Browsing all articles from January, 2014

Foot Ankle Surgery – 10 days and Going

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Ahhhh, I cannot BeGIN to tell you how aggravating a muscle cramp is when your foot is clamped inside of a cast! This morning I was on my cart in the kitchen, fixing to commit to a PTA bath. (You’d have to be a camping person, or a military person to know what PTA stands for. This is a G rated article, and PTA wouldn’t fit that!). While I was kneeling on the cart, the cramp hit my upper thigh on my ‘new’ – surgered ankle. Very painful. I quickly put my leg down, and deep breathed to calm the leg some. It worked.
After my bath, I was getting ready to get my new leg back on the cart and I suddenly had the cramp again, only this time it was inside the cast. What a unique, desperate, and hopeless feeling. The pain was intense, and I felt like I couldn’t do anything about this new cramp. I again straightened my leg out, put it down and attempted to relax again. Took a Lot longer this time. But finally it was over. Thankfully.
Tonight, while on the phone, once again I had a calf cramp. And once again I was able to get the cramp calmed down. My first thought was that I had sat too much today. Maybe so, except the first two were while I was standing. Next, I thought of my cast. It is definitely tighter to my leg than the first splint was. Guess I’ll wait to see if I have more of these and maybe return to the doctor’s office to see about an adjustment.
Today was Sunday, the day following the muscle cramps. Today, my foot decided to itch. If there is a choice, I would definitely rather have an itch than a cramp, but can I just have neither? Constance, in putting the cast on told me nothing goes inside the cast; no hangars, rulers, fingers, etc., to scratch an itch. If there was a persistent itch, I was to take Benadryl. Which may be fine for most folks, but the times in the past that I’ve taken Benadryl meant that I would be sleeping for the day. Benadryl runs my metabolism down to next to nothing. I already have super low blood pressure. Put the two together and what happens is wholesale sleep. So I didn’t take Benadryl. Fortunately, my wife fixed breakfast which took my mind off the itching and it went away.
Now we are in Monday, January 27th. Woke up to foot itching today. I bounced my foot around in the bed, but that was a futile attempt to stop the itching. I refuse to take Benadryl. Already said why. I would probably be asleep within 30 minutes after taking it. So I set about finding a way to – not itch. How to do that? I tried relaxation. It may be that I was too wide awake after having had a good night’s sleep. My body may not feel any good reason to return to the relaxation close to sleep. So, next thing, let’s be duplicitous. Let’s make the body believe there is itching somewhere else, scratch there and see what happens. I deliberately told my brain, out loud, that I had an itch on my neck. Next thing that happened was my neck had a small itch. Lying to my own brain. So I scratched the neck itch. PRESTO!!! It worked!! No itch in the cast!!! Since that moment, I have had no further itch inside my cast. It’s good to try an experiment that works.
What next – Well, when my cast was installed by Nurse Constance, she stated, unequivocally that this cast was a non-weight bearing cast. I didn’t realize until after I left the doctor’s office how hard the cast was. So I’ve been testing the cast since I had it. I find that I can twist my leg, and though my ankle has a small ache, there is no large pain as with my splint. I have also found that I can stand on two feet, although I can’t place weight to speak of on the cast, I can place my foot to touch the ground just for balance until I get my crutch or cart in the right place to work or ride someplace. I also find that even with a no weight bearing order, I can also put my cast down, for balance, and hustle over-top of the cast, while it’s on the ground, to get my full weight down, like to a chair or cart. So even though non-weight bearing, the cast is still useful for balance in my moving endeavors.
We live in a multi-floor house. Since this surgery we have been sleeping on the first floor, not the second as usual. We bought a little sofa that folds out to a bed and placed it in our enclosed porch. It’s a very comfortable little place. I might say, except for the cast, it’s more comfortable than my regular bed. A little lower than my regular bed but the alternate good thing is that I don’t have to stand in order to get in the bed. Standing being a bit difficult at this particular time.
The real reason for being this up about the multi-floor house is that yesterday I decided to go down to the basement to check on our furnace. We have radiators with a furnace which heats hot water and runs it through the radiators for heat. The night before, I could hear the furnace turning on and I was worried about stuff in front of the furnace that might catch fire. (When the furnace turns on, if a shield isn’t in front of it, fire flies out about 3 feet and nothing flammable should be in front of the furnace, hence my worry). I determined I would go check.
So this is the saga of getting into the basement to check for something. I am still fearful of walking with crutches. If I didn’t have to walk at all with them, I wouldn’t. Never get real brave or confident with crutches. One bad turn and you could go right over. I have the same issue getting started down the steps of the basement as I did getting started down the back outside steps as related on the January 23rd post. How am I going to take that first step? The difference is there are 13 basement steps. That’s a considerable longer distance to bump down if I fall! I decide to try the bathroom method. Sit on the commode, and then use my arms to lift myself down to the floor to sit. Nope, that isn’t the way, my arms aren’t long enough without dislocating my shoulders. So I have a toilet seat extension(does that sound funny? Or what?). It’s from my wife’s hip surgery. Put that on the floor. It’s about 4 inches tall. Now I can do the same maneuver as before and this time I’m successful! Now just slide onto the floor. Open the basement door, grab my crutches and begin the bumping along down the steps till I get about 3 up from the bottom. Now I can stand up, put myself into my crutches and I’m up! Success! I can’t begin to say how each little measure of progress causes me to feel better.
I crutch on around to the furnace and make sure there is no debris close by. Nothing there. Good. I wasn’t looking forward to trying to clean any stuff away from the furnace. So now, I’m in the basement anyway, I went ahead and made sure I could crutch over to anywhere else in the basement in case I wanted to come down here and do some work on some projects. I managed to get all the way around the floor, poked into some projects, sat down at a couple and moved things around, found chairs I could sit in, and generally had a pretty good time while there. In general though, this was to build confidence in getting around slightly confined spaces in case I wanted/needed to be in another part of the house.
Now to return to the first floor. First, sit down on the steps back to the first floor, at about the 3rd one up. I placed the crutches down beside me. I used my good foot to push me back up the steps, and pulled the crutches after me until I was all the way back to the top. Then I used the commode extender to get back up, then push on up to the actual commode, pull my little cart over and hop on.
This is good enough for now. More to come.

