Three Months Post-Surgery

Three months ago today, I had surgery for my trimalleolar fracture (compound breakage/shattering of just about everything possible in my ankle joint). I had already spent over 11 days in pain with my left foot/ankle elevated in the effort to reduce the swelling so that the surgical team could go ahead an operate.  When we met with the surgeon prior to surgery, he made sure we understood how serious the situation was: worst case scenario, I’d never walk again or severely crippled by arthritis in the ankle. I’m no athlete but I do enjoying hiking and camping, and just being able to walk, so I was pretty motivated to heal well.

Surgery itself was a 5-hour ordeal for which I was sedated and blissfully “sleeping” (best sleep I’d had in weeks!) and all of us — the surgeon, my husband and I — were pleased that all the repairs had been completed in a single event. Swelling problems could have prevented him from working on both sides of my ankle in a single day, but the easier repair was done and sewn up with no trouble, so he went to work on the more difficult portion as well.  In the picture below, I’m sure you can tell which side was more complicated to repair!

This X-ray was taken on 25 Nov. 2015 while I was still knocked out for surgery. The last one taken  (4 Feb. 2016) shows proper healing but I don’t have a copy of it.

When I was about a month post-surgery, I wanted to know what my recovery would look like and I couldn’t get answers from the doctor. While I understand that everyone is different, I wanted — needed — a timeline for healing. All I found was this blog post, from someone younger, who was at an ideal weight and fitness level prior to her trimalleolar fracture and whose injury resulted in less hardware. While her milestones have been very helpful, I did not have the exact same experiences, so my purpose in posting today is to share what it has been like for me thus far for anyone else with a trimalleolar fracture.

The injury

I slipped and fell on my clean, dry kitchen floor on Friday, November 13th. At first we went to the Urgent Care Clinic, in hopes that I’d just dislocated my left ankle. They took an X-ray, wrapped my ankle in gauze and ace bandage, and sent us to the ER. At the ER they shook their heads over the simple bandaging meant to merely stabilize my ankle on a bumpy car ride, took better X-rays, and — after 4 attempts — “reduced” my ankle back into place. That experience was equivalent to the worst labor pains I’d had over four childbirths, in part because I had just spent 3.5 hours without pain relief, and it was just beginning to kick in when they attempted reduction. Emergency surgery on a Friday night is neither wise nor desired when one has an impressive amount of swelling (definitely not made better by the repeated attempts at reduction) so I was sent home with a prescription for Percocet and instructions to call for an orthopaedic appointment on Monday.

Monday was spent riding the health care insurance merry-go-round (by my husband; I was on Percocet, thankyouverymuch) and finally getting an appointment for Wednesday morning… which didn’t happen because a windstorm of historical proportions whipped through our region on Tuesday night,knocking out power everywhere. (Our home was without power for 8 nights, but that’s another post.)

The other thing we did on Monday was borrow a wheelchair from a friend. This was how I was transported to appointments. For home use (hopping to the bathroom on one foot), I had an old walker from a yard sale. Thank God for that $3.50 impulse purchase!
We finally saw an orthopaedic surgeon on Thursday, nearly one week post-injury. He told us how serious of an injury I had and noted how badly swollen I still was, so surgery was scheduled for the following Wednesday, November 25th. In the meantime, I was to be on my back with my foot and ankle elevated higher than my heart and nose. An upturned laundry hamper with pillows for padding under my legs did the trick. I continued to take Percocet to take the edge off the constant pain.

Post-Surgery to Three Months

I spent one night in the hospital. In part, this was due to such an intensive surgery (5 hours, 2 major incisions – one of which was difficult to close) and we believe it was also decided to keep me there because of our situation at home: we had been without power for 8 nights and 8 days, and there were no promises of when it would be restored. As it happened, the lights came back on around seven o’clock that night, so when we made it home on Thanksgiving day, the house had warmed up to a cozy 68 degrees Fahrenheit.  I was on intravenous Dilauded (hydromorphone) while in the hospital and it definitely does suppress a person’s ability to keep breathing while asleep. Hooray for CPAPs!
I was sent home with 2mg Dilauded tablets for pain. Staying on top of the pain was crucial; going too long between dosages would send the pain spiraling out of control, but the side effects of the narcotics were unpleasant.

For the next three weeks, I returned weekly to the doctor’s office for wound checks and to be wrapped up in a fresh cast/splint combination. At 13 days post-surgery, he removed the stitches from the side of the ankle with the simpler repair. He had hoped that both sides would be ready for stitch removal, but I still had significant swelling which worried him. It was another week before the surgical site had completely closed and the remaining stitches could be removed.

Some of that swelling was probably related to the 15 hours I spent out of the prescribed stranded turtle position (my name for it) when my husband drove us 80 miles to be at a different hospital for the birth of our first grandchild. Knowing now all of what was at stake in regard to wounds not closing properly, I understand why my surgeon was upset that I had disobeyed orders; at the same time, if given a chance to do it over, I would do it again — and he acknowledged that I had warned him in advance that I fully intended to do what I did. Still… no one likes to be chastised and if it hadn’t been for such an important event, we wouldn’t have done it. Open wounds can become infected, and this wound went right to the bone. Infection was a real danger.

