Wednesday, February 13, 2013

Sub-Talor fusion with a tibial bone graft

Before I go any further I want to warn you the pictures In this post will be VERY graphic of my ankle post-op! I will post the same blog without the pictures tomorrow so those of you with a weak stomach can read it too :)

Josh brought it to my attention that I talk a lot about my ankle surgery but never really explain it to anyone any further then it was a sports injury that I had reconstructive surgery on so I figured why not go a little more into detail while I'm sitting here with nothing to do :)

When I was 15 I was on swim team (and pretty damn good!) but one day I wasn't really paying attention to what I was doing, misjudged my foot placement on the starting block and when I did my starting dive the top of my foot slammed into the block... Couldn't do it again if I tried. I thought I just bruised it so I kept going it wasn't until practice was over and I went to get out of the pool that I realized it was more serious then I thought... I broke my 5th metitarcle (sp?) and was cast and put on crutches

I never really thought anything of it again... After the cast came off it still hurt all the time and the dr did more X-rays and found nothing wrong so he said it was more then likely a soft tissue injury and told my parents to send me to physical therapy I did that but it didn't help so they did an MRI and a cat scan on my foot with and without contrast and again came up with nothing so the dr by that point just assumed I was either a teenager who wanted pain meds to get high or was looking for a get out of gym note for school and told my parents there was nothing more he could do

They took me to a few other doctors over the years but everyone came up with the same result of there was nothing wrong with my foot... Expect that about once a year I would fall and break the same bone over and over... Normally once you break a bone it's stronger because it a calcium deposit forms where the fracture was so it was odd the same bone was breaking again and again but no matter how many tests they did every thing came back clean

Finally in June of 2010 right after Josh deployed the second time I was putting Guinness into the car to take her to visit my grandparents (remember I went home to NJ for the deployment) and as I was lifting her my foot slipped and broke again this was the 8th fracture since I was 15 (at the time I was 23)

I was treated at JFK er in Edison Nj and sent home yet again on crutches... Josh was fed up! He told me that of noone in Nj could figure out what was wrong then as soon as I got back to WA to go to Madigan (MAMC) and have them look at it so when I got back in Feb that's just what I did... The dr at MAMC was the first to look at my ankle... When he started looking at it I was like no you don't understand my ankle doesn't hurt, my foot does! And he was like ok but when you fall and break your foot how do you fall and I showed him and he said "right... Your ankle gives out making you break your foot" it was like a light went off!!

He gave me an Rx for a MRI of my ankle but because of the return of 5-2 weeks earlier, there were no appts at MAMC Til after we PCSed to VA

As soon as we got to VA I made an appt at Walter Reed (Bethesda) for the MRI

What they found was mind blowing

The nurse came over to me when I got out of the MRI machine and said "we normally don't do this but here is your MRI on a disk please go right up to the ortho clinic they're waiting for you" um oh shit haha

The ortho doctor was blown away he had no idea how I had been walking all these years all my ligaments and tendons in my ankle were either stretched or torn and a massive cyst had formed in the space where the ligaments should have been

He told me because I was a spouse he was unable to perform the surgery at Walter Reed (they are currently only treating service members at their ortho clinic) and he didn't want to send me to Belvoir because 1. I hate them and 2. They didn't have a foot and ankle specialist so that's how I ended up with a referral for an ASAP appt with Dr Paul Cooper at Georgetown University Hospital in DC. He's the head of the foot and ankle dept and the lead attending... The dude is a rock star.

I have no idea how they got me the appt for 2 days later because I later found out people fly in from all over the country for this doctor and his schedule is jam packed

My first appt with him was on Jan 2,2012 and boy was I nervous!!! I had been shot down by so many drs in the past, told I was faking so many times that I was scared to death he would tell me the same thing... Boy was I wrong!

