The mucous sheaths of the tendons around the ankle. Lateral aspect. (Photo credit: Wikipedia)
Things progressed really well for me this week in terms of walking again with much less limp. I went all week sans boot. I was rather depressed at the end of last week when I was without the boot a few days and had a pretty severe limp. It's gotten much better this week, which makes me happy.
I saw the OS (orthopedic surgeon) today. Probably won't be the last time I see him, but he said he didn't see any reason to book a follow appointment with him unless (until) my ankle bothers me. He highly predicts that in a year I will need to have the plate and screws removed, which will involve surgery and holes in my bones that will have to heal again. I pointed out that I have a tendon (peroneal tendon) that is popping over my outside ankle. He said I would likely have to have surgery to fix it. It would involve deepening a grove behind my outer ankle bone and attaching a sheath to hold it in place. Since I will very likely, in his opinion, need surgery to remove the plates and screws he suggested taking care of both at the same time.
He also thought I should start physical therapy to get my range of motion and strength back. He let me pick my own place/PT and I suggested one with an Alter G treadmill so I could maybe get to running again sooner than I would otherwise. He thought that was a wise idea. :-) But I can't run until I can flex my ankle toe to shin and have enough strength in my calf to push off. Crossing fingers the peroneal tendon resolves itself on it's own, or I might not be doing much running next year.
I think I'm ready to sign up for AXS Moab 30 hour race October, 2015. Maybe I should wait a little while before committing.
I seriously have no idea where this week went. Once I started working again these weeks have FLOWN by. Next week I go in for my 10 week appointment. I was told by my doctor he expected me to be in shoes by that time, and I have been diligently working towards that. So much that I started going to work in shoes 3 days ago. No boot. I gave the boot the boot! Ha-ha! I wore it to work 2 days, then it was the weekend and I wore it a few hours each day, an the past 3 days back at work have been w/o the boot all day long.
Bimalleolar fracture and right ankle dislocation on X-ray (anteroposterior). Both the end of the fibula (1) and the tibia (2) are broken and the malleolar fragments (arrow: medial malleolus, arrowhead: lateral malleolus) are displaced. (Photo credit: Wikipedia)
I don't walk very well. My ankle doesn't have enough mobility or strength to allow me to walk normally, so I walk with a ghastly limp and get asked all the time if my ankle hurts. Surprisingly it hurts very little, it's more of a dull uncomfortable sort of pain, not a sharp hurting pain. I know I look like I am in pain when I walk, but I don't walk funny from pain, simply the lack of joint mobility. It gets sore as the day goes on, primarily the outside ankle where the plate is. Unfortunately today it was more sore than the previous two days. I'm guessing because I got unexpectedly thrown in the lab for most of Monday and Tuesday - so lots of standing and walking. It also meant I didn't even have time to take a lunch. I had not planned on this, but I guess when you show up to work in shoes you are suddenly normal and expected to work normally. Unfortunately I am so slow and walk at a snails pace everything takes 2x or 3x longer and eats away your lunch hour and hour breaks. To make up for it I left an hour early today. I also resorted to using my crutch during the morning hours today.
I get asked all the time about physical therapy, and I keep telling them my doctor doesn't think I need it at this time. I'm not sure he'll ever suggest I go to physical therapy. I'm not sure if it is because he thinks I'm active enough to rehab on my own, or if he just doesn't ever suggest it for people in general.
I still get body aches most days. It comes and goes most days, some days are worse than others. And occasionally I have no aches. Today was a body ache free day, but my ankle made up for that. I take naproxen and loratadine every morning.
My ankle is super stiff first thing in the morning, but after my workout it's fairly loosened up for the rest of the day. And by fairly loosed up, I mean I can move it about 2".
I feel like I'll never walk normally. It's strange to not be able to move your ankle because it just won't move. I'm losing hope that I will race next year. I just got an invitation to do an indoor triathlon in Mid February and I know that's a lost cause. It's so disheartening. I won't be adventure racing either. I'm going to have to find a new hobby.
Week 8 (days 50-56 post-op) has come and gone. Since starting work I find that I no longer have much free time to sit on the couch with nothing to do Writing/updating this blog has taken a back seat to everything else.
