Thursday, September 29, 2011

Response to Your Comments

First, you'll notice I've switched back to the original blog design I made last year. The new stuff just isn't ready.

I wanted to take some time to respond to some comments people have made.
Dear expert snowboarder, I'm also thinking about the distraction surgery. I fractured my talus 5 years ago and I recently had my achilles tendon lengthened in hopes that it would allow for more ROM,but instead I just have horrible arthritis pain and I limp constantly. Thank you for your blog! I also have been blogging about my really helps knowing that you aren't alone. Keep up the good work!
Thanks for the awesome feedback! I think ankle distraction arthroplasty could definitely buy you some time, but from what I understand, we're on the clock once the ex-fix is removed. I'd ask your surgeon what to expect 5, 10, and 20 years from now. I'd also discuss other salvage options, like replacement and fusion, if your bone quality is good and you're at the right age. I believe I've got an earlier post of a few long videos on the current medial treatment protocols for ankle arthritis.

My surgeon, Dr. Jeng, suggested that almost all patients develop arthritis again at some point after this procedure. However, some patients may not have nearly as much pain for the rest of their lives. From what I understand, this is a relatively new procedure, especially in the United States, so there isn't much data out there on patient outcomes. My surgeon said he sees about a 30% to 40% success rate in terms of pain reduction after an ankle distraction arthroplasty.

I think age comes into play here as well. I'm only 29 and my wife and I have not started a family. We want to minimize surgeries and minimize pain so we can get on our with lives. We decided several months ago to get an amputation at some point and, fortunately, our surgeon agrees that I'm a good candidate for one.

Because of the severity of the initial injury and the complications I ran into (infections, non-unions, etc.), salvage options like an ankle fusion or replacement are more likely to fail and require more revision surgeries on my ankle. A fusion also reduces your range of motion, causing stress on the adjacent joints. Not only am I too young for these options, my tibia bone is in rough shape, indicating that these salvage options put me at a higher risk of failures and revision surgeries.

Good luck to you. Stay in touch and feel free to ask any other questions.
Hey there... Thanks so much for your blog. Here's my story -- Tib/Fib break jumping off a pier in 2001 when I was 17. Four surgeries later and my doc says I have the ankle of an 80 year old. She said she would recommend I have a fusion if I wasn't so young. My pain is pretty under control (I can function most days) but I have really limited ROM. Like between 3 and 5 degrees passive dorsiflexion and 10 or 15 degrees active plantar flexion. The new doc I just saw today said that he would recommend distraction arthroplasty (that's how I found your blog -- journal articles are a bit dry and don't convey some of the important recovery bits). I have read that DA is for folks with decent ROM. What was your ROM before the surgery? I am wondering if I have enough ROM to be a good candidate. I am also struggling with the idea of a long recovery since I'm in the midst of a doctoral program. Any advice/info? PLEASE keep posting! Kate
I also read that ROM needed to be very good. At my high point in March, I hit 11 degrees dorsiflexion. However, when I saw Dr. Jeng at Mercy, there's no way I was more than 5 degrees. I think Dr. Jeng moved the universal joints around so that I could get more plantarflexion out of my movement.

Since I'm quickly moving into year two of this recovery, I know exactly what you're afraid of. I quickly got into "crutching shape," so I could fly around and keep up my endurance. I also kept my wheelchair rental for the entire duration of this recovery for going out to events and parties where I know it'll be hard to find a place to sit down and prop up my leg.

The second thing that is important is having friends in the workplace or on campus to give you rides. I rely on several friends to get to work since my right ankle is in the external fixator. You might be able to drive around if it's your left ankle. I tried to show my wife that I could drive with my left foot, but she shot me down!

The third thing that's helped me, above all else, is my wife. She's picked up the slack on everything I've been unable to do, and without her, there's no way I could have survived the recovery at this point.