He came in and was VERY friendly, his office was running about 2 hours later (which I later figured out was kinda their norm) but he was kind and helpful he took X-rays in his office and then pulled up my MRI and said "Wow.l out loud real slowly he turned to Josh and I and asked if we minded if his med students came in I said of course not but I kinda knew that meant I was in trouble "This is what an ankle SHOULD NOT look like" is what he told his students as they stared mouths open at my MRI I honestly couldn't help but laugh

He told me that without question I needed surgery ASAP but we had to figure out which surgery I needed so he filled my ankle with lidocaine (um fucking ow!!!) and told me to walk... It didn't hurt at all!!! He said that meant I needed a sub Talor fusion and he was going to do a tibial bone graft along with a modified bronstrum to fix the ligaments and tendons

Keep in mind this appt was Jan 2nd with one of the leading Ortho drs in the country and he called his assistant in and said I was an ASAP case and he wanted me on the table the following week... WOW Surgery was set for Jan 11 at 11:30am

I tried not to google the surgery or do too much research before hand so I wouldn't freak myself out I knew it was gonna be bad but I also knew it would be worth it in the end.

Dr Cooper told me the basics... I'd have a 6 inch cut on the left side of my right ankle starting right above the "ankle bone bump" as I call it going down to almost the bottom of my foot, a tiny incision on the bottom on my foot on my heal (very small only 1 or 2 stitches) and a 3 inch incision right below my knee cap on the right leg, left side. He would tighten all the ligaments and tendons, remove the cyst, remove my knee cap and take part of my tibia to make my new ankle them replace my knee cap, and insert a screw into my heel that would go all the way up to the top of my ankle to hold it all together. I'm not even gonna lie, the only thing I was worried about was my NJ tattoo on my ankle haha!! He promised to do his best to save it but couldn't make any promises (btw: he did save it! Go Dr Cooper!!) he also warned me I would be castes in the 6-6-6 schedule, 6 weeks in a wrap, 6 weeks in a hard cast, 6 weeks in an air cast... I would be totally non weight bearing for the first 6 weeks and on bed rest more or less (I was allowed to go to the bathroom and go to my appts with him that was it) and he told me that while my foot would no longer break because my ankle wouldn't roll, I would loose 50% of the function of my ankle... That scared me a bit because I wasn't sure what that meant totally and I was too afraid to ask...

When I told my mom what I was having done she kinda freaked out telling me I had no idea how serious this surgery was and that I was rushing into it without thinking... I told her very bluntly I had been living in fear that my foot could break at any moment and Id rather be on bed rest for a few weeks and then be able to walk normal then live like this any longer

Josh's bosses were surprisingly understanding, after I gave them a dr note with my surgery details they have him 10 days off work (I was SHOCKED to say the least) looking back now, I wish I would have had him take the 10 days after I was released from the hospital but I had no idea what was gonna happen at the point and beggars can't be choosers! I was just thankful he had any time off to help me at all because as you remember he wasn't around much after my tonsils came out and I was basically on my own...

The morning of Jan 11 came quick and I was just as excited as I was nervous this was a much more involved surgery then my tonsils and I had no idea how involved it was until I was called back to the pre op area.

Everyone else was in either beds or lounge chairs separated by curtains but I was taken into a real room with glass walls and a glass door... The dr who took me back explained she wanted to give me privacy because they would be starting a nerve block before they took me into the OR... I had no idea what a nerve block was so she explained it... They would put a needle into the back of my knee cap into a nerve there and inject medications which would numb me from there down (basically like an epidural that only effected my right ankle from my knee and down) at first I was very against this idea and she said I could refuse it but she highly recommended it to help control post op pain after talking it over with Josh for a second I agreed... To be honest the idea of sticking a needle into the back of my knee cap is what made me hesitate and the funny part is I have zero memory of them doing it!

She started an IV in my hand and used lidocaine to numb the vein before starting it and I was VERY thankful for that (I hate IVs and I REALLY hate hand IVs) she then told me they were going to start the nerve block so she was going to put some meds into my IV and Josh had to leave because once the block was inserted I would be taken to the OR... I remember laughing and I remember Josh kissing me and telling me I was gonna be ok and he loved me and that's about it... I don't remember him leaving the room, don't remember the nerve block going in, don't remember the ride to the OR nothing!

My next memory is them waking me up in the OR after it was all done... They were telling me to move my toes and I remember it hurting really bad and I don't know if I said it out loud but I kept thinking (and I thought I was saying it but who knows hahah) "this hurts so bad you said it wouldn't hurt why does it hurt?!?!" And then I fell asleep again... The next time I woke up I was in recovery with a massive bandage on my ankle and on my knee, a second IV in my other hand and something called a Polar Pack attached to my ankle (it was under the dressing and when you plug it in, it moved ice water over my wound kind of like a moving ice pack it became my saving grace once I figured out how to work it.

