Sunday, October 29, 2006

Learning to Walk Again

Triple Arthrodesis
Originally uploaded by terpkristin.
Older readers will recognize this picture, as I've had it on the blog before. Since I'm restructuring with the goal of revamping my body by working harder at the gym (combined with eating well, as I've been doing to start losing weight), I figured it was a good place to put in the "back story" of the weight gain.

Stories start best from the beginning, and the beginning of this story is in 2001, when I was in arguably the best shape of my life. I was doing marathon training, was playing soccer on a high-level women's team and on a beer league team, was swimming about 3 days a week, and doing Tang Soo Do (a Korean martial art) about 4-5 days per week.

The story begins on July 3, 2001. I was playing soccer with my beer league soccer team when I went up for a head ball and came down on the outside of my right foot, instead of on the balls of my feet. On a "normal" person, this would probably crack the heck out of their ankle. For me, with strong bones and hyperflexible joints, it popped all of the ligaments on the outside of my right ankle. I figured it was just a bad sprain, as I was sort of prone to ankle sprains already, and in less than a week, was walking (with a noticeable limp) and trying to play soccer again. I was scheduled to have my right shoulder fixed on July 26, 2001, so was eager to keep in shape and highly active until the surgery, so that during the recovery I could ride my bike (on an indoor trainer) to stay in shape so I'd have minimal physical impact from the surgery (other than that my right shoulder would stay in socket).

Fast forward to April of 2002. I've now had BOTH shoulders repaired and am starting to play soccer and run again. The first thing I notice when doing both is that my ankle isn't behaving well. Even after a "normal" outing, it was swollen beyond belief, and was rolling a LOT. I mean, when I was walking on perfectly flat, smooth pavement, my ankle would roll underneath me. Realizing that the injury from 2001 probably was to blame, I found myself back in the orthopaedic surgeon's office. He said it looked like a bad sprain and perscribed PT to strengthen the muscles. After a month of PT, my ankle was still incredibly unstable and it was obvious that PT hadn't helped any. My doc recommended surgery, and I went through with it.

In that first ankle procedure, August 15, 2002, the surgeon took some of one of the tendons on the outside of my ankle and weaved it in and around my ankle bones to become the new ligaments. He'd said that prior to the surgery (after the anesthesia took effect), they could move my ankle more or less anywhere, and when he got in there, there was nothing left for him to "tie up," as everything was shredded and gone (i.e. PT wouldn't have helped). The surgery left my right foot a bit stiff, but all in all, much more stable.

In March of 2003 I started trying to play soccer and run again. Even though I'd been cleared to do so by the orthopod, very quickly I realized that things still weren't good. My ankle was loosening up again and it was extremely painful to run or walk on. I sought out the opinion of Dr. Paul Cooper at Georgetown University Hospital.

Based on my complaints, and confirmed by an MRI, we discovered that the tendons that were used for the ligament graft in the first surgery had become weakened and as such, tore. He also thought I probably re-tore the ligaments, or that the first surgery didn't otherwise hold. I had my second ankle surgery on August 6, 2003. In that procedure, Dr. Cooper repaired the torn tendons and re-repaired the ligaments. As he is a foot/ankle specialist, I had high hopes that this would be the last surgery on my ankle and that I'd be back playing soccer by summer, 2004.

Needless to say, I was wrong. While in rehab after my 2nd ankle surgery, I felt something on the outside of my ankle pop, and the pain returned. Only 4 months after surgery number 2, an MRI confirmed that the tendons were re-torn and that I'd need another surgery. The surgery, on December 24th, 2003, didn't go quite as planned. Dr. Cooper intended to use a cadeaver tendon and graft it in to form my new lateral tendons (peroneus brevis and longus). For some reason, the graft wouldn't take. Dr. Cooper mentioned something about the place where the tendon would "plug into" at the mucle was quite atrophied and not fit for the graft. This probably had to do with the fact that I was barely walking, much less exercising/working out since the surgery in August. Instead of using the cadeaver graft, Dr. Cooper ended up taking a tendon from the bottom of my foot and re-routing it behind my leg to form the new tendon. With this surgery, if it worked, I'd be back to "normal" and would even be able to play soccer and do karate again.

