Friday, December 31, 2010

Week Twelve

Wednesday, December 22nd, was twelve weeks post-surgery. That afternoon I came home from work and spent some time sitting at the computer, and noticed my ankle was a little stiff when I finally stood up. Immediately I thought of my arthritis days, and the stiffness was familiar. But... there was no more arthritis so I wasn't sure what the stiffness was from. When I asked my physical therapist about it on Thursday, he said the muscles were sore and stiff, not the joint, and that sensation was perfectly normal after surgery.

On Friday morning I woke up not feeling so well but went to physical therapy anyway. The two hours there exhausted me and when I got home I spent most of the day resting and sleeping. My husband had been sick and I knew I was fighting off a sinus infection of my own.

The next day I woke up still not feeling 100% but feeling a little better, and I was having company over so I had to push myself through the day. My ankle was sore but amazingly I did well, standing up and walking around, cooking and cleaning and hosting. The year before there was no way I would have been able to do all that. The pain I was experiencing was not anywhere near as bad as it had been in before the surgery. I was happy to be able to enjoy my holiday!

Over the weekend we had a huge snowstorm and I did not go into work or to physical therapy. The snow was just too deep and there was no way I'd be able to navigate through it. Could have been just as well, since I still was fighting a sinus infection and not feeling 100%. I would have to make sure I did my exercises that day, but not push myself too hard.

On Tuesday I saw my doctor for a follow-up exam and he was very happy with my progress. The incisions were healing well, there was no swelling, and he could see that my ankle was getting stronger. He felt I was progressing better than average; I thought maybe it was because I was younger than average replacement patients and he said that was only part of it. He said he chooses his patients very carefully; he only chooses patients who are motivated, and that I was! Although my full range of motion would never return, it would get better and I was determined to live a "normal" life again. Just being able to do things I hadn't been able to do in over a year were very inspiring to me.

That day I hadn't been using my air cast at work, I used a cane instead. I had been worried about walking longer distances but I seemed to be doing fine. My doctor wanted me to push myself more and use the cane less, if at all. He felt my ankle was strong enough to handle more walking without assistance. He also wanted me to continue working on my stretching exercises to help loosen up my Achilles tendon, which he had stretched during the surgery.

I asked my doctor what I should do if I twisted my ankle. Of course I wasn't planning on doing this, but the thought did occur to me, especially with all the snow and ice outside. Plus I knew once I was ready, I'd be hiking again. My doctor told me to see him immediately if I should twist my ankle; he would take x-rays and make sure everything was okay.

At the end of the follow-up I received clearance to go back to work full-time. I was ready, although I knew I would be tired at the end of the day!

Wednesday, December 22, 2010

Week Eleven

Wednesday, December 15th, was eleven weeks post-surgery. Physical therapy was still going well and I could feel my ankle getting stronger and stronger.

On Saturday I went to the library and did not wear my air cast. I knew I wouldn't be walking too far or standing very long. My ankle did well, it was sore but I noticed that I was trying to walk a little faster than I really was able to. Sneakers with a bit of a heel were more comfortable and helped me walk a little easier, as opposed to sneakers with a flatter bottom.

That day I also used the vertical leg press machine at physical therapy, and did a calf-raise with my left foot using the lowest weight on the machine. Just a few weeks earlier I had not been able to do that!

Sunday I spent most of the day cleaning the house, this time not wearing my air cast. I took small breaks now and then and my ankle felt relatively good. It was sore but tolerable, and icing it helped.

On Monday I did a few new exercises and my legs were very sore afterward. Those muscles got a good workout! It felt good to be able to move on to new things at physical therapy... and I knew that having that "beat-up" feeling afterward was a good sign that I was becoming stronger and stronger.

I hadn't been wearing the air cast at home for a few weeks now, and was walking very well in my "indoor shoes." I noticed that sneakers like Skechers helped more because they had a bit of a heel, which helped my foot push up while walking. Walking barefoot was a bit easier as well, but the shoes helped much more and I realized I was able to walk with less of a limp.

By Tuesday I was feeling ready to take off my air cast when I went to work, but I decided not to just yet. Although I spent my days at work primarily sitting, I was concerned about walking from my car into the building to my office. My ankle strength was definitely improving but I didn't want to push myself too far just yet.

Thursday, December 16, 2010

Week Ten

Wednesday, December 8th, was ten weeks post-surgery. I had been back at work, part-time, for a full week and things were going well. That night I used my Wii Fit for the first time in over a year! I did some balance games and although I had to drop myself back down to the "beginner level" on each one, I was very happy with how well I did. I also used my elliptical machine for the first time in over a year, for five minutes.

Over the next few days I continued my home exercises and used the Wii Fit and elliptical, and by Saturday morning my therapist said I was making excellent progress. My ankle was definitely getting stronger and I was still unsure about going swimming at my local YMCA. My therapist thought I was walking well enough to make it from the locker room to the pool; he said walking in the pool would be good for me and of course the swimming would be great exercise as well. I still wasn't sure about my foot holding out so I decided to wait a little while longer and begin swimming again after the holidays. In the meantime, I also considered going for short walks in my neighborhood, just as far as I could manage. That particular Saturday I didn't go because I'd had physical therapy in the morning and didn't want to push my ankle, which was already sore.

