to stabilize the ankle with a plate and some screws to stabilize the joint and speed healing. 

The good news with this is that after a week of a hard cast, he'll remove that and I go back to a boot.  Then, a week or so after that, we start talking physical therapy.  If all goes well, 3 weeks after surgery I could start swimming (as soon as the wounds from surgery heal) so long as there's no discomfort in doing so.  Cycling on the bike trainer could happen shortly after that.  Running?  Not sure I remember exactly what he said, but it's certainly sooner than without going under the knife.

Will I be ready for my Half Iron triathlon in September?  Most likely not.  That could be pushing it.  But there's a lot of individual variance in recovery here.  I'm not setting my hopes on anything, but am hoping to be at least swimming and easy spinning on my bike trainer in a reasonable amount of time.  Hell, if I can walk comfortably (somewhat) in 6 weeks I'll be stoked.

Monday at noon I'm scheduled for the fun and games.  Should be home by dinner - which I'll sleep through I'm sure.  Tuesday, if all goes well, I'll be on conference calls for work from the comfort of my living room.  I'm sure that if I'm not liking this walking boot thing, that I'll most likely despise the hard cast.  But it's only a week of the hard cast, so that's not bad.

The Dangers of Winter Running - Part Deux

So, as I was saying, the Orthopedic surgeon was great.  He gave us a lot of detail yesterday.  And most importantly, he didn't pull any punches and was very to the point and up front.  He explained that my recovery time, without surgery, would yield 6 weeks before I could put any significant pressure on my leg and even think about swimming or cycling.  However, with the surgery, that time would be cut to 3 weeks before I could swim (individual results may vary), maybe cycle, and physical therapy would start after 2 weeks.  My knee-jerk reaction was, of course, then why aren't we just doing the surgery!?  But, my wife, the ever-logical one, jumped in stating that going into my ankle if the damage doesn't warrant it could very well be risking unnecessary complications.  * heavy sigh*   Anyway, as I wrote yesterday, an MRI was in order so the doc could make a fully informed decision.

So, I had the MRI last night (Friday).  I have the DVD of the images, but I of course have no idea what the hell I'm looking at.  The tech that did my MRI said he looked at them - I of course asked if it was truly a car wreck down in my ankle or what?  His response: "...I'm on a low-res display, and there so much fluid in there that it's all fuzzy".  Great.

Oh, and after he asked me what I did to myself, and how it happened, his retort was: "You should take up rowing".

I'm currently awaiting the Orthopedist to ring me up.  He said he'd call on Friday night or Saturday after he reviewed the MRI, and we'd talk about options.  In the meantime, the swelling in my ankle is out of control and there's really not any position now that is comfortable.  My wife has dubbed it the ankle that ate New York



   


Ironically, my wife - JL goes Vegan - had a guest post from Matt Frazier, of No Meat Athlete who wrote about  winter running tips on Friday morning.  I think JL received his post via email shortly after I arrived in the ER.

Again, more to come.......

The Dangers of Winter Running - Part I

Thursday morning was an interesting one.  It started out normal enough - up at 445a to get myself together for a usual morning run.  Depending on the day, the number of us running could be as many as 8 or 9, but yesterday it was just my good friend Tom and I.  We met at 530a at our usual spot and headed off on one of our regular running loops - about 6 miles total for me round trip.

Cut to: about 3 miles into the run, we came to a section that had a lot of piled snow.  It's in a section of a small subdivision that is bisected by creek - the snow is piled up around and on the bridge that lets us cross.  Again, this is one of our regular loops, so we knew it was coming, and started to navigate our way over it.  We got to the other side of the bridge (only 15 feet or so) and as we half jogged, half walked, over the snow section I hopped over the last small mound of snow to get back to clear roads. 

As soon as my left foot went down, I knew I was in trouble.  It only took a second but it felt like forever.