I remember when I first woke up in recovery I could move my toes and then slowly the ability went away it was by far the weirdest feeling I've ever had to look at my toes and think "move" but they wouldn't move I remember touching them and freaking out a bit because I couldn't feel them but it felt like the bandage was way too tight the nurse said that was normal and cut the bandage a bit to give my toes room to swell (and swell they did!!!!) I remember asking for Josh over and over and at first they told me I had to wait Til I was moved to the next faze of recovery and I would close my eyes and ask again and I think I was in the same room and they finally said yes and brought him back... He took a picture of me with my stuffed animal he got me and he took a picture of my ankle all cast up and that's about all I remember until they told me they had a room for us upstairs (I knew ahead of time I would be staying over night at least 1 night and in my mind only a few moments passed but I later realized that like 8 hours had passed haha)

Once we got into the room they helped me move onto the hospital bed from the gurney I was on and then I sent Josh on a mission to get my over night bag and find me a salad and pine apple (don't ask I have no idea why but that was the only thing that sounded even a little good and OMG it was amazing when he brought me it!!)

I remember sitting there playing one phone and then happily eating my odd dinner giggling to myself that I was able to eat which was something I was most def not able to do after my last surgery... At this point my ankle didn't hurt at all and the only pain I had was in the cut in my knee but they had me all doped up on IV diludid so as long as I didn't meds with it I was basically ok it just felt like a bad bruise...

They were really nice and set Josh up with a cot in my room (it was a private room) so he could spend the night and help me if I needed anything during the night they also let me changed into my own clothes (they said as long as they could access the surgical site, my arm for my BP, and could hook up the EKG leads they didn't care what I wore so I changed into a black tank top and black stretchy pants and was one happy little teeny bopper!)

They had me get up once after I changed to go to the bathroom (I didn't realize how bad I had to pee they they asked ahahha!! Then I thought about it and I had been on IV fluids for almost 12 hours so that shouldn't have been too much of a surprise) the nurse brought me a walker because I was far too unsteady from the meds for crutches and it took both her and Josh to get me up and to the bathroom I remember laughing when I got in there because she had to help me with my pants (I couldn't pull them up and hold onto the walked at the same time) and I said "wow. 23 and I can't put on my own pants? Is this rock bottom?" Lol

I had VERY little concept of night and day while I was in the hospital Josh said I would fall asleep mid sentence and then just randomly wake up and finish the sentence hours later... The only bad thing about Georgetown is they have a very odd rule about pain meds... They won't wake you up for them if your sleeping you have to wait to get them Til you wake up which can cause MAJOR issues if you sleep though your dose time (once pain starts its very hard to get it under control again) so I set an alarm in my phone to wake me up every 4 hours so I wouldn't miss a dose.

This whole every 4 hour wake up call caused the no sense of night or day but honestly I didn't care as long as it meant I wasn't in pain!

The nerve block was supposed to last 48 hours but it Didn't even last 24! I'm so thankful to my nurse who advocated for me to the ortho resident who wanted to send me home the next morning the nurse said no no no and said she didn't think it was a good idea Til after I was stabilized without IV pain meds... Had they sent me home I woulda just been getting to my house when the nerve block wore off and let me tell you that was NOT pretty and it most def didn't tickle! It was horrid the pain went from 0 to 100 in like 5 seconds I almost passed out!

They gave me IV dudlidid and IV benedryll (plus Zofran for because all the pain meds can make you sick to your stomach) then OxyContin, Vicodin and a really strong anti anxiety med (I can't think of the name but its super common and holy shit does it work!!) in pill form... Needless to say I was stoned utterly stupid!
I have very screwy memories of the 4 days I spent in the hospital... I remember watching Card Sharks on GSN for what felt like hours (chances are it was like 1 Eppie because I am pretty sure it's only on for a half hour hahaha) and I remember the nurse putting me on oxygen because they took my vitals and my O2 stat was very low from the dulidud, I remember the dr visiting to check on me and begging him to give me back the nerve block (he said no only 1 per customer haha), And I remember being freezing cold and they piling warm blankets on me then scaring the crap out of the nurse because I was sucking on a blue push pop that turned my lips a little blue (my mouth was closed when she walked in so she didn't notice my teeth and tongue were also bright blue hahaha) she was all "um hunny how cold are you?" Haha I quickly explained it was a Lolly pop :)

