Thursday, February 25, 2010

Cat Scan Video

I was able to create a video of the horizontal scan from earlier this morning. You can see the interference caused by the metal plate and screws in my fibula. Those mysterious orbs floating outside my leg are the two titanium bars for the external fixator.

New Surgery Date

Second surgery is now on Monday at 3:20PM.

New CT Scans

We just returned from my second CT scan. Right before we started taking the pictures, the technician asked me if it was possible to remove the external fixator! I told her it's surgically embedded into my shin and heel bones.

The new scans are awesome. The 3D images provide some much needed encouragement. While there are a ton of small fragments in my tibia, these scans show several large pieces that The Closer can use for reconstruction.

In this picture you can see my fibula on the left. You can just make out the plate and screws from the first surgery. You can also see the staples closing the incision site. This is the first time I've been able to count them accurately. Looks like I got 17 staples.

On the right are my tibia fragments. They look pretty big in this picture. This is great news for reconstructing the ankle! The more large fragments The Closer has to work with, the better. If all I had left were small fragments, there wouldn't be much to use for reconstruction.

Here's another angle of the tibia fracture. This is facing the left side of my right ankle. There's a large fragment here that moved down from the main part of the bone by about an inch or so during the impact.

If you can, take a look at your right ankle. Look at the left side. You see how you've got a small bone sticking out of your ankle? That tibia bone fragment in that image is sitting over that part right now. At first I thought it was swelling, but The Closer pointed this out during our last visit.

I really hit that tree.

Here's an image of the external fixator bar that's threaded through my heel bone. Seriously, I cannot wait for this thing to be taken out.

I've uploaded these images to I think the 3D images are frames for a movie. The website is taking a while to recreate the videos, but once they're done I'll make another post.

Brooke is going to take this CD of the images to our surgeon in Arlington. I'm going to continue sitting on my butt.

I owe her. A lot.

Wednesday, February 24, 2010

The Bell

I received a few items in the mail today, including a couple of awesome cards from work. I also got a bouquet of candy from my aunts Lana and Donna, uncle Andy, and cousin Kyle. Thanks, everyone!

I opened another gift from our friend in Egypt.

Brooke took it away from me immediately. Sorry, Jim, there's not much I can do presently to get it back. If it's any consolation, I did ring it to get Brooke's attention that I had received the bell.

National Ski Areas Association Statistics

According to the National Ski Areas Association, "most of those fatally injured are usually above-average skiers and snowboarders who are going at high rates of speed on the margins of intermediate trails."

I can see how this fact is accurate.

Custom Ads

So you may have noticed that there are ads on this blog. Something you may not have noticed is how ridiculously unrelated to this blog they are.

Meth Rehab Treatment? Drug Abuse Solutions? Stop Drinking Alcohol? Seriously? I'm disappointed in Google's Adsense algorithm for determining relevant ads to display. I would have expected to see ads related to snowboarding, trees, and laxatives.

Ankle is doing fine. Thanks to everyone who keeps sending us letters and emails!

Duke vs. Tulsa

Tulsa is at Duke tomorrow night. I know Tulsa's struggled lately, and Duke is on a roll, but if Tulsa wins, I think it's only fair I write the score in permanent marker on my leg before surgery.

Tuesday, February 23, 2010

Ankle Update

We had our second appointment with The Closer early this morning. He said he'd like to do the second surgery early next week. We've scheduled it at the Virginia Hospital Center in Arlington, VA for Tuesday, March 2nd.

Both our nurse, Ashley, and Dr. Buchanan said the foot was healing up nicely. They also both said they thought of my ankle when they saw someone wipe out hard at the Winter Olympics. I have a CT scan scheduled for this Thursday in preparation for the surgery. He ordered a 3-dimensional reconstruction! Hopefully I'll get to post those up here.

I'm also now back on Lyrica to help with some of the neuropathic pain I've been having. If you've never had this kind of pain, it's annoying. Randomly, the tips of my toes, or my heel, or the soul of my foot will starting hurting. I don't even have feeling on the soul of my foot.

Now on to the pictures! Warning: it's still gross.

Here's a really good picture Brooke took of my external fixator. You can see how my ankle is still deformed from all of the tibia fragments. I've also developed quite a nice bruise up my entire leg. It still freaks me out to think that bar goes through my heel.

