Ankle Arthroscopy (The Finale)

This will probably be anticlimactic for most people, but I thought it was cool enough to warrant one last post.

After 9 weeks into the adventure of my ankle Arthroscopy, I had my final follow up visit with my Surgeon on Thursday.

Because of my almost monk like devotion to my physical therapy I have regained a significant amount of range of motion in my big toe and ankle.

One of the other options would be to fuse the entire joint together, for whatever reason anytime I hear the word “fuse” combined with any body part I cringe. (No thanks)

9 weeks is not the end of the road for the procedure either.

The Doc explained that it would take an additional 2 to3 months for full recovery which for me would mean that I could go out and run maybe 5 to 7 miles without issues.

He also gave me his blessing to begin running again, which was what I had been waiting 9 weeks to hear.

His only caveat was that I could run for about….wait for it…..10 whole minutes.

I got home from work, grabbed the dogs and the wife, and went for a half mile jog in the middle of a killer rain storm on the trails at the house.

It was awesome.(I had very little swelling afterwards which the Doctor said was normal).

Probably the coolest part of my final visit was that it turns out my Surgeon is also an avid mountain biker, so he hooked me up with his email and were going to try and schedule a ride.

The fact that the guy who did my surgery understands riding and probably has some level of love for the sport, gave me a sense of kinship throughout the process and speaks volumes in my mind to his character.

It’s pretty wild how things work out…

Steve

Ankle Arthroscopy (Strange days)

I realize that I said I wasn't going to write another post about my Arthroscopy, and I wasn't, but this is bizarre enough to warrant another entry.

To set the background for this post I want to give you an idea of what a “Physical Therapy” business looks like, and this particular office was basically a large room with fitness equipment resembling a small gym.

At any given time there would be at least 6 clients mulling about addressing their rehab needs, with around 4 therapists present. (If you go into physical therapy thinking you’re going to get a personal trainer all to yourself, you may be sadly mistaken).

My primary Physical Therapist was out on family matters last week, so I was delighted to see the original female Therapist who worked on me during my first visit.
But much to my chagrin it was immediately apparent that something was "different".

"What was the nature of your injury again, I don't remember?" she inquired...

She then proceeded to ask what exercises I had been doing, and as I gave my best explanation of things I didn’t necessarily understand, she quipped for me to jump on the stationary bike and warm up as she walked away, which I did.

Then I moved on to the "machine that simulates squats" which may also be known as the "Total Gym" but then I don't know because curiously enough I don't have $3000.00 worth of exercise equipment at my house.

It became apparent that the "stand in" Therapist had limited knowledge of how to properly work the machine, and after another Therapist assisted her with the tension springs I was again instructed to "do what I did last time" since I didn't know what tension level I was supposed to be using.

As I worked through the remainder of my exercises the Therapist grew more and more agitated with my progress. (This is not an exaggeration on my part and I will back this up later).

As she attended to an older woman who I had seen on previous visits, the Therapist began barking at me (from across the room) to stop looking at my foot as I was working on a balance board that assists with range of motion.

"Stop holding onto the bar so tight!!!  She barked again.

Then it was on to the “Bosu-ball” for some more squat exercises.

“You’re going down to far!”

“Stop holding the bar so much”!!!

“You remind me of my kids, I always have to watch what you’re doing!!!”


All of these “instructions” were yipped across the gym in such a manner that other therapist and their clients would stop what they were doing long enough to process the scene.

As I finished my sets I could hear my Therapist explaining to the female client that she didn’t need to work, and that she was only there to “maintain her skills”…

The therapy session was over and as I paid my Co-pay the older female client I mentioned earlier walked up, looked me in the eye, and said, “Wow! She was yelling at you”…I cracked a smile and indicated that it was “tough love” and bid her and the Secretary a good day.

I was done with Physical Therapy.
____________________________

The total cost of the Ankle Arthroscopy process.

-2 Consultation visits at $40.00 a visit “Co-pay” with insurance.
-No Co-Pay for the initial X-rays. (Covered by Insurance)
-$100.00 Co-pay for the MRI prior to surgery
-$300.00 Co-Pay for the actual Arthroscopic surgery
-Physical therapy twice a week for 3 weeks at $40.00 Co-pay each visit.
-$40.00 ankle brace

Total cost: $720.00

Ankle Arthroscopy (Physical Therapy overview)

Another rain soaked day has given me the opportunity to reflect on the physical therapy portion of my ankle surgery and the fact that this will probably be my last post about the subject sans an occasional update on the overall status of my recovery.

