Hints for healing and recovery

Since other folks recovering from ankle and leg injuries occasionally end up on this blog, I thought I would post a few thoughts on healing and recovery.

Get help
First off, get help. Friends, family, a rehab center. Whatever you have to do. Get somebody to give you a hand, and accept the help. I definitely credit my quick healing in the past (and hopefully this go-round as well) to the amazing help I've gotten from my family.

When you're this banged up, driving is obviously out, so you'll need somebody to cart you around. But help for all the other daily tasks (that we normally take for granted) is just as important. If you have to stand up to do dishes, cook food, do laundry, etc., your foot is down and probably swelling quite badly. Not good for healing. Accept the help.

Really elevate
Really (really!) elevate your foot. Not just propped on a chair. Keep it at or above your heart. This probably means a recliner and lots of pillows. One of my docs early on emphasized the importance of keeping it so elevated, and I've found it makes a huge difference. One of those camping recliner/lounger chairs works well if you don't have a typical recliner (and is much cooler in hot weather). Something like this (shameless plug for REI) is a good place to start: http://www.rei.com/product/812204/rei-comfort-lounger-chair

Stay active
Stay active. Do push ups or sit ups or whatever. Get outside if you can. Roll around the neighborhood or local park in your wheelchair or knee scooter. Get out and stay active. Once you're in PT, do everything your PT tells you to, and then do it again (and maybe a third time for good measure).

Knee scooters!
If it's an option for you, use a knee scooter rather than crutches. Crutches are useful for tight spots and stairs, and not bad for around the house, but otherwise knee scooters are (without question) the way to go. Just make sure you get one you can steer. I spent hours on the phone with my insurance company getting a knee scooter sorted out this time around, and it was definitely worthwhile. More here: http://twobrokenankles.blogspot.com/2009/10/knee-scooter.html

Shower covers
Get one of the cast covers for the shower. They're not terribly expensive, and they are much (much!) better than any home made alternative (usually trash bags and duct tape). The one I have is much like the original one shown here: http://www.medcareproducts.com/castcovers/ Oh, and you'll need some sort of plastic stool for sitting in the shower as well. Again, a small and worthwhile investment.


That's all I've got for now. Let me know if you have any questions!

Not much new to report

Not much new to report right now. I've returned to work, and amuse my colleagues by zipping about the office on my knee scooter. Best I can tell, everything is healing well and quickly. Still no pain. Still swelling if I don't keep my foot up (though that has improved slightly). I go back in next week to have my cast taken off and another x-ray taken. Hopefully the doc will tell me good things at that point.

Thanks for checking in!

Images from Post-Op

So, after a crazy last week, I'm finally posting images from my post-op appointment.

The first are three x-rays, showing the two huge screws holding everything together. If I remember the doc correctly, they are 6.5 mm in diameter. The other smaller screws and anchors are left over from earlier surgeries.




I think I mentioned in an earlier post that the surgery ended up only being a single incision on my ankle, and another very small incision at my knee. They are healing nicely, as you can see here:




And finally, for everyone that wanted to see what I look like with a full beard, here's a pic. My parents didn't even recognize me at the airport!

Chest pain?

So things have been interesting this week. Monday, not too long after I finished the previous post, I ended up in the ER with chest pain and difficulty breathing. After a CT scan, the doc in the ER determined that it wasn't a pulmonary embolism (which is the big worry after a surgery like mine) and sent me home.

Long story short, I still felt horrible. Like a 90 year old man with a bad heart. Chest pains and trouble breathing make you feel like you're dying. I don't recommend it.

After several more doctor visits and a few tests, it's finally been determined that I have pericarditis, a condition in which the sac-like covering around the heart (pericardium) becomes inflamed. Breathing deeply hurts because the expanding lungs push on the pericardium. Laying down or bending over hurts because things shift behind the chest wall and push on the pericardium. Heart rate is high because the heart isn't able to expand as fully as it otherwise might. Not fun.

Interestingly, this is apparently unrelated to the ankle surgery in any way, and is instead probably the result of a bug I caught some time in mid January.

The good news is that I have only a minor case and it isn't life threatening. The bad news is that it can take 12 weeks to clear up. I have already seen some improvement (my doc says I'll have good days and bad days) but at least I no longer feel like I'm dying.

That actually becomes an interesting perspective. I may not feel 100%, but when compared to feeling like I'm dying, I feel great.