Day 51: This past weekend we hosted our belated annual Halloween bash. A murder mystery party – and I was neither murdered nor did I murder anyone. It was such a fun time, and I spent a good portion of the night on my feet with just 1 crutch to assist me. I limited myself to 1 beer and 3 small Bloody Mary’s over the course of the evening, which amounted to about 1 drink/hour, plus a couple of waters thrown in for good measure. Let’s face it, a Bloody Mary is really a health food drink, so it doesn't even count as alcohol. I managed to stay upright all evening. J
I have managed to just use 1 crutch this week, and on occasion, perhaps a short trip across a room I would go w/o the crutch in just the boot. In the evenings I would spend most of the time with just a crutch and no boot so as to strengthen the muscles and loosen the tendons and ligaments in my foot & ankle. Weekends are spent most of the time w/o any boot and I would only put it on if we would be leaving the house. I can’t bear as much weight without the boot as I can with the boot, but that doesn't matter, it’s the moving of the joints that matters most.
I hit the weights pretty good this week before work and even did some squats and dead lifts with 60 lbs of added weight. Squats are difficult without much flexibility in the ankle joint, but a sort of decent squat is better than no squat. I was pretty sore the 3 days following squats and dead lifts. Otherwise I've pretty much focused on upper body work and warm ups on the bike.
Oh, I nearly forgot. I made an illegal outing on my mountain bike for 8.3 miles midweek. I was outside. Riding my bike - in a running shoe – no boot. Outside! It was great. I was breathing hard, not race hard, but I had the heart rate up. The wind was in my face. The sun was out. The temperature was cool enough so that I broke just a light sweat. I felt human again. Now it’s covered in snow outside with patches of ice. Glad I took that opportunity when I had it! I did skip out on work one day when it was super icy out. I was still using 1 crutch and I thought it to be very unwise to be on crutches on solid ice.
And now the best news regarding the healing of my ankle, by the end of week 8 (day 56) I was able to walk in my boot without a crutch all day long. All Day Long! In a nutshell I went nearly 1 week walking with 2 crutches, then a week with 1 crutch, and now no crutch. Perhaps I’ll be out of my boot completely before Thanksgiving. The thought makes me smile.
"Fractures also can occur in individuals with unstable ankle joints and a history of recurrent ankle sprains." Aha, I suspected that the fact I had rolled my ankle the morning I broke it probably played a roll in the fact it broke that evening. Plus I had a pretty good sprain on that same ankle during an adventure race about 2 months prior - I rolled it on a rut in a trail. "most women experiencing ankle fractures are over age 50" Hmmm...I'm not that old. I wonder if most are caused by slipping on ice, or falling on stairs? Anyone want to take a bet?
The mucous sheaths of the tendons around the ankle. Lateral aspect. (Photo credit: Wikipedia)
I have the OK to start bearing weight on my foot this week. This first week I'm supposed to use 2 crutches, then work my way to one crutch and then no crutches. This is 2 crutches week, and trust me, I need 2 crutches as putting weight on my foot is rather painful. Not the ankle, but the foot. Why the foot you may wonder? "Yes, please tell me, why the foot if you broke the ankle?" Well, let me tell you. The tendons and ligaments in the foot essentially shrink/tighten up from not being stretched for 6 solid weeks. Plus there is tons of swelling. When you step on a swollen foot, it hurts. When you step on a swollen foot and stretch all the tendons and ligaments, it hurts more. It's like stretching past your stretching limit - think of touching your toes, but add another 5" past your toes. Now spread that pain all over your foot. My right foot is about 1/2 size shorter and narrower than my left, but it's much thicker. I liken it to a cooked hamburger. You put it on the grill thin and big, but by the time it's done cooking it's thicker and the diameter much smaller. That's my right foot, a cooked hamburger. I have to push through the uncomfortable pain in order for it to get better. I also have to start doing exercises to increase muscle strength and flexibility. Both suck. I notice obvious improvements in the amount of movement by day 4 of this week. And get this: I can do squats now! I did 20 just fine - well sort of fine. Guess that means it's time to start doing some sort of workout routine again. My calf cramps up on simple flexing exercises. That will hopefully work it's way out by the end of this week. I forgot to mention that my legs insist on stretching all the time while I'm in bed. Must be from all the laying/sitting around, but if I start to straighten my legs in bed they instantly start to do a full on stretch. Rather annoying and strangely odd at the same time. It's like being possessed. But this has been going on for weeks. I returned to work all of this week. I played it conservative and only worked 5 hours each of the first 2 days. I was pretty worn out by the end of the day and slept pretty well. It has created a nice improvement in my sleep cycle. It also causes my ankle to swell to twice it's size by the end of the day. I've added a photo of how great the ankle looks first thing in the morning when nearly all swelling is gone. Trust me, by the end of the day it looks nothing like this. In fact, with in a few minutes of getting up it looks nothing like this.