New Foot Surgery – Into the 2nd Week

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This is a blog on the recovery of foot/ankle surgery for me. Surgery was on January 14th. The first blog was published on January 23rd. This is the story of the 2nd week after surgery. This is important as tomorrow, January 23rd, the original splint is removed and a new, all-covering foot cast is installed for a longer time.
Tomorrow will be a happy day for me. I’ve had this splint on since the surgery. I have discovered that this splint seems to be attached, somehow, to my skin, and is movable. Especially when I get up to go somewhere. I believe there is an incision a little above my ankle, on the outside of the ankle. When I move enough, the splint moves downward of its own weight. The splint is evidently stuck to this incision because, when the splint moves, I can feel a quick, intense pain, like a cut right at that location described. I think the splint rips the incision open every time. A few times I’ve felt liquid run down my leg, though nothing came through the dressing, so I’m not positive. No matter how long, or how little I am still; when I get up, the splint moves and the feeling of being cut with a knife is immediate. My hope is that the new cast will end this quick pain and I can go about getting around without being anxious if I’m going to be in pain when I move again.
I had a doctor’s appointment today, the 22nd. It snowed during the night of the 22nd and the weather was below frigid, at about 10 with wind chill down to below zero. I was frightened of going out in this cold. With this oversized cast on, I cannot get any kind of long underwear on over the cast, nor insulated pants, or any other kind of insulation for my legs. I thought it was fortunate that it snowed. I called the doctor’s office this morning. They said the streets were not plowed so they reset my doctor appointment to Thursday, the 23rd, in the afternoon. A friend came by today and cleaned the snow off the driveway. So I’m good to go tomorrow. Now I don’t have to think about the cold. All I have to consider now is whether I’m going to slide down the steps to the driveway or fall down the steps. Guess I can think about that fun time when it’s time to go.
Now it’s the 23rd of January and I did go to the doctor today. It was cold outside. I was very worried about getting down my 4 wood steps, then down my 2 brick steps, then getting into my SUV for the ride. At the last minute I figured out that I could drive. So I carted myself out of the house onto the wood stoop outside my porch. Amazingly, the wood steps were completely cleared of snow! I got off my little cart and decided I would keep the cart behind me and pull it down behind me. Now to sit down on the steps. Well, that’s a little difficult since I only have one foot to stand on. How to step down with one foot if the other foot can’t have any weight on it? I grabbed the rails beside the steps and attempted to hold myself up while stepping down. Bad move, I near fell. I stepped back up, tried again. Same result. Next, I remounted the cart, and stepped down one step. Success!! I stepped off the cart and sat down on the top step and bumped my way on down the steps, dragged the cart behind me. Then slid on my butt over to the brick steps and swung my legs over, stood up, and remounted the cart that my wife had placed there. Walked over to the car, backed up, opened the door, got in. WHEW!!!
I was very worried about driving to the doctor’s office. I believed I may not be able to drive with my foot in a cast, thinking it would be too large to fit inside the driver’s area. But….I fit! And I drove! Not much to say about that, we arrived, parked and carted on into the doctor’s office.
We were escorted into the doctor’s office. Nurse Constance, a 27-year veteran of this job, removed my splint. Then removed my tape over my incisions. I noted with interest that the back of the splint had a lot of dried blood at the lower area and the heel. Constance advised me that I had an incision on the back of my calf. Now, I didn’t know that from the doctor, and I couldn’t see it, but I figured it due to the blood and the pain of the scab being pulled off when my splint moved up and down my leg. I felt good about being right about believing there was an incision there even though I didn’t know it till Constance pointed it out.
