New Business Cards

My new blog business cards came in today.  I had this stupid idea the other day.  Now I've got 250 cards to hand out to people at work and while I'm out.

Caught with my Pants Around my Ankles

It's getting colder up here in DC.  I usually wear gym shorts to work, but today called for breakaway pants.

Breakaway pants, particularly as they get older (I've had today's pair since last year), can become dangerous.  The buttons, as they wear and tear from continued use, don't always stay buttoned.

Today, at work, I got up from my chair and my pants felt, well, let's say, a bit loose around the waist.  As I took a step forward, my pants fell straight down around my ankles.  Simultaneously, a friend of mine, Dan, approached my desk to see what time we were going home today (he was my afternoon ride).

Yep.  He saw the whole thing happen, from start to finish.  Dan couldn't stop laughing and all I could say was, "well, I never thought something like this would happen to me at work."

Fortunately, it was late in the day on a Friday -- around 6:00PM, so not many people were around.

But part of it is unfortunate.  Had more people been around, I would have gotten a lot more laughs.

Pin Site Healing and Timeline

Pin Site Healing

Above, from left to right, is a picture of my second-most proximal pin site on the lateral side.  The first picture was taken on October 20th and the last one was taken today.  You can see how the site is healing nicely, though on a weekend, I'm not walking nearly as much.

Snowboarder vs. Recovery Timeline

Today I spent some time creating a timeline I of my recovery since my accident in February 2010 twenty-one months ago.  Laying it out like this helped me put things into perspective.  This injury, and this blog, started almost two years ago.  It's a daily struggle, but somehow, with great friends, family, and my awesome wife, we've managed to have fun with this stupid ankle and keep an optimistic attitude.

I'm still working on putting together a summary of the research reports I dug up earlier this month.  It turned out to be a much bigger project than I had originally thought.

Lastly, here's a video taken today of the most proximal pin site on the lateral side.  It's still weird to me how loose the skin is around the site.

The Soupy Pin Conclusion

Earlier this morning, Brooke and I drove up to Mercy Hospital in Baltimore ready for today's game plan: soupy pin removal.

I loaded up on all of my available pain medication to make sure the pin site removal was as pain free as possible.

While Dr. Jeng went searching for the tools needed to remove the pin, I started taking off the dressings to get a look at the sites.

The "soupy pin," was as red as ever.  This is the proximal wire on the lateral side.

Here's the same pin site but viewed from above.  Ugly.

The medial view of the same pin was fine, though.  Nice and crusty.  This is how all of my pin sites ought to behave.

The second-most proximal wire in the second Ilizarov ring has started acting up in the last few days.  Here's the medial view of that pin site.

It looks like it's having a great time being infected.

Yes, it hurts when I do this, but it's necessary to check for drainage.  There was none.

The lateral side of that same pin did not look as bad as yesterday.  Perhaps the Xeroform helped.  It's still likely infected.

Dr. Jeng was walking in and out of the room quite a bit today.  Each time he came by, he'd bring in something new.  Eventually he got his hands on the tools he needed from the operating room to remove the wire.  There they are sitting on the table across the room, wrapped in blue paper.  

I believe he had asked for a giant sterile wire cutter, a sterile 10mm wrench, and some pliers.

When Dr. Jeng came in for the last time, he took another look at the pin sites and the x-rays.  The wheels in his head turned for a second and wondered aloud if it was worth taking the pin out this late in the game.

With each pin site removal, we inherit more risks with weight bearing, e.g., fractures in the bone, ex-fix breakage, etc.  Bearing weight and walking around on this thing is absolutely critical to having any chance of a successful outcome.  Because the x-rays did not show any problems, such as a fracture or an infection in the bone, Dr. Jeng reasoned that the infection in the pin sites was something we could control with antibiotics.

So at the last minute, Dr. Jeng called an audible and decided to put me back on antibiotics (Augmentin) to try and buy us some time before the November 3rd removal.  I was on board with his change-up for two reasons:

1. I want to continue bearing weight for the next three weeks to maximize the benefit of this procedure
2. I'd love to avoid the pain (and crazy anxiety) of having the pin removed today

While this is probably the best decision going forward, I unfortunately continue to have pain that we've yet to get under control with any of our pain medications.  After discussing this with Dr. Jeng and Brooke, we reasoned that the pain I'm experiencing now is a result of over doing it with unassisted weight bearing on the ex-fix.