Sunday was a cold, rainy day so I spent the day inside, putting out holiday decorations, helping with laundry and cleaning the house. It had been a very long time since I was able to clean the entire house in one afternoon and afterward my ankle was not sore at all. I had worn my air cast to help with support, and I noticed that my heel was hurting. This was because most of my weight was on my heel whenever I wore the air cast; that's the way it was designed. That was fine by me because I was so happy that the ankle itself didn't hurt! Before the surgery I would not have lasted that long cleaning and being on my feet. That evening I used my elliptical and played my favorite balance game on the Wii Fit, and then did my regular strengthening exercises. After all that my ankle was sore but it was a good sore. As I sat with ice I felt so good... it was the first truly productive day I'd had in a long time. The benefits of having had this surgery were definitely (and gradually) becoming clearer.

On Monday I used the elliptical machine for 10 minutes at physical therapy. My ankle was becoming stronger and more flexible. I realized that the more progress I made, the more determined I was to go further, to push myself to the next level. Every week there seemed to be a new achievement and I was feeling very good!

Wednesday, December 8, 2010

Week Nine

Wednesday, December 1st, was nine weeks post-surgery and my first day back to work. I wore my air cast and my ankle held out, but I was pretty drained at the end of the day... and it was only a half-day! I had to get back into my morning routine.

Thursday was a long day... work in the morning, physical therapy in the afternoon, and then a parent-teacher conference in the evening. By that night I was exhausted and my ankle was sore from all the walking, standing and exercise it had endured throughout the day. Before going to bed that night I applied some ice to help sooth it.

By Friday I was very much ready for the weekend and couldn't wait to relax a little! Overall I felt that my first week back went well, even though it hadn't been a full work week for me.

On Saturday morning I had physical therapy and my therapist noticed that the flexion in my right foot was not at a normal range. It was definitely better than my left foot but it could use some improving. My therapist said this was most likely due to years of walking differently to accomodate my weaker and less flexible ankle. He suggested when I do my exercises to also work on my right foot in order to improve the range of motion. My right foot would always be more flexible than my left, but the exercises would get it back into a normal range.

On Monday afternoon I used the elliptical machine for the first time at physical therapy. My therapist could see that I was walking better out of the air cast and he wanted me to try the elliptical. It was set on a slow speed and I used it for about 5 minutes. My therapist suggested I also use the elliptical at home, for only about 5 or 10 minutes, on my non-therapy days. By the end of the session he told me to start walking around the house in shoes, more often than in the air cast. The goal was to continue strengthening my ankle, and he believed that I would soon be out of the air cast.

As I walked around the house in my shoes for the next couple of days, I felt more confident that my strength would return. My recovery still had a long way to go, there was still much more progress to make, but every step forward (no pun intended) gave me more encouragement.

Tuesday, November 30, 2010

Week Eight

Wednesday, November 24th, was eight weeks post-surgery. That morning I went to physical therapy and was told I could begin coming three days per week starting the following week, and I should bring both sneakers so I could begin using the weight machines. So I would wear my air cast to therapy and bring along my left sneaker.

On Saturday I helped with a few errands and did some housework. My ankle was pretty sore by the end of the night! It felt good to have been productive but at the same time I wished my foot didn't hurt me so much when I tried to do "every day" things. Still, the pain I was experiencing was less than the pain I had experienced from the same type of day before my surgery. Since the recovery was slow I wanted to take note of improvements, no matter how slight, to help me look forward to being 100% again. It was important for me to realize my progress, because at times it was very frustrating that I still couldn't use my foot, even after the surgery.

Sunday morning I clumsily tripped while walking out of my bedroom and put my left foot (which was bare, no cast or shoe) down hard. The pain was incredible, and I could feel that my Achilles tendon was pulled. For the rest of the day I could feel the soreness of the tendon when walking, even with the air cast on or using a cane. I didn't do my at-home excercises that day.

On Monday I went to physical therapy and told my therapist what happened the day before. He told me icing my ankle would have helped with the sore tendon; doing that hadn't even occurred to me! I massaged it afterwards but did not use ice... made a mental note for next time around.

Physical therapy was definitely more painful that day, especially whenever the tendon was stretched or massaged. However, my therapist noted that my foot had more dorsal flexion... seems like my clumsiness the day before loosened it up a little!

I used the stationary bike for a few minutes, then progressed to the leg-lifting weight machine. Using the weights felt good... I felt so strong! When my exercises were done the ice pack felt wonderful. And for the rest of the morning I noticed that my tendon was no as sore.

While there were days when I felt bad because I still couldn't do much because of my foot, I noticed that over the past few days this particular week my general mood had improved. By Monday afternoon I was feeling great. I wasn't sure why, but it could have been noticing how much stronger I was getting at PT or being more mobile than I'd been in the past few weeks... or maybe just appreciating my good health. After going through a surgery like this I came out on top and was doing great. Life was good.

On Tuesday my tendon was not as sore, even when doing my exercises. Icing the area definitely helped. I was glad I didn't tear anything!