My therapist, “David” explained my situation in great detail and answered every single one of my uninformed questions.

Part and parcel to my ankle surgery is the fact that David showed me that my arch has fallen as well, which is something else I will need to focus on with strengthening the muscles to help support the area and make it stronger which has been the goal all along…(To get stronger).

My experience with physical therapy has been an excellent one, but in all honesty I see the therapist as a sort of guide who pointed me in the right direction with strengthening and range of motion exercises and now it’s up to me to continue the program at home.

The biggest hurtle with all of this, the surgery, physical therapy, and my overall health is the fact that it’s hard to be active and then sustain an injury that sidelines you. (Yes I realize there are considerably more significant surgeries than ankle arthroscopy).

The trick is to remain positive throughout an experience like this and find humor in the small idiosyncrasies that occur during recovery (like falling down in the bathroom)

Another way to stay “up” is to have goals;

I keep telling myself that I will run “50” at 50, which means that I’m going to run a 50 miler for my 50th birthday…The big 5-0 is quite a few years away, but I see it as one hell of a motivator to recover.

The (A.T.) “Appalachian Trail” will also be there waiting for me at retirement, all 2,175 miles of it.

I see that particular goal as a celebration of surviving 25 or so years on the job, which again, is quite some time in the future.

Right now in the short term the goal is to get this damn boot off my foot and get back on my bike, or go running, or for a hike…

And as this post has evolved over the course of several days, my physical therapist has given me the “go ahead” to ride the single speed on mellow terrain, which is awesome.

Steve
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Aside from my personal experiences with the surgery, this is what you may expect during your own recovery and physical therapy;

-They will probably take measurements to gauge your range of motion.

-They may measure the affected area to gauge any swelling

-They will give you light range of motion exercises to move your ankle both lateral and horizontal to your body. (this will probably be done with resistance bands)

-As you progress you will begin “weight bearing” exercises like machine assisted squats and range of motion exercises like riding a stationary bike.

-*I received several arch specific exercises that included standing in a particular manner and arch lifts and calf raises as well.

Ankle Arthroscopy ( Physical Therapy Day 1)

The first day of physical therapy saw another small storm system drop a few more inches of heavy wet snow onto the area which was just enough for me to call and confirm that the therapist’s office was open.

After I received confirmation that the appointment was still on I looked at the clock and realized that I would be cutting it close with the additional hurtle of removing all of the new snow off of our car.

But then I always haven an ace when it comes to snow, and since my wife wasn’t going to work she obliged me with getting my act together so that we made it there on time.

You know how you talk to someone and a little bit of them and then a little bit of you will trickle out into the details?

This was the case of our conversation with the receptionist, a stylish lady who gave me a glimpse of her past which happened to coincide with my present, which showed me yet again just how small the world really is.

Onto my therapist, who was working as a “stand in” (if you will), for the person I will be assigned to for the remainder of my P.T. sessions.

An auburn haired and bespectacled gem that was quite the character in her own right, she simplified the process for someone like me who doesn’t always pick up on the subtle hints on how to heal.

She was wonderful as she quickly identified and entertained the fact that I am the sum total of a child yet still trapped in a man’s body and that it takes a fair amount of scolding for me to get the point of what I need to do for recovery.

In her paisley “Dansko’s” she took measurements of my ankles to show me what I needed to work on and just how much range of motion I had lost, and then before I knew it she had given me some home work for “range of motion" exercises and sent me on my way.

(Many people in this process have told me that I needed to do these things, this therapist was the first to explain to me the "why"...)

In the amount of time that it took me to gather myself and put my “Robo-boot” back on, my wife and several of the therapist had conspired to restrain me from what I would like to and developed a plan to make me focus on what I had to do to recover.

This story continues with the fact that while I have had a common surgery with a common recovery, I have met some uncommon people along the way…

Steve

The "goniometer" used to measure "range of motion" for my ankle

Ankle Arthroscopy (Day... hell if I know.) "Return of the Unicorn"

An artistic rendering of my drug induced request for a unicorn horn post op courtesy of my brother’s daughter.