It's true.  Sunday night I was walking around the apartment without crutches like I was a 27-year-old with no right ankle arthritis.  Starting the next day the unbearable pain came into the picture.  Cause and effect.

Lesson learned: never do things you'll regret the next day.

On a good note, while we were looking at the x-rays, Dr. Jeng noted that the ankle distraction has noticeably improved my ankle arthritis.  In the picture above is a six week comparison of my ankle with the most recent image from today on the left.  

The first thing you might notice is the difference in joint space.  Today I was not bearing weight and six weeks ago I was.  Nothing to discuss here.

Another thing you'll notice is the difference in brightness of the bone near the joint.  When bone shows up bright white on x-rays, that typically indicates hard, dense, unhealthy bone.  This is a result of the two bones grinding against one another and causing the subchondral bone at the surfaces to harden -- particularly with so much cartilage loss.  This is one source of ankle arthritis pain.

The bottom line is that the ankle distraction has allowed the bone to heal.  The cysts and lesions are going away and the bone is not as bright, suggesting that the subchondral bone at the surface is returning to a more normal and healthy density level.

All awesome news.  I'll continue to rest the ankle until some of the pain is under control and try to monitor how much walking I do on the ex-fix when I'm feeling good.  Only three more weeks until we get to test out the joint after a twelve week distraction.

One last thing we asked for before we left today was the post-op surgery report.  It was very interesting and went over my head several times.  I tried my best to look up some of the medical phrases and terms and link those in so the report is easier to understand.

Procedures Performed:

• Right ankle arthroscopy and debridement, anterior cheilectomy
• Distraction arthroplasty and application of multiplanar external fixator
• Tendo Achilles lengthening

Anesthesia: 

• General, popliteal block and saphenous nerve block

Complications: 

• None

Tourniquet Time:

• 120 minutes at 350 mmHg

Implants:

• Smith & Nephew Taylor spatial frame, four olive wires [I've been calling them Kirschner wires; I've yet to figure out the difference], two smooth pins, two hydroxyapatite coated half pins, and then a standard Ilizarov Smith & Nephew frame with two Taylor spatial frame hinges and two universal hinge struts.

Findings

Mr. Meehan is an amazing, handsome, extremely intelligent, and gifted athletic 29-year-old gentleman [I added the adjectives.] that had post-traumatic injury to his distal tibia and has undergone multiple prior surgeries first for open reduction and internal fixation and then subsequently sustained an infection to his ankle joint [This part is not exactly correct] which was washed out and then subsequently had his hardware removed.  However, in this time he has developed degenerative joint disease in his right ankle with significant arthritis and osteophytes and subchondral cysts seen on his plain films and his CT scan.  He has significant pain with ambulation and has seen various physicians for surgical options with regards to his right ankle.  He was given options previously of fusion versus distraction arthroplasty and does not wish to proceed with any type of arthrodesis of his ankle.  He has had no evidence of any infection in his ankle since his last wash-out [I've never had a wash-out surgery].  There has been no drainage.  It was discussed with him various options including nonoperative management, arthrodesis versus distraction arthroplasty and given the patient's desires, he wished to proceed with the distraction arthroplasty.  It was discussed with him that this may not be successful in the short-term but may be successful in the long-term or with a five-year period.  The risks of the surgery included but were not limited to bleeding, infection, pin track infection, persistent pain, scar, stiffness, incomplete relief of preoperative ankle pain, hardware breakage, need for future revision or reconstructive surgeries, reaction to anesthesia, stroke, heart attack, loss of limb or death.  The patient understood all the above risks and wished to proceed with the surgery [I probably didn't understand all of the above risks].  All his questions were answered in detail and informed consent was obtained from him.  A copy of the consent form was signed by the patient and the attending physician and appropriate witness.  A copy of this was placed in his permanent medical record [I didn't realize permanent records existed].