I took photos of my affected foot showing incisions on both sides. I couldn’t get to the incision on the back of my leg, or my heel so I don’t have photos of those locations but here is my foot with the splint off.

left side of left foot

left side 1 week after surgery

right side one week after surgy

right side one week after surgy

Constance advised me that my stitches would self dissolve. As I commented to Constance, that’s a happy thing to know. After my first ankle surgery, the stitches were removed by a nurse. The pain was searing when the stitches were removed as they had not completely closed so it was still live skin that the wire was passing through. Whew!! I can feel still feel that unique pain with a shiver as I write this.
I discussed the leg lift exercises with Constance that my therapist, Jorge, had suggested. Constance agreed wholeheartedly even mentioning the exact exercises that Jorge had told me to do. So I’m set for exercising now.
After removal of all the covers over my incisions, Constance had the X-ray tech come in and take some photos of my ankle. Next, I saw Dr. Cuttica and he showed the x-rays. I didn’t ask for the x-rays. Perhaps next time. The x-rays showed that I had two ‘wedges’ as Dr. Cuttica said. Doctors didn’t use cadaver bone to hold things together inside the foot, instead using these wedges which were about 8mm X 6mm. One was holding a pin in on side of my foot, the other was holding some hardware installed in my foot. It was very cool to look at these things, knowing they were inside my foot to make it better and yet I could feel nothing there. Dr. Cuttica advised that today a cast would be put on my foot. Three weeks hence, that cast would be removed, and another one placed on the foot. The next one would also be on for three weeks.
Dr. Cuttica left and Constance returned to put my new cast on. I selected a red outside covering. That’s because camouflage is no longer made. The red is bright and I like it. Constance determined that my foot would be cast at 90 degrees to my leg. This was not comfortable. It freaking hurt to have my ankle in this position and my foot in this much more acute angle than it had been in the splint! But it had to be done. And about 20 minutes later, after holding in position, the cast was done. We left the office, made another appointment and left. I carted myself back to the car and left. Enroute home I treated myself to a chocolate milkshake for getting through this. This is what my new cast looks like.IMG_1731 Bright isn’t it?
By the way, I just discovered that if you would like to see these photos closer, click them twice. When the next photo comes up, click it, then at the following one, click that. Pretty amazing how close the photo gets.
Once back home, I realized my ankle, on the right side of the affected ankle, hurt. The place were the incision on my leg was, also hurt. I took a pain pill, put ice on my new cast, and sat down. A bit later, I went on to bed.
Nothing like sleeping the whole night through with the aid of one little pain pill!! It is now Friday, January 24th. Today is 10 days after my surgery. Today is the last day I am required to take an aspirin to thin my blood. The purpose of that was the prevention of blood clots.
Same as yesterday, my ankle aches on the right side of my foot. I haven’t take a pain pill for it. I’m hoping just keeping the cast above my heart and in a certain neutral place will ease the aching. If not, I suppose another pain pill will get me throught the rest of the day and night, though I’d rather not do that.
I did some leg lift exercises and that had a good effect on reducing the aching in my foot. If that’s all it takes then I guess I’ll have some fine muscles by the time I get the next cast on! I’ll be doing leg lifts the majority of the day!
This is the end of this update. More to come!

