Days 133-136 (-4): Traveling after PTTD Surgery

This week, I have been at a conference.  I had to take a 2.5 hour flight to get here.  My doctor wanted me to take blood thinners before any airline travel, but since this is the week before surgery, I have to be drug free.

Airport experience:

I didn't realize how big my local airport really is.  With my low/minimal pain steps per day being a very small number, I was at a level 4/5 by the time I got through security and to the gate.  I had to bring the paper from my doctor that says that I have hardware in my foot with me to get through security.  It took much longer to get through security than usual, because a supervisor had to approve me.  I also kept my tennis shoes on because I didn't want to be limping around, so they had to do the bomb residue test before they let me through to the terminal.

Flight:

My feet only made it a few minutes after takeoff before they started to really swell.  I had to take my shoes off to relieve some of the pressure.  I was wearing compression socks, so that helped a little.  I wish that I was able to take drugs this week, because it definitely would have made it more bearable.  Instead, my feet throbbed the entire flight, and my pain level climbed to a 6. I used the trick that my physical therapist shared with me in my boot wearing days.  I pumped my foot up and down and did circles to stimulate blood flow.  That is the magic cure for relieving throbbing and swelling.

I was really happy when we landed, because the swelling went down, but my pain level only dropped to a 5.

Hotel:

Pretty funny that I had to use the couch cushions placed under my sheets to elevate my feet in my bed.  My showers were also really short, since I have a lot of trouble standing in the shower.

Conference:

I tried my best to match my business clothes with my Clark's Mary Janes.  They actually didn't look half bad and my feet made it through pretty well despite all the walking.  I switched to my tennis shoes at night when we went out to dinner.  My left bothered me more than my right since it compensates for it.


Going Home:

On the way back, I took my shoes off and went through security as if nothing was wrong.  I just didn't want to be bothered by the security people.  I got through the scanner with no problems.  On the flight home, I made the mistake of falling asleep.  This meant that I missed about 45 mins of manually pumping the blood through my foot.  When I woke up, my pain level was around 7.  When I got off the plane and had to walk back through the terminal, my calf was so tight and painful that I had to limp my way through the airport.

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Reflection:

At 5 months post surgery, my foot was not really ready for airline travel.  I am glad I went because this is my first trip since the first surgery, so I really needed to get away, but I will only travel again if I have to.

Day 133 (-7): 19 weeks + Weekend Recap

*19 week surgery anniversary*

Today, I am exactly 19 weeks post-op (Left) and 1 week pre-op (Right).  It is 6:44 am (EST) and I will be leaving for the airport shortly to fly to a conference.  This is my first time traveling since my first surgery.  My doctor wanted me to take blood thinners, but it occurred to me that I can't take anything since I am only a week out from my second surgery.  Compression socks will have to do.

I fell off the wagon posting daily, so here is a recap of the weekend:

Day 129 (-11): Pre-op Blood work, ordered wheelchair, worked on my dissertation and on my poster presentation for this week's conference.

Day 130 (-10): Do or Die work day...And I chose to do.  Finished my poster for the conference AND I finished my DISSERTATION!!!!

Day 131 (-9): Living young and wild and free!!! Went to a memorial day cookout/pool party and had a blast.  I of course wore tennis shoes with my swimsuit, but I didn't let my feet hold back my fun.  Several rounds of icing when I got home.

Day 132 (-8): Whole body exhaustion hit me.  I have been working so hard on my dissertation over the last few weeks, Surgery 1 recovery, and Surgery II prep.  My body only breaks down on me when I slow down long enough to let it rest.  I did build up enough energy to clean out my office space at school.  I won't part ways with my university until the end of the summer, but since this is the last week that I will be able to walk or drive, I figured I should get that move out of the way.

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I'll post when I can on my traveling experience.  I am going to wear my tennis shoes as often as possible to help preserve my feet.  This week will be the ultimate test for my left foot in terms of how well it has recovered.

Later...

Day 128 (-12): Last PT Session

Today was the end.  The conclusion of close to 3 months of physical therapy for my left foot.

My therapist made me a guide with pictures and instructions of exercises that I should be doing for further improvement and long term maintenance of my left foot function.  We walked through them today.  One of the new more advanced exercises caused me some knee pain, so I rode the bike for cardio today instead of the arc trainer.