Description of Procedure

On the afternoon of 8/15/11 the patient was taken to the Mercy operating room and laid supine on the operating room table.  He underwent general anesthesia via laryngeal mask airway and received 2 gram of Ancef intravenously.  At this point a tourniquet was applied to the right upper thigh and then a timeout was called to correctly identify the patient, operation, operative site and all in attendance were in agreement and the procedure was begun, again by starting with a popliteal block, using a nerve stimulator with 40 ml of 1% Lidocane and 0.5% Ropivacaine.  After this was performed the right lower extremity was prepped and draped in the usual sterile fashion.  A tendo Achilles lengthening was made with three percutaneous stab incisions, two medial and one lateral given that the heel was in slight amount of valgus.  After this was done the leg was elevated and the tourniquet was inflated to 350 mmHg.  We first identified the anteromedial entry point with normal saline and then insufflated the joint and then placed the heel distractor on the patient and then distracted the ankle.  

Heel Distractor

We made our anteromedial portal with a nick and spread technique and then inserted the arthroscope and then began our diagnostic arthoscopy.  There were significant findings for complete cartilage loss on both the talus and the tibial plafond consistent with his preoperative radiographic imaging.  There were very small islands of cartilage medially on the talar head [This explains why most of my ankle pain was on the lateral side], however, there was significant degeneration widespread throughout the joint.  There was extensive synovitis which was visualized [This explains a lot of my pain].  We made our anterolateral portal under direct visualization with needle localization and then using a nick and spread technique inserted the shaver through the anterolateral portal [The camera was inserted on the medial side and the shaver on the lateral side] and debrided the extensive synovitis and as well as removed the anterior bone spur on the tibial plafond, performing and anterior cheilectomy.  The patient again had very little cartilage on the talus or the tibial plafond remaining, but given the extensive nature of the arthritis, there is no area to specifically respond to with the microfracture so thus after doing our debridement cheilectomy, withdrew the instruments and then took traction off of his leg.

Following the ankle arthroscopy being completed, we then turned our attention toward placement of our Ilizarov frame.  We used a standard Smith & Nephew two ring foot frame.  We slid this over the foot and ankle onto the tibia and then identified the tibial crest and then placed a half pin through the most proximal frame, which was hydroxyapatite coated.  Following this a second half pin was inserted along the medial face of the tibia for the second ring.

These were fixed to the frame and the smooth wires were then drilled in a perpendicular fashion to these half pins and then one was attached to the proximal ring and another to the distal ring and then these were both tensioned to 130 pounds per square inch and then at this point, held in place through the Russian smooth wire holders, the appropriate nuts were tightened to hold the wires in place.  After this was done we then placed two olive wires in a cross fashion into the calcaneus [heel bone], again tensioning these to 90 pounds per square inch, and then sequentially tightening these through the Russian clips and tightening these with the nuts, and finally two more olive wires were placed in a cross fashion through the forefoot obtaining purchase in the fourth and first metatarsals, avoiding the fifth metaphalangeal joint [my pinky toe joint] and were tightened in a similar fashion, tightening to 50 pounds per square inch.  At this point manual distraction was placed on the ankle and then using the four struts around the frame, the distraction was held in place and locked and then using fluoroscopy we checked the amount of distraction on both the anteroposterior and lateral views.  We noted the cheilectomy that we had performed had smoothed out the anterior aspect of the joint and that we had obtained an increased amount of ankle distraction.  These were then held in place and then the malleolar axis was identified under fluoroscopy, drilling from medial to lateral, from the tip of the medial malleolus to the lateral malleolus [they drilled in a pin through my ankle joint to line up the two universal hinges on the back of the ex-fix].  Using this as a guide we then placed universal hinges along the axis of  the ankle, one medially and one laterally, and then locked these in place and then further distracted the ankle and locked these in place.  Following this the four prior struts that were used were removed and loosened.  We noted at this point that we could get 10 degrees of dorsiflexion and 20 degrees of plantar flexion of the ankle on the table.  The two Taylor spatial frame struts were then applied to the anterior aspect of the ankle and then these struts were locked in place.  Following this all of the half pins were cut and then the foot plate was attached to the bottom of the frame.  Please note that all of the sharp ends of the half pins were capped and then the cut edges of the smooth pins and olive wires were bent and curled into the anterior aspect of the frame.  The wounds were then cleaned and dried.  The arthroscopy portals were closed with a 3.0 nylon and then covered with Xeroform and then 4 x 4's and over-wrapped with Webril.  The pin sites had sterile gauze applied over them and then had foam spacers placed along them toward the outside of the frame and the frame was over-wrapped with an Ace bandage and then the patient received a proximal saphenous nerve block for residual postoperative pain relief.

