Day 35 - Same ol', same ol'

Nothing new to report. Still concentrating on keeping my foot up. Blood flow out of my ankle is improving, but only little by little. Still a long way to go.

My dad left on Thursday. He's returned home to take care of things there for a couple weeks, and will be coming back out later in September. My mom, ever the trooper, is still here. Don't know what I would do without them!

X-rays after second surgery

Finally able to upload the x-rays after my second surgery. I think the only new hardware is the long screw that is connecting by tibia and fibula. With some luck, this will be removed in about 12 weeks, once my ankle stabilizes.

Day 27 - Orthopedics Appt.

Back to the doc today. Everything looking good, so the final sutures were removed from the outside of my right ankle and replaced by steri-strips. My right ankle was put in a cast rather than back into a splint, and it will probably be there for a month.



Swelling is so far down it actually looks like my foot again! As always, surprising how far my leg has atrophied.



This was right after the sutures were removed, and before the incision was steri-stripped. Looks SO much better than it did 3 weeks ago!



So now I've got two casts - my left is in sort of a burgundy/cabernet/merlot color and the right is in blaze freakin' fluorescent orange. (Really, the orange is crazy bright. The photo doesn't begin to do it justice.)

Why So Elevated?

When I did all this damage to my right I ankle, I managed, thankfully, not to do any serious damage to the major veins and arteries in my ankle. No blood spurting from the wound or anything like that. Instead my tibia just shredded a tendon on its way out of my leg.

While I didn't damage the big vessels, I did wreak absolute havoc on all the small veins and lymph vessels all around my ankle. This means that blood gets down to my ankle okay, but doesn't get pumped back up very efficiently. Apparently this will take care of itself over the next six months or so, and will be much improved once I'm able to start flexing the ankle and working the muscles.

In the meantime, however, whenever my right foot is down, it fills with blood. If I leave it down for long (more than a couple minutes), it ends up turning a pretty dark shade of red and swelling noticeably and painfully. Only solution for now is to keep it elevated at or above the level of my heart. This is fine when I'm at home, thanks to a super comfy travel recliner I borrowed from some friends (it had proven its worth helping them recover from surgeries and injuries). But it is pretty darn difficult anywhere else.

First Post-Op Appointment after Second Surgery

Went in today for my first post-op appointment after the second surgery (which was 6 days ago, last Tuesday). Things continue to progress well, although the x-rays showed that there are still some tiny, tiny bone fragments scattered through the tissue under my fibula.

What had the most impact on me, however, was how my surgeon described my injury. He has used the words "devastating injury" when describing it all to my parents, but he's never been quite that emphatic when talking with me. Today, when I was asking questions about the blood flow out of my ankle, he got right to the point.

He said something to the effect of: look, you came close to ripping your foot completely off. If you weren't young and healthy, you might have lost the foot, all the tissue there is extremely damaged....

gulp.

Oh.

I mean, I knew I had really done a number on my ankle. It can never be good to see bone sticking through your skin. And I knew I really sorta shattered the end of my fibula, which is why I've got the plate and all the screws.

But when your surgeon paints the picture that your foot was half off, that's something else entirely.

gulp.

Anyway, moving on, things seem to be progressing fine. As you can see below, swelling is way down, incisions seem to be healing well, so now we're just waiting for the bones to heal.


My foot is finally recognizable as my long and bony foot. No longer a balloon stuck on the end of my leg.


For the second surgery, the new incision was actually made right through the old incision. Looks so different without all the swelling!


The second surgery didn't include any work on the inside of my ankle. It's hard to tell from this photo, but the incision here from the first surgery is now practically smooth with the surface of my skin. I was afraid I was going to have a thick ropy scar, but that doesn't look to be the case.

The second surgery did confirm that the large chunk of bone visible in the CT scan, near the end of my fibula, was in fact the chunk that was missing from the end of my tibia.

Look at your own ankle and imagine this: a piece of bone, about 2/3 the size of a dice cube, was broken off from the back of your inside ankle bone (the rear of the tibia) and driven around and across the front of the ankle until it came to rest adjacent to the front of your outside ankle bone (the front of the fibula). Crazy huh?

But the piece was pretty badly mangled, and the cartilage left on it was badly damaged, so my surgeon elected to discard it rather than try to put it back in place because of all the risks that would incur.


