Learning to walk

Babies are difficult. Anyone who is a parent will tell you this. And I know why. Let me fill you in. It's because they know they are going to have to learn to walk. Having been through that a quarter of a century ago, I have been nothing short of an expert walker until that fateful night last January. And after spending 4.5 weeks on crutches after my surgery, there is nothing I wanted to do more than walk on my own two feet. Oh the freedom! The places I could go if I only had two feet. Over grass, up and down stairs, through the rain!!! The problem, as with babies, is that there is a learning curve between walking and not walking. And IT IS FRUSTRATING!!! Ok, lets start at the beginning here. My beautiful, bedazzled, hot pink cast came off. People saw what my leg hair looks like after 4.5 weeks of not shaving. Remember, cleanliness and dignity jumped ship quite awhile ago. And they put me in a walking boot. A WALKING BOOT! I still get happy when I think about my boot. Why? Well, the first word is walking. And second of all, it is removable. Meaning, I can wash and shave my leg, and my leg can feel the breeze on it's face again. So after the nurse cut my cast off, they slap this thing on, and she tells me to walk. Just like that! And the learning curve starts.....So I crutch out of there, trying not to get down on myself because I still couldn't walk yet. My entire leg had atrophied from the weeks of not using it. The muscle was all shriveled up inside my skin. Don't panic, don't panic, don't panic, don't panic. I tried to focus on the positive (shaving my leg....omg!) and I tentatively tried this whole "walking" stuff. As is, with 90% of my weight still on the crutches, I set my foot down. Now, as we have all learned, I have a high tolerance to pain. And I spent the rest of that day not eating because I was literally scared that if I put food in my mouth I would throw it up from the pain of trying to walk. So I formulated a plan. The nurse said I needed to be walking again in three days. So the first day I would "walk", but I would set my crutches down with each step. Day two, I'd lose one crutch and go all Tiny-Tim style. Day three, crutch free. And so I started. I celebrated making a lap around the kitchen table. And after a couple days of not eating a single thing, I COULD WALK. And I was just as proud of myself as I was the first time, all those years ago. I'm not sure if anyone else thought it was that awesome, but I think it's just because those people haven't had to take breaks from being independently mobile. Either way, I was a walker. Ok, I was more like a limper. It wasn't pretty. With a lot of the muscle gone from my leg, I kind of had to swing that whole leg around instead of bending it at the knee and picking it up. De-light-ful. And this, my friends, is why they created physical therapy. Which I was set to begin, again, in a short few weeks. Would it be as much fun my second time around?

Time flies....

When you can't take a shower. No seriously, the first three days after surgery are a blurry, drug-induced haze, but after that I remember everything clearly, unfortunately. The night of my surgery, I discovered that I could not, in fact, crutch into the bathroom and sit on a toilet. Without walls near enough to hold onto, I was attempting to maintain balance on one leg, lowering myself without using the crutches (since they don't bend) or a wall for stability. I know you all have a mental image, but it was even more dangerous than what you are thinking. Cut to a picture of the rolling desk chair. Which I began rowing myself into the bathroom on. Needless to say, since I wasn't even properly potty trained on crutches, a shower was not in the cards. Over the next two weeks, various forms of not using stairs and having my hair washed for me ensued. Cleanliness and dignity were long forgotten. I used babywipes to clean myself most days. An actual shower involved wrapping my cast in a garbage bag, duct taping the top, placing a chair in the shower, and everyone praying I didn't slip and fall getting in and out. I'd say I took three showers from surgery day to my next doctor's appointment two weeks later. I was so excited for that day. My cast was coming off! This could only mean good things. We sat in the waiting room for a very long time. Long enough for my zen-like patience (ha!) to wear out and me to ask the receptionist what the hold up was. She told me they were waiting for a seat in the cast room. W.T.F. The cast room? I'm supposed to be coming out of my cast, not going into one! But it happened. They took off my cast and removed my stitches. With a chainsaw. Ok, not really, BUT last week I cut my finger and got three stitches and took them out myself to avoid having one of these nice ladies do it for me. No joke. After the stitches were out, they asked me to bend my ankle to 90 degrees so they could put my fiberglass cast on. BAHAHAHAHAHAHAHAHAHAHAHAHAHA
HAHAHAHAHAHAHHA
HAHA
HA
Yeah, not so much. So I got yelled at for my lack of range of motion, put it a pretty pink cast, and I crutched out of the office exactly as I had come in. Two more weeks of waiting!