New – Foot/Ankle Surgery & Recovery

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Prior to writing this new saga on my ankle, I read my last notation on May 13, 2013 about the left knee surgery. In that post, I was having grave difficulties with my right knee buckling and causing great pain during a shotgun shooting round.

I also need to note that in July, while on vacation, I fell down some steps and landed on the side of my left knee. From that day till my ankle surgery, I had swelling on the front of the knee. The swelling had previously been on the left side of the knee. The swelling was moved over from the force of the fall.

I set up the surgery for the other knee. Unfortunately, between that day and the day of the surgery, my ankle and foot collapsed and became a far more painful problem than the knee. Later yet, in November, I was hunting in West Virginia. While walking, something moved inside my foot and I was instantly in serious pain. I could hardly walk. I was satisfied that the choice of ankle surgery over knee surgery was the right thing to do.

On January 14th, the ankle surgery was done by Dr. Daniel Cuttica of the Orthopaedic Foot and Ankle Center. This newest surgery is according to the surgeon, minor surgery on the left ankle and foot. The surgery was to repair several issues on my foot and ankle on the left side. These issues were: repair of the left tibia tendon, stretch the Achilles tendon, reshape the foot with an arch. The methods of this repairing were to break the heel on the left foot, cut the Achilles tendon, incise the foot in two location on the top, pull the tendons on the bottom of the foot, drill holes in the back of the foot’s bone and push the tendons in separate holes. The point of all of this was to make the foot into a normal foot by pulling the Achilles tendon down and reattaching it to the heel with a screw. This fix, alone, will pull the foot into having an arch. The tendons in the holes in the bottom of the foot were to relieve tension on these tendons from the flat foot problem. The breaking of the heel is to realign the foot so it is shaped correct like a normal foot. After all this is done, considerable time in a splint, then a cast is required before a walking boot is issued and physical therapy begins. The recovery time prior to the walking boots could be as long as two months. Here are some graphics showing some parts of this surgery.

PTT surgery

PTT surgery

. My thanks to Certified Medical Illustrations for their permission to use their illustration on this article. See their website here. medical illustrations If the hyperlink isn’t working for you, just copy/paste the site shown here:

I thought readers might like to see the medical explanations for the surgery. The Orthopaedic Foot & Ankle Center of Washington D. C.,2922 Telestar Ct Falls Church, VA. was where I was diagnosed. They were nice enough to allow me the use of a part of their web site to medically describe what problem my foot had.ankle surgery Click to read about it. If your hyperlink doesn’t work, copy and paste their site as shown here:

In 2006, I had this same surgery on my right foot. Following the surgery, I had a considerable reaction to the post-surgery medication and had to go to the emergency room two separate times. This caused great consternation to me upon finding out I was having this same surgery to my left ankle. Generally speaking, I used relaxation techniques and meditation to relieve this stress for the upcoming surgery. I had learned and used these techniques through the years for other stressful times. Knowing relaxation techniques are very helpful in calming oneself prior to any upcoming stress.