The next day I would be going back to work, part-time to start with, and then I would be going to physical therapy afterwards. It was going to be a long day!

Tuesday, November 23, 2010

Week Seven

Wednesday, November 17th, was seven weeks post-surgery. I wore my air cast in the morning and then progressed to my sneakers and a cane. Getting around the house was a slow process and it hurt, but I had to keep up with it. I'd be going back to work (part-time) in two weeks and wanted to make my ankle as strong as possible. I work in an office so I'd be sitting most of the day and I planned on bringing my air cast with me just in case. The doctor advised me not to drive while wearing the cast but I knew I could carry it in the car with me.

On Friday my physical therapist advised me to wear the air cast more often. He told me I would ruin the way I walk by walking barefoot or in sneakers. The air cast had a "rocker bottom" which would give my foot the ability to move in a more natural walking motion, whereas if I walked barefoot or in sneakers I would tend to keep my foot flat and shuffle along. My foot needed to "learn" how to walk again.

Over the weekend I wore my air cast more, and consciously made the effort to move my left foot in a normal walking motion. Walking and standing for any length of time still made me sore. I was longing to be "normal" again, wanted to go about my daily life and do things I haven't been able to do in a long time. My ankle was becoming stronger and more flexible, but I constantly had to remind myself that I was still recovering and needed to take things slow.

I missed being at the cat shelter on the weekends; a typical morning at the shelter meant approximately 2.5 hours on my feet and I knew I wasn't ready for that. Luckily there were enough people on my crew so my absence didn't make things that much harder for them. Still... I couldn't wait to go back!

Tuesday, November 16, 2010

Week Six

Wednesday, November 10th, was six weeks post-surgery. My ankle was sore from the walking around I was doing and my physical therapist assured me that was normal. He reminded me to take things slow and not work my ankle too much. Therapy was very draining on this day and the sessions were becoming longer as I began to work my ankle (and my leg muscles) harder. The therapy was definitely helping but there was still not too much range of motion in my foot and I knew there was still a long way to go.

Over the next few days I continued with my exercises and working on walking around with one crutch while wearing my air cast. Walking or standing for too long was painful but I knew it would get easier with time. I just had to remember to take things slow.

By Monday, November 15th, I realized I could put a little less weight on the crutch when walking, but the longer I walked the more painful my ankle so I began to put more weight back onto the crutch. Building up my strength was important but the pain was too much at times.

The next day I had a follow-up appointment with my doctor. My recovery was progressing nicely and the movement in my ankle was improving. Whenever he would move my ankle up and down I had to resist the urge to fight him, as this type of movement was painful before the surgery. He instructed me to continue walking without the crutch, in the air cast, and begin to work on wearing a sneaker and walking, assisted by a cane, either around the house or outside. He advised me to use the air cast when my ankle was feeling tired and sore, and I felt that it needed extra support. He believed I would be fully mobile in 2-3 months, and pain-free in 6 months. On this day he also told me I could drive, but recommended that I didn't drive while wearing the air cast. So I figured I could put the cast on the seat next to me and then put it on when I reached my destination.
Walking around the house in sneakers with a cane was very difficult and hurt. By the end of the evening I was able to get around with the air cast not using the crutch. I would be going back to work within the next few weeks and would need to start wearing my sneakers more and more often. The next few weeks were going to be rough!

Wednesday, November 10, 2010

Week Five

Wednesday, November 3rd, was five weeks post-surgery. The Celebrex seemed to lessen the pain and stiffness, but of course the tingling continued. I went to physical therapy and the therapist told me that the cramps I was feeling was due to lack of movement in my muscles. This made sense, since moving around helped with that pain. The therapist wanted me to wear the air cast whenever I was walking around, since I needed the support and eventually I would be walking with just the air cast and no crutches. My foot was sore after therapy and I couldn't wait until the range of motion improved.

On Thursday I had forgotten to take the Celebrex in the morning and my foot was fine all day, even after doing my exercises. I walked around the house for at different intervals to get my foot used to walking inside the air cast.

By Friday the pain was back again and physical therapy did not help ease the pain. I noticed that I was probably not pushing myself as much as I should have been due to fear of the pain. I would definitely need to work on that! I also couldn't wait until I could use my foot normally again; I would watch all the other patients doing their leg lifts and other exercises that I could not yet do and was so frustrated. Then I realized the reason for my frustration: for so long I had been unable to use my left foot for so many things, and even after having surgery I still couldn't use my foot! Part of me wondered why I even bothered getting the surgery at all. My physical therapist reminded me that eventually my foot would be normal again, I would just have to be patient and quell my anxiousness to get back on both feet.

Saturday morning my foot was still stiff and sore, so I took Celebrex that morning but it didn't seem to help. So I decided to not take it anymore, especially since it is meant for arthritis pain and technically I no longer had arthritis. I kept my pain relief down to over-the-counter medication.