The wait is over

So I laugh at the lady on the phone. Seriously, I don't TRY to be a mean person, but after everything I've gone through to get ready for this day, and the fact that I am 2 stoplights away mean that this thing is happening, even if I have to do it myself. I check in, I change into my fashionable gown and one non-slip sock. The nurse tries to end my life while she was starting my IV. I'm only exaggerating slightly....after the bloody mess she left, we needed to change my blankets and then I had to reassure her that I trusted her to try again on my other arm. Fun stuff. But it was all worth it the second Dr. McGorgeous walked into the room to do my pre-surgery consultation. Looking at him in his scrubs, I wondered if he was a fake doctor, and this was not my real life, but a made-for-TV movie that would air on the Lifetime network. I wasn't even on drugs at this point, this is really how I think. Anyways, he starts making marks on my ankle and that's when it really hit me, that no matter what he found with the ligaments, I was not going to wake up with the same body I went to sleep with. I would permanently carry a reminder of this injury. That's about the time I hugged my mom, put my hair in a sweet hairnet and got wheeled down the hall. I moved onto the surgical bed and they started arranging me. Arms here and here, stuff on my fingers, something on my forehead. Something in my IV. They were trying to keep the mood light and were asking me questions about my job. The drugs in my IV burned my arm, and made me a little fuzzy. I saw something coming over my face and it startled me. My anesthesiologist explained that it was just oxygen. I remember thinking "THAT'S NOT OXYGEN, THAT'S ANESTHESIA! THAT JERK IS LYING TO ME! MY DOCTOR IS LYING!!!!!" And then I woke up in recovery. My leg was in a cast. My first question was about the ligament, and the nurse told me she didn't know. The same nurse then wanted me to eat. And my poor, drugged up, stressed out brain had had enough. Our conversation went as follows:
Nurse: What would you like to eat?
Me: Nothing
Nurse: Well, you have to eat something. We have crackers, bagels, muffins, dinosaur brains, coffee, tea, soda, water....
Me: FINE!@ I'LL HAVE CRACKERS AND WATER!
said crackers and water show up. I have no intention of eating them. 5 minutes pass...
Nurse: You need to eat those crackers.
Me: I'm not interested in your crackers.
Nurse: If you don't eat them, I can't give you your Vicodin
Me: How many do I have to eat?
(as a side note to my reader(s), I am not a toddler, although at this point I can see how you would be confused)
Nurse: 2 crackers for 2 vicodin
So I ate the two crackers and the two vicodin. And a muscle relaxer. :) They brought my mom in, who explained to me that yes, one ligament did need to be repaired. My expected recovery time from this surgery is 6-8 months. Even through the haze of drugs, I know this isn't going to be good.