In the earlier stages of my recovery, I was really scared of the idea of ending PT.  I thought that it would end abruptly, before I was ready.  I still remember how terrified I was after two weeks of PT, when my therapist cut me down from 3 sessions per week to 2, and when he made the April Fool's joke about it being my last session.  At the time, I needed to go to PT, as much for my ankle recovery, as for my sanity.   Sure, you could be instructed on how to do the PT exercises at home on your own, but the PT experience is much more than just exercises.  This journey is a tough one and you need people on your team supporting you and encouraging you to make progress.  With my left ankle newly reconstructed, I have treated it like it is my baby.  It's name is Frankenfoot.  I have so carefully, borderline obsessively,  followed all of the instructions and guidelines so as to ensure the best outcome possible.  What accompanies a surgery like this, is a fear that you will mess your new foot up, that you might push it too far, and end up needing more surgery.  Frankenfoot felt completely foreign to me for months, as if it wasn't mine.  I didn't know what to do with it.   I needed my therapist to tell me that it was going to be ok to test and push the limits of its capabilities, and in many cases "hold" my hand.   Oh so far from my old personality, but this surgery would break anyone.

Today, I was ready.   Today, NOW, I can stand on my own two feet (well figuratively) and am confident that I can handle managing the rest of the 5-8 months of recovery time remaining for my left on my own.   I have gone through so much to get to this point and it absolutely amazes me that I can say that.  My left foot feels good.  It's got a long ways to go before it is fully back in action, but all it needs is time, continued training, and for me to be patient.

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DISSERTATION

Another 8 hours today, and I'm still not finished.  It is such detailed work that just takes a lot of time.  I'll get it done when I get it done.  I've missed so many of my "deadlines" for it, but I am doing the very best I can and that is all I can do.  I haven't taken a day off working on it since I refocused on finishing it last Saturday.

I have to do my pre-op blood work tomorrow, so more distractions.  It is the last business day that I will be home before the day before the surgery because of my conference next week.  I also have to set up my wheelchair rental, fill my prescriptions for my post surgery meds, and completely prepare my life for being in jail all summer.  I have had a medical appointment every single day this week.  My life is so high maintenance right now.  Geez.  I am not even working a job this summer and I still end up working from the minute I wake up to the minute I go to sleep on my dissertation, surgery I recovery, and surgery II prep.

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Reflection

I restored my inner peace today.  I am no longer wrestling with what my life has become and how far it is from the life that I thought, expected, dreamed it would be.  I have accepted that the second surgery is knocking on the door and that in 12 days, I'll be back to ground zero again.  I am a phoenix.  I rose from the fire one time, I will rise again.

Day 127 (-13): Surgery II Confirmed

Today was a life defining day.

This morning I had my final pre-op appointment before my right foot surgery.  There was a different look in my eyes from the time I woke up.  It was a combination of worry, nervousness, sorrow, and excitement that I would finally know my fate.

I waited for just over an hour past my appointment time in the waiting room.  The earliest I have ever been seen is maybe 45 mins past my appointment time, so I knew before coming in today that I would be waiting. That 1 hour was excruciating.  I tried to listen to some music, but I ended up turning it off because it was as if my thoughts were shouting over the sound of it.   It was hard to not let my mind wander to the worst case scenarios.

When I finally got called back, I went and waited in a patient room.  Then, got taken to do some x-rays of my right foot, and back to the room.  More waiting.

Finally, my surgeon's PA walked in and went straight to the computer to pull up my X-rays.  He  showed me a comparison picture between my left before surgery when it was collapsed to my right now currently collapsed.  My feet looked literally identical.  Eerily similar.  No more questions at that point about if I was going to have surgery.

See for yourself:

My doctor came in and used the computer tools to draw lines on my talus bone that, when extended, were supposed to line up with my first metatarsal.   He demonstrated how my right foot is 15 degrees off, whereas my newly reconstructed left foot is only 2 degrees off now.  

