Sunshine

Today I had an appointment with my surgeon. See, this is what I love about having told you guys the whole story. Now I can just tell you about my day! So, I saw Dr. McGorgeous today. He came in, and I started to tell him "I just wanted to talk to you. I need some reassurance about this next surgery. The past few weeks I've been....." and I just kinda trailed off. But no worries. Dr. McGorgeous chimed right in with "Going a little crazy?"
DON'T MIND IF I DO!!!!!
Anyway, yes, I've been stressed because I just wasn't sure if the surgery is the right thing to do, and if it is, I need more details on what's going to happen. So he goes "Would you be willing to try something". Now, anyone who knows me can tell you that I love to experiment. It's why I went into science. And the only thing I love more than experimenting, is experimenting on myself. It's terrible, I know. Call my IRB. So without even knowing what I'm agreeing to, I agree to whatever he wants. I iz smart? Anyway, his suggestion is to inject the soft tissue around that craptastic suture with a numbing medicine. If that takes the pain away, then we know that's where the pain is coming from. He tells me that we won't be able to get all the way to the bone, but we can do it right now if I want. And I do. So I get to play doctor and mark my own ankle where it hurts, and then he gets to actually be a doctor and use the needle. He used some numbing spray first and I didn't feel the injections at all. So he left me alone for a couple minutes to wait to see if the drugs worked. He comes back in the door all excited to find out if our experiment worked. I told him "New plan. The surgery is off, and you can just follow me around and inject me like this every couple of hours!" Turns out, that doesn't really fit in his schedule. Go figure. So I told him I could still feel a small pinpoint of pain, like he didn't get to the center of my ankle, but I think this worked. He asked what a normal amount of walking is for me. I told him this weekend I tried to take the dog for a walk and made it 4 houses before I had to turn around and come back. So he kicked me out of his office and told me to go take a walk and see how many houses I could get. And call him the next day to let him know if it worked. So I went for a walk. In the beautiful, sunny, 60 degree spring weather. And I saw flowers, and a park, and birds, and a spray painted fence sign. Beautiful. And when I got home, I checked my route. I knew I had gone more than 4 houses, but I'm a scientist, and I need hard data. I had walked 1.01 miles. And the only pain I had was that same tiny pinpoint that we didn't reach. It felt amazing. Then I went to the grocery store and shopped, which is normally a vicodin-inducing activity all on its own! The other thing Dr. McGorgeous told me is that I would pay for this, pain-wise, tomorrow. And I can tell you that as the injection is starting to wear off, I will be paying for it. Whatever! I went for a walk, who cares?! Also, we decided that I will definitely have my shin opened up. Because I don't have enough scars. Actually, that's not the real reason. I lied. It's really because my anterior compartment is all messed up, and we're (do you like how I say "we" like I'm actually going to help with the surgery?) going to dissect the tendon sheath. So like I said, we just think I need more scars.

"Anyone can give up, it is the easiest thing to do. But to hold it together when everyone else
would understand if you fell apart, that is true strength"
-Unknown


I'm trying.