At 3 weeks post surgery, with the wound finally closed and stitches removed, I was placed in a CAM boot but was told to put no weight on my foot whatsoever. Believe me, I had no desire to do so!  With the closing of the wound and the blessing of the doctor, I could put my foot in a lower position, so I was able to “do” a few things: watch a movie in the living room recliner, attend my son’s band concert in a wheelchair, attend a Christmas party with my husband, and go to church. Those events wore me out physically but helped my mental and emotional state. At least I was no longer limited to visits to the bathroom and visits to the doctor!

I began physical therapy after my 6 week post-op visit. The doctor told me to start bearing weight in my CAM-booted foot as tolerated. He also told me I shouldn’t need the strong pain meds anymore. I’d already cut back quite a bit but now was time to go off them. He explained that it would take up to four days but that my body would begin making its own natural form of opioids once the pharmaceuticals cleared from my system. I’m not sure if that is true, but I wanted to move on. Five days later my system was clear and I was no longer taking pain meds (although I continue to take Tylenol and Ibuprofen for pain) and I began driving myself to PT when the roads were not icy.  There are nights that I have trouble sleeping because of pain and/or spasms, but I like the freedom of driving so most nights I suffer until I can fall asleep. For the occasional truly miserable nights, when a cup of chamomile tea, a hot pad for my calf and a frozen bag of peas for my ankle doesn’t relax me or ease the pain enough to allow me to sleep, I take half of one of my remaining Percocet pills from before surgery — but that is always a last resort.

I had hoped the doctor would write a prescription (for insurance purposes) for me to get one of those cool knee scooters. Initially I wasn’t able to use one because of my issues with swelling and the need to keep my left foot elevated. However, once I was allowed to put a little weight on that foot in the CAM  boot, he said he wanted me using that foot, not babying it,  so I was stuck with using a walker for the month of January. It is a slow mode of transportation. Physical therapy has been very important in teaching me how to walk without limping or injuring my back with overcompensation.

At the beginning of February, one month after my 6-week post-op visit, I saw the doctor for what might be the final time (unless I have future problems with the ankle or the hardware). Fresh X-rays showed that my ankle has healed well and he told me “ditch the old lady walker” and resume life as normal. Easy for him to say! I found the concept of putting weight on my unprotected foot to be terribly frightening. The physical therapist has a much more measured approach. I am walking at home and at PT in bare feet with the walker, learning to put normal amounts of weight on that foot. The rest of the time I wear the CAM boot on my left foot, a hiking boot on my right foot, and use a 4-point cane for stability as needed — particularly for uneven surfaces, curbs, and stairs. I’m still slow but not as slow as I was a month ago when I could barely put any weight on my foot at all. There are times now that I am barefoot in my house and I use the walker to get across the room, then forget to use it to return. This is progress!

I went back to work at the beginning of February. I only work two days per week and spend a good part of the time sitting, or this would have been impossible. However, I still swell up easily and a weekend of babysitting my grandson — with the 90 minute drive each way, the lack of time spent elevating and icing, and the carrying of extra weight — while I was thrilled to spend time with him, I’m still battling painful swelling 4 days after coming home. If it doesn’t go down soon, I’ll be plunging my foot/ankle/leg into contrast baths: a bucket of ice water as long as I can bear it, then a bucket of warm bath water, then a bucket of ice water… Does that sound like fun? It’s my last resort but I may soon be trying it.

I decided to tag/categorize this post as Thankful Thursday because I am aware that, despite the pain and frustration which accompany me on this journey to healing, I am doing so much better than I was led to believe I would be doing. When I first injured my ankle, I thought it would be about 6 weeks before I would be walking again. Denial, much?  And yet, when I first met with the surgeon, he warned me that I might never walk again or that I might have crippling arthritis. It’s true that I am regularly hovering at 3-to-4 on my personal pain scale (between 3-and-5 on the scale with bees) and that I often reach 6-to-7 during physical therapy or at the end of a busy day; however, there is an awful lot of hardware inside my ankle. My left ankle is a full inch larger in circumference than my right ankle at this point in time. I hope that is due mostly to swelling and that I don’t continue to rock that steroid look, but I would much rather have a fat ankle than not walk at all. I returned to work ten weeks after surgery and prior to that I was working from home on my laptop. I’m walking in a CAM boot away from home and walking barefoot with ready support at home. That’s a lot of progress! It’s important for me to continually remind myself that I’ve come a long way since injury.

If you’d like to read all of my post-injury blog posts in order, you can start with this one and move forward chronologically. I’ve also put all of my “journey to healing” posts under that category, so you could use that term to search for the posts that way. (There’s a search engine and category cloud on the sidebar to the right.)