At this point the patient was awoken from his general anesthesia and then transferred to the recovery room in stable condition.  At the end of the case all needle, sponge, and lab counts were correct.  Dr. Jeng was present and participated in all aspects of the surgical case.

How to Freak Out My Mom

Everyone has a Mom.  As you know, a Mom's primary job is to be concerned.

Tomorrow at 11:00 AM I'll be getting at least one Kirschner wire holding the most proximal Ilizarov external fixator ring to my tibia removed.  As Dr. Jeng put it, he wants to get rid of my "soupy pin."  

The plan is to get fresh x-rays of the pin sites to see if there are any issues with the tibia bone and the pins.  If the images reveal any issues, there's a chance we'll remove more k-wires or just take the whole apparatus off since we're close to having this thing on for twelve weeks.

This is Step One to freaking out my Mom.  She's far away and won't know what's happening until after it's already happened.  In other words, she's worried about not being able to worry about what's specifically happening to me.

Step Two is showing my Mom new developments with my ankle without first running it by her on the phone.

Last night, Brooke and I discovered something interesting I can do with my new Achilles tendon.  During my August surgery, my Achilles tendon was lengthened with three cuts.  These cuts left three dark marks along the tendon.

When I flex my calf muscle, it appears that the skin, muscle, and fat all pull along the sites where the tendon was cut.  In other words, I've now got awesome calf muscle definition that most people dream of.  My definition just so happens to be severely deformed.

We'll talk to Dr. Jeng about what's going on here tomorrow, but I suspect it's scar tissue that's formed around the incisions made in August to lengthen the tendon.  With physical therapy, this odd deformity will probably go away.  This deformity might also be due to the fact that the joint is pulled apart by 5mm.  This might also go away once the ankle is no longer distracted.

Step Three is to show more cross leaking pictures, including a new leaking pin site, and note that pain has become an increasing issue in the last few days.

This is the original soupy pin that will be removed tomorrow.  Nothing new here -- it's still leaking.

Unfortunately, the lateral side of the second-most proximal k-wire is also leaking now.  There's a chance that both of these k-wires get removed tomorrow.

But if those two wires are removed, then the argument for keeping the external fixator on the leg becomes harder to defend -- particularly with November 3rd just around the corner.

We'll let you all -- especially you, Mom -- know how it goes tomorrow!

Wire Soup and the Foot Race Society

Let me quickly tell you how this post is going to go.  It's going to start out gross, get grosser if you watch the video, then get sweet and sappy.

That's just how I do it, especially when the Redskins are down to the Eagles.  At least the Redskins have realized it's time to pull Grossman and put in Beck.

Over the last week or so, I've experienced more pain and soreness in all fourteen pin sites -- particularly the proximal k-wire on the lateral side of my leg and the two pins on the lateral side of my fore foot.  In order to sleep, we've had to resort to some of the heavy duty medication from several weeks ago to keep the pain managed.

As a quick aside, walking on an external fixator is a totally different experience than passively wearing one for three months.  Last year, I was off pain medication within two weeks of the surgery.  This year, it seems like as time goes on, pain medication is becoming more important to help me tolerate bearing weight.  Bearing weight is an essential part of ankle distraction arthroplasty, as I'm learning from the research, so it's extremely important to me to continue walking on the ankle.

Part of my problem is edema.  As the ankle and leg swells with fluid, extra pressure is exerted on all of my pin sites.  If the pin site is not sealed, it will spring a leak (so to speak).  The edema fluid will dry around the pin site and form a crust -- kind of like a scab.  As the edema continues to build up, the skin inflates around the dried crust and causes irritation.