Word gets around, but really? These beast are mythical creatures held in high regard in the fairy tale community so I don’t understand what all the fuss is about. I think it was a legitimate request under the circumstances…

Today I had my stitches removed, sans the one I managed to pull out at some point.

The Doc was curious as to why I was no longer wearing my “Robo-boot”. I couldn’t think of a good explanation so I resorted to mumbling incoherent reasons under my breath.
The Doc was on to me, and he knew I would stray from the path of rehabilitation.

So in short here is the outcome of my visit with my physician.

I am back in my boot for at least 2 more weeks.
I have Physical Therapy twice a week.
I am NOT allowed to clean my garage again.
I'm NOT allowed on ladders...
I actually have to wear the boot.

I didn’t tell him about my dancing episode because the unicorn has to boogie!!!

Ankle Arthroscopy (Day 7) "The Waiting Game"

Seven days in, I expected this post to come at around 2 weeks, but here I am sitting on my duff having completed my mandatory "range of motion" exercises for the day with the rubber band that I smuggled out of the wife's work out room...(Ok she surrendered it willingly)

Between exercises I couldn't resist stretching the band to its full length like a bow with my ankle then launching it at my dogs who went crazy at the sound of it flying across the room.

Looking at my foot and ankle I’m really surprised at how much bruising there is. For whatever reason I did’t think about bruising when it came to the surgery and afterwards.

The Doctor indicated that the femoral block would get me “over the hump” for the majority of the post-Op pain, but I’m experiencing some pretty good shots of it throughout the day.

I was working on something at the house and accidentally folded my toe into the hardwood floor and it crippled me to ground in seconds, pretty severe, and unexpected to say the least.

But being down with an injury doesn’t mean that one is out, and I managed to find a few old CD’s which led to an impromptu jam session and some “Random Acts of Dancing” as I boogied peg leg style. (Picture the scene in Forrest Gump where he starts dancing to Elvis Presley’s guitar playing)

 ”You got new legs Lieutenant Dan”!!!

Ankle Arthroscopy (Day 6) "First Follow Up"

Monday found me back at the Orthopedics office for the first of several follow up visits after the surgery.

As I negotiated the 3 flights of stairs from the parking deck to the entrance of the facility I chuckled to myself as to whether or not I would qualify for a coveted “handicap” parking spot closer to the sliding doors.

As I cleared the final landing in the stairwell, my momentum got the better of me and I almost went for a "ride” down the last section of steps creating quite a racket with the aluminum crutches.

I laughed out loud and muttered a choice obscenity as I caught myself on the hand railing.
At the bottom of the stairs just out of the trajectory of my stumbling there was a female chatting on her cell phone.

While I’m pretty sure I sounded like the Tin-Man from the Wizard of Oz as I struggled to regain my footing, the women not once looked up nor acknowledged my presence during my acrobatic routine.

As my hopes of receiving a judge’s rating of “5” for execution faded I cruised on by not wanting to interrupt her conversation.

“Clop, Clop, Clop” through the lobby, onto the elevator, and up to the receptionist’s desk where a pleasant office assistant handed me a clip board with the same form I have now filled out no less than 3 times and a pen.

“Waiting Room 5”….all the way at the end…Awesome!!!

“Clop, Clop, Clop” 2, 3, 4…Damn It! Dropped the pen…

I would estimate that there were five to seven people who were present in “room 4” when this occurred.

Granted I moved "lighting quick" for a man on crutches in the recovery of my pen, but no one budged, nor did they offer.

Over my right shoulder I realized there was a television hanging off the wall and that everyone was content where they sat.

The Doctor explained that he shaved off some scar tissue from my talus bone and cleaned up a few other things floating around in my ankle. My big toe received the same treatment and everything looked “good to go”.

“Looks good, start working on range of motion, you can walk on it when your ready, see you in 10 days to get those stitches out”.

I must say I’m bit perplexed as to what part of the recovery will take 6 weeks, but my intentions are to try and follow the Doc’s advice to the letter and not get ahead of myself.

Now for those toe curls…

Ankle Arthroscopy (Days Three & Four)

So the effects of the "femoral block" wore off and I started getting sensation back in my ankle and toe.

My big toe came back from his "post-Op" slumber pretty grumpy, and he definitely let me know about it.

