Snowboarder vs. Ankle Distraction Therapy

After yesterday's doctor's appointment and quick visit to work, I was exhausted -- that was the most active I'd been in several weeks. When I got home, I crashed and did not wake up until this morning. I'll need to be more careful about pacing myself.

This morning I decided to try walking around without crutches -- and, of course, I captured it on video.

It's an odd feeling to bear all of your weight on 6 k-wires and 2 large screws in your foot and tibia. I can feel a lot of my weight on the top screw on the top ring, so I'll start using crutches to ease the burden on the ex-fix for the next few weeks. Walking on the ex-fix doesn't hurt, but it also doesn't feel amazing.

I'm using large rubber bands to help pull my toes up while I walk so that I do not stub any of my toes while walking. This also helps stretch the toe tendons -- especially the big toe. Without substantial flexibility in your big toe, it's very difficult to walk. This will be another thing I'll need to focus on for the next three months.

The next video shows you how to unlock the ex-fix to release it for moving the ankle.

You can see our dog, Spunky, was extremely interested in this instructional video. Oh, by the way, please don't tell Brooke I let her on the couch. I'll get into a lot of trouble.

Unlocking the ex-fix feels weird. You can feel the large amount of tension used to pull apart the ankle joint move from the two rods in the front to the rest of the ex-fix. I fear that because it's so difficult to unlock one of the rods that I won't move my ankle as much as I should.

What I need to do is come up with a schedule to exercise my ankle since I intend on walking on my foot everywhere.

Gross Pictures and Videos, Aww Yeah!

First, let's start with a video of the unlocked ex-fix. I got to move my ankle for the first time in a few weeks. Yes, this hurts.

Now come the gross pictures. Click on them for some high-resolution gore!

Unfortunately, we couldn't get a copy of the x-rays or the arthroscopic images. Next time we show up, we'll bring a thumb drive and get those copied onto the blog. I did get a chance to capture some of the x-rays they took today as they were displayed on the monitor.

You can see how much joint space has been added. Now I just need to start walking and moving the ankle to encourage cartilage growth. It hurts, but it's the only way to do it.

Snowboarder vs. Driving

Earlier tonight, Brooke and I decided to visit our new vehicle to see if my wheelchair would fit in the caboose.

After our doctor's appointment, I intend to visit work for a bit while Brooke searches for nurse practitioner preceptors for her final year of college.  I'd like to roll into work on my chair while visiting friends since it'll be easier to keep my foot elevated.

Brooke ended up doing most of the labor while I ran some experiements. I wanted to know if it would be possible for me to drive a car.

I think the evidence speaks for itself.  The right leg fit nicely over the console and the left foot reached the pedals without any issue.

What do you think?

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.

How To Have a Terrible Day

I occasionally -- no, I obsessively worry about "crossing the line," with these blog posts. My friends, family, and co-workers all read this blog. These people all mean something to me in my life and I want to try my best to keep my posts tasteful, informative, and honest.

I've had to, however, pull the, "well, at least it's an honest post," card quite often.

To everyone that reads my blog, you need to understand where the posts' tone, style, and substance comes from. Most of you probably already know, but for you new followers, look no further than the narcotic pain medications prescribed to patients with impressive injuries such as my wrecked ankle.

These drugs, when used appropriately, usually take care of the pain. Unfortunately, they have many side effects -- including constipation and making me look like Martin Prince from The Simpsons.

When you've got a giant external fixator attached to your leg, and the muscles in your foot, ankle and calf haven't had a chance to do some work in weeks, you start to suffer from amazing atrophy twitching. Not surprisingly -- because it's the worst time of the day -- these atrophy twitches tend to occur in the morning while I'm asleep in bed.

So what's it like? It's difficult to describe. Staying with the Martin Prince theme, this picture is a very accurate depiction of what I usually look like when I wake up with an atrophy twitch in my externally fixated ankle.

So let me give a shot at explaining what one of these twitches does to you. Imagine your foot, ankle and calf muscles decided it would be totally radical to chug thirty Red Bulls in five minutes. According to Red Bull's website, when my foot, ankle and calf muscles chugged those thirty sweet energy drinks, they:

1. Increased performance
2. Increased concentration and reaction speed
3. Improved vigilance
4. Stimulated metabolism
5. Makes you feel more energetic and thus improves your overall well-being

However, according to my patient testimony, here's what I believe is actually happening:

1. Increased pain -- going from 0 to 120mph in 1 second
2. Increased concentration on pain and no way to react -- except screaming
3. Improved vigilance: my ankle is out to murder me
4. Stimulated Spunky from her slumber
5. My well-being was neither improved nor enhanced

When something traumatic like this happens to me, it's difficult to get up until I take my medication and sit and wait for the magic set in. While I'm waiting, there are occasions when the classic race between "the call of nature" and "narcotic relief" take place in my bed, and nature tends to get out in front and hold onto a substantial lead.