It's an endless cycle of awesome.

This is the proximal k-wire pin site on the lateral (outside) side of my leg.  This picture was taken yesterday.  Of all of my pin sites, this guy has caused us the most grief since mid-September.  While edema is a problem here, Dr. Jeng and I are more concerned that either a latent infection is causing some issues or, worse, a partial fracture around the bone might be allowing the k-wire to move as I bear weight, irritating the muscle, bone, and skin when I walk.

The fluid leaking out of the site does not appear to be infected.  It's clear and yellow, indicating that it's edema fluid.  However, the pin site itself is continuing to get more red and the fluid is now draining from the site like its a bathroom faucet.  

Warning: this video is gross.  

You'll notice two things in this video, taken yesterday.  First, the lemonade is indeed flowing from the pin site like a bathroom faucet.  Second -- and this one takes a keen ear -- you can hear a clicking noise from my shin muscle rubbing up against something -- either the k-wire or the half screw.  

After sending this video and other pictures, linked above, to Dr. Jeng last night, I got an email from him this morning:

We should get the soupy pin out this week. How many more weeks until 12 weeks?

Hence the Campbell's Wire Noodle Soup picture above.  So it looks like on Tuesday we'll be taking this k-wire out.  My immediate concern is whether or not I'll be allowed to bear weight without this k-wire.  I assume he was asking me for the removal date to help him decide whether or not I could continue bearing weight.

We're currently sitting at three weeks until I've worn this ex-fix for twelve weeks.  We'll see what happens Tuesday.  I imagine we'll also take some X-Rays of the mid-section of my tibia to look for hairline fractures near any of the other pin sites.  I will, of course, have video of the k-wire removal.

Now that the gross part is out of the way, now it's on to to the sappy and sweet part of the post.  A few months ago, I was joking with my Grandmother that she and I should get matching canes.  We were discussing with one another that we needed to setup an official race to see who was faster on their feet.

She was challenging me to a foot race.  And, worse, I was very worried that she'd dominate.

Last week I had two custom canes made for both of us.  It's a golden sienna derby walking cane with a black beechwood shaft and silver collar.  In other words, it's extremely fancy.

More importantly, both of our canes have a custom oval engraving that includes our initials and our position in the Foot Race Society.  My Grandma ended up beating me in the presidential race, so she's the President of the Foot Race Society and I'm the Vice President.

I'm hoping this stops her from continuing to challenge me to a foot race.  Like I said, I'm fairly certain she'd beat me every time.

The handle is my favorite part.  I know you're jealous.  You want one, I know.  

Here's the President of the Foot Race Society proudly displaying her new can along with her beautiful October decorations outside her country home.

And here is the Vice President, proudly displaying the exact same cane in front of a deadbeat dog in the background that only knows how to sleep, eat, and fart.

I'm forcing a smile here because I just found out the Redskins lost.

American Healthcare II

In March 2010, just a month after my accident, I was curious to see how much it costs to "fix," my ankle.  I put fix in quotes because, obviously, we're still in the fixing stage. I titled that post, "American Healthcare."

It's been a hot topic in our country for a while.

After adding up the costs, my first reaction was shock.  Over the three days I stayed at the hospital in Colorado, my medical bills exceeded $73,000!  I found out later from a friend of ours that operating rooms bill you and your insurance company the same way Verizon and T-Mobile do it: by the minute.

That seemed nuts, so I Googled.  According to this Consumer Reports article from 2009, "operating-room use is generally billed at rates that vary from $69 to $270 per minute."

That is nuts.

My second reaction at the time (and still to this day) was relief at how lucky my wife and I are to have jobs and to be covered by a good health insurance plan.  Not once have we had to argue or dispute anything.  Moreover, they've covered almost all of my costs.

Today I took a quick look at what providers have billed my insurance company since my accident on 13 February 2010 to 25 September 2011 (so we're still missing several visits to my family physician and surgeon).

The grand total: $288,947.54.

My insurance company negotiated those bills down to $161,986.16, a difference of $126,961.38 (a 44% discount).