My physical therapist had told me to start using one crutch instead of two, to help begin the process of putting more weight on my foot. He said it would be uncomfortable in the beginning but that was normal and part of the rehabilitation. So over the weekend I worked on getting around on one crutch and by Monday morning I was getting around much better. My ankle was still sore after walking around but it felt good to have one hand free; getting up and down the stairs in my house was much easier but I still didn't do that unless I absolutely had to.

I also noticed that the spasms were less and less frequent, although when they did come they were still excrutiating. Sometimes there was a pulsing in my foot, usually in my heel or my big toe, that felt like a small, stabbing needle. The worst part of the spasms and pulsing was that there was nothing I could do except massage and move my foot around. Pain medication did not help these sensations at all.

On Monday my therapist also started me on more leg exercises during our sessions and these hurt immensely. How I wished I had worked up my leg muscles before the therapy! I had begun using one crutch to walk around so I could put more weight on my foot and by the end of the day my ankle was pretty sore. One of the bad things about being a little more mobile was feeling like I could do so much when I still needed to take things slow. My endurance and energy were still not 100% and I could not spend too much time on my foot. Having been a very active person before the surgery it was hard to remember to take things one day at a time.

Wednesday, November 3, 2010

Week Four

Wednesday, October 27, was four weeks post-surgery. The night before was the first time I had slept without a cast on my foot. It was more comfortable than before, but sleeping still did not come easy to me. I would wake up two or three times each night and was very tired the next morning.

When I felt cramps I would remove the air cast and try massaging my foot, although this was not too easy because I still did not have feeling on the bottom of my foot and it was still tingling. However, it felt good to be able to remove my foot from the cast now and then.

During the day I tried sitting in different places around the house and would still need to elevate my foot now and then. I took my pain medication in the morning and waited until the afternoon before taking it again, as per my doctor's instructions. The pain was intermittent in between doses. Having my foot up, massaging it, or removing the cast would help. Weight bearing and the exercises I did to improve range of motion were also painful but I continued them. It felt good to be a little more mobile but I knew I still had a long road of recovery ahead.

On Thursday the pain was worse than the day before and I was also exhausted from not being able to sleep the night before. The past few nights I would wake up 3 times from either pain or having to go to the bathroom, but the third time I awoke it was hard to go back to sleep due to the pain. I was beginning to realize how much the pain medication had helped in the previous weeks. The pain I was experiencing now was what I had expected all along, and yet it still wasn't as bad as I thought it would be. The tingling sometimes bothered me more. The next day I was going to begin physical therapy and I was worried about the pain that would bring.

On Friday morning I went to Pro Sports Physical Therapy and I talked with my therapist about my situation. Total ankle replacements are not a common surgery and I wanted to make sure he understood that he couldn't move my ankle around the way he normally might. He understood and assured me that we'd be taking things slow.

He measured my range of motion and put ice on my foot for a while, then I did some stretching exercises and tried putting a little weight on my foot. Aside from the tingling, the experience was not as painful as I had worried it would be. My therapist explained that nerves are slow to come back and it could be as long as a year before they did. He said massaging would not help the tingling and suggested putting ice on my foot at home now and then. I was to continue stretching my foot to improve range of motion and continue weight bearing as tolerable.

When I returned home I was very tired... it had been a busy morning for me. Doing my exercises caused pain but I continued them. Around dinner time the pain was bad since I was weaning myself off the Vicodin and Celebrex. I hadn't taken those since the morning but I was continuing with Aleve or Advil when needed. My foot ached and the spasms were sometimes hard to tolerate. I put ice on my foot for 10 minutes and the coldness seemed to make my ankle hurt even more, but I knew the ice would be good for the swelling. While it had gone down considerably, it still needed to go down some more. I dreaded the day when I wouldn't be taking the Vicodin and Celebrex any more and hoped over-the-counter medication would help.

Sunday morning I had taken the last of the prescription medications. The spasms were still coming now and then but walking around seemed to help. Throughout the day I did my exercises and continued to try some weight bearing. I noticed I was able to stand on both feet, distributing my weight almost evenly, and I also noticed that I was able to stand flat-footed, with no shoes on, with my feet together! I couldn't remember the last time I was able to do that. Prior to the surgery if I stood barefoot I had to have my left foot extended forward because it would not bend. Now it still did not have full range of motion and it was stiff when I stood with it straight but that didn't matter... I was so excited to see the first benefit of having a new ankle.

Sleeping at night had not gotten much better over the past couple of nights, but I noticed when I woke up my foot was not as stiff and painful as before. However, Monday morning was different. I woke up to a very stiff and painful foot and as of that morning I would only be taking Advil or Aleve as needed. Exhausted and not feeling well, I rested for most of the day, keeping my foot elevated. The tingling seemed worse than usual, so much that my foot felt numbly frozen, even though it was under a thick sock. I did some weight bearing exercises and moved my foot around to keep it flexible but it was still painful and stiff.

On Tuesday morning the pain was not as bad but there was still tingling and stiffness. I took an Advil and, since I had taken Celebrex before the surgery to help with arthritis pain, I decided to continue with that for a little while longer. I knew the physical therapy and my home exercises would eventually improve the range of motion in my ankle, and then I could stop taking the Celebrex. Although it was tempting, the Vicodin would no longer be an option as it could become addictive.