Enter the bedside urinal we brought home with us from the hospital.

Now let me tell you one thing. When I first saw this by my bedside at my second surgery, I was petrified. I've never:

1. Urinated in front of people
2. Urinated while laying down
3. Urinated under severe pressure ("Pee in this cup or we'll insert a large tube in your penis.")
4. I've never measured how much urine I typically produce in one session.

When we came out of the PACU into my final room during the second surgery, my Mom was hanging out with us. She asked about the bedside urinal and I, of course, opened my mouth. Trying to make a joke (which is never a good idea when you are heavily medicated), I told my Mom it is a bedside urinal and she can hold it for me -- referring to the bedside urinal. Unfortunately, and probably inevitably, that is not what everyone else in the room thought I meant.

So a few days ago, I get a Red Bull twitch. After being vigilant and increasing my reaction to the pain, I determine it's business time. Now, remember, I'm groggy. I have just woken up from a deep slumber because my ankle downed a million red bulls and decided it was time to dance the night away in my ex-fix. I reach for my bedside urinal and pull it toward the fire hydrant area to proceed with the operation. Unfortunately, the last jerk to use the bed side urinal did not clamp down the lid.

While Brooke, bless her heart, empties out the bed side urinal when it becomes full, she cannot get every ounce or drop of fluid out of that disgusting jar. Occasionally, there are stragglers. Free riders.

The Start of The Terrible Day

So, as I reached over for the jar and made the move for the fire hydrant, I noticed a light, spotty, cold splash across the crouch of my shorts.

"Is that water?" I asked myself -- mainly hoping it to be true so that I could buy myself some time before the inevitable sank in. It was about two seconds later when it sank in.

Expletives were declared, expressions were emoted. Cries of, "Why me?" and "Holy Moses Smell the Roses," echoed through our new apartment.

I just started my new day by technically peeing on my lap from a pee bottle. Now am I going to cower down into a ball and whimper all day and night?

Hell. No.

Yes, I just came this close to peeing in the bed with a previous day's leftovers. But I'm going to take this like a man. I am going to go out in that world with a level of confidence through the roof, ready to take on anything -- just as soon as I get a change of shorts and a shower.

Operation Pink Gorilla

While I was in the hospital last week, my wife provided me with the emotional strength and unwavering support I needed to get through several painful days. She is amazing and one of a kind. Her selfless commitment to me and my health since my accident a year and a half ago just goes to show you how much I dominated at choosing my partner for life.

When I got home from the hospital last week, I leveraged what little functioning neurons I had left to brainstorm ways to say thanks to my wife. Shoot -- let's not even call it a brainstorm. It was more like a braindrizzle.

I came up with one dumb idea.

The best way for me to relay my appreciation and love to Brooke was via the ancient and sacred art of the singing telegram.

Surprisingly, American Balloon Company still offers singing telegram services here in Washington, DC. One of their employees, who cannot possibly be getting paid enough, shows up to a location of your choosing to sing an impromptu song and deliver several large balloons, a coffee mug full of Jelly Bellys, and a personalized letter.

After employing their services, the next step was to develop and execute a plan of attack -- code named Operation Pink Gorilla.

What is the best way to deploy a singing Pink Gorilla to Brooke with the right amount of embarrassment and maximum entertainment value? To solve this problem, I enlisted the help of the three lovely ladies responsible for the recent covert operation to unpack our apartment while we were in the hospital: Alison, Crystal, and Katy.

Over a series of secret emails, Operation Pink Gorilla was developed and set to go for today at approximately 12:45PM. At a prearranged meeting location setup by the girls, a Pink Gorilla wearing a top hat found Brooke in line about to make her food order.

As you can clearly see from the video evidence, absolutely nothing will divert Brooke's attention away from food -- especially when that girl is hungry. I know for a fact that if held at gunpoint, Hungry Brooke wouldn't back off of a Stromboli or discontinue mowing down a bowl of chicken and dumplings.

This was clearly poor planning on my part -- the unfortunate side effect of my earlier braindrizzling. Brooke, on an empty stomach, will beat up small children and puppies to get nourishment.

That said, this was still extremely funny and totally worth it to see the surprised looked on her face.

Here's a picture of the personalized card I had delivered by the Pink Gorilla. If you can't read it, here's what it says (well, what it should have said -- it appears they misinterpreted some of the things I asked them to write down):

Viss,

Thank you for being a loving wife, an understanding partner, and that Mom from the hospital scene in Steel Magnolias.