Our out-of-pocket expenses so far have been $6,950.81.  That's 2.4% of what we've been billed and 4.3% of what my insurance company negotiated with each provider.  Another important thing to note is this out-of-pocket figure does not account for the hundreds, if not thousands of dollars we've spent on our own to help manage wounds, the ex-fix, and other rehab equipment.  I'm betting our out-of-pocket figure is probably over $9,000.

The crazy part about all of this is we are not even close to being done with my ankle.  My guess is we'll reach half a million before all is said and done.

New Crutch Tips vs. Piggyback Rides

On October 2nd, I wrote a post about how to prepare for your first external fixator. One of the items I recommended was a new set of replacement crutch tips for the low, low price of $8.99.

I received my new extra large crutch tips on Wednesday, the 5th. Eight days later, the replacement tips were dangerously unusable.

Please keep in mind that I don't do much on my crutches. The most activity I see in a day is racing for the remote control on the other side of the couch when Grey's Anatomy comes on.

I have to make sure the volume is up high enough for me to follow TV's most compelling prime time drama.

I had two problems on each tip. The first problem was a minor tear in the grip. While this isn't terrible, these kinds of tears make it more important to keep your center of gravity over the points where your crutch tip meets the ground.

I'm not sure how I got this tear so quickly. I crutch on carpet, tile, hardwood floors, and rarely, sidewalks.

Here's problem number two. This is the most dangerous type of crutch tip break down. It highlights the importance of examining your crutches every morning and evening.

When the crutch tube is poking through the tip, you've lost all grip. At any moment, you could place too much faith in the gripping ability of your tips and end up having the crutch slip out from underneath you.

You could fall on your ex-fix or, hurt your other ankle, or even worse, injure your dignity.

Do not buy these replacement tips. They are terrible. I should have read the review, "Do Not Buy - They wore out in one week," before buying these tips. That guy was right. All it took was one week.

Instead of getting these replacement tips, ask your friends for piggyback rides.

This is my good friend Alison giving me, a 6'3" 215 lbs. (all lean muscle) man a piggy back ride on a bet that she couldn't carry me 30 feet. This is the same Alison that won the inaugural Injured Tony Award. To Alison's credit, she dominated it and carried me the entire distance.

The ironic and funny part of the story -- Alison injured her ankle.

Oh, no. Stop right there. She didn't injure it while giving me a piggyback ride. That would make sense.

No, she injured her ankle after trying to give me a high five to celebrate her performance. She had a poor landing on the way down from slapping skin. Perhaps I held my hand too high, or maybe she tweaked something during the piggybacking.

Whatever the reason, the lesson of this story is very clear: Alison is terrible at high fives, so don't buy these replacement crutch tips.

Ground Hog Day

Have you seen the movie, Groundhog Day? If you haven't, leave right now, run to your nearest Blockbuster, grab a VHS or DVD (if you're lucky, Blockbuster should have one last rental sitting on the shelf in the Awesome Movies aisle), and park yourself on the couch for one of 1993's best comedies.

The premise is simple: a weatherman, played by Bill Murray, finds himself living the same day over and over again.

In many ways, the last two years of my life are taken right out of Groundhog Day. Instead of reliving the same day, I'm stuck in the same year -- over, and over, and over.

As the movie teaches us, reliving this experience is an opportunity -- a gift to learn how to be a better man. You'd think I'd learn. You'd think I'd be a able to handle the daily onslaught of questions from strangers about my ankle a little better.

I'm afraid I've learned nothing.

I usually stick with, "it's a snowboarding accident."

But some people are smart and quickly realize that it's not winter yet. So the questions continue. I average about ten new strangers a day. Each encounter is about a minute. That's over an hour a week of me talking about my stupid ankle.

Look -- I don't mind taking time to tell people how I was an idiot and snowboarded into a tree two years ago. I just occasionally wish these people would organize, form a board and write a charter, and then ask me all of their questions. Their secretary could write it all down and we'd be done. I'd just direct all of the new strangers to the board and have them review the minutes from previous meetings.

My friends have also suggested I get a business card with a link to this blog. That's probably a more practical idea. And not dumb.