The Big Day

Some girls look forward to planning their weddings. They spend months making sure every detail is in place and the day goes off without a hitch. I planned my surgery with the same fervor. There were so many things that needed to be taken care of. The surgeon told me to plan on taking 6-8 weeks off of work to recover. Since I had only been at my job about a year and a half, I wasn't able to go on short term disability yet. So I was going to need to take sick and vacation time to have this done. I planned it for the Thursday before Memorial Day, with my tentative return date the Monday after 4th of July to buy me a couple of holidays in there. There was paperwork from my department that needed to get signed by me, my boss, his boss, my doctor, the pope, and Elvis himself. I needed to figure out a place to live. My current house had my bedroom and the bathroom on the 2nd floor, and the kitchen and TV on the first floor. My mom would be coming to stay with me for a couple of days and she needed to be housed. I was fortunate that my sister lives in the same town as me, and her apartment had an elevator. Seeing how I was going to be on crutches for a month after the surgery, stairs were going to pose an issue. I needed to make sure that my finances were in order, because my surgery required a $500 deposit from my own pocket, which would at some point be covered by the insurance company. I needed to purchase a lot of loose fitting comfy shorts and pants that would fit over a cast. I made one shopping list prior to surgery that was as follows: "Duct tape. Garbage bags. Baby wipes". I made a note on it, should anyone ever find it and recognize my handwriting, that the purchases were intended for bathing after surgery. Duct tape and garbage bags to wrap my cast, and baby wipes for the days when showering would be too difficult. I was required by my insurance company to complete a pre-surgery physical. I had a very interesting debate with a hospital representative who deals with the insurance as to whether my father was my husband. It was all very whirlwind, and during it all I was working 40 hours a week and finishing up one of my grad school courses. I'm sure you know me well enough by now to know that I was trying to learn everything I could about the surgery I was about to have, and it's true. Now, since this is not my first rodeo with surgery, I can tell you from experience that I am a puker. You get some anesthesia or some morphine in me, and all I do is barf. It's very classy. So for this surgery, I requested to have some numbing medicine injected into my ankle while I was being worked on, so that when I woke up I wouldn't have to take very many drugs to avoid pain. And therefore, avoid becoming a drugged up, heaving, unable to walk, Intervention-style mess. The morning of my surgery was gorgeous. I remember being up around 5, even though I didn't have to be there til 7, and it was only a 5 minute drive. My mom and I hung out and she drank coffee while I pouted about not being able to eat or drink anything before the surgery. I drove to the surgery center since she wasn't that familiar with the part of town we were going to, and I was halfway there when the phone rang. It was the surgery center, calling to tell me that my anesthesiologist wasn't going to be able to make it, and the new doctor did not feel comfortable injecting my ankle with the numbing medicine. And did I want to postpone my surgery.....

Surgery

I can feel my jaw drop as he says this. I was NOT expecting to hear that I need surgery. For a bone bruise? What is going on here? He tells me that the MRI shows that I did not bruise that part of my talus, I actually broke it. The broken bone is causing my ankle joint not to fit together correctly and move smoothly. The surgery involved going in with a drill and a camera and removing the broken part, and then drilling into the bone marrow to encourage new bone to grow. I'm holding myself together pretty well at this point, until he brings up arthritis. And the fact that it's now a given that I will develop it at some point. I feel my eyes well up with tears, but I'm not a cry-in-front-of-others type of person, so I blink them away and ask how long it will take for the arthritis to develop. I remember him telling me that was a wonderful question, and unfortunately, he couldn't answer that. It could be 10 years, or 20 years, or.....whenever. Now, Dr. BlueEyes is a great guy, and he walked me all the way out to the lobby with his arm around my shoulder and told the receptionist that I was going to need a consultation with the Foot and Ankle surgeon. He told me to hang in there and if I needed anything, I could call him. And that was the last time I ever saw him. I mean, he didn't die or anything, he still works there.....I just haven't needed to see him again. So the receptionist tells me that the Foot and Ankle surgeon doesn't have any available appointments for 3.5 weeks. I got into my car, closed the door, and burst into tears. And I cried for quite a few miles on the way home. But now what? I have 25 days to sit and wait and worry and not have anyone to answer my questions. I'm still in pain. Surgery?! What about my job? I stand a lot! Will I need to be on crutches? Drilling my bone marrow? How much pain will I be in when I wake up? So I did what researchers do. I researched. I went straight to the medical journals and I learned everything I could about my injury [an Osteochondral Fracture of the Talus, for you nerds out there :)] and the different types of therapies. And I will not lie to you, I got a pretty sick satisfaction out of telling my boss that I needed SURGERY and apparently, you CAN be that injured and still walk on it. The day of the surgeon's appointment finally rolls around, and I am so confident. I know my injury, I have seen the data on different therapies. I have made decisions on how I want my treatment to go. I am READY for this. I have been in pain for nearly 4 months, and I am ready to move on with my life. So I'm sitting in his exam room, my shoes and socks off, waiting to get this ball rolling and he knocks on the door and walks in. And he's gorgeous. Oh my god. And he shakes my hand and introduces himself and I can feel myself blushing because he is so attractive. Grey's Anatomy was lying when they called that guy McDreamy. I officially declare his official name to be Dr. McGorgeous. So he looks at my MRI, and does the same ankle exam that I've had done 3 times in the past and I feel smug. Because I am prepared for this. And because I'm an idiot. He sits down and tells me that yes, we will repair that fracture, but he thinks we will need to repair at least one ligament. This is that point in the movie where everything gets all fuzzy and slow for the main character, because what's currently happening to them is so bizarre and so unreal that it can't even be filmed in real time without camera tricks. He goes on to explain that if the ligament needs to be repaired, my surgery goes from an arthroscopic (meaning, done with a camera and tiny incisions) procedure with me walking in a week (which repairs the bone), to that procedure PLUS an open procedure where they drill a screw into my leg and reattach the ligament to that. And the recovery is much more difficult. Tears in eyes AGAIN, I ask him what are the odds that I need this done. He said the only way for him to diagnose this for sure is to do a stress test while I am under anesthesia. Apparently, when your ankle hurts as much as mine, you start "guarding". Which means, all your muscles and tendons tighten up to prevent it from moving too much, and this makes doing a stress test while I'm awake impossible. I tell him to level with me, because I can't be put under not having a good idea of what I'm waking up to. He tells me he would guess that there is a greater than 90% chance I need a ligament repaired, in addition to the bone repair. In a daze, I was led to the scheduling department and was signed up for surgery on May 21st. Four and a half months after the injury happened. Walked out to the car, burst into tears, lather, rinse, repeat. I need to know what is going to happen if Dr. McGorgeous is right, and I need at least one ligament repaired. How could a simple "sprained ankle" have turned into this?