The morning after surgery and every morning from then on the Physical Therapist came and got me up out of bed and made me practice using crutches I was not a fan of the PT dr but he would bribe me with the promise of a dulidud shot if I did what he wanted hahah

I was finally released on Sat and by that point I was pretty ready to be he and thought my pain was under control... Getting home was an adventure... We live 45 mins from Georgetown, which is smack dab in the middle of DC so we had to time leaving perfect to avoid traffic (they gave me a final shot of dulidud right before removing the IV to get me though the trip home and hold me over Til Josh could get my Rxs filled at the pharmacy

I don't really remember the drive home I'm assuming I fell asleep (that's normally what dulidud did to me!) but when we got home I realized we had quite a problem... How the hell was I going to get inside?!

Our front stairs of set up weird I have no idea how to even explain it so I'm gonna have to just post a picture to show why this was such an issue... I couldn't use crutches or the walker up the stairs so after trying twice I finally gave in and did it the only way I could think of to do it safely... I crawled.

Yes you read that right I crawled from the truck up the 7 steps to my door, up the 3 porch steps as then up the 8 steps that takes you up stairs into our living room. I took a small break that before continuing to low crawl, with my ankle in the air and trying to avoid hurting my knee any worse to my bedroom where I somehow found the energy to pull myself up onto the bed using only my arms I had worked up quite a sweat the by time I got into bed but I made it!!! And let me tell you I didn't move after that unless I had no other choice!!!

Just put 2 pillows under my ankle to elevate it (1 body pillow bent in half but a hospital pillow and covered it all with a pad thing they gave us at the hospital to protect the pillows from the blood that was leaking out of the cast

I was basically ok for 2 days but on Monday things got bad and I was in an unreal amount of pain the only way I could explain it is that it felt like the cast was going to cut off all circulation to my ankle and the feeling of pressure was unbearable! Josh finally said this has gone on long enough and said get in the car were going to the ER. He didn't wanna take me to Georgetowns ER because it was so far so we figured we would try Belvoir's first... Never again! This visit was Strike 3 against them in my book and I now refuse to go there for anything! I don't care how sick I am ill drive the extra 30 mins to Georgetown or 40 mins to Bethesda!

The ER staff was rude, uncaring and totally unsympathetic... After making me sit for 4 hours in the waiting room they called me back into a room and said there was nothing they could do for me because my surgery was at a diff hospital... WHAT THE FUCK why didn't you tell me that when I got here 4 HOURS ago so I could have gone to Georgetown instead of waiting here for 4 hours to have to go there and wait 4 hours?!

We go to Georgetown and they totally unwrapped my ankle taking all the dressings off of it and this is where I got my first look at the wound and Hod damn it was not pretty! I looked at Josh and was like "um at least my tattoo wasn't cut? I can't think of anything else positive to say about this..." The ER dr was pretty sure I was gonna be admitted because he was sure it was infected by the Ortho Resident thought otherwise and put me in a walking boot (5 days post op this SOB put me in a walking boot... What that fuck?! Over. And told me it looked fine for 5 days post off and to just make an appt with Dr Cooper for Thursday to have the stitches out...

I did what I was told and by Thursday I really thought I was dying I couldn't get comfy, I was in so much pain I was throwing up, none of my meds helped at all and the morning of my appt I remember begging Josh to not make me go because I was in so much pain and my head hurt so bad I was getting sick just thinking about taking a shower to leave the house... Thank GOD he pushed me to that appt!! He very well might have saved my life!

When we got there he dropped me off at the door (in a wheelchair) and we to park the truck I wheeled myself to Cooper's office, the foot and ankle center. When I got there I signed in then rolled myself to the back of the waiting room and burst into tears Imy head hurt so bad and my ankle pain was off the scales and I just wanted to throw up and pass out... There was an older woman who was in the waiting room who went up to the desk and requested they took me back next instead of her... She is a saint if you ask me and I now try to do this for others...

