S.T.A.R.

I've been looking forward to this morning's appointment with Dr. Cooper for several days. The clicking and grinding from the joint is getting louder. Occasionally, it's nearly impossible to walk. I'm ready for some relief!

Dr. Cooper was straightforward and, Georgetown University Hospital being of the Jesuit tradition, dropped F-bombs within the first 30 seconds. I had brought in my iPad to show him old X-Rays and photos of the accident. As soon as he saw the original fracture, he told me my ankle "was f**ked from the moment it happened."

I like Dr. Cooper.

I showed him more photos on my iPad. He went through my CT images. I told him my most important goals were:

• Snowboarding
• Golfing
• Bicycling

I don't golf (anymore). I'm terrible at it. But I told him it's a goal because golfing requires walking six miles up and down hills and other types of terrain. I want to be able to do that kind of activity.

He gave me three options -- all of them considered salvage operations.

Option 1: Ankle Distraction

I mentioned this as a possible treatment in a previous post. I'd be fitted with yet another external fixator to pull apart my ankle joint. He would do a bit of debridgement of the bones at the joint. By separating the joint by 6 mm, it allows the surfaces to heal and repair themselves. I'd wear the external fixator for about four months and probably would not start seeing any results until two years from the day of the procedure. He said this requires a ridiculous amount of patience but shows promising results.

Option 2: Ankle Arthrodesis (Fusion)

This is the option Dr. Buchanan suggested last month. Dr. Cooper told me what we already know: I'm guaranteed more arthritis and more fusions of the adjacent joints in about 10 to 20 years with a fused ankle. I would not be able to do a whole lot on it.

Option 3: Ankle Arthroplasy (Replacement)

In older patients with post-traumatic arthritis, Dr. Cooper often chooses to install a prosthetic called the Scandinavian Total Ankle Replacement (STAR). He said most surgeons would be nuts to put one in my ankle because I'm so young and active, but that he's just insane enough to do it. With a replacement, Dr. Cooper thinks I'd be walking in two weeks and snowboarding this winter.

I can always fuse the ankle joint once the prosthesis fails -- when, as he eloquently put it, I "don't give a s**t anymore about snowboarding."

I asked him about amputation, and he laughed. He said that's always in the back of an orthopedic surgeon's mind with an injury like mine, but that there are too many other options for us to try first that might work better. He said knee arthritis is a concern in below-the-knee amputees, in addition to skin breakdowns and bone callous formations in the stump.

Amputation, though, will increasingly become an option as I have more surgeries later in life.

Those were the three options he gave me and after hearing my goals, decided to go with the ankle replacement. The concern would be whether my insurance would approve an ankle replacement for someone as young as I am.

I told him I had one more opinion to get from Dr. Jeng in Baltimore before I decided what to do. As I was leaving, he noticed I had brought a cane with me and said, "we need to get you off of that cane."

I also walked out with a prescription for Celebrex, which I can take up to two days before surgery. One reason for the switch is that my blood pressure was a stratospheric 145/85! It's never been that high in my life. This does explain other random symptoms over the last week or so. I suspect the increase is due to the 15mg Meloxicam I've been taking.

So that's it. Even though I waited for about an hour and 45 minutes, I was glad to hear a new option. He sold me on a replacement. He said I might not have much pain after the surgery, recovery would be very fast, and that I could do all the activities I wanted to do (except running or other high-impact sports).

Next up: Dr. "Cliffy" Jeng.