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.