Look Ma, two ankles! This is the first time I've seen both ankles in two and half weeks. With both legs down, so that you had something to compare it to, it was amazing to watch my right foot and ankle swell and change color as the blood drained into it and didn't get pumped back out. You can see this in the photo above, but it doesn't quite do it justice.  It was also amazing to be able to watch my foot and ankle literally drain, once I elevated the foot.  More on this in another post soon.


My poor calve muscles are so atrophied. (And I'm told I haven't seen anything yet. Ugh.) But at least the gashes on my shin are healing up well.

So that's all for now.  I'm back to laying back with my feet above the level of my heart.  I've heard that PT is hell, but right now I can't wait.  All this laying around helpless is killing me!

More about surgery

So my surgery was at 4 o'clock in the afternoon. But the folks in my surgeon's office insisted (I called twice) that I not eat or drink after midnight. I should have mentioned to them that this would almost certainly lead to a migraine, maybe they would have relented a bit. But I didn't.

And, boy howdy (as my cousin Jonathan would say), did I end up with a migraine. Wicked pain, light sensitivity and nausea. Laying on a bed in pre-surgery, covered by a stupid hospital gown, with both feet in casts, shivering cold and yet drenched in sweat from the migraine...and dry heaving. If that's not fun, I don't know what is!

Anyway, learn from my mistake: if there's a reason why you shouldn't fast for more than the 6 or 8 hours that the anesthesiologists actually need you to, let folks know. Maybe your experience will be a little happier.

Second Surgery

So the second surgery on my right ankle was Tuesday evening. It apparently went quite well.

It's my understanding that I had a long conversation with my surgeon about it that night. Unfortunately, I was still all doped up and don't remember any of it. Lucky for me, my surgeon realized that I wouldn't remember a thing so he also talked with my folks at length. As I wrote above, surgery apparently went quite well.

The large bone fragment did, in fact, turn out to be a piece from the end of my tibia. I'm still amazed that it ended up on the other side of my ankle below my fibula. It was too badly damaged to reattach to my tibia, however, so it was simply removed.

A large screw was also inserted to connect the lower ends of my tibia and fibula. This stabilizes the ankle by providing a secure channel for the talus, or top ankle bone. It does, however, limit the range of motion of your ankle pretty severely. The plan is to remove this screw in about 12 weeks, after the tendons and ligaments in my ankle have had a chance to heal.

I was pretty out of it when I got home, and in a fair amount of pain yesterday morning. That seems to have resolved itself, and now I'm back in the land of trying to keep my ankles elevated as much and as often as possible.

Stories from the ER

So once I got rolled into the ER and slid from the ambulance gurney to the hospital bed, they determine pretty quickly that i didn't need to be on the backboard, so I was untaped and unstrapped and the backboard was removed.

Two funny things happened in the ER. Shortly after I arrived, as things were just about to get underway, a woman comes into my room and exclaims "Oh, that's awesome!" She was, of course, commenting on my compound fracture, and it turns out she was one of my ER nurses. Always good to be in the hands of someone enthusiastic about their job!

Later I heard somebody come in the room, but they didn't come up to the head of the bed. I lifted my head and looked around to see two paramedics checking out my compound fracture. It was a little disconcerting; I'm not sure you really want to be the freak that the other paramedics are coming to check out.

For what it's worth, the folks in the ER at Overlake were top notch. While I certainly hope to never be there again, it was a good place to end up after my fall.

Third Appointment

Had my third appointment with my surgeon today. Swelling has gone down enough that I will go into surgery on Tuesday as planned. Had one more small blister de-roofed (?) and sutures removed from both sides of my ankle.

Asked about my left ankle, and learned that it will probably be in a cast for another 5 weeks. Somehow I didn't think it would be nearly that long. Yikes.

Anyway, as you can see, the swelling really has gone down, my foot has even started to resemble a foot again.


In some ways, now that the swelling has gone down, the sutures stand out even more.




Around the back of my leg, I'm amazed at how close together the incisions are.


I'm also amazed at how much my calf has atrophied already. Hard to imagine what it will be like after another 6+ weeks in a cast!



