Monday, August 29, 2011

First Follow-Up and Las Vegas

The Two Week Follow-Up

My first follow-up appointment with Dr. Jeng is tomorrow morning at 11:20AM. This will give us an opportunity to get a good look at the ankle since the surgery two weeks ago.

There are three goals for this visit. First, the stitches from the arthroscopic incision sites will be removed. Second, the 14 pin sites and two incision sites will be assessed for any signs of infection. Finally, Dr. Jeng will provide instructions for operating the ex-fix hinges. The hinges must be locked while walking and unlocked to move my foot while I'm at rest.

I'm curious about what it's going to feel like to move my ankle after the joint's been cleaned and the Achilles tendon has been lengthened. Amazing? Wonderful? Kill me now? Only time will tell.

Tomorrow we will also get an opportunity to see two different and interesting views of my ankle.

The first view will be from the images taken from the camera during the arthroscopic procedure to clean my ankle joint. We'll (hopefully) see the color, texture, and any fractures of the tibial mortise. I image we won't see much cartilage.

The second view is one we're all used to by now. After we remove the bandaging that was applied immediately following the surgery on the 15th, we'll finally see my new ex-fix and the 14 pin sites in all their glory.

While we haven't seen what the installed ex-fix looks like without bandages yet, we have a pretty good idea of what to expect from the ex-fix Dr. Jeng put on display in our first appointment. The Ilizarov ex-fix is comprised of three rings.
1. Bottom Ring
The bottom ring anchors four k-wires through my foot -- two through the forefoot and two through the hindfoot. As I bear weight while walking, most of the force will be carried through these four k-wires. From the people I've talked to online that have had this procedure, the forefoot wires will hurt the most.

2. Middle Ring
The second ring in the middle is held to the leg with one k-wire all the way through the tibia and a large half screw into the tibia. This is the first ex-fix I've had with a k-wire that goes through my entire leg this high up.

3. Top Ring
The third ring at the top has the same setup as the middle ring: one k-wire through the tibia and one large half screw into the tibia. Can't wait to see that k-wire going through the middle of my leg.
From the picture above, you can see how all three rings are connected with several rods. The two pairs of rods between the first and second ring are special and quite different than the ex-fix I wore last August. One pair of rods is hinged near my ankle joint and the other pair contains screws that control the distraction distance.

Above is a picture of one of the distraction rods. With equal twists of each screw in this rod, the distance in my ankle joint between my talus and tibia can be reduced or increased.

During the surgery, my ankle was immediately distracted to the maximum desired distance of 5mm. As a result of this continuous stretch, I've lost sensation in the bottom of my heel. I suspect it is also related to the tibial nerve I damaged I suffered during the initial injury. There's no telling when the feeling will return. It could be a matter of weeks, when the ex-fix is removed, or never. We'll be sure to bring up the question with Dr. Jeng tomorrow.

Before I left the hospital, Dr. Jeng encouraged me to try bearing just a little bit of weight on the ex-fix. In the last few days, I've given it a few shots. Surprisingly, it has not been too uncomfortable -- though I've only put about 15% of my body weight on the right leg.

Now, I know what you might be thinking: "How did he come up with that 15% measurement number?" It's a great question. And if you know me at all, you know it came from the same place I stick those glycerin suppositories. I really have no idea how my weight was distributed.

Here's a front and rear side view of me bearing some weight on my ex-fix. I experienced no pain or discomfort. However, I only stood like this for a few seconds.

Here's a few side view pictures. The bottom of the ex-fix has a horseshoe shaped rubber pad to make walking easier. It's also curved, much like my Shape-Up shoes, so I'm able to roll the ex-fix as I walk. My foot does not touch the floor at all. All of my weight is on the k-wires and half screws through each of the three rings.

Las Vegas

Now on to something important. This story about Las Vegas is related to my ankle. Several of my good friends and I have held an annual Las Vegas trip in the summer for several years. They always turn out to be great reunions with old friends and inevitably we come back with some great memories.

Unfortunately, because of my new August surgery tradition, I've missed out on the last two Vegas trips. My friends have asked me to come out anyway with a mobility scooter, but I had a feeling it was only so I could carry the thirty packs and use my disability to cut in lines.

Pranks tend to occur with high frequency in this group of friends. This morning I was sent a video of perhaps one of the funniest pranks pulled so far (this video is safe for work, home, small children, etc.).

The victim in this prank, Chris, has a reaction that is totally unexpected. From what I've been told, he had only been asleep for a few hours. There's an excellent chance that Chris might still be inebriated from his last night in Vegas. Certainly, he looked the part.

I fear this sets a dangerous precedent for future Vegas trips. I might need to schedule another surgery for August 2012.

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