Tuesday, October 26, 2010

Week Three

Wednesday, October 20, was three weeks post-surgery. The cramps were still coming on strong and my foot felt as if it were burning; this was definitely my nerves "coming back to life" but it was so uncomfortable! I was also doing my best to ignore the abrasion on the back of my foot but it wasn't easy.

Meanwhile, the fall weather was cool and crisp and I wanted so much to enjoy it! Of course I wasn't ready to venture outside anywhere yet. My pain medication made me sleepy and getting around on my crutches or walker for too long tired me out. Not to mention my foot was still in considerable pain. Not only did that need to subside, but I also needed to build up my strength.

Thursday the pain was a little better and I couldn't decide whether it was the abrasion on the back of my foot or the actual ankle that was bothering me. I took my pain medication upon waking in the morning and was able to wait 6 hours before taking it again. There were still spasms but during the day they didn't seem to bother me as much. I decided I would continue taking the pain medication until the cast came off the following Tuesday. At that time I would be able to take care of the abrasion and possibly massage the cramps, and hopefully I could wean myself off the medication. It all depended on how the rest of the week went.

Of course, by Thursday evening I wasn't able to wait 6 hours before taking my pain medication again, and the next day my foot was still tingling and burning. My next appointment with my doctor was that coming Tuesday and I planned on asking him about the sensations I was feeling; I wondered how much longer they were going to last.

Saturday I was still feeling the spasms and tingling, and the incision site and ankle itself were also painful, although I noticed the abrasion on the back of my foot did not bother me as much that day. The spasms were making it harder to wait 5 hours before taking pain medication but I persisted. I wasn't sure exactly what type of pain I was supposed to be feeling other than the spasms; it seemed there were only a few times when the actual ankle hurt. I wondered if the pain medication was helping, since I didn't know what type of pain I was supposed to be feeling. Was I not feeling pain because the medication was doing its work, or was I lucky that the pain was not too bad for me? The pain was different from when I had initially broken my ankle; I would need to speak with my doctor at my next appointment.

Getting up and moving around helped the spasms but not always the tingling. I continued with my left leg exercises as well to keep the leg from atrophying too much. It had atrophied when I'd first been on crutches 7 years ago and I felt as though it never went back to being the same size as my right leg. I was worried it would be even smaller and more noticeable now. Hopefully I would be able to build it back up again.

Most of my days were spent reading and watching TV or movies, and occasionally napping due to the pain medication. I was able to log onto the Internet through my Netbook, so I could keep in touch with friends and stay posted as to what was happening at the shelter. Each day I would get up and move around the house in order to build up my stength but it was still very tiring. Not being able to sleep well at night didn't help; I would wake up 2-3 times a night due to pain or just being uncomfortable.

The next day the hard cast would be coming off and the walking cast would be going on. Although I knew the air cast would stay on most of the time, I began to worry about when my foot was out of the cast, when I was sleeping or in the shower. My foot would be able to move freely, and movement could hurt. All I could do was wait and see.

On Tuesday the hard cast was removed and the air cast was put on. My doctor said the wound was healing nicely, the swelling had gone down and everything looked good. He told me the tingling and the spasms were normal and would continue for a while. The pain medication was not helping those, and he advised me to start weaning myself off.

When he moved my foot back and forth it did not hurt too much; it actually felt nice to move my foot without the pain I was experiencing before the surgery! He told me I would be allowed to put weight on my foot as tolerable, but I still needed the crutches to get around. I was also supposed to exercise my foot by moving it back and forth, and start physical therapy. I tried standing up in the doctor's office and although it was somewhat painful, it worked!

I was so happy that I would be able to let my foot breathe again and that I wouldn't have to balance on one leg when standing. I wanted to do so much when I got home but I was exhausted from my busy day and needed to rest. I also knew I needed to take things one day at a time... baby steps.

I found a physical therapist in my neighborhood and made an appointment for Friday morning. I was nervous and excited at the same time.

By evening I could definitely feel pain in my foot and knew this is what I would have been feeling all along if I had not been taking my pain medication. But I was holding out for my bedtime dose so I could begin the weaning-off process.

Tuesday, October 19, 2010

Week Two

Wednesday, October 13, was one week post-surgery and the pain was somewhat worse that day; the medication helped but not as much as before. The day before I was fitted for my walking boot and the additional pain could have been from walking around on crutches that afternoon. Could have been part of the healing process. Could have been from doing my leg exercises. I'm not one for calling the doctor for every little ache and pain; I planned on calling my surgeon if it didn't get any better or got worse within the next few days.

On Thursday the pain was better. When walking around or doing my leg exercises, I focused on how I bent my leg, using my thigh muscles rather than my knee. I thought that may have been the problem the day before and planned to keep an eye on things.

Friday was better. I was watching how I bent my knee and I noticed that the more I moved around, the better my foot felt. Laying down and elevating it too long seemed to make the tingling worse. Of course, walking around too much didn't make it much better! A good mix of getting up and moving around along with resting helped, but there were still small spasms of pain in my foot. My surgeon had mentioned the nerves were "coming back to life" and I figured this was the cause of these sensations. I also noticed I was able to go a little longer between pain medication, from every 4 hours to every 5 hours.