I would give the pain a 3 or 4 on the pain scale and it ranged from a dull throb to a sharp piercing pain depending on how I moved it in the "Robo-boot".

I joke about the fact that I was given the pain killer "Oxycodone" for pain management, but to be honest I have taken only 4 pills since the surgery on Wednesday as I don't like having the stuff in my body.

The way I look at it is if I can stand the discomfort in a controlled environment like sitting on my couch at home, then I am actually participating in "pain inoculation". The idea being the more comfortable one is with being "uncomfortable" the better you will perform when the "chips are really down" in a far less ideal environment.

Some people who see this will understand exactly what I mean. You can't know how you will respond under stress or injury if you never put yourself in that position.

Anyway, I'm sitting here at "day 4" propped up, relaxing with little to no pain. I won't post again about the ankle until Monday unless something out of the ordinary occurs. (Like me falling flat on my face trying to hop to the bathroom last night at 2:00am after my hand missed the bed railing, THUMP!! I'm down!!!) Good times.

Vintage Rock for your listening pleasure;

Ginger Baker, Jack Bruce & Eric Clapton... "Sunshine of your love".

Ankle Arthroscopy (Day Two)

DAY 2:

Day 2 was a bit rough as my body was still waning itself off of the anesthesia which made it difficult to sleep.

From 8 am on the day of the surgery to around 11am the following day I probably got around 2 hours sleep.

The only real adverse reaction I have had thus far was that my cheeks became flush similar to a sun burn as a reaction to the anesthesia.

The femoral block that the anesthesiologist administered prior to surgery was still working and I would describe the feeling as if your entire leg were asleep. No feeling or sensation in my foot or toes whatsoever.

The first requirement “post op” is to keep my foot elevated for 72 hours. Sounds easy enough, but I’m not one to lay there in bed prostrate, so I usually end up on the couch for most of the day.

From this point I’m going to start describing my pain and comfort levels on the “1 to 10” scale that you typically see used at the hospital.
On the second day there was no pain, and my only discomfort was a result of sitting there with my leg up…All day.

They say another snow storm is on the horizon for next week so as I sit here typing I’m wondering if my gamble of putting the surgery off until 2011 is going to work out after all.
There’s probably never a “good” time for something like this, and it’s always going to shift the burden somewhere else.
The funny thing is that my wife recruited my own mother to keep “over watch” on me during the 72 hours of foot elevation, so at 38 I’m back to taking orders from my mom. (So is "The circle of Life")

Another area I’m going to cover is the financial aspect of having the surgery;

Here is the break down so far;

2 Consultation visits at $40.00 a visit “Co-pay” with insurance.

No Co-Pay for the initial X-rays. (Covered by Insurance)

$100.00 Co-pay for the MRI prior to surgery

$300.00 Co-Pay for the actual Arthroscopic surgery
Sum total of $480.00 “out of pocket” thus far.

Ankle Arthroscopy (Day One)

THE ankle surgery is a done deal and I was really impressed with the level of competence, efficiency, and affability of the staff and Doctors.
So my plan is to do a “running journal” here on the blog of my experiences with ankle arthroscopy and the process of recovery. I’m also going to try and convey the details via a “photo essay” as well.

There may be an actual video of the procedure, but I don’t know that I will be able to get my hands on it. That being said, I’m going to use a mix of photos that I took with some “file photos” from the web to paint a picture of the experience.

The next step in the process is a follow up visit with the Doc Monday to change the bandages and such.

{Throughout the post I have used the term “nurse” and “Doctor” to describe my caregivers, though I am sure this is not an accurate description of their individual titles. I came away with a healthy respect for them regardless of their positions in the hospital.)

-On a side note; When I describe the female nurse as “a tall blonde” that’s because she fit the profile, So to the guys; get your minds out of the gutter, you filthy beast!!!

Here is how the story begins…

Day 1:

My wife and I weren’t in the waiting room of the Ambulatory care Center for a hot minute before a tall blonde nurse called my name and took me back to my “room” and instructed me to put on my obligatory hospital gown and the accompanying hair net. (More on the hair net later)

She put the IV in my left hand telling me that I had “great veins” along the way, and I was ready to roll.