It sounds like you might be a good candidate for ankle distraction if you're not having much pain right now. Also remember that you can walk on it. I was out of work for about three weeks, but that was because we did a very poor job coordinating pain management ahead of time with our surgical team.

If you get the surgery, work with your surgical team to get all of your pain management ordered ahead of time. Definitely get a PCA. Get Dilaudid bolus on order for when you're taken off the PCA and get the oral pain meds ordered as well. Overdo it like crazy so you don't have to fight with nurses to call doctors late at night to get an order or approval. We did this for my second exfix last year, and because my pain was so well managed, I was able to return to work within about two weeks. Once your pain is under control, you're allowed to leave the hospital. This seems like the best way to guarantee your hospital stay is short.

With that said, this exfix was definitely more painful than my second one last year. The tension placed on the joint is hardcore, so that might have contributed to my slower return to work. Also, I struggle with pain every night after walking on it all day at work. The combination of walking around to meetings eight hours a day and not propping it up to prevent edema probably contributes to all of my pain. I take Percocet at night to help with that pain.

If you've never had an external fixator, I also recommend Valium. When your muscles atrophy, they'll spasm. You'll sometimes get a, "slamming the brake," spasm in your foot, and if your ex-fix isn't open, that'll hurt. Valium helps with this quite a bit.

I also recommend you meet or talk to a physical therapist to get a few exercises down that you can do with the ex-fix to do your best at addressing atrophy. Try emailing the physical therapist I used at C.O.R.E. Physical Therapy, Kim Stepien, here in DC. Just say Tony referred you and ask for a few examples of things you can do while you're in the ex-fix.

Do you have digital copies of your X-Rays? Are they in dicom format? If so, you can use free PAX tools to measure the distance in your joint. The more space you've got, the more I'd recommend you get the procedure. Keep in mind, though, that I'm not a doctor. Just a computer scientist. If you get stuck, I don't mind taking them and measuring the distance for you. Your surgeon, though, might be able to do this for you.

I hope everything goes well! Please keep us updated on how things go and, as always, if you have any other questions, just comment away and I'll get back to you.
Tony, I'm a 39 year old male and I currently have an ex-fix on my ankle as well since 8/11/11. The day after surgery I was able to stand on it and walk with it. I take Vicodin for the pain, no real probs for the first 2 weeks but once I started making the adjustments it got more difficult to walk around because of the pain. It is difficult to sleep at night but I find that hanging my leg off the bed helps me sleep for a few hours before I have to readjust again. Although it has been a challange I am optimistic that I will get good results and pray for the best. I hope that you are able to recover and get back on a board, because my passion is in cycling and it has me sidelined since the surgery. Keeping you in my prayers.
Thank you so much for keeping us in your prayers. I'd talk to your family physician about getting a drug called Flexeril. I ended up doing this when we thought the Valium I was taking was causing my four-day hiccup binge (turns out it was probably just the combination of all of the drugs plus the way I was sitting). This is a hard core muscle relaxer that is guaranteed to help you sleep for at least eight hours. Buy a pill cutter in case it's too much. I highly recommend this if you're having problems sleep.

I also learned to sleep on my back when I had my initial accident. Propping it up on one or two pillows helps, as well. I like to sleep on my left side occasionally, so I'll also occasionally put a pillow below my right knee.

I'm also hoping to return to cycling as soon as this ex-fix is removed. Snowboarding is the end goal, but cycling was something I got into a few weeks before my arthritis got to the point of forcing me to get this surgery.

Good luck to all of you and please stay in touch to let us know how everything goes. We're a tiny community, I imagine, but we can learn from each other. I started this blog to just keep my friends and family up to date, but I'm beyond ecstatic to see that we can use this blog to communicate with one another and help each other out.

The bottom line for all of you is find the right surgeon. I've had three so far. For this fourth surgery, I talked to three surgeons. In fact, Dr. Jeng's first words to me were, "so I'm the tie breaker?"