Up to date

So this is the last post I need to catch you guys up to where I am now. I'm excited to share these last few details, but even more excited to have the story told, and be able to post about my current struggles in real time. So back to the girl with my injury. We shall refer to her as Ankletwin. Because from the first minute we met, it was unbelievable how similar we were. To the point where we refer to "our" surgeries and "we" went to the doctor. It wasn't until I met her that I realized how lonely the chronic pain had made me. I mean, I still live a pretty awesome life, but I've also definitely changed. When I think back to my old workouts.....60 min on the elliptical doing 6 min miles on level 8. Weights 3-4 times a week. I had just finished a 10 week beginners yoga course when I was injured. That's not my life anymore. I haven't worked out since Jan 13th, 2009. I'm now the person who has to calculate the distance between two stores in the mall so I know if it's feasible. My old life ended that day. And I'm still working on accepting that. But I have always been a fighter. And I refuse to stop fighting to get a life I can enjoy. After talking to Ankletwin and realizing that other people struggle in situations like this every day, I decided to take my feelings from private to a blog. I truly do hope there is someone who reads this and finds some comfort in the fact that I'm fighting too. And I have a collection of characters, from my massage therapist, to my physical therapists, nurses, doctors, friends and family who refuse to let me quit. I saw my surgeon on March 8th for the one month follow up to my 3rd PRP injection. My pain is worse now that it's been in at least 6 months. The surgeon can see that the swelling is worse now than it has been in months. I'm very clearly backsliding. I knew it before he even walked in the exam room that day. And for the last few months my biggest fear has been that he will give up on me and send me to Pain Management. I'm 26, and the prospect of spending the next 50 years using narcotics to manage my pain brings me to tears. But there's always that ray of hope. I tell the surgeon that while the pain is worse, it's also changed. I used to just feel pain everywhere from mid-calf down. And after the 3rd PRP, all the "background noise" pain disappeared, and I can now point to EXACTLY where the pain originates from. I can pinpoint it. And once this pain starts, if I don't stop whatever I'm doing (ex: grocery shopping) the pain completely debilitates me. And here's what he comes back with. When he repaired my ligament, he used a suture to reattach the ligament to my bone. The area of pain I'm pointing to, and the swelling I'm having are directly over this suture. He thinks my body is rejecting the suture as a foreign object, and literally trying to push it out through my skin. So, two weeks from today, he is reopening my big incision to remove that suture. He's also opening my smaller incisions to remove scar tissue and inflammation. And while there is nothing "hilarious" in this post, this is the current state of affairs. I'm allowing myself a small ray of hope, but also mentally preparing myself to go back on crutches, back in a cast, and back to my un-showered, dignity-lacking, post-surgery self. So no worries....hilarity will ensue.

Rollercoaster

So after sleeping through Christmas and New Years, another sacrifice I had made in this whole ordeal, I expected to pretty much feel amazing. After all, I had already been through a PRP treatment, so I totally knew what to expect, right? (wrong.) At one point just after New Years I almost emailed Dr. McGorgeous to ask him if I was ok. I didn't feel anything like I felt the first time. I felt awful. I was still on painkillers after 10 days! After getting back from my parents, I made an appointment with my massage therapist, DJ MT. I always feel like I'm at my wits end until he drops some piece of knowledge about my anatomy that I don't even know. So during this massage, we keep pinpointing this certain part of my ankle. Apparently, my anterior tibialis is very angry with me. I wikipedia'd the crap out of anterior tibialis, and found "It functions to stabilize the ankle as the foot hits the ground during the contact phase of walking."
Hmmmm, anterior tibialis seems important. BUT, since we are finding the hilarity in chronic pain, I am willing to both copy AND paste my favorite line:
"The anterior tibialis aides in the activities of walking, running, hiking, kicking a ball, or any activity that requires moving the leg or keeping the leg vertical"
Way to sum it up, Wikipedia. Seriously.
At this point, I'm just a few days away from my follow-up appointment with Dr. McGorgeous. I've also just passed the one year anniversary of my injury. I wish I could have invited all of you to the pity party I threw myself that day. It was a riot. Because by this point, I know that my second PRP isn't working. The pain is back. So what does Dr. McGorgeous have to say when I see him next? He says that we are going to do another PRP and we are going to focus on my anterior tibialis. And I am about to be the first patient he's ever done 3 PRP treatments on. Ummmm, do I get an award for that? But towards the end of the appointment, I kinda......lost it. Like, I have always tried to be really cool around the surgeon, because I have the emotional maturity of a middle school girl. But the end of this appointment was different. I told him I was scared that the time we spent marking my ankle pre-op went too quickly and that maybe because we were marking so quickly, we weren't finding the exact right spot. He asked me to go see DJ MT the day before my surgery, and have him mark me!!! Talk about teamwork! So that's what we do. And on Feb 4th, I show up for my 3rd PRP treatment and my 4th overall surgery. As I was sitting on the hospital bed waiting, I saw one of my old nurses walk past. She disappeared out of view and then reappeared. "Mary! You're growing your hair out!!!" For future reference, here are three ways to know that you spend too much time in the hospital. 1. They recognize your face. 2. They remember your name without a chart. 3. THEY HAVE SEEN YOU SO MANY TIMES THEY CAN TELL YOU ARE GROWING YOUR HAIR LONGER. Geez. Here's another funny for ya. Dr. Grinch recognized me and still tried to deny me the anti-nausea drugs. And I still got them. +1 for me! So we do it allllllll over again. And I take another week and a half off of work. About a week after the surgery a co-worker invited me to her house for a party. I had been trapped inside due to my surgery and the nasty Midwest winter weather for awhile, and I was excited to go. But more than anything I was excited to meet one of the other guests. According to my coworker, this girl was about my age, had the same injury, and the same doctor. This was going to be interesting.