I hit a patch of ice, and my left foot twisted and pronated in.  At the same time my leg twisted around the ankle - still underneath me - and all my weight came down on my left leg.  I had a flash in my mind of "oh, this is not good" and I went down hard.  I hadn't felt pain like that in a long, long, time.  I was on the ground, grabbing my lower left leg and trying to keep it from flexing and torquing in the middle of the shin / calf.  I calmed down enough to lay still, and could flex my foot - sort of - so I was beginning to think that it was just a bad sprain and in a few minutes the pain would start to go away.  My friend Tom had his hand on me, telling me to relax and take my time.  Eventually we tried to get me on my feet.  That was a short lived exercise.  As soon as I put weight on my left leg I went down again in just as much pain as before.  I remember Tom saying "oh my god" a few times and then we had to figure out what the heck we were going to do.

The pain was tremendous in my ankle, and strangely up high on my shin.  Hence, every time my leg would flex or torque, it would hurt everywhere. I had no idea what this meant at the time, but I was just happy to be able to flex my foot.

Tom did a nice 5K (roughly) sprint home to get his car.  I lay on the ground, in lovely 20F weather, and was just starting to get cold when he made it back.  I hopped into the front seat of his car and he got me to my house, and inside, and into a chair.  Tom told my wife JL,  what happened.  She hurriedly got her things together and we headed to the emergency room.  All this before JL had her 2nd cup of coffee!

It wasn't yet 700a when we got to the ER.  Check in was quick and everyone was great.  It took a bit of time to get me through the triage process and I sat in the hallway in a wheel chair waiting for radiology to come get me for some scans.

Waiting for the Radiologist

The radiology tech was great.  He was taking the scans, and being careful with my leg.  At one point, I was trying to convince myself that it was just a bad ankle and / or high ankle sprain.  You hear about some athletes getting these and it sounded good to me.  However, after one of scans, I realized he was on the phone talking to someone and I heard my name mentioned.  He came back to me and said he "saw something" higher up my leg, where half the pain was, and wants to rescan the ankle now to double-check something else.  The radiologist on-call came in, and they talked for a bit longer while I remained on the X-Ray table.

He then broke the news that he saw a fracture on my fibula and "something" in my ankle. 

The first words out of my mouth? "Oh, Fuc# me!"  I apologized for the outburst, to which he replied that he'd heard that one a few times before and not to worry.  I was wheeled back out to the hall in the ER where JL was holding station, and I sat and waited with an ice-pack on my ankle.  I told JL what he saw and said.  I was just beside myself.  The doc stopped by and said they were calling the Orthopedist on-call to review the scans.  She had office hours that morning, so shortly after 900a she called back - had looked at the scans - and asked that we should drive over to her office immediately.

So, with crutches and a lightweight ankle brace, we headed to the Orthopedist office.   Upon arrival it looked like a lot of the docs at this office are sports medicine docs.  That was comforting in some way.   Long story short here - more scans, and a bit of a more revealing diagnosis.

It looks like, most likely, the ankle twisting and pronating, combined with my leg twisting around it, snapped the tendon that holds the fibula and tibia together in the ankle.  This allowed the two bones to snap apart and causing a chain reaction up my leg that caused the fracture high up on my fibula just below my knee.  And tragically there was indeed a fracture in my ankle.

Lots of talk about "gaps" and "spaces" in my ankle.  Then the statement that I needed to come back tomorrow (well, today) to talk with one of the surgeons about the potential need to put a couple screws in there to get things back together.  Awesome.


Day 2: What, this isn't a normal ankle size?

So, we've been back to the Ortho to speak with the surgeon.  He didn't see enough "distance" in the gaps between some bones on my ankle X-Ray to be certain of next steps just yet.  And after torturing me on the table asking "does it hurt when I do this? (and then proceeding to twist my foot and ankle) he needed more information.  He ordered an MRI - stat - to determine if the ligaments and tendons (primarily the deltoid ligament) were damaged to the point of needing repair or if they're just stretched.

I'm booked for surgery on Monday, as he can get me in, and his opinion is that if it's needed, let's do it now.  He'll cancel it if need be based on the results of the MRI.  So, I'm scheduled for the MRI later today, and they've been instructed to call my Orthopedist as soon as it's done.  He said he'd call me later tonight or tomorrow and we'll make our final decisions.

More to come.......