By Saturday I realized most of the discomfort I was feeling was due to the tingling in my foot and not actual pain at all. At least, not until the pain medication started to wear off, and once that did the spasms themselves were painful. Now and then my foot would twitch inside the cast, on it's own, and that hurt the ankle joint itself. Understanding where my pain was coming from was helping me cope with it.

As the week went on the swelling subsided and the cast became looser, which caused what felt like an abrasion on the back of my foot, along the heel. It was frustrating but I had no other choice but to ignore it, since there was nothing I could do as long as the cast was on.

I still did not have feeling along the bottom of my toes or foot and hoped that would change soon, especially since the tingling and cramps were still coming on strong. The cramps were very uncomfortable and had a "charley horse" type of feeling.

The mornings were probably the most difficult part of my day because my foot felt very stiff and tingly upon waking. It was also hard to get comfortable because I could only lay either on my back or my right side, with my foot elevated either way. I also tried sitting with my foot elevated differently because the abrasion on the back of my foot was bothering me. If I was able to have my foot sideways it didn't hurt as much. It also felt better when I got up to move around or to do my leg exercises. I couldn't wait for the cast to come off next week so my foot could breathe and I could tend to the aches and pains.

Sometimes I would become upset thinking about how my surgeon had told me I would no longer be able to participate in mountain biking. This was my favorite hobby and it would be very hard to give up but I knew the surgeon was right. I couldn't risk loosening the implant and shortening its lifespan. My friends were supportive and reminded me there are plenty of other activities out there to enjoy. Some even said the surgeon could be wrong, if I modified my style of riding or rode a full suspension bike then I should be fine. I knew I couldn't take any chances and instead of focusing on what I couldn't do, I focused on all the things I would be able to do. For over a year I hadn't used my elliptical machine or Wii Fit, and I hadn't gone hiking with my family or gone for morning walks around my neighborhood. The simple tasks of cleaning the house or grocery shopping had been very difficult. I reminded myself that giving up one of my hobbies was a small price to pay in exchange for doing so many of the other things that I enjoyed doing. Plus... who knew what other new hobbies I could take up!

Thursday, October 14, 2010

Week One

On the morning of the surgery I was still coming up with excuses not to go through with it, but of course I did. My husband accompanied me to the North Shore Glen Cove Hospital but he was not allowed into the holding room with me. Any time hospital staff approached the gurney I was sitting on, I would burst into tears. Dr Segal, my surgeon, came to see me and assured me everything would be fine. I asked him what kind of hardware he had decided on and he told me he would be using the Salto Talaris. The design is small and implanting it would require removal of less bone than other prosthetics out there, making it ideal for the future when revision surgery may be necessary.

The anesthesiologist came over and assured me I would not wake up during the surgery nor would I be able to fight the anesthesia and not fall asleep. Everyone told me I would be fine. A nerve block was injected into the back of my left knee. I was brought into the operating room and placed on the table. A mask was placed over my nose and mouth and off to sleep I went.

Approximately four hours later, I was in the recovery room with the hospital staff telling me I had made it and the surgery had gone well. I was very drowsy and feeling no pain and I was back! Things had gone well as everyone had promised me.

During the next few hours I did not experience any pain. The nerve block worked well until the next morning when the pain started to set in. Still, I did not think it was as bad as I had expected. I was feeling rather good and was already anxious to go home.

Thursday morning the physical therapist came in and had me get up out of bed and use a walker. The blood rushing down to my foot caused such a stinging, burning, tingling sensation that I was close to tears. It was almost impossibile for me to move around because of the pain. I got back into bed and was told we would try again the next day.

Over the next couple of days the painful bloodrush I felt when getting up to do my physical therapy became easier to tolerate. The therapist had me practice going up and down stairs on crutches and walking down the hallway with my walker. When I got back to my room I was pretty tired! Muscles were sore from not being used in that way before. Thinking back, it would have been good to do exercises at home before the surgery to strengthen my legs, arms and shoulders to prepare me for getting around on crutches and a walker. I was never much for lifting weights, I would much rather do aerobics or walk or ride my bike. But I would say now that lifting weights would have definitely benefited me.

By Saturday, October 9, I was more than ready to go home and got the doctor's clearance to be discharged. My first night home I slept like a rock! It was good to be back in my own bed. The next few days it was a little hard to get around, I would become easily tired. The pain was still under control with medication.

On Tuesday I was put into a hard cast and it would stay on for two weeks, after which my surgeon would remove it and the stitches and put my ankle into a walking boot. However, I was told I would still not be able to put full weight on my foot for another three weeks.

There had been tingling in my foot and the doctor told me it's because the nerves had been "asleep" during the surgery and while the block was in effect. Nothing to worry about, it was perfectly normal. I was also instructed to keep my foot elevated as much as possible to help the bruising subside.

My first week was over and I was feeling pretty good.

Preparing for the Big Day

For the first few weeks after I made my appointment I was excited with thoughts of pain-free mobility and doing all the things I'd missed out on for so long. I couldn't wait!