Credentials matter, but patient interaction is more important. Does your surgeon feel rushed when he sees you? That's a bad sign. Does he stick around until you're done asking questions? That's a great sign. This idea was the reason I switched to Dr. Jeng at Mercy in Baltimore. When I first met him, I felt like he came into work that day only to see me and my ankle.

His awesome attitude is what led him to working with me on my infection last week through email, Picasa, and YouTube only -- no visits! Every day, including weekends, I was sending him high resolution video and picture updates, and Dr. Jeng was emailing me ideas, thoughts, and instructions every day.

Again, good luck to all of you. Let's stay in touch. If you want, let me know who your surgeons are and I can speak to Dr. Jeng about them. He and his clinic at Mercy seem to be fairly popular on the East Coast, so I'll be more than happy to ask him about his thoughts on your doctors. He told me that one of the surgeons I had seen was insane for recommending an ankle replacement, so he's definitely going to be honest.

The bottom line is to stay positive and keep a good attitude. Some days it comes naturally, and some days you have to force it. Lean on your friends, force yourself to go out, and talk to people about how you're feeling.

I'm all ears.

Walk This Way

The pin sites are looking great.  They've scabbed up nicely and there is no more drainage.  Today, Dr. Clifford Jeng gave me approval to begin walking on and moving the external fixator again.  This is great news.

Here are a few pictures of the pin sites taken today.

I've streamlined pin site management and care down to the bare essentials.

Scissors, tape, latex gloves, rolled gauze, saline wound wash, large gauze pads, hand sanitizer, and a TV remote control.

Here's a video I took today trying to produce some drainage around one of my pin sites.  As you can see, it's bone dry!  

I've also successfully captured an awesome noise that my external fixator makes depending on how I bear weight on one of the rings around the proximal part of my tibia.  I sent this off to Dr. Jeng this evening to prove I'm not crazy.

Don't worry, it does not hurt.  I'll have to keep an eye out on it as I start walking again.

Now I just get to sit back and start annoying my wife again with constant ankle movement while I sit on the couch.

Wednesday, September 28, 2011

Design Change

You might notice we've got a new design for the blog.  It's been a while since I've changed it, so I'm going to be doing some experimenting over the next several days.  Please feel free to provide any feedback you may have on the changes!

I've also received several comments from other people following the blog and checking out my YouTube Channel thinking about getting an ankle distraction arthroplasty procedure.  I will make sure to respond to each and every one of you shortly.  Thank you for your support and kind words!  

Quick update on the ankle.  I've been sending daily updates to Dr. Jeng so we could monitor the infection situation.  The good news is that the pin sites are improving dramatically.  Click on the Picasa web album above to see more gross, but better, images.

The bad news is we might have a loose k-wire.  I've been in discussions with Dr. Jeng about some movement in the frame, so he and I have been talking about meeting up again before my November 3rd removal to see what's going on.  We'll keep you posted!

Tuesday, September 27, 2011

Football Disappointments, Infection Progress, and Surprises!

The Redskins are my team. I'm from Oklahoma. I despise Texas with a passion.

It was a natural fit to become a Redskins fan when I moved here.

Tonight was the big rivalry game at Dallas, so we hosted a watch party with our friends. If you don't know me, I tend to -- prematurely boast our wins. Tonight, I created a "Cowboys Excuses Box," for the two Cowboys fans to write excuses on paper for why they didn't win.

At the end of the game, we'd draw one of the excuses and that would decide why the Cowboy's lost.

I even created Troy and myself custom coffee mugs.

Here you see the Redskins arrow through the Cowboys star, and Jerry Jones, the gregarious owner of the Cowboys, picking his nose.

Here you see the other two pictures on the mug.

On top, Tony Romo is crying about something. I'm not sure what, because there are a million pictures of Romo crying about something on the Internet. I'm assuming it's because he just heard R.E.M broke up.