An Idiot's Guid to Snowboarding into Trees

http://snowboardervstree.blogspot.com

I'm always polite and I try to keep it humorous to put the other person at ease. I really want people to feel comfortable and feel free to ask anything. Usually, the conversation starts because the other person is genuinely concerned about my well being. But once the friendly stranger comes to the realization that, yes, the pins and screws are going all the way through the skin, muscle, and bone, things turn and the friendly stranger ends up needing the counseling.

Last year, with the help of some friends, we came up with a list of alternative stories to make the daily grind of addressing the giant thing on my ankle a bit more entertaining.

Surprisingly, to this day, The Bear Trap post is the most visited on my blog. Is this because there are a lot of hunters (I'm assuming they're mostly Canadian) Googling for bear traps but are stumbling across a ridiculous post on the Internet?

No one knows. Probably.

Because I entitled this post, "Groundhog Day," I imagine I'll get a lot of hits from people either looking for the movie or what the holiday is about.

Sorry, dudes -- you're not going to get the answers you were Googling. Learn how to Google. Instead, you're going to get my 2011 list of alternative stories I need to start feeding to people.

10. I Didn't Make the Jump

First of all, from the very moment you hit play, it's obvious I'm not going to make it over the ramp. We didn't plan for enough road to allow my bike to get up to the 88mph needed to successfully clear the ramp.

Second of all, once I get to the edge of the ramp, I know the show's over. My brain should be coordinating a complex series of maneuvers to get me a quick, graceful, and pain-free exit out of the fall.

But instead, the brain uses that jerk tone of voice with me and says, "you got yourself into this, so I hope your face enjoys cement."

Then somehow I severely break my ankle.

9. I Watched an Intense Episode of House

I broke my left ankle just by looking at this creepy picture of House.

8. The University of Stanford Mascot

There are a couple of options here. The obvious one is I broke my ankle when I learned that one of the most prestigious universities in America has a tree as it's mascot.

Another idea is the Tree kicked my butt for making fun of how it routinely shows up in top ten lists for the worst college mascots in America.

Regrettably, I have little room to talk. This is my school's current mascot.

7. Troy and his Lu Lu Lemons

The other day, I was hanging out with my friend, Troy. He was wearing -- what I thought -- were regular eBay or hand-me-down sweat pants. It was a casual Sunday, and I wear either gym shorts or break-away pants all the time.

I'm not one to judge.

But then I found out they were Lu Lu Lemon pants. That changed the whole story. I did some judging and ended up breaking my ankle.

This one needs some work. I don't want to imply that Troy broke my ankle. That wouldn't happen.

6. Bath Crashers

Have you ever seen this show on HGTV? It's freaking awesome! This guy hangs out at Home Depot all day asking random people if he can use their bathroom. Then he surprises you by tearing your bathroom apart and building your dream office-at-home.

I'm not sure how this breaks my ankle. I just think this show rocks.

5. Marital Argument

I lose every time. If I attempt at defending myself over why I left an empty bowl of cereal out in the living room, especially after my wife gets home from a twelve hour shift that ran fourteen hours long, bones get broken.

I'm not even making this one up. She leaves the bruises in places where people won't see them.

She doesn't read this blog. Help me.

4. Complainers

We all work and know people that incessantly whine and complain about everything -- especially little, insignificant things. If you've been around someone like this long enough, you know there's a good chance you're ankle will snap when you slam your foot up his -- sorry, I forget sometimes I've got family reading my blog.

It's easy to break your ankle around a complainer.

Also, if you don't know of anyone that acts like this, then you're probably the whiner in your group of friends.

Stop whining.

When people try to complain to me about a bruise they have on their thigh or a sore wrist, I wonder if they're color blind. And by color blind, I mean I wonder if they're incapable of seeing eight steel pins stuck in my leg surrounded by a bird cage.

3. Las Vegas with my Friends

This is a friend of mine getting a wake-up call from two of my other friends in Las Vegas this summer. And with the way my friends operate, it's a never ending war of escalating pranks.

We've already passed buckets of water. Broken ankles are only a few more pranks away.

2. Rock, Paper, Scissors Accident

First of all, yes, this is real. I haven't quite figured out yet how to break my ankle doing this, but I'm sure if someone threw rock hard enough, it could cause some problems.

