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.