Next Up: Physical Therapy

I returned to my Orthopedic Surgeon this past Friday to have the cast removed from my leg.  It had been 15 days since I broke my leg, and ankle, on a morning run, and 11 days since my ankle was operated on.  From both a mental, and emotional standpoint, I was really looking forward to having the cast removed.

I arrived at the office, was shuttled back into the office pretty quickly, and a Medical Tech had the cast off in no time.

Wait, staples?  I knew there would be stitches, but not staples.  And surely not 16 of them.  You can't see them all here - but on the lateral side of my ankle is what looks like big zipper.  I'll come back to that later.  In the meantime I checked out the old ankle and it didn't look as bad as I had anticipated.  There was some bruising, but nothing that made it look like a prop from a bad horror movie.  And the swelling was no worse than the day I went in for the surgery.  Next it was off to X-Ray for a scan:

Very cool indeed!  A plate, 2 screws, faint shadows where the doc drilled through both bones, and "buttons" where the bone sutures were anchored.  My Orthopedist said everything looked great and we were moving on to next steps.

Initially, physical therapy will be non-weight bearing for the first week.  The focus will be on stretching and flexibility.  Week two will then introduce weight bearing exercises to start building up strength.  The really good news is that I can start swimming and water walking as soon as I'm ready.  That was quite exciting to hear.

My obvious first question for the Orthopedist: "So, am I swimming with these staples, or is something else going to happen here?" 

Yes, the staples were removed

Once we begin to introduce weight bearing exercises I can get back on my bike trainer and spin with minimal resistance.  The flexing of the ankle will be good and I'll start to use my calf muscles again.  However, like everything that's good for you, moderation is key.  If the ankle swells up and becomes painful, well, I'll need to pull things back a notch or two.

I'm set to head back to the Orthopedist in 4 weeks for a follow up consult.  At that time he'll decide how much longer I need to keep the boot on.  Maybe an additional two weeks - it all depends on how quickly things progress in physical therapy.

So, I'm making headway.  Things feel better every day, and I was quite happy to sleep without a cast or walking boot last night.  I'm well past feeling sorry for myself.  Not that I don't long to be outside running or cycling, but things are moving along quicker than I expected.  Tomorrow I'll schedule my physical therapy and start getting the strength and flexibility back. 

Not knowing anyone who has gone through something like this, I'm dealing with the learning curve of this adventure with no real knowledge base.  However, just this morning I discovered an individual who went through a very similar experience.  After reading about her injury, and how she worked through it, Cortney certainly registers as pretty tough in my book.  The recovery bar has been set pretty high.

From Running to Triathlons

As I was saying in my previous post, things snowballed quickly and the running thing really took off in my house.  My wife JL and I were eating better (thank you, JL, for seeing that we were indeed in need of a dietary makeover) and we both benefited from losing a lot of extra weight.  We thrived, and still do, with this new active lifestyle.

I became totally engrossed with running.  I still am.  I love to run.  It's what gets me out of bed in the morning (well, the coffee maker actually does that).  It gives me energy, and makes me feel great.  Running the trails with my good friends Tom, Mark, and Matt is always a highlight of any given weekend.

The club that JL and I joined - the Sound Shore Running and Multisport Club has a regular Saturday club run that we used to attend on a religious basis.  On one particular Saturday, 5 or 6 years ago, a few of us were chatting it up, talking about what we did - in regards to athletics - back in the day.  At some point the conversation came around to me and I mentioned that I swam through high school and into college.  Someone then immediately asked: "Do you own a bike?"  I didn't, and their immediate response was:  Why not?  I can't recall who it was that said this, but the conversation flowed into how I would have two of the three legs of a triathlon down pretty well, there were numerous cyclists that belong to the club to help get me started, and maybe it was maybe worth thinking about.

A little time went by, and JL and I were out to lunch on some random Saturday.  At that time we had actually been toying with the idea of buying a couple of kayaks, as a friend of ours had recently taken us out into Long Island Sound and we had really enjoyed it.  We thought that it would be an interesting way to continue to be active and to be outdoors.  I then mentioned the discussion that took place on my run the previous week, and our conversation soon turned to focus on bikes and triathlons.