What's that feeling? Oh, it's hope...

So what does a PRP injection feel like? Well, other than sleeping 20 hours a day, it was more fear of pain than actual pain. Don't get me wrong, I'd definitely choose a spa day over a PRP injection, but on a scale of 1-feeling.your.ligament.snap.and.ankle.bone.break, it's registering down around a 4 or a 5. Four days after the surgery, the swelling was down and I had DEFINITELY noticed a change in the amount of pain I was feeling during the day. A change for the better!!!! The real test would be going back to work. Tuesday was my first day back. Things were OK, and for that whole day I let myself wish and dream and hope that this was the end of my journey. I mean, Tiger Woods had this therapy, and it helped him! It didn't help with the whole cocktail waitress situation, but whaddya gonna do? Wednesday comes and goes, then Thursday, and by Friday I was back to square one. The swelling hadn't come back, but there was that pain. My old familiar friend. The pain that is so much a part of my life that I truly can't remember what my body used to feel like before the pain moved in and forced me to carry it around. And so I wait. And I plot. I don't see the surgeon until mid-December. In the meantime, I decide that going back to work too soon was the reason the procedure didn't stick. So I continue to plot. And my appointment with Dr. McGorgeous finally rolls around. He takes a peek at the ankle and tells me it's a good sign that the swelling went down because it means that my body does respond to this therapy. When you're dealing with an experimental procedure, any sign that it works is a good one. So I explain the pain and ask him how close to Christmas he's performing surgeries. This guy knows me pretty well at this point and he gives me a "Cut the bullshit" look and asks when I want my surgery. I tell him December 22nd. He tells me he needs to leave the hospital to catch his plane by 11:30am, and asks if I can be there at 7am. Seriously, I would let the guy operate on me in his kitchen if it meant this thing would get fixed. So I agree to show up 3 days before Christmas so that I can have 11 straight days of recovering without having to stand on it at work. It also means another round of pre-op phone calls, another physical, more paperwork and all the other boring stress that goes along with an operation. And sure enough, I show up on December 22nd for my next procedure. Same room, same nurse, same smells and sights and sounds. Same x marks the spot on my ankle, same signature on the paperwork. Same initials from the surgeon reminding him this is the correct leg to operate on. Same pinch and burn of the IV. The familiarity and routine of undergoing surgery definitely registers somewhere in my mind. Until Dr. Grinch shows up again. Of course. And tries to deny me my anti-nausea drugs. I tell him what happened last time and tell him to check his records and order my drugs. He doesn't argue. Have I ever mentioned how much I absolutely love getting my way? Well, I do. And keeping with the routine, I wake up in the same recovery room. I get sent home to sleep. I manage to wake myself up the next morning and forgo the drugs long enough to drive the 2 hours to my parents house. Once there, I take my drugs and proceed to fall asleep for 7 days. Seriously, Christmas day I was only awake for 2 hours. But these are the sacrifices I'm willing to make if that's what it takes to heal my ankle. And this has to work. It has to.....