You are the love of my life,

Your Crippled Husband

"Viss" is what we used to call Brooke in college since her last name used to be Visser. I still enjoy calling her that, and some of our friends up here in DC have jumped on board with it. Although I've not seen it, Brooke was telling me that Shirley McClaine plays the role of a mother with a sick child in Steel Magnolias (I'm now being told it's Terms of Endearment) who goes nuts on a nurse that fails to take care of her child's pain.

Here is a photo of my wife sitting down for some gelato with my co-conspirators. From left to right we have Alison, Crystal, Brooke, and Katy. I had asked Brooke to pay for their gelato under the guise that it was payment for unpacking our apartment -- but in reality, it was my payment to them for their participation in this operation.

Turns out that crap is expensive. Yet another casualty of my braindrizzle.

I found out later that I narrowly avoided disaster by asking too many probing questions. Last night Brooke was stressing out about how busy her day was going to be today. Not wanting her to miss out on the singing telegram, I probably asked too many questions about her schedule.

So I'd say it was a successful operation. Thank you so much to Alison, Crystal, and Katy for yet again taking part in Operation Pink Gorilla. Your efforts and hard work are commendable.

And, thank you, Brooke, for being an awesome wife. I love you!

Lovenox Instructional Video

When I got up this morning, I realized that my Buddha Belly has yet to make an appearance on the Internet. I wracked my brain a bit to figure out the best way to display this piece of art to the world and came up with an instructional video on how to administer Lovenox injections.

At first I thought there couldn't be that many instructional videos on administering Lovenox injections. But as it turns out, everyone on the Internet has uploaded an instructional Lovenox injection video.

Important Blog Update

The website snowboardervstree.blogspot.com, can confirm at this hour that our friend Laurel, introduced in the previous post, does indeed not enjoy close range Spunky farts (where "close range" is defined as 12 inches or less). While this is contrary to the current popular opinion and goes against what is trending on Twitter at this time, evidence has recently come to light to support this important and very relevant announcement.

The evidence: Spunky farted and woke Laurel up. Laurel got upset and called our dog stinky.

Further experiments will be necessary to calculate the degree of dog fart appreciation as the distance from dog butt to Laurel's face varies. Graphs and Excel workbooks will be in order and a peer reviewed paper discussing the outcomes must be completed before we can make our analysis official.

I am unfortunately up late due to a late night pain battle. The good news is we've finally gotten it back in control, but for a while there I would have taken anything over being in pain -- including close proximity Spunky farts.

Earthquake!

Earlier today a magnitude 5.8 earthquake struck Washington, DC. That was the first one we've ever experienced. We're all okay -- nothing broke or fell. However, our dog, Spunky, was quite upset that the Earth woke her up from her nap.

We visited our family physician yesterday to see what could be done about the hiccups. I was a bit embarrassed to be seeing a doctor about hiccups, but I couldn't take four days straight of hiccuping.

My family doctor suggested we change my muscle relaxer medication from Valium to Flexeril. He also noted I have poor posture when I slouch in a chair to elevate my ankle on my left leg. He suggested I try and avoid that position and move around the apartment more often. By avoiding the slouched position, I'll reduce the amount of pressure on my diaphragm. I still had a few bouts of hiccups last night, but not nearly as many as the last few days, so it looks like it might finally be under control.

One of our friends, Laurel, is staying with us tonight before she moves to Philadelphia for school. Laurel is a recent addition to our circle of friends. She used to be a nurse with Brooke. It's unfortunate that she's leaving us so soon!

As you can tell from this picture, Laurel either 1) does not know about the power of Spunky farts, or 2) enjoys Spunky farts. The butt to face distance is quite frankly too short for this to be a mere coincidence. I'm fairly certain option 1 is what's going on here, but we cannot yet rule out option 2. When Laurel wakes up from her nap (perhaps after Spunky rips one), we will ask Laurel which option is correct and update the blog.

Finally, I've been using large rubber bands (not the kind you use to wrap newspapers) to help stretch my toes up. Without doing this, my toe tendons that run along the bottom of my foot would tighten up, making it more difficult and painful to walk months from now. I'm not sure how often I'll do this, but, as our potential dog-fart-loving friend Laurel pointed out, it adds some flare to the external fixator.

Snowboarder vs. Hiccups

My Mom did some Interneting last night and discovered that some people have reported developing hiccups after taking massive amounts of Valium -- which is exactly what I'm doing. Last night I stopped taking my 30mg a day.