And then the sutures were pulled. Seems amazingly soon, but I guess when you know the skin won't be moved because the joint will be splinted, you can remove sutures a great deal sooner. (And of course, they were steri-stripped, so it's not like they're opening anyway.)

Old Proverb

You know that old proverb about crying because you had no shoes until you saw a man who had no feet. Well, life has a way of keeping things in perspective.

I saw a guy in a wheel chair the other day (I suspect that you notice them more when you're in one yourself. Sort of like the car thing where you notice your model of car all over the place once you've purchased it. Anyway...), so I glanced over to see what might have happened to him.

Well, first I noticed that he wasn't wearing any casts.

So I gathered that it must be more of a permanent thing rather than a recent injury.

Then I noticed that he didn't have any legs.

And that he only had one arm.

Which he was using to push himself alongside his wife while she ate ice cream.

I hurt, and my plans for this fall have sure been drastically altered. And if it wasn't for the support being provided by friends and family, I'd really be struggling (thank you thank you thank you!).

But, really, I'm doing just fine.

Updated Second Appointment Post

I finally had a chance to download some photos from yesterdays post-op appointment. I've used them to update the post I made last night, which you can find below.

Sad (but funny) conversation

So right before this all started, I received an order from Superfeet of new replacement insoles. My mom's wondering what she should do with the box, since I won't be needing the insoles any time soon. Ouch.

The Fall

I slid on a 5.9 route while rock climbing in an area called Exit 38, about, oh, say, 38 miles east of Seattle (right off I-90). [If you know your way around Exit-38, I was in the Deception area on Write Off Rock, climbing Knife in the Toaster.]

The face on this part of Write Off Rock is shaped not unlike some sort of exponential growth curve. Starts out at a nice even angle and but just keeps getting a little bit steeper. Well, when I got to the pretty darn steep part, and was something like 7 or 8 feet above my last bolt (and not far from clipping in to the next one right at the top of this steep section), I slipped. Because Write Off Rock is so accessible, much of the face has been polished smooth by countless shoes and chalky hands. One moment I was looking at my next move, then something slipped and, bang, off I went.

Because of the angle of the face I didn't tumble, and I didn't fall away from the rock, and I couldn't push myself away from the rock. I just slid down it.

And I slid and slid.

As I recall, I was more or less spread eagled and constantly trying to latch onto a passing nub. This didn't help.

So my belay partner caught me (thank you!) just like she was supposed to, and after swinging around to face out, I came to a stop maybe 20 feet off the ground (and who knows, it might have only been 8 feet, my perspective was a bit screwy).

My body had that kind of shocky feeling you get when something is really wrong, and I had a kind of dull distant pain in my right ankle. I looked down to see white bone sticking out to the left and my foot hanging limply off to the right. Blood was dripping slowly from somewhere. Ouch.

When I looked down past my ankle, I could see that my belay partner's eyes were as big as saucers. This confirmed for my rattled brain that things really were as bad as they looked.

Some other folks immediately began scurrying around my belay partner. Two other couples (one with kids) had been climbing the wall when we got there and they sprang into action in what seemed to me to be a well oiled machine. The two women were the most medically qualified, one was a nurse practitioner who works as an ER nurse in Portland and the other was a radiologist that practiced at Overlake hospital (where I would end up going later). The dad took the kids on a little hike - I'm afraid that the kids were a little freaked by the whole thing - and the other guy was immediately on the phone calling 911.

If you are ever going to be in a climbing accident, these are the sort of people you want to fall among!

So my belay partner lowered me to these two women who laid me out in the gravel along the trail and positioned my foot in a way that limited the bleeding.

One advantage of climbing in the Deception area at Exit 38, at least if you get injured, is that the Iron Horse trail (a wide gravel trail that used to be a railbed) can be accessed by ambulance.

Since we didn't need to reduce the fracture, and since I wasn't bleeding profusely, we just played a waiting game. I'm sure the ambulance was there relatively quickly. For me, it felt like they took ages.

But finally the paramedics arrived and started packaging me up. My ankle was just now really starting to hurt, but the paramedics had brought along some nice happy pain medications which took care of that pretty quickly. Once my ankle was stabilized in a temporary splint, they I was loaded onto a backboard and then into an ambulance. Riding the bumpy trail in the back of an ambulance was painful enough (even with the nice happy pain meds) so I'm really glad I didn't have to get hiked out in a litter.