I also used prayer. I have used prayer to calm myself, or to get thru various life situations since I was a little boy. My mother and grandmothers were my early life teachers. A lot of their teaching was on religion and how much prayer helped them in circumstances beyond their control, or helped them make correct decisions on situations within their control. I could go on and describe many times where I relied on prayer. Perhaps in another posting I’ll describe those times. Suffice to say that prayer assisted me with calming before the surgery, at the surgery, nearly at the moment of anesthesia, and following the surgery. Relying on God, a power above all known human power to assist one into calmness is a far more reaching relaxation than relying on one’s own small brain to do it.

In the first surgery, to my right foot/ankle, the recovery time was nearly exactly two months. Recovery time means the foot is encased in a cast to the knee, but not over the knee. No weight is allowed on the problem foot. Mobility is with crutches, or a special little cart made for foot and ankle recoveries.

ankle surgery cart

ankle surgery cart

Anyone who has ridden or driven in their childhood’s little red wagon is immediately familiar with how to operate this cart. Those unfamiliar with the cart might take a couple minutes to be a competent driver. The hardest part of using the cart is getting on and off of it. But it is still far better than crutches and far safer as well. With the cart, the operator’s weight is over 4 level wheels with a brake. Crutches depend on the adeptness of the user to stay on balance. If the user is off balance there is nothing that will prevent a fall, which could cause further injury. About the only bad thing with the cart is it is awkward to carry in a car.

On the first ankle surgery and after recovery time, I received a walking boot and began therapy. I believe therapy was about 3 months at 3 days a week. There was a very large problem when the cast was removed, and the walking boot attached: my calf muscle had atrophied so bad it look like a leg from a POW. I had zero muscle left. Not only would I have therapy, I also had to rebuild my entire calf muscle! This muscle rebuilding took far longer than the therapy took. What this meant was that when the therapy was complete, I still didn’t have a good calf muscle. How is calf muscle evaluated? According to the surgeon, when the rehabilitation is complete, the patient should be able to lift his body by pushing up on the toes of the affected foot. It’s the calf muscle accompanying the foot that does the lifting. It took me about 3 years to be able to do this. It’s been 7 years since my first ankle surgery. I still cannot do this on demand. Meaning, I cannot show this lift without preparing to do it by first stretching my ankle and pushing several times.

So what to do about this calf muscle issue? I asked my physical therapist that did my knee replacement therapy about exercises to make sure this didn’t happen again. A handy thing about physical therapists is that they are knowledgeable about every part of the body and can give exercises to help a patient on any exercise subject. My therapist, Jorge, advised me to do leg lifts in all directions. That is: standard leg lifts while lying on the back, leg lifts while lying on the unaffected side and raising the affected foot up and lying on my stomach and raising the leg backward. The point of this was to build up the muscle around my knee and have my calf muscle stay the same, or even build a little more. I understood building the muscle around the knee. I did that during knee replacement surgery. According to my therapists I recovered from that quicker than normal. I figured that was because I do a lot of leg weight lifting at the gym and had a lot of muscle prior to the knee surgery. Whatever the reason, I determined to do these leg lift exercises during my recovery time.

The first day after this newest ankle surgery was a complete fog. Even though, when I awakened following the surgery, I was only kept in the recovery room for about another hour or two. On returning home, I had assistance from my wife and daughter, and her boyfriend to get back into my home. I had rented a wheelchair which was a great assistance. My last surgery found my two sons having to lift me up the 5 steps into our house and place me in a recliner chair. Even though they ate their Wheaties every day, that was an overpowering lift test for them. This time I got into the wheelchair by sliding out of the vehicle I was in, and settled in. My help pulled me into the house on the wheelchair and I got myself into a bed/chair that my wife & I had purchased prior to the surgery. This bed on the first floor was so I could stay on the first floor of our house. After the first surgery, I wanted nothing to do with climbing stairs in a fog. Nothing like pre-planning after knowledge of a previous disaster. The reentry into the house and into the bed was easy. The day ended in success and calmness rather than the last chaos.

This is the first post of more posts on the recovery from this surgery.

About Detective Estes

Detective EstesMr. Estes has lived in the DC Metropolitan area for most of his life. His father’s influence and expertise in firearms resulted in Mr. Estes beginning to rifle shoot at a young age and eventually shooting on the Washington-Lee High School rifle team in Arlington, VA.

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