First Post-Fusion Appointment

I had my first post-op appointment today, after the ankle fusion. Doc and PA were definitely surprised to hear how quickly I was off pain meds. Incisions are healing nicely, and swelling, though visible, was fairly minimal. The only incision in my ankle was along the outside, but not up the main incision, instead it was along the line of one of the minor incisions from the last surgery. When this is all said and done, I'll have two pretty significant scars running up the outside of my ankle. I did get a new cast, in the same burgundy color I've had before.

Mom took some pics, and I'll get them posted before long.

I did learn a little more about the recovery plans. I'll be in the cast for four weeks, no weight bearing. Assuming that the fusion is going well and the bones are growing together, I'll move from the cast to a rigid boot at the end of four weeks (six weeks after surgery) and will probably be allowed partial weight bearing for the next four weeks (10 weeks after surgery). At that point, I'll probably be allowed to put my full weight on the ankle, but will still be confined to the boot. At some point after that, I'll switch to normal shoes. Full bone fusion will probably take about four months total, if I remember right.

Things continue to go well, and I have very little pain. The biggest issue is just keeping my foot elevated to minimize swelling.

A quick note about the original fall

Just a quick note to clarify the accident that started all this. Most everyone that learns that I broke my ankles in a climbing accident assumes that I fell to the ground (or "decked out") and broke my ankles on impact. While many climbing injuries certainly do happen that way, that wasn't the case here.

Instead, I slid down an angled slab of rock. I probably slid 20 or 30 feet before the rope brought me to a stop. At that point, I was still 20 or 30 feet off the ground. As I slid, my feet caught (either in a crack, or on a bump, I don't know which). My momentum kept me sliding, even though my feet were stopped, and that's what did such terrible damage to my right ankle.

Nothing much new to report today. Pain level is still pretty low, but I still have to keep my foot quite elevated.

All good after surgery

Surgery to fuse the ankle took place last Wedensday, Feb 1. All apparently went quite well. The surgery took considerably less time than anticipated, partly because I had no cartilage left that the doc needed to clean out.

My surgeon reported that the bone surfaces at the joint were badly deteriorated, but that the surrounding bone was healthy, strong and hard.

What he did in a nutshell was: carve out a place at the bottom of my tibia, shave down my talus (the small bone that sits beneath the tib and fib) and fit the two of them together. Then he pulled bone marrow from the top of my tibia (near my knee) and used it like grout to pack the joint (this apparently speeds the growing/fusing process). Finally, he bolted the tib and talus together with giant (6.5mm, I think) screws.

I ended up in the hospital overnight, but for less than 24 hours. Once again, the staff at Overlake hospital up in Bellevue were quite good.

Pain has been very minimal, and I haven't needed heavy duty painkillers since Saturday morning. I do have to keep my ankle elevated above my heart or it gets swollen (and the pain ratchets up) very quickly. This means lots and lots (and lots) of time sitting in a recliner or bed with my feet propped up high on pillows. Comfortable for a short time, not so much for days on end. Today is the first time I've been able to manage without quite so many pillows. A small, but nice, change.

Things could definitely be worse.

My folks have, again, been heroes, and are out here for the long haul. They're planning to stay until I can drive again (6 - 10 weeks) which is fantastic. I definitely credit my speedy healing in the past to the care they provide. If I had to spend more time on my feet cooking, doing dishes, washing clothes, etc., my foot would be much more swollen, I would be in a great deal more pain, and I don't think the healing would happen nearly as quickly.

I'm still a little confused about the recovery time line, but definitely no weight bearing for 6 to 10 weeks. And then several months before totally healed. I go back next Monday for a follow-up appointment to take out stitches, check healing, take x-rays, etc., and I should know more then.

For now, I'm going to hobble out to the porch on my crutches and sit in the sun and enjoy this marvelous fall day (never mind the fact that it's February).

Getting ready for surgery

Getting ready for more surgery, to fuse the main ankle joint (tib to talus). X-rays this morning show that I am truly bone on bone. Nice, huh? This x-ray illustrated it best:




Compare this with an earlier x-ray, below, and it becomes very clear how much my ankle has deteriorated. (It's not quite the same x-ray view, but it illustrates the difference.)

After the MRI

I'm afraid that I haven't been very good when it comes to keeping this thing updated. I did have a chance to look at the MRI after I returned from my recent trip to CO/UT/ID (some great hiking and backpacking!) and I learned that my ankle is pretty well toast.

I hardly have any cartilage left in the main ankle joint, and the bone surfaces are showing significant signs of deterioration and bone loss (both tibia and talus) - which I gather is typical of serious arthritis. Even my uneducated eye could see that thing do not look good. The subtalar joint is showing signs of wear, but looks pristine compared to the main ankle joint.