I was actually doing remarkably well, between my shock system and the pain meds. Talked and joked with paramedics a fair amount, and even got them to take a photo of me laid out in the ambulance. Isn't the thumbs up cheesy?



(In case you're wondering, yes I've intentionally left names out to protect privacy.)

Second Appointment

So I had my second appointment this morning. Nothing new with the left ankle, although the CT scan from Friday definitely shows the fracture (and it's deeper than i expected). The CT scan also shows that the fracture is ever so slightly displaced. Dr. Idjadi gave me the option of surgery and screws to get it a tiny bit less displaced. He joked that he loves to do surgery, and would be happy to cut me open and screw some bones together. But the risks associated with surgery (many) seem to far outweigh the gains to be made (very small). We agreed that we should just let it continue to heal in the cast, and only consider surgery if things somehow (unlikely) get displaced in the future.



The right ankle is progressing right along. Swelling continues to recede (you can see the wrinkles in my skin that are forming as the swelling goes down). Huge fracture blisters were still present, so Dr. Idjadi de-roofed them (or whatever the fancy name is for cutting off the top of a blister).



We did learn something interesting from the CT scan, however. We thought that the piece of bone that is missing from my right tibia had been left behind on the mountain. Instead, it appears that, during the injury, that piece migrated all the way across my joint and is now sitting near the bottom of my left fibula. This is at least a portion of the bone we were going to inspect and possibly reattach with surgery. Dr. Idjadi has never seen anything quite like this before, nor has anyone else in his office. Great - just what I wanted to be: a journal article.

So part of surgery will be to inspect this larger chunk of bone. If it's not too mangled, we'll probably reopen the inside of my ankle and reattach it to my tibia. This opens another can of worms though, because, when the piece wasn't found during the initial surgery, the tendon or ligament that normally attached to it was re-anchored to the broken end of my tibia. Anyway, no decisions can be made until Dr. Idjadi can look at the fragment and determine where it goes and if it's still useful.



Things look good enough with my right ankle that my surgery has been tentatively scheduled for next Tuesday. Another appointment this Friday will reassess if that remains appropriate.

X-rays after initial surgery

So here's what my foot looked like after the initial surgery. I'll try to point out some specific things another day.

Photos from first post-op appointment

So I went in to the appointment with a camera, and everyone thought I was a little odd. But I'd already asked my paramedic to take a photo of the wound, so asking to and then taking photos here was easy by comparison. Mom got into it and was able to take some photos that I definitely wouldn't have been able to. Without further ado:



This is my very fat swollen right foot. Looks horrid, but much better than last time I saw it, when it was uselessly hanging off to the right. The wispy cotton bits are exactly that - wispy cotton bits, left over from the splinting.



This is the inside of my ankle, where the bone broke through. Turns out that I actually left a portion of my tibia behind on the mountain. Youch.



This is the outside of my ankle. Under these attractive stitches is now a plate a whole bunch of screws holding most of my ankle together.

The wonderful blisters are called fracture blisters and are apparently formed when the skin is asked to stretch more than it really can. In and of themselves, they're not a big deal, but they apparently get infected pretty easily so I'm told that we'll be keeping a close eye on them. Also means I'll be staying on antibiotics for a while.



My lower leg was pretty banged up all the way to the knee. Nothing too serious, but plenty of scabs. If it only it was just this, and not the ankles!



We ended up putting a fiberglass cast (did you know you got color choices now? even paw prints and polka dots! last time I had a cast, admittedly quite a long time ago, this was not an option!) on my left leg and a plaster splint again on right leg. The splint is essentially a three sided cast that is tightly wrapped in heavy-duty ace bandages. The splint can then expand and contract slightly as the joint swells and contracts. In this photo, the plaster splint is drying and Valerie is about to get started with my left cast.

Val is my surgeon's assistant and she is a total bad ass. When she's not doing this, she's a high angle rescue medic. If that doesn't mean anything to you, well, just take my word for it. She's bad ass. She was very amused that we were taking photos. Everybody understood a little better once we explained that my dad isn't here and wants to know what's going on.



And now we're leaving with me patched up. I'm on my way get CT scans of both knees, and to get my very own wheel chair. So much fun and excitement. It was a very long day by the time we were all through.