My incision site is, apparently, healing up well. It looks like a chainsaw wound to me. That ankle is still huge!

Here's what's left of the fracture blister. I learned in bad fractures, blisters can form on the skin and fill with clear fluid. In really bad fractures, those blisters fill with blood. I got the latter kind.

Here's a close up of the pin sites on my shin. Yep. Still disgusting.

The plan is to screw back together all of the large pieces of my tibia, secure it with another plate, and remove the millions of small fragments. The hope is the bone will heal back together and replace all of those missing pieces. This is a much better solution now than to have a total ankle replacement. It's always good to wait as long as possible for technology to improve before getting a prosthetic joint.

At some point, they'll throw on a cast after surgery. I imagine they'll wait a few days to monitor the swelling for compartment syndrome. I should return to a somewhat normal life next month!

I hope I get to keep the external fixator.

Monday, February 22, 2010


The mail just arrived. We received several items from friends and family, including a DVD collection of two American classics from a friend in Egypt: Navy Seals and Red Dawn. Thanks, Jim!

I also received two drawings from my nephews Jacob and Joshua. One of the drawings is a very accurate re-enactment of the accident.

There's me, in the tree, with my snowboard on the ground. I think that's the skier I tried to avoid and a Ski Patrol person to the left. It's like I'm back at the scene of the accident all over again.

Independent Research

Because Brooke is studying at George Washington University to become a nurse practitioner, she has access to hundreds of medical journals. Since my next appointment is tomorrow, and the majority of my time is spent ironically watching the Winter Olympics, I thought I'd do some research today and prepare for tomorrow's meeting with The Closer.

The first article I checked out was co-authored by my first surgeon. Entitled, "The Snowboarder's Foot and Ankle," I figured it would still contain some relevant information even though it was written 12 years ago.

As Figure 1 from his paper demonstrates, I am not the only idiot that's hit a tree. I've considered contacting the other 8% to form an exclusive club. We'd have monthly newsletters about how dumb we are.

I also read in another paper that high energy or crush injuries to the ankle and lower leg are at risk for tibial compartment syndrome. During my stay at the hospital, I was advised of this risk and informed I did not want to get it. When your surgeon tells you that no amount of morphine can alleviate the pain from this syndrome, it's surprising how quickly one can overcome any constipation issues.

Another paper from 1996, "The Spectrum of Injuries from Snowboarding," said that over 80% of injured snowboarders were male. Shocking.

I learned that my tibia break is called a comminuted tibial plafond fracture. When doctors hear this, they understand that the surface, or plafond, of my tibia is severely fractured into multiple fragments of various size, shape, and density. They can infer the amount of reconstruction and rehabilitation necessary to return the joint back to something resembling a working ankle.

When I first heard my doctor at the Breckenridge Clinic say, "comminuted tibial plafond fracture," I figured, hey, that sounds a bit more complicated than, "broken ankle," but no problem. Let's throw a cast on it and call it a day.

Of course, I'd have to bring in an independent consultant to verify the color of my cast. Since I'm color blind, Brooke would jump at the chance to get my foot wrapped up in pink fiberglass for four hilarious months. She's known for her antics. She sneaks Miralax into one of my drinks every day.

But to be serious for a moment, when the doctor told me those words, I didn't need to understand what they meant. The look on her face said it all.

After some more research and countless attempts to add up the number of fragments in my tibia (that's a fun challenge for those of you bored at work), we're starting to doubt I'll end up in a cast.

From one of the papers on my type of injury, I'm guessing this is what's in store for my ankle. This looks like something MacGyver would piece together in a tight situation using only a rubber band, someone's sock, and a nun-chuck. Yet another external fixator. I can't wait!

So we're armed with information for The Closer tomorrow. I'm hoping the whole ordeal goes well and we can get an official idea of things to come. If all else fails, MacGyver should be able to rig something up for me.

Sunday, February 21, 2010

Updated a Few Posts

I updated the CT scans post below highlighting the broken fibula and smashed tibia. Most of the movies off of that link are hard to follow. Now I'm off to inject myself with Lovenox!

Saturday, February 20, 2010

Drugmart (or, Why I'm Not at Work)

I'm fairly confident I've been injected with or I've taken orally a large sample of America's best medicines.