The other picture at the bottom is of our good friend Binoy. While he's a Dallas Cowboys fan, we decided to make him a custom Buffalo Bills jersey earlier this year.

Here's the quick story behind that. The number on the jersey is Scott Norwood's, the kicker for the Bills infamous for missing a 47 yarder wide right that cost he Bills the Super Bowl. There are daily situations, such as a failure to successfully parallel park, when we tell Binoy, "ooooh, wide right."

The name, "Hands," is a nick name that Binoy claims was given to him in collegiate flag football for having great hands as a wide receiver. No one has been able to corroborate this story, and Binoy has declined offers to display his talents in a mock combine.

Because of the overwhelming lack of evidence to support the validity of the nickname, we decided to start routinely calling Binoy, "Hands," to remind him that he should never make such claims without the ability to back them up.

The other half of the mug is the Redskins' fight song.

Unfortunately, we didn't get to sing the fight song much tonight after the Cowboys beat us with only field goals. It's embarrassing. I haven't stopped receiving text messages from Binoy and Crystal.

So, the ankle. How's it doing?

Much better -- all due to Dr. Jeng. I am convinced you cannot find a better doctor than Dr. Cliff Jeng. Since Friday evening, when we first discovered a potential issue, he has been in daily contact with us over email.

Each day, I take high resolution images of my leg before and after cleaning it. I upload them to a Picasa web album and send Cliff an email with a brief description of the changes, improvements, and any new developments of the pin site situation.

Here's how it's gone so far.

Friday, September 23rd

I spoke with Dr. Jeng on the phone Friday evening. He asked that I start sending him daily updates through Picasa. Here was what we found that concerned us.

Saturday, September 24th

On Saturday, things were looking a bit worse. Dr. Jeng emailed us back after seeing both sets of images.
All right. Sounds like not getting any better. Give me a pharmacy number and I will call in some augmentin tomorrow. Stop duricef and start augmentin. Eat yogurt so you dont get the runs. Updates daily. Are you allergic to anything?
It's difficult to name a doctor that's worked on a weekend with a patient like this -- every day!

He works up in Baltimore. I live in D.C. We're working on a possible infection together using the Internet on the weekend. He's calling in drugs on a Sunday when most surgeons are watching football and relaxing.

Who knows, twenty years ago I might have waited the weekend, maybe longer, before seeing someone -- and by then it would have been much worse.

Oh, and, yes, I have stocked up on yogurt. He was absolutely correct on that one.

Sunday, September 25th

By Sunday I had the new antibiotic. The new pin site management we employed seems to have helped. The doctor's orders to discontinue weight bearing and ankle mobility exercises also helped reduce the stress on the pin sites.

After seeing this series of pictures and notes, Dr. Jeng commented:
From what I can see not too bad. The augmentin should kick in by tomorrow. Not too worried...
Monday, September 26th

Today looked even better. Here was Dr. Jeng's comment this evening:
looks good. cute dog. once pins are quiet lets begin weight bearing and Range of motion again.
I'm super pumped about getting back on my ankle and moving it around again. I forgot how frustrating it is to wear an external fixator without bearing weight or getting a chance to move your foot.

Did I say how awesome Dr. Jeng is?

While we were doing all of this work on Sunday, we threw a surprise going away party for our good friend Alison. We secretly coordinated a massive gathering at our party room and awaited her arrival.

Alison ended up being late, so our first attempt at a surprise was a false alarm. She went downstairs to get some orange juice for what she thought was a girl's brunch.

Here was the real surprised Alison. We totally got her! She had no idea.

We had a great show of support and we're really going to miss having Alison around. She's awesome, and I'm not just saying that because she won the inaugural Injured Tony Award last year.

And finally, thanks for sending the cookies, Mom and Dad! Brooke has hidden them from me, probably in a place I cannot reach. But from what I hear, they are still delicious.