My doc was very surprised at just how well I'm getting around, given what he could see in the MRI. He's advised me to just keep on keepin' on for as long as I can. While surgery is in the future, I'm hoping that I'll be able to put it off for another year or more.

Two weeks ago (actually, the very day I got to see my MRI), I got out rock climbing for the first time since the accident. Since then, I've been out three more times. I've definitely developed a bit of a fear of heights (something I never had before) which has been interesting to work through. But it's been fantastic to be back on the rock.

Back to the Doc.

So, things had been progressing just fine. I was out of PT and had even gotten backpacking a couple times. I was in the gym late-winter/early-spring, getting in shape for climbing and hiking season... and then my ankle starting giving me more and more problems. Mostly nothing big, just soreness, but occasionally there were days when it was painful enough that it was hard to walk.

So I got myself back into PT, and kept at it. A couple winter backpacking trips on snowshoes (very tame, nothing extreme) aggravated my ankle, so I laid off a bit, but kept stretching and strength training. Still no progress.

Eventually, I got myself back to the Doc, only to learn that I basically have no cartilage left in my main ankle joint, between the talus and heads of the tib/fib. Fusing my ankle is somewhere in my future, and I'm not real pleased about it.

For now, I'm gritting my teeth, taking some ibu, and carrying on. Once the pain gets bad enough, though, I'll be in for more surgery. And then recovery all over again. Have I mentioned that I'm not real pleased about it?

Just had an MRI on Friday, to determine just how much cartilage is left and whether or not I'm doing any damage to the peroneal tendons which (as I understand it) run through a small notch between the talus and the head of the fibula.

More soon.

No posts of late...

So once I started walking, and now that I'm back to work, I'm afraid that I've stopped updating this site. Things are progressing: I'm still in PT a couple times a week and my ankle still gets swollen pretty quickly if I don't keep it elevated (walking long distances or working on my feet for long periods of time is not happy), but I'm walking - and mostly without a limp!

My parents were total heroes. My mom ended up spending five (count 'em, five!) months out here, and my dad was out pretty frequently. And we didn't even kill each other.

I'm not sure how much more I'll post here. Thanks for reading!

These boots are made for walkin'...

As usual, I've been remiss in updating this blog. For a little over two weeks, I've been walking around in my mountaineering boots, not using my big Darth boot at all!



Today I went in for a minor surgery to remove the syndesmotic screw, the large screw that connected the lower ends of my tibia and fibula together. If you like the big words (fun!), the screw had been put in place to stabilize the distal tibiofibular syndesmosis - the tough fibrous connection that holds the distal ends of the tibia and fibula together.

We had hoped, one, that the screw would come out easily and in one piece and, two, that we wouldn't have to replace it with any other hardware. Neither of these quite worked out. The screw had broken about 3/8 inch from one end and so needed to be pulled out from both sides, meaning small incisions had to be made on both sides of my ankle. In addition, my surgeon decided to replace the screw with a "tightrope" system that holds my fibula in place against (basically) my tibia, but allows the two to move in relation to one another.

Some more info can be found online about Ankle Tighrope Syndesmosis Fixation. I'm not sure if that link describes the exact system used by my doc, but it makes the whole thing pretty clear and will certainly give you a better idea of what was done than I could accomplish here. Of particular interest, check the Rationale and Surgical Technique tabs on the left side.

All in all, I feel okay now, several hours after surgery. Of course, I'm on some pretty good pain drugs which always helps! I was able, though, to hobble in from the car without much trouble. I am, however, and despite the title of this post, back in my Darth boot for the rest of this week. Ugh.

All for now, I'm off to nap. G'nite!

I'M WALKING!

I'm sorry that I've neglected this blog in recent weeks.

It's because I'VE BEEN WALKING!

So I went to the doc a week and a half ago, and he checked over my feet and ankles real well and then had me stand up (barefooted!).

He looked up and said "Well, this is the first time I've ever seen you standing. Congratulations!"

All good, so he okays me moving from the Darth boot into a standard hiking boot on my left foot ("Since you work at REI, I know you have hiking boots, right?" well yeah, maybe a pair or two...). The right foot stays in the Darth boot, but I can begin putting weight on it. I'll need to leave the knee scooter behind and start using crutches.

My doc's assistant walks in and says "Huh, you're taller than I thought you were.." Again, first time she'd seen me standing up.

So I went to PT the next day, and took sneakers along with me so that I could ride the recumbent bike more easily. After ten minutes on the bike, I walked over to the hip sled/leg press.

Walked.

In my sneakers.

Yikes!

My physical therapist looked and me and asked "WHAT are you doing?"