I'm taking drugs to combat four key issues: 1) pain, 2) infection, 3) blood clots, and 4) an unnamed problem I'll save for last. I'll explain each in detail below.

Pain control is essential when one has a mashed potato tibia, an adamantium fibula, and a cyborg exoskeleton. Here's my current setup for pain control:
The main difference between the Oxycodone and the Oxycontin is that the former is fast acting. If you have pain now, that's what you take. I'm slowly being weened off of the Oxycontin so that it can be used as an effective weapon during my next surgery.

The Percocet is similar to the Oxycodone. I think it has Tylenol in it as well.

Finally, the Valium is used to mitigate muscle spasms in my leg and ankle.

Valium makes me fall asleep randomly for about 5 seconds. On my flight into Baltimore, I was carrying a drink of water in my hand over my lap. One of my sleep attacks hit me and before I knew it I had an icy cold and soaking wet crotch for the rest of the flight. How funny!

nfection is fought with an antibiotic called Cefadroxil. This is to help improve the conditions of my skin around the injury and prepare it for another surgery. Get well soon, skin! Seriously, do it right now.

Blood clots form more frequently with bone fractures. Every morning I get the opportunity to face one of my biggest fears and receive an injection of a drug called Lovenox. Today was my first time to inject myself. It was extremely enjoyable.

I also get to wear a woman's stocking on my left leg, called a "compression stocking." No one has yet explained to me how this helps prevent blood clots. I fear it's simply a long running joke.

Here's a picture of most of the drugs I'm on today. I saved it until now because of some of the ridiculous products sitting in the back. It's now time to explain the fourth and final issue we're fighting: constipation.

Due to the massive amounts of opiates flowing through my veins, my digestive system is moving slower than beltway traffic during rush hour.

My favorite drug is "Super Colon Detox." This isn't your regular, run of the mill colon detox. It's super. And you can tell the manufacturer is a straight shooter by their plain, simple, and direct product name. They're not trying to hide behind some obscure made-up word like Olestra.

Before I finish this post, I need to be exceedingly clear about two of the products you see in that photo. I have not used the saline enema and I have not used the rectal suppositories just above. Though, thanks to the twin pack savings we got, I have not one, but two opportunities to try Fleet's great product.

These tools are a man's last line of defense. Neither one should be brought to the battlefield until all other options have been exhausted.

Until that moment arrives, I've armed myself with prune juice and Miralax.

My Wife

For friends of mine that don't like sappy stuff, skip down below to see the gore.

We used to always joke how I could safely run around the house with scissors since my wife is a nurse. If I ever needed to be fixed, she'd be there.

Well, it's finally happened. I need to be fixed and she's there to do it. I can't tell you how much my wife has helped me through this entire ordeal. She's been keeping intricate logs of all of my medications, giving me my blood clot shots, and constantly monitoring my pain level. She translates the doctor lingo for me and has not once left my side since the day of the accident.

She's amazing and I'm a lucky man for marrying her. I love my wife! And she loves my glorious mustache!

The Closer

Our new surgeon in the DC area is Dr. Matt Buchanan. Here's a link to his profile at the Orthopaedic Foot and Ankle Center in Arlington, VA. He used to roll with Dr. Janes at St. Anthony's. That's how we got the recommendation.

He got his B.S. from Duke, but I'll try not to hold that against him. Unfortunately, this makes Brooke like him even more. Hopefully Tulsa will dominate the Blue Devils on Thursday, February 25th. I had bought a ticket to go to that game, but I'm an idiot and snowboarded into a tree at 40 MPH. I won't be making it.

My first appointment with Dr. Buchanan was Friday, February 19th. After we unwrapped the leg, he took one look at it and called for his resident doctor to come in and take a gander. I wasn't sure if it was because of how bad it is, or how good of a job Dr. Janes did. I wonder if they see many injuries like this in this area.

After lots of technical discussions with one another, they popped and drained my hematoma. Because my skin is so swollen and fragile, we're going to have to wait a while for the next surgery. Our next appointment is Tuesday, February 23rd.

Don't worry, I'll wear a Tulsa shirt.