This week flew by. I finally got to the point where I could be up long enough to cook food. Grant it, it was not easy, and took about 2x as long as normal due to trying to maneuver my knee scooter back and forth around the kitchen island. I resembled Austin Powers turning his cart around inside the building. Frustrating. But at least I had one free hand to carry something.
I was trusted to be on my own most of this week. Towards the end of this week my husband had the decking installed (no railing yet) so I could finally go OUTSIDE, and let the dog out. We have been without a deck for 3 - 4 weeks.
Speaking of letting the dog outside, I attempted to let him out the front door, we have a short lead line from the porch. Opening a storm door one footed, on crutches, while going down a stair simultaneously is quite the feat. I attempted this in addition to picking up the lead to clip on the dog. At this point the dog seizes his opportunity and takes off out the door and across the street. He's completely ignoring me. Deaf. Stone cold deaf, or perhaps sound does not travel across streets. I hobble across the law, across the street and towards the back of the neighbors house where the dog continues to avoid me. He apparently has forgotten who I even am. He now not only can't hear me, he now can't even see me. I'm like a ghost. It dawns on me I can't get him back home and will need a leash. So I hobble back home and get the leash. (I now remember a story about the leash and the dog from week 2 that's rather humorous and I didn't tell it. I'll have to tell that story at some point.) I get the leash and hobble back through that stupid storm door, I swear it tries to sweep my crutches out from under me, and down the stairs, across the yard, across the street. Now the dog has wandered up the street and is going behind another house. I hobble after him, calling him the whole time. He just keeps going. I'm at a dead sprint on my crutches, roughly 2 mph. I nearly wipe out several times in the grass. I am not happy, and yet, I'm sort of laughing at the situation. He has managed to find a stretch of backyards w/o fences. We continue this oblivious chase through several yards before he stops to smell something under some tall pampas grass. For fear of this continuing for the next 4 hours, I seize the opportunity and I hurl myself on top of him. Yes, I hurled. My crutches went every which way, but I had him, and I had the leash. He was mine. I tie the end of the leash around my waist leaving just enough leash to drop down to his collar. I can't hold the leash with crutches, so this is my only option. I crawl around some persons back yard and gather my crutches with him tied to my waist. I'm sure it was pretty funny to watch. "Honey, there's some strange lady crawling in our back yard with a dog tied around her waist." I drag him all the way back to the house and take him inside and don't let him out again until the deck is built.
Right ankle, inside view.
That's a chunk of my tibia not attached to anything.
At the end of this week, day 41 to be precise, I had another set of x-ray's done. I finally looked at my paperwork and it said I had a trimalleolar fracture with ankle dislocation. Trimalleolar is fancy speak for I broke the right side, the left side, and the back of my tibia/fibula that make up my ankle. This time I had hubby get a photo of the side view. This was the nasty looking view. So much more healing needs to take place. I was told this is normal for someone "my age." So much for taking calcium, vitamin D, fish oil, and a multi-vitamin. I thought for sure I would be the one outlier / miracle with complete healing at this stage. My hopes were dashed. Despite acting like a kid, I do not possess the healing abilities of a child. You would think the two would translate.
Now the good news. I can start putting weight on my foot. I'll be in my boot another 2 weeks while learning to walk again (cue inspiring music) with the aid of crutches. In a matter of seconds following my first attempt at walking, I have learned it feels like my bones are going to pop through the skin in the bottom of my foot. I was told this feeling would eventually go away. Oh, Lord it better go away! I get to work on daily exercises at home to strengthen my muscles, and perform stretches for the calf, ankle, and foot to move again. I can't move them much at all right now and my itty-bitty calf cramps when I try to use it. It's like all my joints and muscles are filled with cement. Click here to see my video displaying my fancy foot work side by side - good versus evil.