While things looked good at first, they steadily went downhill after I got out of the walking cast and into PT. Whether it was all the trauma to my ankle of the 3 surgeries, or just bad quality tissue, a combination of all of these, or just fate, I was walking worse after the last surgery and was in even more pain. It was to a point where my limp was quite pronounced, and even then, walking 100 yards would make my ankle swell and make me want to cry. I went to see Dr. Mark Myerson of Mercy Hospital's Institute for Foot & Ankle Reconstruction.

After watching me walk for a few minutes on a treadmill and after some other tests, he decided I needed my ankle completely fused--a triple arthrodesis. He also determined that I needed to have a portion of one of my ankle nerves removed, and said I'd probably need the ligaments re-re-reconstructed. On June 24, 2004, I had my fourth surgery, to fuse my ankle, remove part of the sural nerve, and perform a Crisman-Snook lateral ankle ligament reconstruction. This is a surgery not usually done on people who don't qualify for AARP benefits, and was done on me (at the age of 24) because my foot was too far everted (possibly a remnant from previous surgeries?) and because I was in a LOT of pain.

Happily, after the fusion, a lot of the pain went away. Unhappily, with the fused ankle, I will never run or jump again, and I had to learn to walk all over again, with a significantly stiffer foot. 7 months after my surgery I became unemployed, having graduated from the University of Maryland with my MS in Aerospace Engineering. I'd been making good progress in PT, though still wasn't 100% pain-free, nor was I walking quite right, but with no job, I had no insurance, so I had to stop.

I remained unemployed until September, 2005. During that time, I must admit, I became depressed. I was jobless, bored, and frustrated, and the things that used to keep me sane--running, playing soccer, martial arts, were no longer an option for me. Between not being able to walk much (and not able to work out at all) from late 2002 on and the depression, the weight added on.

Finally after I got a job, I resumed physical therapy, where I finished learning to walk properly, pain-free. In February, 2006 (4.5 years after my initial injury, 3.5 years after my first surgery, and 1.75 years after my final surgery), I was given a full clearance to do whatever I wanted--bike, swim, walk, anything I could do given the limitations of a fused ankle.

Some things came up even after that, between then and now, including a broken hand, back spasms, and a very hectic time at work. I joined Worldgate Sport and Health in September and am now swimming and biking. Between the workouts and the modified diet, I've started losing some of the surgery and depression weight. But now, the time for excuses has past. Now it's time to get back to my old body, especially in light of the wedding I have to be in come late March. Now's the time I call and take the next step to focus my workouts to reach that ultimate goal.

And so, the next chapter begins...


FrogMan said...

I'll be cheering you on :)

Take care, Steve.

Anonymous said...

How did the fusion go?Please e-mail,David.

kristin, a/k/a gimpy said...

The fusion went well, all in all. I was given a drug during the surgery that I'm allergic to, which was bad, but didn't cause any long-term damage. My recovery took a long time, and it is very frustrating not being able to run or do martial arts anymore, but now I can walk pain-free, and bike, and in the grand scheme, that's infinitely better than I was.

Willards World said...

Its kindof weird but ive had almost everything go the exact same way as you....but for the fact i havent had a fusion because iam way to young to give up anything where i run in and not beeing able to do that scares the daylights out of me and that my 3 surgeries have been each spaced out about 2 years and right now i can tell the last one done at Foot and Ankle Clinic at Mercey by Clifford Jeng is just not right still. It is good to hear that someone else has had problems like this besides me

kristin said...

Hi, Willards World...I dunno, looking at your profile, you're probably about the age that I was when I had my fusion. Of course, at that point, it wasn't really a choice, I couldn't walk anymore. After 3 surgeries in 1 year, 5 months, my 4th ankle surgery (the triple) came a month and a half before the 2 year anniversary of the first ankle surgery. I know what you're going through, it's frustrating beyond belief.