The nurse wasn't able to remove the Ace bandage I had put on my ankle (it was too swollen for the resident's walking boot and clearly I couldn't walk yet) the normal way of unwrapping it so he cut it off and called Dr Cooper in as soon as my surgical site was visible... Dr Cooper walked in, took 1 look at it and said "so you've earned yourself a weekend of IV antibiotics and pain meds! That one rockin' infection but what did you expect it's off the coast of New Jersey" haha Josh still laughs about that little joke

Dr Cooper also made the call at this point to put me into a hard cast with a window cut into it to view the wound site and keep an eye on the infection and the stitches... The nurse later told me I coulda picked a cast color but he just did it white because I could barely sit up without puking let alone talk to anyone so he didn't think I'd mind the white cast... He was very right. Cast color was the last thing on my mind!

They had me fill out all the admission forms and then have me the bad news that at the current moment the hospital was totally full so they sent me to the ER to wait for a room...

They put me in a bed in the ER and I was honestly a huge bitch to anyone who even looked at me let alone spoke to me until the nurse gave me a shot of dulidud then I was happier then a pig in mud!

They told me they didn't know how long it would be Til they got me a room but it was already 10pm and Guinness had been alone since about noon so I sent Josh home to let her out and feed her and get to bed so he could visit me in the morning

He was gone about an hour when I melted down... I burst into tears that I was all alone in the hospital and then it hit me that this was the first time since he was hospitalized since we had been apart and that was it I totally lost it

I called him crying so hard I was barely breathing and he was so sweet he told me over and over how much he loved me and that everything was gonna be ok and he'd be there with me in a few hours

They were able to get me a room at about midnight and I was very sad to find out I had a room mate (if it was a private room Josh would be allowed to spend the night) the girl was very friendly and she let me use her IPhone charger so she was my hero at that moment (I had thought to pack a small bag figuring I was gonna be admitted but I forgot my charger)

I talked to my roommate for a little while and then I fell asleep from all the meds I kept my alarms set and recommend to my roommate that she get on a similar schedule so we could get our meds at the same time (we had issues getting our nurse to bring our meds we were on an oncology floor and neither of us had cancer so they kinda forgot about us because we weren't actively dying...

We had to keep the door to our room shut because the smells on that floor were awful... You could literally smell death... It was a nightmare...

My roommate was nice but VERY needy and very whiny... She didn't like taking meds so she would wait Til her pain was totally outta control to ask for them and by the time they got them to her she was losing her mind and screaming and crying and it made me crazyyyyy!!!! Why wouldn't you just take the meds when you need them rather then wait Til your screaming in pain?!

I was in the hospital for 3 nights this time and on the morning after the 3rd night I basically told the resident she had 3 options: 1. Get me a private room 2. Send me home or 3. I was gonna sign out AMA because I needed sleep and just couldn't get any with her screaming and crying every 5 hours!

Thankfully she was willing to release me (she wasn't happy about it but said as long as I took the antibiotics at home she would agree to it) the Downside was the day I was released was the day Josh was set to go back to work and after 10 days off we couldn't ask for more so he picked me up at the hospital and signed me out then brought me to Ft Myer where a friend "Nikki" if you have read previous posts, picked me up and brought me the rest of the way home then helped me crawl up the stairs and into bed again

My second return home went surprisingly smooth... Josh set me up a little cooler with drinks and snacks in it to get me though the day while he was at work because I could barely get to the bathroom alone and most def couldn't go anywhere else

This system worked shockingly well and I was very happy with how we set it all up... I'd say we handled my severe limitations VERY well!

I didn't go down stairs post op for months... I was in bed with my ankle elevated for about 3 months I can't remember going or doing anything except laying in bed and going to my dr Til April when I went to the military Spouse Convention in Arlington (I was in a wheelchair but I HAD TO go see Mollie Gross preform!!)

I ended up being cast much longer then originally planned... I had 5 hard plaster casts, each one between 2-7 weeks then I was in the walking boot for 2 months followed by months of PT

In Dec when we were in Disney was still limping pretty bad when out of nowhere I felt a huge pop in my ankle and for a second I thought I really messed it up and then I realized it didn't hurt near as bad and I was able to move it way more it was like a Disney miracle! Josh thinks that either something was stuck under a bone and got loose or one of the internal stitches finally broke... Whatever it was it was amazing and completely life changing! I was almost totally pain free and VERY happy!

It's 3am right now and I'm falling asleep so Im gonna publish this how it is and then tomorrow I'm gonna go back in and organize the pictures into the story in order and finish the story :) night!

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