Dr. BlueEyes

So where were we? Oh yeah....the Sports Medicine Specialist. Hmmm, as a main character in this story, I think he needs a name. Dr.........BlueEyes. OK, Dr. BlueEyes sits down and tells me his take on the situation. He thinks I have a bone bruise. And I think this is the best news I've ever heard. That pesky Biology degree I got taught me that some tissues in the body heal easily. Bone is one of them. Some tissues are much more difficult to repair. Cartilage, tendon, and ligament are some of those. So this sounds great, and I tell him that! The bone is hurt, and it will probably just take awhile to heal. So how did my bone get hurt? Ah, the gory details. The main bone of your ankle is the Talus. Above it are the leg bones (PS- if you're not singing the song in your head right now, you're not cool) and below it are the bones of the foot. Dr. BlueEyes suspects that I sprained my ankle in December and those loose ligaments hadn't healed by January when I went to the gym. So without the ligaments to hold my bones in place, the leg bone actually knocked into the ankle bone and bruised it, and that was the snapping noise I heard. So there are actually two issues. One is the bone bruise, which will heal itself over time. Second are the loose ligaments, which need to be corrected or this will happen again. So instead of getting the RICE runaround, Dr. BlueEyes gives me an ankle brace and orders twice a week physical therapy sessions. He tells me there's an 80% chance this is all the help I will need to get better and put this whole mess behind me. Joy and elation follow. I have a diagnosis! It's not that bad! So I start physical therapy. I'd never had any kind of PT before, so I wasn't quite sure what to expect. The first session was your basic get to know your ankle stuff. We measured my range of motion compared to the good one. We measured the strength compared to the good one. I filled out a lot of forms asking me to rate a lot of things on a scale of 1-10. In the next few sessions I started to really like PT. Essentially, it's like recess when you're a kid. The room is a giant playground full of toys, and you hop on this and jump off that, and throw a ball here, and since my therapists were two awesome girls about my age, it was easy to get past the pain I was feeling while I was doing it. I thought I was progressing really well, and now that I had an explanation for my pain, I didn't worry that I was still feeling like I was before. I was working hard during my sessions and ACTUALLY DOING THE ASSIGNED EXERCISES AT HOME! About 5 weeks into my stint in PT, I was hanging out with a friend over the weekend. We were watching TV, and I got up off the couch to get a drink of water. I was wearing my ankle brace religiously at this point, so imagine my surprise when I stood up and tried to walk and I could feel that the bones of my ankle were not properly in the joint. This is Friday night and this unstable feeling (insert your Mary is unstable joke here) lasted all weekend. First thing Monday morning, I was on the phone with Dr. BlueEyes scheduling an appointment. Something still wasn't right, and now it was worse than before. Dr. BlueEyes orders an MRI, and after an entire week (who's doing the math here? how many weeks since ankle snap night? 11. good job!) of fighting with the insurance company about whether or not I really need one (yes) and whether or not they were going to pay for it (hell yes) I walked into the hospital to get an MRI. And it was fun! I brought in a CD, which I listened to while wearing comfortable, metal free pajamas under a warm blanket. Honestly, when the 45 minute procedure was over, I was so relaxed that I didn't want to leave! I had to wait until the next day to see Dr. BlueEyes and have him tell me the results, and it was nerve wracking. When I finally got to his office, I sat in his room for what seemed like an hour. Well, that's because I actually did sit alone in the exam room for an hour. Hindsight tells me that this is red flag #1. F........I.......N.........A.......L.......L......Y........the door opens and Dr. BlueEyes comes in with another doctor (red flag #2) and apologizes for keeping me waiting for so long, but he had looked at my MRI and wanted to confirm with the Radiologist at the hospital who also looked at it to make sure they were seeing the same thing (red flag #3). As a side note, at the time, none of these red flags are apparent, I am literally still just sitting there like a fool, smiling and nodding at the doctors. He doesn't waste any time getting to the point. "Mary, I have some bad news. You're going to need surgery."