Well, 2 glasses of wine later we were at a bike shop near our town browsing and asking questions.  After an endless litany of questions, and a few test rides, and we had purchased road bikes, shoes, helmets, shorts, gloves, and were heading home.

Yes, we're big fans of immediate gratification.

I fell in love with cycling.  I loved the speed, I loved being outdoors, and this was opening up new doors for for both of us.  We started to ride with the cycling group within the club on a regular basis.  I had thought I was pretty fit, but I was struggling to keep up with these guys.  They pushed me, and drove me to get stronger on the bike.  More importantly, they taught me the in's and out's of road cycling. 

Soon after, we signed up for our first triathlon.  That was the whole point of this exercise anyway.  It was coming up at the end of the summer - a sprint triathlon - and a few folks from the club regularly raced it.  I borrowed some clip-on aero bars for my road bike and started to get used to them.  JL and I went to another local sprint tri a few weeks before-hand to look at the transition area and to see how everything goes down on race day.  Yes, we're a bit OCD.

Long story short, race day came, and it was awesome.  I finished in the middle of the pack but had an absolute blast.  I was hooked.  It didn't take long for the type-A personality to set in, however. The next season I was determined to run the same race faster than before.  They hold multiple triathlons on this course throughout the spring and summer, and low and behold I came in 3rd in my age-group in the June early season race.  Well, that sealed the deal.  I started working harder, started getting more AG podium finishes, started doing Olympic distance tri's.....  Yeah, I had the bug, and bad.

And it helped that my wife was hooked as well.  Weekends were soon devoted to long runs and rides.  And there was no guilt from either party when the other headed out for 2+ hours on a Saturday or Sunday morning.  This was really working out well.

Soon, my wife (very smartly) suggested that I start training with the Westchester Triathon Club.  Our friend Rich heads it up, and he had been inviting me to join them for their Saturday rides and Sunday runs for quite some time.  I finally joined them on a Saturday morning group long ride and promptly had my ass handed to me.  These guys (and girls) were tough.  But, over time, I became stronger and faster.  My endurance improved.  I was training with some big-dogs (this past year alone, 4 folks from the club qualified for Kona) and it was paying off.  I never dreamed that I'd be regularly getting age-group podium finishes and placing in the top 10 overall at competitive tri-state races.  But it's amazing what happens when you train with people that are stronger, faster, and just plain better than you.  You raise your game up a notch.

Well, just like with running, this too snowballed into a completely engrossing endeavor.  My road bike (well, my upgraded road bike) is still in the basement, right next to JL's upgraded roadie and my Time Trial rig for racing.  We now do more laundry that contains racing and workout gear than we do regular clothes.  We joke on the weekends that we not only do our regular grocery shopping, but we now hit our favorite running and triathlon store, Westchester Road Runner, for gels, bars, drink mixes and supplements - we call it our 'real' grocery shopping for the week.

The triathlon community is great.  The people that I met are wonderful and all just as addicted to a healthy lifestyle, being fit, and racing hard.

So here I am:  My leg up on pillows (still), my ankle in a cast, waiting to get back out there.  I realize I have a lot of physical therapy to do before I'm back on the roads, but I really miss training and am going to miss racing the early season races I had on the calendar even more.

As my wife says: Have patience.

How it started: How I Became A Runner

As I sit here with my leg propped up on some pillows, waiting patiently for Friday to arrive so I can have this damned cast removed from my leg and start rehabbing my ankle, I was thinking back to how all this running and triathlon stuff started.   As I get in the 'way-back' machine and think back to 2001, I wasn't fit at all.  I sat behind a desk all day (still do) but wasn't active in the true sense of the word.  I was about 35-40 pounds heavier than I am now, I ate like crap, and my fitness routine was a once a week football (soccer) game on Sunday mornings. 

I began to run (well, jog) as a way to get ready for Sunday League football (soccer).  Sorry for the Euro-phile phrasing, but as this league was composed mostly French guys, along with some Germans, Brits, Spaniards, and Turks, it was called football.  I figured I'd hit the treadmill at the local gym and get "in shape" for the upcoming spring and summer Sunday morning run-arounds.  I think I might have run about 3/4 of a mile on my first attempt.  I was destroyed.  My wife said I look like I was going to die - my eyes were sunk in and I had the complexion of non-fat milk.  But I kept at it.  Once or twice a week I would torture myself on the treadmill and I was proud of the accomplishments, albeit small ones, I was making.  So much so, that I started to talk about my forays into running with a friend of mine at work.  I knew he ran - at least I knew he ran more than I did - and we started to bond.