Saturday, September 24, 2011

Drainage: Day Two

It's been twenty-four hours since we first discovered drainage from two pin sites. Dr. Jeng asked us to send him daily updates, so let's take a look and see where we're at.

The area shown above is the primary area of concern. All of the wires and screws you see here are in close proximity to one another. All of them are in the tibia. And all of them are near the site of a possible future amputation.

After a quick examination, the first thing we noticed was a new, third drainage site. The dressing from last night was stained around this pin on the lateral side of my leg, suggesting the drainage had not stopped since last night. We didn't need to do any squeezing of the skin nearby to produce this drainage. As you can see, this is a slightly different type of fluid draining from the pin site than the other two from yesterday. This pin is on the lateral (outside) of my leg and the most proximal (closest to the core of my body).

Brooke was not too concerned about this new drainage, primarily because of its color and its consistency.

I trust her judgement for a three reasons:
  1. She's my wife and I'm obligated to trust her judgement.
  2. She's been in school for a few years to become a nurse practitioner.
  3. She recently and successfully diagnosed someone with genital warts instead of herpes when the rest of her class group incorrectly believed it to be herpes. I'm not sure how that applies to this situation, but, in my book, her ability to correctly diagnose disease is a good reason to trust her.
The picture above is the most proximal k-wire on the medial side (the small wire at the top of my leg on the inside). After squeezing the skin around the site, the same type of fluid we saw yesterday emerged.

I have been discouraged from referring to this liquid as yogurt.

This site concerns me the most of the other two. There is very little "meat," between the pin site and my tibia -- which means very little tissue for an infection to traverse before reaching the bone.

Same k-wire picture from above but a different angle. This time I made to sure to wear my latex gloves and had Brooke take all of the pictures.

The second-most proximal k-wire on the medial side is also continuing to drain the white, sticky fluid. It's the same amount as yesterday.

The odd thing about trying to squeeze out fluid from this particular pin site is that it feels like a giant reservoir of this fluid is sitting just underneath and around this pin.

Now, I imagine that many of you refused to watch yesterday's drainage video -- because, well, it's gross. I've modified this video a little bit to make it easier to watch.

Make sure your volume is not on mute.

This is probably the first video on the internet of someone draining infected bodily fluids out of a pin site to the tune of Benny Hill.

You might be wondering at this point, "why is his skin brown and disgusting looking?"

You have made a valid point. We've not washed the skin around the pin sites since the surgery on August 15th. Dr. Jeng preferred we keep the site clean with weekly iodine soaked gauze pads.

How does it smell?

Ask Spunky, she's the expert on bad smells.

After seeing the pin site drainage, Dr. Jeng has asked that we revert to the pin site care and management we used last year -- but without using running water. After draining as much fluid as we could, we spent a lot of time cleaning the pins and the skin around each site.

To clean the skin around the pins, we used something called a chlorascrub. It's extremely important to clean the skin around the pin sites. Bacteria love places that never get washed.

Here are a few pictures after we spent some time cleaning the skin. This gives you a more clear indication of how the skin is doing around the sites.

This is the second-most proximal pin site from the medial side after it's been cleaned. The skin around the site still looks good. The skin is also not warm to the touch compared to the rest of my leg, which is always a good indication of no infection.

Here's the same pin site from the top. After cleaning the skin around the site, it looks better. The skin just around the pin is a bit red, but, as Dr. Jeng said yesterday, it isn't angry.

Here's a view from the bottom of the most proximal k-wire on the medial side after it was cleaned with a chlorascrub.

Here's a view from the top of the most proximal k-wire on the medial side after it's been cleaned.

And finally, here's a view of the same proximal k-wire from the lateral side. The skin looks good, which is always a good sign.

Here's a view from a different angle of the lateral side of the proximal k-wire.

After examining the pin sites and cleaning the skin, we wrapped up the area with several two-inch flexible dressings. We've stopped using iodine soaked gauze pads since they could be caustic enough to cause some of the irritation of the sites we're seeing.