The Map of the Apple Sauce Wreck

I found the tree I hit on Google Maps! So I created an annotated map to show you where and how I turned my ankle into the consistency of apple sauce.

Cat Scans of the Ankle

Here's a link to the CT scans they took of my leg in the emergency room at St. Anthony's Summit Medical Center just before my first surgery.

While I'm not trained in reading these things, I can see why my leg hurts. Notice how my right leg was almost two inches shorter than my left leg! My talus bone is about an inch up inside where my fibula and tibia should be. How awesome is that?

Here's an image of the cleanly broken fibula. That felt amazing when it happened.

This is what's left of my distal tibia (lower tibia). This is what's to be repaired during the next surgery. I'm really interested in seeing what they do. There's two million pieces in there. How will they put them all back together?

The People of the Accident

There were a ton of wonderful, professional nurses and doctors that helped us along the way to my first surgery. Unfortunately, we didn't have a camera when the accident happened. And, I was on a million pain medications. Of course, calls and gifts from our friends and family kept our strength and spirits high. We are very lucky.

This is my first orthopedic surgeon, Dr. Peter Janes. This guy is THE MAN. Check out his credentials. He used to be a snowboarder. He has a pretty funny quote about snowboarding. Dr. Peter says, "you don't fall in snowboarding, you're sucked into the earth." He has a million publications on snowboarding injuries! How awesome is this guy?

This is The Team of Breckenridge 2010. Trevor, the guy just to the right of Brooke, told me he'd keep is stache going until I was fully healed. No one's told him yet how long this is going to take.

This group of friends really helped us during our initial days of the injury. While Brooke was waiting for me to come out of surgery, they brought her a Valentine's Day gift on my behalf. They supported us and showed us how important it is to have wonderful friends and family. Thanks, guys!

Pictures of The Strongest Ankle Known to Man

Warning: the following images may be too gruesome for some of you. For others, this is probably the only reason you're here.

These are pictures of my right leg while I was receiving a new dressing on February 15th, two days after my first surgery. The minute we saw what was hiding underneath, Brooke leaped for a camera and grabbed some amazing photos. I also threw in some post-op x-rays for kicks.

In this image you can start to see the two metal titanium bars holding my leg together. The marking on my foot is where the nurses were able to get a reliable pulse.

Check out that hematoma (blood blister)! Apparently, this is a common occurrence with ankle fractures. This dude was huge! You can also see one of the nurses in the background doing the redress. I think her body language is saying, "this patient is loud and annoying."

Here you can see the incision site where they placed a semi-tubular plate to fix my fractured fibula. Since this bone was cleanly broken all the way through, it was the easiest to fix. They used eight screws to secure the plate. On my way into surgery, I may or may not have asked my doctor that I get the plate engraved with the words, "Big Rig."

Here's a good view of the external fixators holding my leg together. I have three pins screwed into my leg. One long threaded pin through my calcaneous bone (the heel bone) and two on the upper part of my tibia. This leaves four external sites to clamp down two titanium bars on the lateral and medial sides of my leg. This gives me the length of my foot back and holds the remaining broken mash of bones in place.

A fun quote from my Operative Procedure Report reads, "the distal-most proximal pin could not be placed into the back cortex, either by hand or by drill, due to the density" of the bone. This means I have super-human bone strength. I could probably punch through cement walls if I wanted.

Another line from the report says, "pre-drilling at a slow speed," was used to "avoid burning the bone." Thanks, guys!

Here's a close up of my blood blister. This was taken on February 15th. It grew quite a bit when we looked at it again four days later. Unfortunately, my new doctor in DC decided to drain it. I was hoping we could let it grow to about the same size of my head.

While we're on this picture, I guess I should mention I have nerve damage. The trauma to two nerves in my foot prevents me from feeling most sensations in my big toe and the bottom of my foot. This was due in part to the injury and in part to the titanium bars stretching my leg so tightly. We're hopeful the nerves will heal on their own and return some feeling. No worries, though. I can still walk if the feeling doesn't come back.

Here's a post-operation x-ray of my fixed fibula. You can see the staples used on the incision site. That's going to be an awesome scar! You can also barely make out the eight screws. The one at the bottom is difficult to see.

Here's a different angle on the plate and screws on the fibula. You can also see the fun times happening in the distal tibia just above.