Oddly enough, my recent diagnosis of Ehlers-Danlos Syndrome has made some of what I went through make a lot more sense. Had I known prior to my first ankle surgery that I had EDS, I probably would've though twice before having it. Alas, that's in the past. I miss running, but I've become a gym rat, which fills that gap for me.

Oddly enough, I think my ankle needs to be re-examined, as I have a hunch that the ligament is re-torn and that I need to get the hardware taken out (the hardware from the triple), but until I have time, I'm just managing it. I've found that using the whirlpool a the gym helps a lot.

Anonymous said...

I have had similar experiences with ankle atrophy and certainly the same experience with Cliff Jeng at Mercy. I had a lower fusion of the calcaneus performed by Jeng in 2008 which went horribly wrong. The alignment of the lower foot was completely off and I ended up with sub-talar impingment of nerves and tendons, making each wieght bearing step bring tears to my eyes. The recommendation for complete fusion was the only advice Dr. Jeng could provide to remedy my blotched surgery, which was/is not an option with the latest advancements in ankle replacement. I had to have my hardware removed as 3 of 5 screws were not seated correctly in the bone causing severe irritation and pain. I was 37 at the time of first fusion and would not consider a full fusion and complete loss of range of motion. I did not fully trust the advice of Dr. Jeng and asked to consult Dr. Meyerson of his opinion, but was quickly declined and informed that once your under the care of one physician, you have to stay with that physician....even though my condition was worse 200% from the time I walked into their office for the first consultation. I consulted Dr. Paul Cooper from Georgetown University Hospital to look at my case prior to returning to Mercy for further treatment and care. Dr. Cooper quickly ordered an MRI and CT Scan of the ankle and found the complication with the calcaneus and fibula causing the impingement of nerves and tendons. Dr. Cooper extracated the bone around the ankle and severed the nerves to aleviate the burning pain sensation. This procedure and many months of physical therapy have allowed me to walk, but not without a noticable limp. I am highly active and have a demanding lifestyle on my feet every day, therefore I have experienced the same weight gain and bouts with depression as the other bloggers. Since I did not have the full fusion (triple) done as advised by Dr. Jeng at Mercy, I'm still a candidate for ankle replacement which I plan to pursue when I cannot subdue the pain any longer. When my first surgery became evident is was failing, the only remorse I got from Mercy was "I'm sorry, that sucks it didn't turn out better". What really sucks about the matter is that I have to re-learn to do the simplest of tasks and have to adapt to my young kids growing up without a father that can run and play like he used to before his surgery that was supposed to fix a problem, not compound it. My recommendation would be only have surgery as a LAST resort, and get 5-6 opinions before doing so. I felt comfortable with Dr. Jeng, but if I had met Dr. Cooper prior to surgery, I would have certainly gone with him to complete my procedure as he is much more conservative to operate; he will explore all options prior to permanent fusion.

kristin said...

I'm sorry to hear of your bad experience with Dr. Jeng! I've never seen him except for a post-op suture removal, so I can't really speak to his expertise, but I'm surprised things went so horribly wrong for now two of you. Dr. Myerson did my triple, and all things considered, it went very well (AND I can walk again, which is a far cry from where I was, pre-op). I guess I'm fortunate that when Dr. Cooper (who is wonderful!) recommended I go see Dr. Myerson, that he could take me. I'll be the first to say, Dr. Myerson is a bit of an ass without any bedside manner, but does good work.

My Ehlers-Danlos Syndrome is most assuredly the cause of all of my repeat issues; unfortunately I wasn't diagnosed until late 2008, way after all my attempts at reconstructions (and it explains why my reconstructions have no held--the first was done by a guy whose name I don't remember, the second 2 were by Dr. Cooper...after that 2nd Cooper one failed, he referred me to Myerson). Knowing what I know now about Ehlers-Danlos Syndrome ( or if you're interested), it's not a surprise that I needed the triple, and to this day, I don't regret it (though I did recently have one of my screws removed).