The Saga Continues...

Cut to 4 weeks later. It's now February of 2009, and my "sprained ankle" is still a nightmare. I never really had any swelling or bruising, just this pain that lasted from the time I woke up til the time I went to bed. Except for the times it didn't hurt at all. Was I crazy? How could it hurt sometimes, but not hurt other times? And why didn't it hurt the same way each time? Sometimes it ached. Sometimes it was a burning pain. Sometimes, if I was super lucky, it felt like a jolt of electricity shooting through me. Maybe it really was nothing but a sprain. I mean, I could still walk on it. As my boss so kindly put it "if it was really hurt, you wouldn't be able to walk on it". Still, if it was just a sprain, shouldn't it at least START to get better after 4 weeks? I decided it was time for a visit to my primary care physician, and during the appointment, I explained the whole story to her. Her official diagnosis was "sprained ankle", and she asked me if I had tried taking Tylenol. It was a pretty defeating moment, because I knew *something* was wrong with me, and this month long chronic pain situation was really starting to interfere with my life (side note: I was so cute and naive back then. If I had only known....). I think she could tell from my demeanor after her diagnosis that I was not happy with what she was telling me. Ha! Who am I kidding....I can't remember exactly, but I know myself pretty well, and I'm guessing that it was pretty blatantly obvious that I thought her medical degree was the prize from a cereal box. She told me that if the pain didn't go away in another 4 weeks, that I should call her back and she would refer me to a Sports Medicine Specialist. A week later, and I could.not.take. the pain anymore. I had a lightbulb moment. I HAVE THE EXPENSIVE HEALTH INSURANCE! I DON'T NEED A REFERRAL! It was another week til I could get in to see the specialist. For those who are keeping track (and you should, there will be a quiz later) we are now 6 weeks out from the ankle snap night.

So doctor number 3 is a Sports Medicine Specialist. I figure, if this really is a sprained ankle, it is the *WORST* sprained ankle in the history of mankind, and this guy treats athletes, so he will be able to help. So I'm sitting in the room, and he starts the exam. It's a whole bunch of moving my ankle around into various positions and asking if it hurts. Just like the other two doctors. And, as with the previous 2 doctors, my answer is always "no". So I'm starting to break out into that cold sweat where you start thinking that no one is ever going to figure out what is wrong with you, and you're going to be like this for the rest of your life, and why doesn't anyone believe you that it's not a sprained ankle, and.....ok, so I'm a little dramatic. But, then the most magical thing happened. My doctor tells me "Yeah, I didn't think those things would hurt, but I'm guessing this will..." and with that he turns and pushes and I come off the table in the most excrutiating, 10 on the pain scale, I thought pain like this was reserved for childbirth, can't remember to this day how I ended up curled in the fetal position pain. But when I recovered from that, I was happy. Because this doctor knew where to look. He knew something the other doctors didn't, and I knew he wasn't going to tell me that I had a sprained ankle. He didn't.

Am I really gonna leave you on the edge of your seat like that? Damn straight!