I was told that I could keep one sock on the foot that was not to be operated on; and I thought to myself how ridiculous that would look so I opted to go with bare feet, “because a man in a gown with a hair net and one sock was considerably more goofy than a man barefoot with the same right?…

I went over my surgery with the Doc who can be described as a super laid back fellow, so much so that it can be disconcerting when you first meet him, but rest assured he’s a good guy.

After a brief consultation I opted to have some additional work done on my big toe, “That’s right… my big toe”.

Shortly thereafter I was introduced to the anesthesiologist, a guy with a full beard, piercing eyes and a wicked cool disposition.

He and the blonde nurse did several things to me that included a “femoral block” and another “block” for which I can’t remember the name. These would help mitigate the pain later on.
(More on the blocks on day 2)

Then the real fun began…

I heard them utter the words of giving me the “cocktail”, and from that point on I was “good to go”.

They took great care of me and asked me no less than 15 times to repeat which foot I was having the surgery on. I recall the anesthesiologist explaining to his peers that I was a “happy drunk”.

Things began to get fuzzy from here but there were some really odd occurrences that I find absolutely hilarious.

At some point I began asking the staff if they had yet to see the Movie “The Spirit” because for whatever reason in my altered state I associated my surgery with the “human headed foot” that Samuel L. Jackson’s character the “Octopus” created in the movie.

During that scene “Octopus” stared in bewilderment at his creation as it hopped around while he muttered to himself “that is just damn weird”.

Now imagine a guy on a gurney doped up and trying to explain the correlation of his surgery and the movie to several Doctors…I can assure you that my composure continued to devolve from there.

Shortly thereafter I was being wheeled down the corridors to the operating room, and I remember asking the nurse how I would go about getting a cooler hat than the one I was wearing, (Hair net) as hers was multicolored and cloth. She indicated that I would have to stay there with them if I wanted a better hat… fair enough.

I recall speaking briefly with another nurse, female, blonde as well, wearing dark rimmed glasses and sporting a nose ring. I thought to myself, “punk rock nurse, cool as hell”, but I don’t think I conveyed my admiration verbally…then again.

We made our way into the “OR” which seemed like an excessively bright cavernous and unusually cold room and from a distance I noticed a burly solid looking guy sporting a woodland digital camouflage hair net.

I couldn’t help myself…and I blurted out “That’s what I’m talking about! that’s the hat I want” Marine digital camo”!!! (Don’t ask why I know this)

He responded with; “That’s right 8 years in the Marine Corps”.

“Cool as hell”, I thought again.

I was moved to a much smaller table where my arms were spread out to my sides and I remember seeing an older gentleman with an “Alabama” hairnet to my right. I don’t believe we spoke.

As I laid there staring up at the ceiling I was given several instructions for which I have no recollection, but then a set of eyes peered over from behind my head, absolutely stunning eyes reassuring and kind, the best kind of eyes to gaze into if you’re going to be in that position.

I don’t know who she was, but I gathered that she may have been the same brunette nurse or Doctor that I had also spoken with earlier about what I do not know.

Her voice was quite soothing as well, but our contact was brief and the last thing I recall was her placing the oxygen mask over my face and then I was out.

I believe the surgery ran around an hour and a half total though I can’t say for sure.

I “came to” later in a recovery room and the same folks were there attending to me. (Looking back there seemed to be a bunch of people involved in the procedure).

Ash was waiting for me as well and as I drifted in and out of consciousness I jovially ranted on about how the staff hit my foot repeatedly with a rubber mallet during the operation…(This of course didn’t happen)

As things went on in recovery I requested that the staff give me a “unicorn horn” poking out of my head for whatever reason, because I suppose unicorns are cool?..

Then Ash, who was there throughout the operation, informed me that as I got dressed back into street clothes I proceeded to make a sock puppet with my right hand and continued to explain to the “punk rock nurse” that “Steve” wasn’t there every time I was asked a question. (A sock puppet, go figure)…

I do recall someone asking my wife if I was always like this, and that her reply was “No, and that I was usually quite serious”.

Another short pleasant brunette nurse wheeled me out to my car as Ash pulled around and helped me into the vehicle and we were off to get the prescription filled for the pain meds.

I am now equipped with a bad ass black Robo-boot that will stabilize my ankle for at least 3 weeks.
I wonder if you can get them in clipless?