Then, as the surgery date drew closer, I began to get nervous. Maybe my ankle was fine and I didn't need the surgery. I could still get around fine, the weight loss had helped with the pain. I had Celebrex and my brace and I knew my limits, I would just rest when I needed to. And how could I be off my feet for weeks, not able to help around the house or with errands? My husband and son would need to do more than their fair share for as long as I was off my feet. My husband reminded me of my limitations and of the things I hadn't been doing that I missed doing. He reminded me that the doctor told me I'm a good candidate for this surgery and no complications were foreseen. He also told me he did not mind helping more around the house; the next few weeks would be hard for us but in the long run it would pay off.

Still... I was scared and I realized that I wasn't afraid of the actual surgery itself, it was the anesthesia. I didn't know why that bothered me, especially since I had been under anesthesia two times before in my life due to my ankle, and I had had a C-section when my son was born and although I was not under anesthesia, there was another surgery done! For some reason I was afraid of either going to sleep and never waking up again or waking up in the middle of the surgery. My husband continued to reassure me everything would be fine. I had to continue to remind myself that I was young and healthy and strong, and if there were any issues my doctor would not be going ahead with this surgery.

I felt the need to prepare for the few days I would be at the hospital and away from home. I made sure bills were paid, ran last minute errands, cleaned and reorganized the house and tied up loose ends at work and at the shelter. I felt as though I had the nesting syndrome many women feel when they get close to the end of their pregnancy.

Two weeks before the surgery I was told to stop taking my Celebrex and all other supplements I was taking except for the multivitamin. I also began taking Vitamin C and iron, although it then turned out that I did not donate my own blood. This was a personal decision and I would recommend anyone considering this surgery speak with their own doctor regarding blood donation.

Soon the night before the surgery came... the next day would be a big one!

The Decision

When I began the search for the surgeon who would do my ankle replacement, I started with my health insurance company. I needed to make sure the procedure would be covered. Luckily it was, under ICD 9 code 81.56. Once I understood how the coverage worked and what exactly was covered, I needed to find a surgeon who participated with my health plan.

Initially I wanted the surgery done at the Hospital for Special Surgery in Manhattan. After all, they specialize in this sort of thing! So I searched on the insurance company's web site under the criteria "orthopedic surgeons" and "Hospital for Special Surgery." When the list came up I narrowed the doctors down by location, keeping in mind that I would be going for follow-up visits and knowing my family would be visiting me at the hospital.

Then I began calling the doctor's offices and crossing off the surgeons that did not specialize in ankle replacement surgery (many specialized in knee or hip). The list was finally narrowed down to three doctors and one of them didn't have an appointment available until March 2011. Of course that was too far away so I made appointments with the other two.

On August 20, 2010, my husband and I sat down with Dr Ayal Segal for a consultation on total ankle replacement surgery. He went over the various options that were available to me, from having a cadaver part put in, to having the ankle joint "stretched" with a surgical splint, to ankle fusion.

Having a cadaver part put in is a very experimental procedure and Dr Segal would have had to refer me elsewhere to have it done. This procedure didn't really appeal to me; I wanted something more concrete. The splint would stretch my joint and buy me 2-3 more years before I would have to undergo the replacement surgery. I didn't want to have to have surgery now and then again 2-3 years from now, so that procedure was out. Ankle fusion would basically render my foot motionless for the rest of my life and I would have to wear special shoes. Arthritis would most likely set into to the knee and hip joints of the same leg earlier on because I would be walking differently. The good thing about this procedure is that it would only be done once; I would never have to have surgery on my ankle again. But I didn't like the thought of never moving my foot again and having other joint problems due to the fusion. So then it came down to replacement.

Total ankle replacement is a relatively new procedure but within the last 10 years the technology has come a long way and the success rate for patients has improved. With the replacement I would be able to do everything I've done before, with the exception of high-impact sports such as running and tennis. But I would be able to walk around my neighborhood again, hike with my family, use my elliptical and Wii Fit again, and do so many other things that I haven't been able to do in over a year. Dr Segal told me I am an excellent candidate for total ankle replacement. I'm young, thin, healthy and active. If I were 20-30 years older I would have to have fusion; replacement would not be an option for me.

My husband and I felt the consultation went well. Dr Segal answered all of our questions, layed out all of the facts regarding the options available to me, and didn't pressure us in any way toward a particular option. He had done many ankle replacement surgeries previously and specialized in complex reconstruction of the ankle. He would do my surgery at North Shore Glen Cove Hospital. This was not initially the hospital I had wanted to have the surgery done at but I decided that the surgeon was more important than the hospital. Not to mention the hospital was only a half hour from my home, whereas the Hospital for Special Surgery in Manhattan would probably be over an hour away.

I knew this was what I wanted to do and I felt comfortable with Dr Segal. I made the surgical appointment for October 6, 2010, and canceled the appointment I had made with the other orthopedic surgeon.

Tuesday, October 12, 2010

An Introduction

I decided to start this blog so I could help people with their decision to have total ankle replacement. Since I hadn't planned on recording any of this I do not have photos to post or exact timeframes for certain things before this year. The main purpose of this blog is to explain the factors leading up to my decision to have total ankle replacement surgery and to document my recovery afterward. I am hoping my experiences will help those of you out there considering having this surgery.