He then checked out my feet.  He asked a lot of questions about how my posterior tibial tendon had been feeling.  I told him that it was not nearly as painful as when my left collapsed because that one was so badly inflamed from running.  With my right, one day, it just decided to fail.  I have pain and inflammation on some of the bad days, but mostly it is just intense pressure on the medial side of my ankle since it completely collapses when I walk.  We got to talking and he said that my case is atypical...OBVIOUSLY...we all know that at this point.  He told me that he thinks that if he fixes the structure of my ankle, that there is a good chance that my tendon will be fine.  

What's the benefit of not transferring the tendon? Less surgery procedures. Faster recovery.

What's the risk of not transferring the tendon? Another possible surgery down the road.

He really left it up to me, but I agreed with him.  I am only 25 years old.   I would much rather do less and take the risk of having to have another surgery, than do more than needed and risk not being able to run again with a transferred tendon in both feet.  The flexor digitorum longus that they use for the transfer is no where near as strong as the posterior tibial tendon. I will have to be very careful going forward with my left especially because of this.  

I came prepared with a number of questions as I normally do:

1) How rare is my case and why do you think this happened to me?  Really rare and no clue.  We both sat there baffled trying to come up with some type of explanation, but there really isn't any.  I fit none of the typical criteria for those who have this condition.

2) What can we do to better manage my pain for the second surgery?  I reminded my doctor that I spent 3 and a half days in the hospital, that the nerve block didn't work, that the dilaudid (hydromorphine) drip didn't relieve my pain, and neither did percocet.  He said that we have to really hope that the nerve block works this time.  He said that since it didn't work, my pain probably peaked too high before the drugs had a chance to do anything.  For pain management, it is all about staying ahead of the pain, catching up doesn't work.  I learned this lesson on my own after the first surgery.  I didn't think about it in relation to the nerve block and IV drugs.  So, we are going with the same strategy, just hoping it actually works this time.

3) Can I do one less week in the hard cast this time ( 2 weeks soft cast + 3 weeks hard cast, instead of 4)?  Yeah.  That will be fine.  Later in the conversation, he came back to this, and said that I can go straight to the boot after the surgical splint.   He said that the primary reason for casting after this surgery is to keep the tendon fully rested while it heals.  No matter what, since the boot comes on and off, there is no way to keep your foot completely still; however, this surgery is different.  It will primarily be bone work except for the calf and achilles lengthening.  I will still be non-weight bearing for 6 weeks, but he doesn't see a reason why I have to be casted, of course as long as I am compliant with the non-weight bearing.  There is no doubt in my mind or his that I will follow his instructions, so that will be the plan.  Straight to the boot after the soft cast!!! He wants me to start moving my foot around and working on the flexibility just weeks after the surgery, other than dorsiflexion which will affect the gastrocnemius recession.  This also means that I get to return to PT sooner, which means I will be back driving sooner, which means I will be ready to walk flexibility and strength wise as soon as I am permitted to start partial weight bearing, which means I will be walking with no assistance sooner, which means that I will get to work towards running again sooner, which means that I will get my life back sooner than expected.

4) I'm flying to a conference next week, any special precautions?  Yes.  Take blood thinners.  He gave me a new prescription for this trip and for after the next surgery.  

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Surgery II Plan: 

Medial displacement calcaneal osteotomy (saw off my heel bone and reattach it to the correct position with a titanium screw through my heel)

Lateral column lengthening (add an extra bone to assist with rebuilding a normal arch)

Gastrocnemius recession (lengthen my calf and achilles tendon)

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This appointment was so different than the ones before.  It didn't hit me until tonight that the major difference is that he didn't treat me like a patient, he treated me like a colleague.  With a PhD in Exercise Physiology, my field is not that far removed from the orthopedic world.  In fact, the two fields completely intersect and cross over each other.  Today, he told me everything straight, nothing was sugar coated, and he explained the scientific/medical reasoning for everything that he was going to do for this surgery.  Before the first surgery, he talked to me like I was a kindergartener.  Most people need their hands held and need to be sheltered from the truth. I am just not that kind of a person, especially when it has anything to do with science, especially medical sciences.  The way he treated me in our first encounter is not a criticism, it is exactly how he should have behaved.   My doctor has excellent bed side manner.  At the time, he didn't know me and my personality.  After all, I only met him one week before the surgery since I switched surgeons at the last minute.