Did you know that there's an actual strategy to this game?

Here it is. Now you know how to resolve all arguments by proposing (and subsequently dominating) a rock, paper, scissors game.

1. Air Guitar Melted My Face (and Ankle)

This is also real. It also sounds just as stupid as a rock, paper, scissors league. Back in 2009, a few of us decided to go watch a live regional competition in Washington, D.C. We thought it would be terrible.

It turned out to be AWESOME.

This is C-Diddy. He's retired. But this is what started it all. Some of these guys are so good, they can easily break ankles.

Summary

That's my list. Let's see if we can outdo The Bear Trap post. I'll have some updates this weekend of a sweet new custom cane I had made for my Grandmother and myself. You'll be jealous (for about a second or so) that we get to use canes and you do not.

Working and Running on Columbus Day

Across the world today, several of our close friends ran a marathon -- two for their first time.

Congratulations to Katy (left) for completing her very first marathon in Chicago with seasoned marathon runner Crystal. We're very proud of both of you! Nice work on a personal best time, Katy!

Halfway across the world in Oslo, Norway, our friend Ken also finished his first marathon. We're not as proud of him, though.

Why?

Hopefully this picture of Ken should explain why we do not care. Also, as a side note, if you're familiar with the Internet, you might recognize the following picture and see a close resemblance to Ken.

Days like today I usually make fun of my friends for having to work (or, apparently, run for 26.2 miles) while I sit on my couch and watch Sports Center all day long.

It sounds good on paper. I always enjoy making fun of my friends. But there are only so many times I can watch an ESPN segment about whether or not Tim Tebow should get the start against Miami or see what LeBron James had to say about it on Twitter.

Of course Tebow should start. Quit arguing about it every 45 minutes like there's a choice.

The ex-fix feels great. I'm able to walk around the apartment without crutches and it feels comfortable. Of course, after walking around like that for a few minutes, the pin sites get sore and Percocet is required to quiet down the pin site pain.

So I guess I shouldn't say it feels great. I should probably say it feels great until I use it. Then it feels terrible.

The proximal pin site on the lateral side, the one that's been giving us some grief for some time now, still won't quiet down and scab up like the rest of the pin sites. After walking around I usually start bleeding out of the site (as seen above).

This picture was unusual because the blood seeped through the Xeroform wrap we placed around the pin site. We would have expected it to hold in some of the drainage.

We decided to employ some Xeroform gauze recently because 1) we have a lot of it, and 2) it should help keep the site clean and protect it from contamination.

Here you can see that the site is still a bit red.

I decided that all of the hair was in the way of a good picture, so I spent a few minutes pulling it all out near the site.

Now, normally, if you pulled leg hair, it would make you cry. But, when your skin is in rough shape and hasn't been thoroughly washed since August, hair can be pulled right out without a problem.

I know. That's super gross. But, lesson learned. If you can't afford a razor and need to remove some leg hair, don't wash your leg for six weeks and it'll just start falling out.

I usually take videos of the squeeze test for questionable pins and hand them over to Dr. Jeng to review. This one is a bit gross, but not too bad. No infected fluid came out. Just some clear and bloody fluid.

I sent these pictures and videos off to Dr. Jeng earlier in the afternoon today -- primarily because I didn't want to get yelled at again for not keeping him updated.

We just got an email tonight from Dr. Jeng a few minutes ago:

How many more weeks before we remove it? Don't love how that pin looks.

We let him know that we're about three and a half weeks away from removing the ex-fix. I'm not sure what he's thinking, but I let him know I'm cool with removing this k-wire while I'm awake if I'm allowed to continue weight bearing.

I suspect he won't go for that idea since the only thing holding that Ilizarov ring would be one half screw in my tibia, but we'll see.

I'm telling you, when you pick a doctor, these are the kind of intangibles that you cannot unfortunately measure but are absolutely critical to ensure your recovery is as good as it can get.

Think about it.

It's Sunday night. There's a Bears at Lions game on. It's late. And here's this guy thinking, "Tony's pin site looks a little crappy. We need to do something about this."