Um, walking?

"Are you supposed to be doing that yet?"

Um, probably not...

"Does it hurt?"

Nope.

"Well, you've got two choices. You can lose the boot, and use crutches. Or you can keep using the boot, and not bother with crutches."

This is a no brainer as far as I'm concerned. No crutches for me!

I okayed this with the doc by phone and so now I'm up and about!

I can't walk quickly. And mom says it always looks like it hurts when I walk, but that's just because I have to take awkward steps with the Darth boot.

Like before, the biggest problem is one of blood flow. After a day at work, even when I try to keep my foot up as much as possible, I come home with a sore and swollen ankle. But its not going to get better unless I use it. And I'm so glad to be walking, I'm happy to put up with sore and swollen!

The Knee Scooter

So the first knee scooter I got was quite well made, and brand new, but not really that well designed. The front wheels were essentially on casters, which made it very easy to turn around in tight areas like an office. Unfortunately, these same casters made it turn downhill whenever I rolled across something that was the least bit sloped.

Like a sidewalk.

You know how sidewalks are canted just a bit to cause rain water to run off? Well, pushing down a sidewalk always ended with a drift to one side - into the curb or grass or parking lot or whatever was next to the sidewalk.

In general, I'd have to say that drifting towards a parking lot is not good.

The casters also meant that turning required me to reach out with my left leg to pull or push me in the direction I wanted to go. Since my left leg is still healing and in a boot, this was not exactly optimal.

And so I search and searched for one that actually steered. (This is what several friends had recommended to begin with, but the medical supply company I'd been getting everything from didn't have any.) I couldn't locate any in the greater Tacoma area. None. The one company that stocked them, but had them all rented out, is actually based in Bellevue, and they had some in their Bellevue location. So off I went.

I ended up convincing them to give me the one really cool one they had available. They actually had to drive it out from the warehouse for me. Totally worth it!

Day 59: Cast Free!

Visit to the doc today and now I'm cast free! I'm now allowed to fully weight my left ankle and to start physical therapy on my right ankle. Yippee!

My doc also said that the knot at the top of my left Achilles wasn't serious. I had probably strained my muscle or tendon when I fell, but hadn't done any significant damage. Also yippee!

Since I can weight my left ankle, I can now get rid of the wheel chair and move to a knee scooter. Fun fun!

More soon...

Day 57: After a week of work

So I've finished a week of physical therapy, and a week back at work. Physical therapy has been okay so far. Since I can't put any weight on my ankle, it's mostly been stretching and core exercises (working glutes, quads, hip flexors, abs, etc.) so that I'll have the strength to walk once I reach that point.

I, of course, have home exercises to do, and I've been doing about twice as many as suggested. Any lack of recovery won't be from lack of trying on my part!

The only item of concern so far is that my Achilles has been extremely swollen (two to three times as wide as normal). My physio was able to get some of the swelling down with ultrasound and massage, and that allowed us to see and feel a knot right at the junction of my calf muscles and my Achilles. Looks like I must have injured it at some point. I just hope it isn't injured too badly!

Day 51: Hi Ho, Hi Ho, It's off to work I go...

Off to work tomorrow. I'll be working 5 hours shifts for the next couple weeks. And obviously I'll have to keep my right foot elevated all day every day. But finally back to work!

Day 46 - One Cast Down, or Out of the Cast and Into the Boot

So I had an appointment with my doc yesterday, and my left ankle is now out of a cast! Instead, it's all immobilized in this big black boot/splint. It's still not supposed to be weight bearing, but least now I can wash my leg and stretch my ankle. I will hopefully start physical therapy this week.

My right ankle is in a new RED cast (Go State!) and will be for another two weeks.

I didn't have new x-rays taken, but my doc pushed and poked and prodded my ankles pretty thoroughly and we didn't find any pain. This apparently indicates that the bones are healing well.

I expect my left ankle will remain in the boot for two to four weeks, and then move to a splint. My right ankle will remain in its cast for another two weeks and then be put into a boot where it will remain for two to four weeks.

Blood flow out of my right ankle remains an issue. Every time I hobble around on my walker, I look down to see purple toes. But it's improving, and I hope to be returning to work before too long.





The new boot is this heavy plastic footbed, with aluminum stays up the side, and a big neoprene wrap and six straps to keep my foot and ankle in place. I was trying to describe it to somebody and said: "it's sorta like Darth Vader meets neoprene." Now I'm jokingly referring to it as my "Darth boot". (You'll notice that I put in an orange Superfeet footbed, which looks a little silly but makes the boot much more comfortable.)

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.