My friend at work, Brian, was great.  He was supportive and kept egging me on.  "...just run for 5 minutes longer next time.   You can do anything for 5 minutes"  This continued for a while, and I was soon pushing 2 - 2.5 miles on the treadmill.  I thought this was great.  Then came his next challenge: Get off the treadmill and run outside.

That changed things.  Running was much harder.  Wind, elevation changes, concrete.  This was terrible.  But I kept at it - always trying to run just 5 more minutes on my Sunday "long runs".  I hurt more than I did on the treadmill, but I still ventured outside 3 or 4 days a week.

What I wasn't aware of is that Brian not only ran, but he ran a lot.  Marathons?  Check.  Ultra's?  Check.  Why didn't he share this with me before?  I would have been a bit more cautious in what directions I took from him.

Finally, one weekend I ran 6 miles.  Then a few weeks later I ran 8.  Slow, but 8 miles none-the-less.  That apparently sealed the deal for Brian.  The next thing I know, with Brian looking over my shoulder in my office, I'm on the NYC Marathon web page and I'm registering for the New York Marathon lottery.  I was also instructed to sign up for the Marine Corps Marathon, as a backup, just in case I didn't get into NY.  Whoa.  How did I get here!?

Low and behold - I got into New York.  Now, mind you, I'd never run a 'race' before.  Ever.  Not even a 5K.  Now I have to train for a marathon.  I promptly went to the running store and got some better shoes.  The ones I had been wearing were 3 year old running shoes that I bought because they looked cool at the time.  I got a beginner's training plan from Runners World Magazine and plotted out my training schedule.  I can't remember how many months I had to get ready - it seemed like a long time, but it flew by.

My training for this first marathon, first race, wasn't good by any stretch of the imagination.  There was no speedwork involved.  I didn't know what that was.  I ran the same speed - every day, every run.  I just assumed that the "marathon miracle" would occur and I would somehow just be faster on race day.  I still ate like crap but figured since I was running, I could.  Nutrition and hydration on long runs?  Both inadequate I'm sure.  If there was a public service announcement on how not to train for a marathon, I would have been the poster boy.

Cut to race day.  It's mostly a blur as I think back.  But a few things do stick out, and I have memories of certain things that oddly seem quite vivid:

I remember the surreal atmosphere at Fort Wadsworth waiting for the race to start.  So many people there that looked very serious and I hadn't a clue what I was doing.  It took me a while to figure out why the roads were always sticky after passing a water station.  I vaguely remember entering Central Park and people yelling "..you're almost there".  I remember thinking that they should just be quiet because I really hurt, and 4 miles to go really isn't "almost there".  It took a lot of effort to keep running the last 6 or 7 miles.  Math was impossible.  I remember seeing the 22 mile mark and saying to myself, "okay, just 4 more miles....wait, is it four?  23, 24, 25, 26 (visualize me counting on my fingers)...is that really 4?"

I finished in over 5 hours.  But I finished.  My legs were just solid knots, and walking took much more effort than it should have.  I took the subway back to Grand Central Terminal to catch a train home.  I had no long pants, or dry clothes to change into in my gear bag - I wasn't prepared.  I had no thought of packing clothes for after the race.  I was wrapped in a post-race heat blanket the entire trip home.

My wife JL picked me up at our train station.  I limped to the car and whimpered my way into the front seat. That night I swore I wouldn't do that again.  Well, we all know how that goes.  I ran a handful more marathons.  I worked my marathon PR down to a respectable 3:30-ish (I honestly can't remember what the exact time is off the top of my head).  Things snowballed from there.  JL started to run.  We joined the Sound Shore Runners and Multisport Club to get involved with the local running community.  I was introduced to speedwork thanks to my good friend and first running coach , Joe G.  I started running more races: 5 milers, 5K's, 10K's, 15K's, 1/2 Marathons.  We started eating better at home.  My race times started dropping - I started to get faster. Things really took off. 

I then discovered the drug that is triathlons.  I'll cover that in my next post.

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.