I left the office feeling much better about my situation.  I know that my surgeon has my best interest in mind and that he is going to do everything he can to help me get my life back.

So the surgery prep begins...13 days and counting.

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Surgery Supplies

New Hobby: Cross stitching.  I searched long and hard at the craft store trying to come up with something that I would actually be able to do while sitting with my legs elevated for the next two months.  I got several designs that all have great and relevant messages for me at this point.  That section of the store was speaking to me, as if I was meant to find it.


~Lap desk with Laptop cooler for editing my dissertation and preparing for my defense after surgery.
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DISSERTATION

Put in more hours today.  I am not done yet, but I am inching closer and closer.

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Reflection

Today, my appointment with the doctor was much more laid back and casual than I expected.  I am looking forward to having the other surgery because I know that it is necessary to get me back to where I want to be.

I started prepping for my surgery and found a new hobby.

Found out that I have another job interview next week.  Now, that makes 3 interviews for next week.  I might actually get my first real job offer!

Made more progress on my dissertation.

The pieces of my life are starting to come back together.  You know what they say, "Bad times don't last always."

Whoa this is a long post...

Day 126: 18 weeks + PT Session #25= Live Ultimate

*18 week surgery anniversary*

This morning I woke up later than usual.  I think my brain is just really tired from working on my dissertation.  I went to take my first step out of my bed, it happened to be on my left foot, and I crumpled in pain.  I could feel pain along the line where my heel was cut and the rest of my foot was tight.

I almost cried...almost.  For a quick moment, I let my mind find the place of desperation that I have hidden so nicely in a corner of my brain.  The thought flashed in my head that I can't remember the last time I woke up without pain with the first step of the day.

I regained my composure and took my normal morning trip to the bathroom.  I like to call it the walk of shame because my feet are in the most pain when I wake up and my gait is really compromised.  I am so ashamed of how terrible my walking is in the mornings. For several months after the surgery, I would have to crawl there, or hop on my right foot (of course that was only an option before it collapsed).  After my initial trip to the bathroom in the mornings, I immediately put on my tennis shoes.  Taking steps without the support of my custom orthotics is a recipe for pain for both of my feet.

After avoiding this close call of slipping back into the darkness, I knew I needed to get out and do something I enjoy.  I decided to go to the pool for a swim.  I sat in the sun for probably 45 minutes before I even got in the water.  I love the feeling of the sun rays being soaked up by my skin.  I used to spend so much time outside training...hours and hours at a time.  I have many more months of captivity ahead of me, but when I get back on my feet, I am going to return to being outside every day.

1000 m SWIM

100 m warmup- with pull buoy

100 m drills- with pull buoy

300 m- with pull buoy

50 m

100 m- with pull buoy

50 m

100 m- with pull buoy

50 m

2 x 25 m

100 m cool down- with pull buoy

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Interview

After the pool, I had a phone interview for a job.  So far, this is my third interview since I have been on the job market.  This interview went so well that I landed an interview with the Dean of the school next week.  She mentioned that after the next phone interview, they would invite me to their campus to do a presentation.  I didn't say anything about my feet at that point, but that is going to be an interesting conversation explaining to them why I won't be able to come/ figuring out an alternative considering the condition I will be in after my second surgery.

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Took 1 ibuprofen with lunch.  I wanted to push back the timing of taking my oh so lonely 1 ibuprofen per day now, so that I would be able to make it through PT.

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PT Session #25

My therapist continues to make the exercises harder to progress my left foot.  The hardest exercise today was step ups on a platform with 20 lb weights in each hand!  My legs are really sculpted (except for my left leg baby calf) from all the step ups, squats, and lower body lifting that I have had to do to rehab my foot.  Add that to the silver lining list.  I can only imagine how strong of a runner I would be at this point with the added leg strength and flexibility from all the PT.  I have lost the endurance base that I worked so hard to build, but my cardiovascular fitness is still really high from all the cycling, swimming, and the arc trainer.

My left calf has increased by 2.5 cm since the start of physical therapy.  It is still 2.5 cm behind my right calf, but the second surgery will take care of that difference.  Hee hee.