The game plan is to continue monitoring the situation until we've finished the Duricef antibiotic run Tuesday morning and to keep in touch with Dr. Jeng.

Brooke and I are going to go back to watching Tulsa get destroyed by Boise St.

Friday, September 23, 2011

Looking for Some Breaks to Catch -- Got Any?

Ladies and gentlemen, uhhh, this is your Tree-Hitting Snowboarder speaking. Please, uhhh, return to your seats and fasten your seat belts. Remain calm. There is absolutely nothing to, uhhh, worry about. This is just standard operating procedure. Our systems indicate that, what we refer to as a rough patch, is heading right for us, and, uhhh, there's a slight chance our ankle recovery could crash and burn spectacularly. Thank you.

This was one of those blog posts where I had to call Mom and Dad first to help manage some expectations. Otherwise, the phone line would be busy until the cows come home.

Before we go any further, there's no need for you to freak out.

Well, not yet.

Here, just let me quickly summarize what you're about to read: the first act will be scary, the second act will be scary but optimistic, and the third act will leave you hanging until the sequel comes out.

Like some sequels, it could be totally awesome -- perfect example: The Dark Knight.

But, like other sequels, it could be absolutely awful -- see Speed 2: Cruise Control.

Yes. This movie actually exists. This is probably the first time you've heard about it. It was that bad. Or, at least, so I've heard.

Act One

Today I stayed home from work to wait for a repair guy to fix a minor leak in our air conditioner. Since my accident, I've always payed careful attention to how much annual and sick leave I use. Each hour I use is a serious decision.

After the technician did an excellent job fixing the small leak (thank you, Fry Plumbing), I decided to change my dressing several days early. Due to some new pain, I wanted to get a good look at a few troublesome pin sites. The pain is not unbearable, but after a long day of walking on pins (no needles), I have to resort to my pain management medication. Moreover, I can no longer walk without crutches due to the pain.

These are significant changes in a matter of a few days. That's usually not a good sign.

Unfortunately, removing the dressing revealed drainage in two k-wires in the top of my tibia on the medial side (the inner side of my leg).

Drainage from a pin site can mean many things. It could be from agitation from pin movement or skin movement around the pin, it could be fluid build-up from the initial trauma of the surgery six weeks ago, or -- in a worst case scenario -- the fluid could indicate an infection.

The drainage was very minimal, but as I poked around the skin, it felt like a water bed underneath my skin. It was time to use some skills I picked up as a teenager and play, "Pop That Zit." As you can see in the picture above, a small amount of warm, sticky yogurt oozed out of the pin site.
This is your Tree-Hitting Snowboarder again, reminding you that, uhhh, we've conveniently placed barf bags in the seat pocket in front of you.
I'll give you a few moments. When I squeezed that bad boy, I had to take a few minutes myself to recover. Two years ago, I would have fainted after getting my blood drawn. Now, I'm pushing bodily fluids out of metal wires sticking through my tibia, muscle, and skin on both sides of my leg.

Back to the yogurt. As an experienced external fixator wearer, pin site yogurt is a red flag. Immediate action is necessary: continued squeezing and popping to see what other items emerge from the pin site.

I'm was hoping for something awesome and better than pin site yogurt. As you are probably well aware, pin site yogurt serves no purpose in life. I can't sell it on eBay and I can't trade it to replace Arian Foster on my fantasy football roster.

After more squeezing, not much more fluid came out. Without Brooke at home, I quickly assembled an action plan. I decided to examine all of my pin sites, take high quality pictures of questionable areas, and contact my surgeon, Dr. Jeng.

Here are several pictures of the same pin site on the medial side of my leg.

After thoroughly documenting this pin site, I noticed that the most proximal k-wire on the medial side was also oozing the same type of fluid -- without any application of my super zit popping techniques.