And most importantly, if you have followed these weekly blog posts, I finally figured out what is causing me to feel like I have the flu. It's not a metal allergy (I should probably stop doing so much research about these things). It's doing too much, being too active. I had no idea that doing too much would give me achy muscles all over, chills, and make me feel like crap. Live and learn. So, I guess I'll relax a bit more and heal a bit more. And to be honest, I'm kind of getting tired of the computer and watching TV.
I might try a half day at work Thursday and Friday during "week 7". The problem is that I am still not allowed to drive due to the boot. Apparently if you are to get in an accident you will automatically be at fault due to the boot (or cast). Crazy right? So if I figure out a way to get to/from work, I'll make an attempt to go. I'll have to spend the day in my office and avoid the lab - open toed shoes, or boots in my case, are not allowed in the labs. Plus I can't stand, or carry, or do anything other than sit at my desk anyway. But I can sort of walk with crutches! Things are looking up!
Missed the story on how I broke my ankle? You can read it here.
I just saw two doctor bills came in from the Surgery on September 17th for about $10,000 (for an hour of surgery), bringing my total now up to nearly $30,000 for the surgery.
So far I've only had to foot the bill for the ambulance ride at just over $900. It appears that the ambulance provider in my town is not "in network" so I get to pay for the entire ride myself.
Days 28-34 Look at that incredible shrinking leg! My right calf resembles an old lady's batwing and just hangs off the bones. My knee looks huge in comparison. It's fun getting to take my boot off for photo ops.
This week I had a major outing! My parents came to town over the weekend and were a big help. This was the second weekend they have come up to help out. Dad assisted Hubby on re-building our deck and Mom helped inside, vacuumed the main floor and basement and most importantly, took me on a major outing. This major outing was going to the indoor mall. I rarely go to the indoor mall, but I needed to return some clothing I ordered for the girls that didn't fit. We made a stop at 3 stores for the girls and then we swung into Bath & Body works to pick out new soaps and air fresheners. They have everything pumpkin right now, and our house will smell like some version of pumpkin until next year.
I'd guess I was upright for over an hour on my knee scooter and my foot did not feel like it would explode. That is improvement. However my knee felt like it might explode. They need a little more cushioning on those things for those of us who's legs have whittled away to pure bone. Hence photo #1...
Day 33. Put my socks on and had to take a photo to show the difference in size of my left (good) ankle and my right (bad) ankle. I then put a shoe on my right foot for the first time since the break. I loosed up the lace about as much as I could to gingerly put my foot in. It didn't hurt, but I was afraid it might. I wasn't sure I would be able to get the shoe string tied. I had just barely enough string to tie a little bow.
I jumped on my stationary bike (my triathlon bike mounted to a trainer) for 20 minutes at the lowest resistance with what I would guess was just 60 RPM. The OS told me I was to use a stationary bike, not my bike on a trainer. I don't know what the difference is exactly, but I tend to do my own thing anyway.
During my 20 minute spin my ankle was really stiff - not much flexing going on. I had twinges of pain on the outside of my ankle bone (fibula) and the backside of my heel. The heel seemed to loosen up as I pedaled. If I angled my foot just right the outer pain would stop, but it was hard to keep my foot at just the right angle. Otherwise it didn't feel bad at all. A little dissapointed I didn't work up a sweat or even breathe hard. I'll add 5 minutes on tomorrow. I'm not sure how much to push it. I'll have to mount my bike computer and see what kind of cadence I'm keeping, then eventually try to up the cadence until I get to >80 rpm, this will come in time.
9 more days until I see the Dr. I'll ask if he thinks my flu like symptoms are ongoing withdrawals or a possible metal allergy.
Day 34 - the end of week 5. I chose not to take an allergy pill yesterday evening. My aunt-in-law suggests that I am having continued withdrawal symptoms from the narcotics. She convinced me to give up the allergy pill (aka mental cure). I woke up a bit achy in my neck, upper back, and shoulders this morning, the same feeling as when you are sick. I took one naproxen and feel better this afternoon.
Today I also decided to get back to eating better. I have sure appreciated all the delicious goodness people have brought over, but my stomach flab seems to be increasing and I don't like the look of it. So, no more sugar for awhile...or at least not until I eat some. :-)