My therapist told me that my left foot is done, totally rehabbed, except for running and high impact activities.  He also said that I would have been running for a month now if my right foot didn't collapse.  I try not to dwell on where I could have been without the right complicating my situation, but I would have been back in business, training for a triathlon that is in July.  I put that triathlon on my calendar before the first surgery.  It was the carrot in front of my nose.  It was what kept me motivated to commit to my recovery.  Based on how my left feels now, I know I would have met my goal of returning to racing by then.  Now I have to move my goal back at least another 6 months.   So close but yet so far.

At the end of the appointment, I tackled 20 mins of the Pike's Peak program on the arc trainer.  I was determined to do it without causing the return of my left foot heel pain, and I did!  My feet were both more sore than usual when I got to icing, but they didn't bother me while I was exercising.

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DISSERTATION

After showering and eating after PT, I got back to work on my dissertation.  My swim this morning gave me great clarity.  Working out always has that effect on me.  Tonight, I re-ran and added to the stats that I originally ran for all 44 of my variables!!!  That only took me 4 hours...no big deal.  Tomorrow, I will be prepared to adjust my results section to reflect these changes and tackle my discussion section.  I hope that I can finish the whole thing by tomorrow night, but I am not going to be make that a hard deadline.  I have learned that I have to be more lenient with my goal setting because I am functioning at about what I would estimate as 25% efficiency compared to my old self.  I can't get as much work done in a time period as I used to because my feet bother me all the time and are such high maintenance.

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Reflection

Today was one of the few days that I have felt like my old self since the surgery.  I used to live by the motto: LIVE ULTIMATE.  To me that meant trying my very best at everything in my life and pushing the limits of what was possible.  I used to laugh in the face of challenges and obstacles.  Now, even the smallest thing completely shakes me.  But today, I didn't let anything get in my way.  2 workouts, a job interview, and more progress on my dissertation.  I call that a red letter day people.

I am two weeks away...just 14 days...from my second surgery.  I have my doctor's appointment tomorrow morning, where I will get my final confirmation that it is on.  Generally, I toss and turn all night and feel sick to my stomach before appointments with my doctor.  My life is always on the line every appointment.  That really tears me up inside.  After today, I am definitely too tired to be up worrying.  Thankfully, I have no doubt that I will get a good night's rest.

1:20 am...time for ice, Tylenol 3, and my bed.

Day 125: Pain Level Creeping Up

I continued my drug weening strategy. I took 1 ibuprofen with breakfast and I will take 1 Tylenol 3 when I go to bed. For the last few weeks, taking 2 ibuprofens (morning and afternoon) and one Tylenol 3 at night has kept my pain level between 2 and 3 (except for graduation week where it hovered around a 6).

Today, my pain level creeped up to a 4. My feet were sore when I woke up, and they bothered me throughout the day. I iced two times to reduce some of the aching. I will start thinking of my strategy to drop down to 1 pill per day tomorrow. I am not sure if I will cut out the ibuprofen or the Tylenol 3 first.

I haven't worked out since my last PT session. I have been putting in so many hours on my dissertation that I haven't wanted to cut out the time for a workout. I was going to swim today, but the weather has been bad.

I had another productive day working on my dissertation. I am 1-2 serious work days away from being done with the full draft. My dissertation has been distracting me from thinking about my doctor's appointment on Wednesday and my upcoming surgery. I have focused all of my energy on taking care of my academic responsibilities before I am out of commission again. It was really difficult to read even two weeks out from my first surgery because of the haze that the pain meds cause. I actually remember being really frustrated trying to text from my hospital bed because all of the letters were running together, making it really hard for me to type.

It is funny or tragic to think that most people look for distractions from writing their dissertation, while I am using my dissertation as a distraction from my sad circumstances.

Day 124: Productive

1 600 mg ibuprofen with breakfast.

Put in 10 hours of work on my dissertation.  I am so close to finishing the full draft.

Ice and elevated with dinner.

1 Tylenol 3 before bed.

New Goal:  I am working on weening off my pain meds because in a week I won't be able to take any since it will be the week before my second surgery.  Both yesterday and today, I just took 2 pills total (1 ibuprofen and 1 Tylenol 3), down from 3+ per day.  It has been fairly easy because I have been sedentary working on my dissertation.  I hope that I will still be able to manage with the increased activity that I am forced to have during the work week.