I'm A Puker

Ahhh, the Pre-Op room. This room, along with the doctors, nurses, scheduling department, billing department, physical therapists, massage therapists, and pharmacists are all quickly becoming first-name-basis friends. So I'm in my bed, wearing my gown (this is all so familiar) and trying to keep my dad amused while we wait for this show to get on the road. So in walks my anesthesiologist. Although this procedure doesn't require a fully intubated-type of anesthesia, I will still be out for it. I tell him that every single drug I've ever been given, from Tylenol 3 to straight up morphine, makes me vomit. A lot. As in, in my purse I have packed bags for me to throw up in on my way home. And I ask him for some anti-nausea drugs in my IV while I'm having the procedure to prevent it. So the doctor....we'll call him Dr. Grinch, explains to me that drugs have side effects. Um, really? And that I should avoid taking them if I don't need them, and in his 394803404 years of practicing medicine, he has never seen anyone get sick off the type of anesthesia I am about to get. So my dad jumps in and tries to explain that if anyone would get sick off of it, it's me. He starts to disagree with my dad (you would think he's gotta pay for anti-nausea drugs out of his own paycheck or something) when I interrupt. "Ok, so WHEN I wake up vomiting, can I just have the drugs then???" And Dr. Grinch gave me his best evil stare and told me yes. So it's just about time to go. Dr. McGorgeous comes in to make the marks on my ankle, where my blood products will be injected. I'm surprisingly not nervous about this. If I got through last May's surgery, I have no doubt I can handle it. So we head back to the very same operating room, and the next thing I know, I'm awake in the recovery room. Being an old pro at the surgery thing, I did not throw a temper tantrum over having to eat crackers, and I received some very lovely drugs. With my dad sitting next to me, I reached for the cup of water to wash down the drugs when it hit me. The nausea. Like none I had ever experienced. I literally threw my head back into the bed to force the room to stop spinning, and we got the nurse to push the anti-nausea drugs Dr. Grinch swore I wouldn't need. 2 doses and an extra hour in the recovery room and I was wheeled to the car. Back in my black boot, I was nervous about the pain and walking. The only thing I have to compare the situation to is what happened before. So I go home and sleep for all of Thursday, Friday, Saturday, and half of Sunday. I'm not kidding, 20 hours a day, I was OUT. I wasn't in nearly as much pain as the first surgery, but it seemed like my body needed the recovery time, so I called in sick to work on Monday and slept some more. By Tuesday, I was out of my boot and back at work full time. I wasn't set to see the doctor for 4 weeks. He said the therapy can take that long to start working. I had noticed by the day I went home from work that the swelling I had in my ankle had changed. It wasn't as widespread as it had been before, with the main swelling over my big incision. A good sign??? I had to wait 4 weeks to find out!

The Results Are In!

Now that you've met my full cast of characters, lets get back to the results of the second MRI. I spent the whole night trying to figure out what I wanted them to be. Because, you know, I can control things like that. I certainly don't want the results to show some massive problem that sends me back to the operating room. That would be devastating. But if the results come in and show there is nothing wrong, and this is just the amount of pain I'm expected to live in for the rest of my life, I'm going to drive out to the country, dig a hole, and live in that. So I'm sitting in Dr. McGorgeous's office again, looking for red flags. How long have I been waiting? Not too long..... How many doctors are here to tell me the news? Just one..... He's here and he has things to show me. He pulls up my MRI on the computer and shows me the osteochondral fracture. It's still visible, it's healing slowly, but that's what bone does. See this empty circle in your fibula? That's the bone screw that hasn't finished dissolving yet, give it another 18 months. The ligament looks GOOD, blah blah blah. I'm tuning him out. Until he gets to THE PROBLEM. Duh duh duh....I have.........................................................INFLAMMATION AND SCAR TISSUE in the ligament and all the surrounding tendons! Um, I know. I have inflammation and scar tissue BECAUSE I'VE BEEN WALKING AROUND ON A SCREWED UP ANKLE FOR 10 MONTHS! THAT'S YOUR CONCLUSION???? THAT'S NOT A DIAGNOSIS! THOSE ARE MY SYMPTOMS! COULD YOU BE MORE VAGUE?! Anyways, I'm obviously not saying any of this to him, because he's adorable and it would be awful if he thought I was crazy. So I just ask him what we are going to do about it. And he tells me about a new procedure that's still experimental, but has shown some promising early results. Now, I have a degree in Molecular and Cellular Biology. I DO research. This intrigues me. So he explains Platelet Rich Plasma Therapy, or PRP for short. My surgeon, unbeknownst to me, is one of the pioneers in his field, and has won numerous awards and honors. I knew I liked him for his mind, and not just his looks ;) Here's the Cliff's Notes version: When you cut yourself, you form a scab. The cells in the scab (the platelets) tell your body "HEY! LOOK OVER HERE! WE HAVE A PROBLEM! FIX IT!". And your body kicks into action and repairs the injury. So we are going to draw my blood, take out the platelets (and the plasma, the juice your blood cells sit in) and inject them directly into my problem ligament and all the tendons showing inflammation. This should trigger my body to go fix it. I will be under anesthesia, no knives or cutting, just a couple needles. It's a short procedure, and I should only be out of work for a couple days. He says that I may only need one treatment, or I may need two treatments. Regardless, we are going to get pre-approval from the insurance for 3 treatments, just to be on the safe side, although he's never done 3 treatments on anyone. I'm beyond excited! In just two shorts weeks, I go through ANOTHER pre-op physical (they're only good for 30 days) and find myself back in the pre-op room waiting to see if this experimental treatment is the key to my recovery!