I will be 40 years old this month. I have always been an active person. Years ago I was enjoying hiking, mountain biking, snow-shoeing, rock wall climbing, softball, aerobics, Tae Bo... anything that would keep me healthy and fit.

On June 17, 2003, my life changed. I was playing softball and a baserunner slid into me, breaking my left ankle. I was told it was a trimalleolar fracture, which basically involves three bones in my ankle joint. Pretty bad break. I had open reduction internal fixation (ORIF) surgery, which resulted in a plate and screws being placed into my left fibula and initially three screws into the left ankle itself. After the stitches were removed, a hard cast was put on for about 6 weeks.

After the hard cast was removed one of the screws in my ankle was taken out. This was outpatient surgery and I left the hospital the same day. Physical therapy was not difficult for me. I tolerated it well and was back on my feet, without crutches, by September 2003. My orthopedist, Dr Steven Erlanger, attributed my good recovery to my healthy lifestyle, which had kept my body strong. I continued with my active lifestyle for a few years without any complications. I even started volunteering at a local cat shelter in December 2006 so I could give back to my community.

Then in 2007 I began having discomfort and stiffness; my orthopedist told me osteoarthritis was setting in. I received a cortisone injection that year and it helped tremendously. I was back to doing all the things I loved doing, including going for morning walks around my neighborhood before work each day.

In 2008 I received a couple more cortisone injections and had a brace ordered for my ankle so I could walk longer distances. The brace did not help with the pain but it helped give my ankle the extra support it needed. Things were starting to get a little tougher for me. The cartilage in my left ankle was wearing away quickly. I could no longer go for my morning walks, which was something I really enjoyed doing. I decided to purchase an elliptical machine; the low-impact workout was good for me. I also purchased a Wii Fit and used those games and exercises to help. I was unable to do the "running" portion as it was too much for my ankle. I was still able to mountain bike but anything hard-impact like hiking or walking were no longer options for me to exercise. After doing any sort of exercise I had to rest my foot, elevating it with an ice pack.

Having my foot flat on the ground was too painful; I could no longer walk barefoot. I had to wear shoes with a small heel so I could walk easily. High heels were out of the question, even though I never really wore them to begin with. My shoes had to either be sneakers with a heel lift inside or comfortable wedges, which have a flat sole and a slight heel, no more than 2" for me. I was now wearing my brace whenever I volunteered at the shelter.

My orthopedist prescribed Celebrex, 200mg once per day, and I was able to stay relatively active, including the use the elliptical and Wii Fit, until the middle of 2009. By then any sort of activity was hurting my ankle badly, including things like cleaning the house. I was also unable to carry anything heavy and walk at the same time. The extra weight on my ankle was just too much. The 2.5 hours on my feet every other day at the shelter basically put me out of commission for the rest of the day. The cortisone shots were not lasting as long as they had in the past. I began parking as close as possible to entrances whenever I went to work or ran errands. A cane was sometimes used for extra support. My orthopedist recommended ankle replacement surgery and although I thought about it, I did not take any steps towards it right away. I wasn't sure about having surgery just yet.

I researched foods that were both good and bad for osteoarthritis and started taking supplements such as glucosamine chondroitin and fish oil to help with my painful joint. I tried keeping a journal to keep track of what factors were affecting my ankle, such as weather or food or activities. In September 2009 I decided to sign up for swimming three to four nights a week at my local YMCA. Swimming is a great total body, low-impact exercise! By December I was getting into a groove and becoming stronger.

My ankle was also becoming weaker. I was unable to be on my feet, walking or standing, for more than 20 minutes. Cleaning the house was almost impossible; I would have to do little by little on the weekend and rest in between each chore. There were certain errands I couldn't run simply because there was too much walking involved. Luckily I work in an office and sit for most of the day, but I was unable to complete tasks that required walking to the other side of the office or upstairs to the next floor. My daily activities were becoming severely limited.

It was time to take action. My first step was losing weight. In April 2010 I joined Weight Watchers with the intent of losing 20 lbs. I knew this would significantly reduce the stress on my ankle. I joined an arthritis forum group and read about other people's experience with osteoarthritis, what they were doing for relief and also if anyone else had undergone surgery. I searched for blogs and forums and read up on people's comments about their experiences. I searched online for sites explaining total ankle replacement surgery, what was involved and what the recovery period would be like.

In June 2010 the x-rays showed there was absolutely no cartilage left; I was completely bone on bone. My worst fear was ending up in a wheelchair and my orthopedist told me if I didn't do something about my ankle, that was exactly what was going to happen.

By the time August arrived I was close to reaching my weight loss goal and although my ankle was doing better because of this, I was still very limited in my daily activities and I knew my ankle would not last much longer. My journal showed that food, weather and activities may have had some impact on the pain and discomfort, but the fact of the matter was that my ankle had deteriorated and would not be getting better any time soon. The time had come to seriously consider undergoing total ankle replacement surgery.