Sunday, September 19, 2004

"Cast? What's that about?"

so, yes, there's a good reason that the URL for my blog starts with "gimpygal." i managed to go through my first 21 years of life relatively unhurt. though, once i started graduate school, things went downhill it seems. since starting graduate school at university of maryland in summer, 2001, i've had 8 surgeries. yes, that's EIGHT. i will attempt to describe all of them here in brief...

for those so interested, the information on my shoulder surgeries is at my comcast webspace, so i won't take up more webspace here talking about it. be warned, there are eight pictures on the page, all taken with the arthroscopic camera before the main, open surgery was started. personally, i don't think they're that gross, but i am planning on going to medical school (there is no blood in any of the pictures). so those surgeries (on 26 july 2001 and 20 december 2001) were my first two ever surgeries, and all that i'd ever expected i'd need. boy was i wrong...

the next part of the story gets a bit muddled, since a lot of things happened at once. on 3 july 2001, i was playing soccer in my recreational "beer league" with my team from work. i went up for a head ball and instead of coming down on both feet, my ankle rolled inwards on top of the foot of the person that was marking me. a lot of snaps and a blood-curdling scream later (as my teammates described it), i was on the ground thinking i'd broken my ankle. after composing myself, though, i felt it, realized it wasn't broken, and proceeded to get up and jump on it, "to see if it would hold." it did, so i decided i was ok and tried to keep playing. though the ref and my teammates didn't let me play anymore that night, they didn't stop me from playing in the next week's game, which i played after taking about 1600 mg of ibuprofen. this was a bad idea. not only was my ankle still in a lot of pain, but i was sick to my stomach because of all the ibuprofen and seeing triple, probably as a combined result of the pain and the ibuprofen.

i'd already had the ankle x-rayed so i knew it wasn't broken, so i went with the assumption that i'd sprained it. since i was set to have surgery on 26 july anyway, i just lived with my bad ankle. however, as i recovered from shoulder surgeries and got back to my normal soccer routine, i realized i could barely play soccer, let alone walk, without my ankle turning. i went back to my doctor and he ordered rehab. PT didn't work in the a matter of fact, the physios laughed at me because my ankle was so dead that i couldn't even do the things (like balancing on one foot) to make my ankle better without it rolling.

concurrently in the spring of 2002, i was getting a lot of sore throats and generally feeling pretty run down. when my normal doctor couldn't find anything drastically wrong, she referred me to an ear/nose/throat guy who decided i had chronic tonsilitis and needed my tonsils removed. so, on 6 june 2002, while i was still trying to rehab my ankle to good health, i had my tonsils taken out. i was 22 at this point. my ENT had warned me in advance that it would hurt a lot. i really didn't take him seriously. after surgery, though, i realized what he meant: it hurt so much that i could barely swallow ANYTHING (not even ice cream) and i more or less stopped eating for 3 weeks. it was a great diet, let me tell you, since i dropped 15 pounds. it turns out that adults tend to have more pain with tonsillectomies than do the kids that get it. there is no real reason known why except for the fact that in adults, there are usually more nerve endings and the tonsils are that much bigger. my ENT told me at one of my post-op visits that he's had adult women say it was worse than childbirth. i believe him.

so anyway. that's 3 surgeries so far. once the tonsils were out, i could focus full-time on my ankle. unfortunately, the PT's gave up hope on me and said i needed to go back to my doctor. he decided i had chronic instability and we scheduled surgery for 15 august 2002. the surgery he did was to take a part of my peroneus brevis tendon and use it to reconstruct the lateral ankle ligaments i tore. he'd gone in hoping that he would be able to "just tie up the loose ends" but once i was out, he said my ankle just flopped around and had nothing left. so, he took the part of the peroneus brevis and weaved it in and out of my ankle bones to create the new ligament structures.

following this surgery, i was in a cast and on crutches for 6 weeks and then in an Aircast stirrup brace for another 4 weeks. i got "released" from the brace on 25 october 2002 (a friday) and was told to start rehab. on 28 october (the following monday), i came into my office jumping all around showing everybody how my ankle was finally free. i recall glenn said, "oh, that's ok, you'll just go hurt something else." that night, after getting frustrated with a professor in my satellite communications class, i left the classroom and punched a cinder block wall. i was so frustrated with things, i decided i couldn't go back into the classroom so i went out to call my parents and tell them what had happened in the class. while talking to them, i realized my hand was getting bigger and bigger and that i couldn't move my pinkie finger at all. i hung up with my parents and called my friend john (my current roommate). i believe my immortal words were "john, what does a broken hand look like?" a few hours later in the ER of washington adventist hospital, i was getting my hand set for having broke my 5th metacarpal on my right hand. what a disaster.