The skin around both pin sites looks good -- the oozing, along with the pain while bearing weight, appear to be the only two symptoms at the moment.

Both k-wires on the lateral side of my leg seemed fine. There was a bit of redness around the most proximal k-wire, but no yogurt.

Act Two

After taking pictures and uploading them to a Picasa Web Album, I called up Dr. Jeng's surgical coordinator, Denise, to let her know about the new pin site drainage. Because it was so late on Friday, I was expecting I'd have to leave a message and wait until Monday to hear back -- if I was lucky.

But that's not what happened at all. Denise quickly tracked down Dr. Jeng in the office and we spoke on the phone for a while. This was late in the day -- around 4:30PM -- and here's Dr. Jeng taking time out of his busy schedule to discuss my concern.

This is the type of doctor all others should emulate.

Dr. Jeng asked me to email him my web album to his personal email address so he could take a look. He insisted the pictures be taken with a high resolution camera with adequate lighting. He also instructed me to stop bearing weight and to stop moving the ankle.

While I waited for Dr. Jeng to review the images, I tried my best to ward off the Eeyore mood. Sometimes a good mood just comes to you naturally, and sometimes you've got to force it. Either way, bad attitudes can be detrimental to a recovery.

But the Eeyore thoughts were racing through my head. I could live with a pin site infection anywhere on my foot -- but a pin site infection in the same part of my tibia where a future amputation will take place is bone chillingly frightening.

That part of my leg needs to be pristine.

I eventually kicked Eeyore's tail out of my head when I realized how lucky I was to have taken the day off. If I hadn't, I would never have caught Dr. Jeng on the phone. And, how awesome was it that Dr. Jeng was willing to take time away from the end of his work week to work with me over the Internet?

Pay attention, doctors -- this is the right way to do things.

Act Three

Dr. Jeng called me a few hours later after reviewing the pictures. He said he was encouraged that the skin around the pin sites did not, "look angry." He asked if I had taken a shower with it yet. I had not.

Dr. Jeng really did not want us to put the pin sites under running water due to a study his old roommate did on shower head bacteria.

He asked if the pin sites and pain had improved since we started the Duricef on Tuesday, and I replied that it had either stayed the same or had gotten worse.

Dr. Jeng told me that, fortunately, k-wires are extremely easy to replace in case this ends up being an infection. He reminded me that I should have enough antibiotics left to last me until the beginning of next week.

Being the awesome surgeon that he is, Dr. Jeng wants to see daily updates. I'll have to take photos and videos of the pin sites so he can track the progress over the weekend.

That's the kind of care, concern, and professionalism that inspires awe.

Dr. Jeng is awesome.

So, stay tuned for the sequel. We'll keep tracking the pin sites and work with Dr. Jeng this weekend to see if we notice any improvements. In the meantime, I'm no longer bearing weight and I'm no longer moving my ankle. While this will slow down any cartilage growth opportunities, it's worth the sacrifice to prevent an infection in this part of my tibia.

One of my good friends told me today that I just can't seem to catch a break. If anyone's got one, please email it over or fax it. I need a couple. And while this might be bad news, it's helped show us that we've picked the right surgeon.

It takes a special person to work with someone as annoying as me over the weekend during college and professional football season.

Maybe Dr. Jeng is willing to give up Adrian Peterson for some yogurt.

Tuesday, September 20, 2011

Snowboarder vs. The Million Dollar Idea

Last night was my first night to go out with friends after work. It was my friend Scott's 26th birthday, so I decided to dust off my old sweet dance moves and bring them back out to liven the party.

These moves can be performed with and without an ankle injury.

This morning I had my second follow-up visit with Dr. Jeng. This time around, we remembered a thumb drive to bring back the X-Ray and arthroscopic images taken during my surgery.

My ex-fix will be removed on Thursday, November 3rd -- just around the corner. I was not able to convince Dr. Jeng to let me stay awake and take video during the procedure this time -- he thinks it'd be too painful.

