Day 14 - Cast - Post Op appointment FINALLY

Well, after many, long nights of sweating about this cast, I finally had my 2-week post op appointment.  After spending the last restless night reading about all the worst things that could possibly be happening in the cast, I sat up from 4am until around 6:30 am when I finally got up.  The appointment was at 8:45am, so we left an hour earlier.

Even up to this point, I felt some random stinging pains on the right side of my ankle.  This mostly occurred when I was crutching around, since the weight of the cast was heavier on that part of the ankle.  Also, if I stood up for long periods of time, I would feel some burning and stinging on the top of my ankle.  My toes would turn red, and I'd feel the tingles.  So, how on earth  would I be able be upright in a walking boot?

What's under the cast? 
We finally arrived to the doctor's office.  It wasn't more than 10 minutes when I was called in.  The surgeon's assistant, who I talked to on the phone brought me into the room.  She mentioned my call to the doctor's office, and I reiterated that I feel like there is drainage that I'm feeling.  She, again said that was normal, and she would be taking off the cast now.

So, she pulled out a pair of scissors and started cutting the outer-layer of the cast first...basically the Ace bandage.  As soon as the entire bandage was off, I instantly felt some relief from my ankle.  The burning sensation lessened.  Now was the time to starting cutting down the layers. There were like 20 layers of cotton and padding.  She started cutting them down one at a time. I reiterated that I didn't see any drainage come through, so not sure how much there was.   After getting through like 10 layers, the cotton layer was still pristine. 

I was slightly embarrassed by this, but she would see that it would be soaked as we got down.  So, she started cutting the last 10, layer by layer.  Each layer cleaner than the last.  Then the last layer I knew had got to be the worst and then would reveal some type of boils or something.    She cut down to the last layer....and nothing!  Solid white layer of cotton...nothing!  Then she removed the last layer, and voila, and completely dry ankle! 

Cast finally comes off!

The assistant only said that everything looks really good.  In fact, other than the markings on my ankle and some slight redness, I could barely tell that I had surgery.   Very weird.  So, I'm definitely going crazy.

The next step was that she cut the sutures.  There were only two...one on each side.  Basically 2 snips and then a slight tugging sensation, and they were out.  No pain or anything.  She reiterated that everything looks good and left the room to get the surgeon.

I sat there in relief when I took the above picture. 

Talking with the Surgeon
The surgeon came and said things look pretty good.  He said I have some slight bruising and then started feeling the top of the foot, between the ankle and the toes.  It was a little numb as he was touching it.  He said that was pretty much nerve irritation, possibly inflammation from the incision.  He also said that there could be some after effects from the nerve block still present.

The next thing he did was start tapping around the right-side incision.  He asked if I felt anything...I didn't feel any pains.  He said because this incision is so close to the nerve (which, of course I had googled a million times), it can cause some sharp sensations.  I think these are the stinging pains that I feel first thing in the morning.  Other than that, he said the wounds look good and everything looks like it's healing well.

He said that I would get into a walking boot to help me walk again.  I asked him a few questions:

1. Were there two bone spurs?  Did surgery take them both out?
   Yes, one on the side of the talus, and the other on the bottom-middle of the fibula.  Both were taken out.  Also, there was some synovitis swelling which he took out as well.
2. Was there anything to watch out for?
   He said there could be some discoloration...your toes could even turn bluish, which is normal.
3. Should I do physical therapy?
   He said that he could order physical therapy if I think I needed it.  It might be better for me since I'm active and would need to get up and running quicker.  
4. How long should I be in the boot?
   Until it feels comfortable to walk...probably within 1-2 weeks, and when the shoe fits my foot again. It's based on how I feel.
5. Should I continue to elevate?
   This is also based on feel.  If I start feeling pain or swelling, then elevate it.  It'll be based on how much I do on my ankle...so play it by ear.
6. How much can I do?
   As much as I feel comfortable doing.  He said I couldn't really hurt it anymore.
7. How long before driving?
   When I'm able to stand fully weight-bearing, on both legs without pain.  No driving on the boot!

Then we talked a bit about the things that have been going on.  I told him that I've been experiencing insomnia, and even had to go to the ER with shortness of breath.  He only relayed a story about when he was younger that we used to experience heart palpitations during some stressful times...and that it could be a product of the anxiety.  He said that pulmonary embolisms are a really low percentage, as well as infections from this particular surgery. 

His recommendation, though, was to see my primary care physician to check out what could be going on.  A bit of a relief, but I think it'll be a while before I'm comfortable with these "attacks". 

And now the walking boot
So the surgeon's assistant came back in with the walking boot.  She show me how to use it. It's basically a large padded cast that fits around your leg from knee down.  When wrapped around it, it feels really snug, but not painfully tight like the cast.  It also felt really heavy.  

My new robot boot

It was awkward at first trying to walk with this thing on.  I had to use both crutches to get around.  Since the thing was a lot heavier than the cast, I wasn't as mobile...and that was it.

My next follow-up is in 1-month.


Walking with the boot was pretty rough at first.  I actually try to walk without the cast for one step, and my calf muscle instantly cramped up.  It was as if you were lifting weights and you were on the very last rep, where you could only half-lift.  That's how weak the muscle felt. 

The thing felt awkward, but somewhat comfortable.  As I went through the day, I was able to walk on it with one crutch...and then eventually got to the point where I could walk without a crutch completely.  Very short distances, but still.

Toward the night, I was actually able to walk even without the boot, but didn't want to do too much yet, since I didn't know how it would react overnight.  Unfortunately, as expected, the ankle still burned quite a bit...I fell asleep around 12:30am, and woke up at 2:30am, feeling the burn.  The good news, though, is that the burning sensation was lessened quite a bit as soon as the foot came out from under the covers.  It was still uncomfortable, but nowhere near having the cast's padding right on top of the sensitive nerves. 

I actually got a patchy 7 hours of sleep...but at this point, I will definitely take any sleep I can get!