i went and saw my doc on the 30th and got put into a real cast. it was supposed to take about 4 weeks to heal, but at 4 weeks post-fracture, i was still in a lot of pain so he put me into a cast for another 4 weeks. all during this time i was still rehabbing my ankle, so i had a lot of bodily injury stuff going on. right before christmas in 2002, i had the cast removed from my hand. it still hurt, but my doctor thought it was "normal" so sent me on my way. i spent christmas eve and christmas in mass amounts of pain so called the doctor's office on 26 december and got an appointment to see the hand specialist. he took a look at my x-rays and saw that i had about 60-90 degrees of angulation. that is, the head of my knuckle was pointing in towards my palm instead of out towards my finger. he suggested a course of therapy to see if that would reduce the pain, though admitted that in cases of such extreme angulation, surgery is sometimes the only answer.

after a week and a half of fruitless therapy, my hand therapist told me i needed to go back to the doctor, since i could barely tolerate any of the exercises she wanted me to do; they all hurt too much. needless to say, surgery was scheduled for 29 january 2003 (if you're keeping count, this is surgery #5). the hand surgeon told my mom after the surgery that not only was my hand fracture angulated, but it was also twisted. he said it took next to nothing to re-break it and it definitely explained why i was still in pain. he re-set my hand and fixed it with 2 k-wires (it's a bit like piercing the outside of your hand...except the wires go in through the bone). 4 weeks later, he pulled out the k-wires (a very weird feeling) and i started to rehab my hand in addition to the continued rehab for my ankle. my hand healed up quickly after that...unforunately i wasn't quite so lucky with my ankle.

in may 2003, after 8 months of rehab on my ankle, i was still having a lot of pain and "popping." my surgeon reffered me to dr. paul cooper, a foot/ankle specialist at georgetown university hospital in washington, dc. at my initial appointment with dr. cooper, he determined that i had scar tissue build up and most likely tore the peroneus tendons (brevis and longus). an MRI later that day confirmed it, and i had surgery on 6 august 2003. dr. cooper had hoped to be able to go in and clean everything up arthroscopically, but my ankle was more damaged than even the MRI showed; i had re-torn the lateral ligaments and torn the tendons, so he had to do a full open surgery to re-reconstruct the ligaments and to repair the tendons. i spent the first 6 weeks after THIS surgery in a cast and on crutches, followed by another 6 weeks in a walking boot. then i started rehab, but things didn't go for very long before i realized that "something wasn't right" and saw dr. cooper again on 12 december 2003.

an MRI that same night confirmed i'd re-torn both peroneal tendons, so we scheduled surgery for as soon as we could do it, 24 december 2003. the plan for this surgery was to use a cadeaver tendon to replace my torn tendons. however, it turned out that the muscle he needed to attach the cadeaver tissue to wasn't there anymore (probably lost as a result of previous surgery) so instead he ended up taking a tendon from the bottom of my foot and wrapping it around the back of my lower leg and to the outside of my ankle. he also had to clean up more scar tissue, so things were generally a mess all over again.

6 weeks in a cast on crutches and another 6 weeks in a boot later, i found myself, where else but back in rehab. things weren't initially as bad as they were from the august surgery, but as time went on, my ankle started hurting more and more, which really made no sense to me. we backed off a bit at rehab, but by the time i went for my 4 month post-op appointment, i was having a lot of problems walking without pain. this was already a familiar theme with me, and based on the noises my ankle was making and how much it hurt, i assumed that i'd re-(re-)-re torn the peroneal tendons. a visit to dr. cooper suggested that he agreed with my self-diagnosis, but he didn't think that fixing the tendons AGAIN would really solve anything, so he suggested i might need a subtalar fusion. basically, that's where they stick a big ol' screw up through your heel so you can't move your ankle much anymore. but before he did such a drastic procedure, he wanted me to see his mentor (and apparently one of the best foot/ankle surgeons in the world), dr. myerson.

dr. myerson was luckily able to take me in for an exam on very short notice (i got extremely lucky with this, since he's normally backed up for upwards of 4 retrospect, i suppose that he took me so soon because my ankle was really bad, and it was an interesting case...i'm not sure that's a good thing). he took one look at my ankle and watched me walk (try to walk, really), and decided i needed not just the subtalar joint fused, but the talo-navicular joint and the calcaneo-navicular joint fused, a procedure called a triple arthrodesis.

this triple artrodesis, along with a sural neurectomy, general debriedment, and crisman-snook ligament reconstruction, happened in surgery #8 on 25 June 2004. this means that i no longer have those pesky peroneal tendons, nor do i have any feeling on the outside of my foot. he also had to do the crisman-snook reconstruction because it turned out that my old reconstructions had popped (again). now there are 5 screws in my ankle, 4 marking where the fused joints are (they initially held them together, now they're justthere for support), and another 1 holding the ligament reconstruction. that mess over, i was on crutches and non-weight bearing for 6 weeks, and then spent another 6 weeks in a short leg walking cast.

my 11 week post-op visit with dr. myerson was on 13 september, and he gave me the go-ahead to start rehab. he also moved me to a simple Aircast AirSport brace, which i'll wear for the next month or so. i start physio this wednesday, 22 september, so expect updates here.

and there you have it. 8 surgeries in 2 years, 11 months. hopefully if nothing else my experiences can help others out there prepare for their surgeries so they know what to expect...i found when i was going into my surgeries, i didn't have much info on any of them so wanted to know more. hence, i'm gimpygal. :) tomorrow, i promise, not such a long entry!

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