Saturday, February 21, 2015


All of the medical shows on TV are proof some people just love knowing the nitty-gritty about medical procedures. I usually shy away from them, especially the gruesome pictures.

However, many friends and family have inquired about my ankle surgery, wanting to know what happened, what type of surgery, how long I'll be down, etc. The biggest question was "Did you get hurt? Is that why you have to have surgery?" Well, the short answer is no, but yes. Here is the slightly longer answer, for those who really want to know. I promise no gruesome photos, and I'll even try to throw in some humor.

Apparently, some people are prone to "ankle instability", otherwise known as "weak ankles". Apparently, I am one of these people.

Medical History/Causes
When my doctor asked if I had twisted my ankle a lot as a kid, I honestly couldn't remember, although I confessed to being a clumsy child. He inquired about sports or dance injuries. I was in softball, intramural soccer, gymnastics, volleyball, basketball, and track -- but most of those not since the 8th or 9th grade and I could only recall one volleyball injury involving my shoulder. I was in colorguard and show choir in high school, both involving dance, and recalled one minor ankle injury.

As an adult, I've slipped on the ice a few winters and twisted my ankle. But I also had 2 very bad sprains...

Sprain #1
My youngest daughter was a newborn and after rocking her to sleep in the middle of the night, I groggily climbed the stairs to take her to her crib. When I got to the top, I mistakenly thought I had one step to go. I stepped down harder than need and in an attempt not to drop the baby, I rolled my right ankle pretty bad. I thought I broke it. Instant tears. Instant swelling. Instant bruising. A trip to the insta-care a few hours later revealed the bad sprain which took nearly 7 weeks to recover. I've had issues with ankle pain and swelling ever since; my baby girl is now 15.

Sprain #2
Three years following the right sprain, moving furniture, walking backwards, and misjudging the corner of a step - ouch! I rolled my left ankle pretty bad.

Since then, anytime I am on my feet a ton, both ankles swell and cause severe pain, I sought help from my primary care physician. She told me it was all tendinitis and to take anti-inflammatories as needed. This has been my regimen for over a decade.

This past summer while on vacation my ankles would swell and then I'd get this shooting pain in the tops of my feet. If I didn't take the anti-inflammatories, my feet and ankles felt like they were on fire. I'd rest them a bit, ice them, take the pills, and take it easy a few days, and soon all better.

The past two months however the pain increased. Resting did not help much. The pills and ice only helped a little. My ankles and feet just bore a constant pain.  I went to the foot & ankle clinic 3 weeks ago.

Proper Diagnosis
The specialist determined the CF ligament (of both ankles) was weak (probably started as a kid) and eventually damaged (during the bad sprains) and is no longer protecting the ankle. He also sensed some scar tissue from the previous injuries. Since the ligament isn't giving proper support, arthrosis started to develop in the ankle ligaments and joints. Additionally, the tendons that start from the ankle and spread up into the foot and up to the toes are not receiving proper protection, hence the reason I was feeling shooting pain symmetrically (tendons of the extensor digitorum). It was time for surgery.

Because the right ankle was far worse, that is the one he chose to do first. The left ankle will be done later this year. (Which is nice because I will have met my annual deductible by then = Free!)

Surgical Procedure
The surgery was done via Ankle Arthroscopy, a "scope" which allows tiny incisions to be made allowing a thin fiber-optic camera to be inserted and then transmit the images to a monitor.  Once inside, he can then determine how much scar tissue there is, where the ligament needs to be cut, repaired and sutured, and if anything else needs to be done. (There is a wonderful video simulation here: {Ankle Ligament Reconstruction}) The method my surgeon used was the Brostrom Procedure. It's really quite fascinating if you're into that sort of thing. (I'm not.)

In essence he went in, scraped out old scar tissue and the arthrosis, cut, repaired and tacked down the ligament where it should be, and then - here's the coolest part - he implanted a synthetic ligament as well (since mine was fairly worn out). He wanted to give my ankle the best possible chance at a full recovery and the best stabilization as possible.  He said the synthetic ligament is stretchy, sort of like medical tape, but obviously much more durable.

The Big Day
Surgery was yesterday, and there were a few minor hiccups. I was at the surgical center a little longer than anticipated. The initial problem was it took nearly 30 minutes to get a good poke so they could start the I.V. My veins just weren't cooperating. After 2 pokes, the first nurse called in another. (She said she has a 2-poke per patient limit.) The 2nd nurse came in and tapped up and down my arms and wrists while I pumped my fist and breathed through the tourniquet pain. They even pulled out their vein finder (think stud finder, only cooler), and still nothing. A 3rd nurse stopped by to see what the delay was and together they decided to try a wrist vein that was sort of playing nice. The 3rd nurse came to my other side, placed one hand on my shoulder, told me to grip her hand and that she was going to start praying. She prayed, I gripped, they poked, I winced several times, and they finally got it in. I've gotta say, the Lamaze breathing technique I learned over 20 years ago, still comes in handy!

The surgery went great, as far as I was told. Coming out of it, however, I was in dire pain. I remember dreaming a lovely dream, then hearing voices, then hearing myself cry out, "Ow, ow, ow,..." over and over and realizing I was crying lots and lots of tears. They gave me 3 hits of Demerol 5 minutes apart, to which I didn't feel any relief. Next they whipped out the Toradol and gave me a dose. That took the edge off. But I was still in quite a bit of pain. 

I heard one nurse tell the other, "This isn't common. She shouldn't be in this much pain." The other nurse came to my side, rubbed my shoulder and said, "Okay, just try to relax so this Toradol will start to work." Then she went back over to the first nurse and whispered, "Sometimes you just have to mention the drug again, so they think they're getting another dose. Sometimes it's just psychological." 

Part of me wanted to laugh really hard and say, "I can hear you." But I was honestly in so much pain. Instead, I managed to say, "It feels like someone has my ankle in a torture device and is twisting my ankle all the way to the right and it is causing a shooting pain all the way down to my toes and up my leg to my knee." 

The 2nd nurse stopped whispering and told the 1st nurse, "Get the surgeon in here now." Both the Dr. and his residency Dr. came in, and when the nurses relayed what I had said, they both nodded and said, "Well, the sensation is pretty accurate, since that's basically what we had to do to stretch everything and put it in place." So, they gave me 3 local pain shots in my leg and within about 2 minutes all was well. 

Poor Eric had already visited with my surgeon and was told I'd be wheeled to recovery in a few minutes. After about 20 he hadn't seen me, and inquired and they said, "Well, she's still in a lot of pain." I'm sure that wasn't exactly relieving. 

Expected Recovery Process
The best part of the process is that while it's still a 6 week post-surgery "rest and recuperate" protocol, I asked how soon I could go back to school. I hate missing class. He told me after 5 days of constant rest, he would allow me to go back IF I promised to elevate my foot during classes, walk on it as little as possible, ice it regularly, and then call it a day as soon as I return home in the afternoons. (He also gave me permission to skip class as needed.) Woohoo! That also translates to no housework, right???

This is of course all best case scenario. He did say a "full" recovery can still take 3-6 months. But a lot of that depends on how closely I follow his orders during the first 6 weeks. 

So there you have it. Oh, and the other best part is this is the first surgery I've ever had in which I can eat solids. Definite Win.

No comments: