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!

Day Thirteen - One more day 'til cast off!

Finally, only one more day until this bloody cast (hopefully not literally).  The cast is the bane of my recovery.  When I was originally told two weeks, I wasn't sure how I was gonna make it.  But still one more day to go!

The morning at my parents was nice.  My parents get up early, so I pretty much followed suit after waking up around 8am.  I was tired, but I couldn't sleep...so I just decided to get up instead.  7 hours of patchy sleep is still better than 3 hours of non-patchy.  (don't quote me, I'm just assuming it is)

The ankle, as usual, it felt pretty decent in the morning.  I was still getting a stinging pain when I first get up from the bed.  Again, it feels like the blood is rushing all at once, and then certain parts of the ankle, I'm guessing where the incisions are, just burned for a bit.  After a few seconds, the burning settles down and I'm am ready to actually get vertically up and crutch around.

I was totally being babied by my parents, and I was totally ok with it.  Dad cooked nummy blueberry pancakes for breakfast.  I was still feeling little pangs throughout the morning...perhaps a little more constantly than usually, but not as intense as usual either.  Either way, though, it was still a little unsettling.  Mom actually went out and bought me a thermometer (to ease my nerves that I'm not coming down with a fever) as well as some fruit.  This was good, 'cuz we don't have much of a variety of natural foods at home.  We ended up ordering pizza for lunch, and watching a movie.

The doctor's office called me back in the morning and I told them that I have a dripping sensation in the cast, and of course, the shortness of breath issues.  She said that the dripping could be be just the moisture building up from the inside of the cast or even a little blood. She also said that they've had people report some claustrophobia with the cast, that could lead to those anxiety-type responses.  I asked what the plan was for tomorrow, and she assured me that we'd be able to take the cast off tomorrow, which made me feel better. 

(More anxiety stuff...nothing about ankle):
The one thing weird that I noticed (and I apologize if this is turning into an anxiety blog as well) is that when watching the movie, I would kind of start dozing off...but just as I was about to fall completely asleep, I would feel a rush and wake up completely.  Not good if you're trying to catch up on sleep.

Anyways, so after the movie, my parents brought me back to my house.  It felt a little foreign, even though I've only been away for a day.  I still kept getting the weird panic sensations (surprise) but I started giving it a little thought and figured that perhaps it was a combination of being cooped up in the house too long, with my body not knowing how to deal with going from constant activity to nothing at all.  In addition, the few days before it hit, I had barely been doing anything to keep my mind active.  I was laying in front of the tv, and watching it without really watching it, if that makes any sense.  (kinda of keeping it on for the noise, but not really invested in the show).  So, I decided to keep my mind active.  I started to play piano again...started to play some word games.  If anything, it'll keep me distracted.

I found it kind of hard to concentrate...whenever I tried, I again, would feel that rush of something (adrenaline) that breaks me out of the concentration.  I notice this when I'm trying to speak...I'd be speaking and then would just feel the flash and then lose track of what I was saying.  It seems to occur when I try to recall things as well.  It's a very odd sensation.  Maybe chalk it up to anxiety again...but I just felt off.

(Back to ankle stuff)
So that night I was up and around.  My appointment for getting my cast off was at 8:45am the next morning...so we had to leave around 7:45.  I was freaked that feeling all this dripping sensation that I might be stuck with the cast on for even longer.  (anxiety anyone?) So, I went to bed around 11pm...  This was another rough night.  My ankle was burning again, which seems to be the trend...hoping this nerve will settle down soon.

I didn't get to sleep until midnight and then just woke up at 1...feeling the burning.  I took a tylenol and then was able to back to sleep, and woke up again at 2.  This time I couldn't get back to sleep.  The burn was intensify, and of course, my mind was racing to what was going on with my ankle.  I was thinking a bunch of things....infections, bleeding, sepsis (combination of the two).  Oh and having the iPad by my side did NOT help.  I would just keep looking up things that my mind raced to.  It's like going to webmd, when you have a cold and then thinking you have the plague.

I did manage to fall asleep again at 4am and then again, woke up an hour later.  This time it would be final.  I just lied in bed until it was time to get up for my appointment.    Only a few hours to go!

Day Twelve - Spending time with my parents

Monday was memorial day.  It was a miserable night.  As usual, the burning occurred worst at night.  I kept feeling like there was some leaking happening in the cast.  I couldn't sleep too much.  I think maybe only 3-4 hours at most.  I tried to go without taking any Tylenol, as this was one of the changes that I made before my shortness of breath incident.  Mental note: burning pain minus painkillers equals burning pain!

I did wake up to my ankle nerves being settled in the morning, though.  It's very weird how much of a difference it makes from night to day.  All the burning sensations went away and the ankle pain settled.  It was such a difference that I thought I might perhaps join Becky for a cookout at her parent's house.  I decided to wash up, which always refreshes my body/mind.

The one thing that happens with the cast, is that the longer I'm up, the more burning sensation I start to feel.  It seems like the wrapping is too tight or that it's just rubbing right on the nerve.  Then I started feeling that leaking sensation and with each of the "leaks" I felt a pang of nervousness....almost as if my heart had fluttered.  Of course, this started making me nervous again.  I was actually nervous about not just being left alone, but also going to Becky's family's place and then having something happen. 

My mom actually offered to have me come over and stay the night.  So, prior to Becky going to her family's house, she took me over to my parent's house.  This was such a good idea.  Mom and Dad did everything they could to calm my nerves.  The current theory is that I'm having anxiety attacks...probably from either the lack of sleep, the stopping of the oxy, or even maybe even just being inactive for so long.

So as I lie on their couch, elevating my foot, Mom just sat and chatted with me.  She brought me water, fruits, snacks.  Just chatting with my mom helped take my mind off of things.  Dad threw in a movie, and cooked a nice steak dinner.  ha, it was like I was a 10-year old kid with a flu.

This was a nice change of pace for me.  It had been a while since spending significant time there.  As wonderful as Becky has been through this whole thing, I needed some change..and this was exactly what the doctor ordered.  It didn't fix whatever my breathing/heart/anxiety problem is, but changing environments was a good thing.

I slept semi-decently overnight.  I took 2 tylenol before going to bed.  I fell asleep around 12, woke up around 2.  Fell asleep at 2 woke up around 4...then finally fell asleep around 5 and woke up maybe around 8...  So added all together was about 7 hours of sleep.  Unfortunately it was pretty patchy, but it was the most total sleep that I've had in quite some time.  So I'll take it!

Day Ten (part two) and Eleven

So the night of day ten changed the course of my healing a bit and may change the course of this blog a bit. I had been resting the ankle quite a bit throughout the day. The night before was pretty uncomfortable, so I had to skip a party in the afternoon. Instead we decided to do something low key and have friends over. It was wonderful...they brought me some healing ice cream cake and provided the much needed distraction from the pains.

Unfortunately the nit took a weird twist, when I suddenly started to feel a sense of nausea and then felt that I couldn't breathe in all the way. I had been doing so much reading that I knew that this could be a sign of a pulmonary embolism. I started to sweat a ton and felt like I was breathing in, but just not getting enough oxygen.I wasn't sure if the feeling had gone away, but the sense of dread was still coursing through my veins. So, I ended up crashing the party with a trip to the emergency room.

The ER took me in right away and they immediately placed an IV on me (after missing a vein). They took four vials of blood samples and the doctor told me that a pulmonary embolism is pretty rare, but still worth checking out. So they wheeled me into a CT scan of my chest. The injected a dye and basically said that I would feel a warm sensation throughout my body and would make me think I peed myself. I felt it exactly like she describe. They put me through the scanner laying on my back and had me hold my breath and then start to breath. Twice for two pictures. That was it...and it went by pretty quickly. As the dye wore off, I fell shivers for a little bit as they wheeled me back to the ER room.


The ER doc came in and said that it was the right thing to do to get it checked out. They looked at the results of the cat scan and saw no evidence of an embolism. They had me do the usual physical tests where they listen to your chest while you breathe in and out as well as cough everything sounded Norma. Then they did an ECG on me, where they taped these white sensors all over your chest to see how your heart is beating. Then another where they tape all these black sensors to your chest and knees and they hook up what looks like jumper cables to each one. I asked, and I guess it's supposed to take an image of your heart. They didn't find anything abnormal there either. So, he just chalked it up to asthma that I had when I was a kid.

He said everything would be ok and had someone from respiratory give me instructions on using an inhaler. So,after all that I seemed to alm down a bit. I didn't feel anything else weird the rest of the night.

Day Eleven

So, the next day I woke up and for the most part felt pretty normal. I didn't have a lot of sleep, cuz the events had freaked me out so much. I was going through my normal routine of pretty much just laying down and elevating my ankle. Then I got up and crutches around and then sat down on one of the couches and bam! It hits me again. A little bit to a lesser extent than the night before...but kinda a pang of overwhelming dread...like something bad is about to happen. I didn't break out into sweats this time, just decided to lay down instead.

I basically laid there, kind of afraid to get up and experience this "doom" sensation again. I thought maybe it was cuz I've been inactive for eleven straight days and my body didn't know how to deal with inactivity. So I decided to crutch around and spend some energy. It seemed to have helped as it didn't really occur when u was crunching around. I had stopped for a moment and then it happened again. Same feeling...it was like my heart pounced really quickly and then that danger feeling occurred. It's really hard to describe of you haven't felt it before. It's like your body's way of telling you that something bad is about to happen...but in my case it just creates a bit of nausea and then eventually dissipates. Almost like the feeling you get when you hold your breath to its limit right before you exhale. Only, at youre breathing in normally, just still not getting enough oxygen.

I felt like I was going crazy. I read some things that point to anxiety or panic attacks, which commonly occurs after quitting oxycodone. I had really been on the ox for a few days at its minimum dosage, but who knows?

I had to skip another event, just due to both the ankle being painful and my nerves being shot.  My girlfriend was wondering and brought home some KFC and we ate it outside on the patio.  I didn't realize it, but this was pretty much the first time I've been out of the house since the surgery.  It's been pretty hot, and I've been in pain and on basically bed rest.  I felts the pangs a couple of more times, even though it was a nice mix in my recent activities.

Anyways, that night, was a bad ankle night...probably from all the crunching around trying to get exercise. The ankle burned up and it felt like it was boiling on the inside of my cast. I didn't want to take an oxy or a tylenol as that is the only thing I changed since the issues started happening. So, it made for a pretty miserable night of very little sleep.

Day Ten - AM

This might be a 2-parter since I'm writing this so early. But I figured I'd relay last night's experience while it's fresh in my memory. So, I was a bit on the miserable side last night. It wasn't necessarily a painful night, but just a very uncomfortable night. First off, whether it was nerves (literally!) or the cast, but my ankle and foot were just burning up. It was like that part of me was in an oven, and the rest of my body followed suit. I was just lying there broiling, trying to get myself to go to sleep.

Now, I hadn't taken an oxy since the morning, so perhaps because it was night, and I was completely off of painkillers, caused the flare up. I'd say about 30 minutes after I took the oxy, things settled down. I woke up at 3:30 am, which was exactly 4 hours since I took the oxy, and I was back to the oven state again. I immediately took another, and it immediately settled down. I woke up again at around 6:30, but this time, I was relatively comfortable still. I think the ankle was still warm, but the rest of me felt normal. I decided to wait instead of dosing up early. 7:30 came around and I was still relatively comfortable. Then, masochistic me decoded to wait. I was still relatively comfortable around 8:30 (1 hour post dose duration) but decided to just take it.

I was kinda hoping that I wouldn't be as dependent on the oxy as I am...but I guess it's early days.
But, hey, it's day 10, ankle.. Figure it out already!

On a positive note, I was off the painkillers for most of the day yesterday. And I guess if I were to compare, at least I didn't wake up to random stinging pains. Just this burning warmth. I'd love to find out if it is just the cast that's exacerbating the warmth or if it's just the nerve irritation.

I think I'll try to switch out to aspirin during the day to see if that makes any difference. But I am planning a date with oxy again tonight.

Day Nine - decent start, uncomfortable end

Well, today started out pretty decently. I woke up to no pain or tingles. I took my normal dosage of oxy in the middle of the night and when I woke up. My ankle felt cool and not heated at all. It was actually to the point that I wasn't really hesitant to get up from bed because the stings weren't even around.

I actually laid in bed for about a hour after I woke up. Of course, getting up, I can feel a bit of the warmth still rush to my feet. I'm guessing that's the blood just rushing down. So, I don't feel very confident crutching around too long. First thing I did was go and wash up. Since I was feeling a little more human this morning, I figure I would go all out.

Today, I actually decided to skip the pain meds and for the most part I don't think anything flared up. I did feel the tingles im the top of my foot every now and then. I only rarely felt the heat wave in the cast. The only time I felt it was if I got up. One thing I notice, is that when I do get up and I feel the rush of heat come down, I see that my toes start getting more and more red. I'm not sure if this is due to some constriction in the cast, but I still do have a sneaking suspicion of it.

So for most of the day, I was relatively comfortable. I also kep radiating the cast, and didn't feel any of the sharp twinges that I had before.

Of course this was too good to be true for the whole day. I should be so lucky...I think by around 7pm, the tingling started getting a little more constant. On top of that, I really felt some significant flashes of heat in the cast in general..that I I feel like I have some sore spots on the skin that the cast is rubbing on. I almost think that when the heat waves come, I feel like my leg is sweating in the cast. Then the sweat makes the skin irritated when it rubs against the inside of the cast. Argh. I really wish I could just take this stupid thing off, but I'm trying to be a good patient. How do people do this for months?

I guess the consistency is that the all the weird tingles and heat seems to always come toward the evening. So before I go to bed tonight, I, gonna take some oxy and then maybe take the, consistently tomorrow. (why do I tempt fate like this?).

Just a few observations:
If I elevate too high for long periods of time I start feeling tingles
If I stand up, my toes start turning red and I start feeling tingles
My compromise is to elevate with maybe two pillows
I notice that I can sit for short periods of time without the tingles starting (maybe 15 minutes)
I hate this cast...splint.

One Week Report

Today marks the one week point since I've had my ankle arthroscopy.  Surgery is a completely new thing for me (I don't count Lasik as surgery), so I'll recap what I've learned, but first, let me go over the last few hours.

So, last night, even though I was on the Oxy, I continued feeling all the sharp twinges and burning in my ankle.  It was decent during the day, but I guess it does get worse as it get toward the evening.  However, I think I did discover one of the sources of the problem (other than the cutting of 2 holes in my ankle).  I mentioned that when I bump the cast, it hits my ankle on the inside and then it flares up.  Well, I think it's actually one step further.  First off, I should probably describe the cast.

It's basically a splint that run along the calf muscle and the bottom of your foot.  It's basically a cup that the back of your leg and foot goes into...think of a cast, but then the top half of the cast is gone.  So my leg goes into the bottom half the cast and then it's stuffed with cotton (at least that's what it feels like) and then wrapped all the way down with a large elastic bandage.


From what it feels like, the hard shell also surrounds the bottom half of my ankle.  I think since the swelling has gone down (I'm guessing this since I can't actually see), the cast has been able to move around a bit.  Well, last night, I was feeling these sharp nerve twinges waaay more than normal.  It seems like the cast had started rotating a bit, and the hard edge of the cast started to dig into the area of my incision.  I start rotating the cast the opposite way, so that the soft bandage part was on top, and it instantly started to feel better.  I still felt tingles and the heat sensation, but the sharp twinges seem to have stopped ( or at least occur less often.)

I think the Oxy still helps with the ongoing tingles and how sensitive the area is, so I'm gonna continue taking it...but it does seem that the cast was part of the problem.  So, hopefully that didn't cause any further damage and add to the healing process.

This morning, I woke up with no major pains...I did notice that upon getting up, I still feel the rush of heat move to my leg, plus the associated tingles.  I'm hoping that's more indicative of the blood all rushing downward after being elevated for so long versus being an actual nerve injury.  As soon as I get up, I basically keep my leg completely still while I wait for the rush of heat to go through the leg, and the eventually dissipate.  Once that passes, I can pretty much crutch around without too much problem.  It's about 1:45pm now and it has been happening every time I get up so far.


One week lessons learned
As promised, here's a recap of lessons learned so far...I'll break it down:

Surgery:

1. Prep your house for your recovery areas before you go in.  I set up my beds and cleared paths for crutching and it helped tremendously!
2. Inserting the IV needle is probably the worst part of the actual surgery. 
3. Scratch #2, failing to insert the IV needle twice before finally getting it in is the worst part. 
4. General anesthesia, while freaky, turned out to be a no biggie.   
5. Don't try to do too much after waking up!  Take your time, and don't let them rush you into anything!
6. Lorna Doone cookies post surgery are amazing (so are cupcakes)

Post Surgery:

1. I've got post-op anxiety big time...
   Google + downtime + new and painful experience = anxiety
   If you're like me, this can't be helped...just try to learn as much as you can of what to expect before the surgery.   Ask lots of questions!
2. Nerve block can last past 24 hours.  I saw a forum post on this, and most people averaged from 24-72.  
3. Nerve block = foot doesn't work right.  I've only found 1 site that specifically said that you will not be able to move your toes while the nerve block is in place.  All other sites, says that it just makes your leg numb (duh)
4. Call your doctor and ask questions...if something doesn't feel right, ask...if anything, maybe it'll settle your nerves so you can sleep and heal better.
5. Take your painkillers that they prescribed.  They are there for a reason...don't tough it out unless you have a bad reaction.  The more they give, the more they expect you to feel it.
6. Ask for help!  I don't know where I'd be without my girlfriend or my parents to help me.  This is not a time to be selfless...I'm getting a bunch of help and still managed to fall over a couple of times on my own.  (Also, managed to spill drinks everywhere)  At least you can minimize these accidents with those who are wiling to help
7. Try not to freak - I have problems with this...but it's something that I need to do, so I'm listing it.