But I was persistent -- or, more likely, I was annoying -- and got him to meet me half way. He conceded that I could setup a video camera on a tripod during the removal procedure. Hopefully we can get him to provide some good narration to provide some educational value and insights in addition to the awesome gore we'll see when the wires and screws are removed from my leg and my ankle snaps back 5mm into its socket.

Now on to the pictures from the August 15th surgery.

You can see how much space the distraction therapy adds to the joint. We haven't seen that much space in my ankle in almost two years. While it feels awkward and painful to walk on 6 k-wires and 2 half screws, it's simply amazing to be able to walk with absolutely zero ankle joint pain.

The lateral view shows the same massive amount of healthy space. This is exactly what's needed to promote cartilage growth. Compare this space to what I was dealing with in June when I posted about my Swiss Cheese Ankle. It's a significant improvement.

Now on to the arthroscopic images. I thought it might be useful to provide a quick diagram of how ankle arthroscopic surgery works.

One hole is used to insert a camera -- the arthroscope -- and another hole on the opposite end of the ankle is used to insert instruments to clip, chew, and claw away pieces of bone and scar tissue to clean up the joint.

Before we go on, keep in mind that normal articular cartilage is usually shiny, smooth, and milky white. You will not be seeing normal cartilage, if any, in the following images.

Here you can see one of the instruments used to clean up the joint. Most of the arthroscopic work was done on the lateral side of my tibia to remove bone spurs (osteophytes) that had built up from bone rubbing on bone. It's basically a callous on your bone.

Whatever it was -- it caused the most amount of pain. Unfortunately, while removing bone spurs helps reduce pain in the short term, it's by no means a long term fix to ankle arthritis.

I believe the bottom bone in the picture above is the talus. You can see some cartilage, but it's not smooth, congruent, or shiny.

In fact, it's barely hanging on.

To perform ankle arthroscopic surgery, the joint needs to be distracted. By the time Dr. Jeng was performing this part of the surgery, my external exfixator was likely already installed and pulling the joint apart 5mm. Saline is usually pumped into the joint to keep debris out of the view of the camera.

In the picture above, you can see a patch of cartilage that seems to be somewhat more healthy than the first image. I suspect this is the medial side of my ankle (the inside part) where I have no arthritis symptoms at the moment.

This is a picture of a barren wasteland.

I suspect this is the lateral (outside) side of my ankle. The metal instrument you see was used to remove the bone spur from the part of my tibia and talus causing me issues.

Dr. Jeng reported taking out the bone spurs was like taking a hot knife through butter -- not a good sign. In healthy bone, it's very difficult to remove osteophytes. This, along with the non-union last year and the incomplete union this year, all suggests operations like fusions and ankle replacements lead down roads of more revision surgeries, pain, and frustration.

Quick tangent -- did you know that for half of my marriage with my wife, Brooke, we've been dealing with this ankle? We're ready to be done.

I'm not sure how this picture of a geological cave ended up in my arthroscopic image set. This can't be an ankle.

This view, however, is a promising image. I see several patches of cartilage still holding on for dear life. Maybe we'll get some growth out of this patch. I believe you can see one of the malleoluses in the background -- I'm just not sure if it's the tibia or fibula malleolus (the boney part that sticks out on either side of your ankle).

Another cave picture. Not a piece of cartilage in sight. I like how some of the bone has brown spots. And by like, I really mean it's terrible and I hate it.

So that was the view inside the ankle. It's a lot to take in. So while you're digesting that, here's what the pin sites looked like today.

This was one of the pin sites we were a bit concerned about. It's red and irritated -- probably because it runs through the muscle used to pull the foot up. I've been prescribed an antibiotic as a precaution just in case there's an infection brewing.

Now what about this million dollar idea?

My boss is awesome. In one weekend, she crocheted the first external fixator cover ever created -- in my aluma mater colors, no less.

How awesome is this?