Unfortunately, last night was more of the same as the previous four nights. I went for bottles of Sprite (carbonation), spoonfuls of peanut butter and jelly, and held my breath for as long as possible. All with little to no success.

This morning I called my family physician. We go in to see him at 2:15PM today. Here I am, a guy ambulating on crutches with a giant, bloody bear trap on his ankle, hobbling into a doctor's office complaining about -- hiccups.

This is ridiculous.

They Won't Stop

I cannot stop hiccuping. No sleep. Nothing. I've gone through two jars of peanut butter. I've held my breath. I'm at a loss.

I hate hiccups.

The Hiccup Chronicles

The hiccups continue on. Don't laugh, but hiccups are worse than pain. I can't explain it, but try hiccuping every 30 seconds for about 20 hours straight.

I'm not sure how hiccups work, but the above diagram is supposed to shed some light on it. I called the surgeon's office today only to find out I'm the third young male in as many weeks to call in a few days after surgery complaining of hiccups.

Brooke asked that I request Thorazine, a prescription drug for hiccups, but the surgeon's office recommended -- believe it or not -- peanut butter.

Surprisingly, peanut butter gives me some relief for about an hour or so. I've gone through several spoon fulls so far. Hopefully this will end soon!

The Hiccup Problem

Late last night we came across a new problem -- uncontrollable hiccups. I'm not talking about a few hiccups every now and then.

No.

We're talking about a massively uncontrollable hiccup from the bottom of my gut every 30 seconds. You could set your clock to it. They started around 09:00PM last night and kept going through the entire night.

At around 05:00AM, Brooke woke up with me and came up with an idea. She had leveraged her recent graduate school skills to conduct some important, life-saving research.

Apparently honey and peanut butter eliminates hiccups. Sounds ridiculous, right? I agree. But it also sounds delicious.

This odd concoction worked for a few attempts. I'd take a spoonful of peanut butter and honey, and I'd stop hiccuping. But inevitably, a few hours later, I'd start back up again -- only this time, I had a belly full of delicious, sugary condiments.

This morning, I decided to crutch around outside to get some fresh air and exercise. That seems to have done the trick for the time being. It's surprising how badly out of shape I'm in after spending three days in a hospital.

So the first few nights we lost sleep due to pain. Last night it was hiccups. What's it going to be tonight?

We Meet Again, My Arch Nemesis

Last February, a few days after my accident, I wrote up a post about the pharmacy I had established at home. On this our fourth time around, we've reduced our inventory to the bare essentials:

• Lovenox Injections
• Diazepam 10 MG (Valium)
• Hydromorphone 4 MG (Dilaudid)
• Oxycontin 20 MG
• Glycerin Suppositories

The Lovenox injections help thin my blood to avoid blood clots while I sit on my butt all day. The Valium reduces the number of muscle spasms I experience in my leg. This is especially common in a limb that is both recovering from a nerve block and experiencing atrophy from a lack of muscle movement. The dilaudid is an emergency narcotic that's used to recover from significant and sudden spikes in pain while the oxycontin is a slow release narcotic that lasts around 12 hours.

The last resort -- but ol' reliable -- medication is the bottle of slightly used Suppositories, dedicated to a solitary and lonely life of fighting my evil arch nemesis -- constipation. The Lex Luther of poop.

At first, it was quite surprising to me that Lex Luther didn't even show up on the Bristol Stool Chart. But then it occurred to me -- usually Lex Luther's evil schemes play out without a single soul knowing what went down (except the poor sap that ends up constipated). He does his damage and escapes in the cover of night without notice.

How does one summon the hero necessary to defeat an enemy brought on by excessive use of narcotics? Batman and Robin had the Bat Signal. Captain Planet had the Earth, Wind, Fire, Water, and Heart rings. The Superman of Constipation -- he's got one gigantic suppository.

And I do mean gigantic. That's a pinky finger. Typically, pinky fingers are considered small. Let's be honest -- those people are blind.

Two of the warnings on the suppository bottle frightened me a bit. The first one, "Insert 1 suppository well up into the rectum and retain for 15 minutes," suggests to me that I can't just joke around and leave the suppository sitting at the front door. Apparently, I gotta run this thing all the way into the house and leave it in the kitchen. The second warning, "you may have rectal discomfort or a burning sensation," kind of makes me upset. If there's a chance that this is going to burn, why not tell me about the chances of it being awesome? "You may have rectal discomfort or, you may win the lottery after sticking this suppository up your rectum."

Well, Lex Luther is a formidable foe. I had been battling him since Monday -- and I had lost every single battle. Today I had enough. I called in Superman and, together, we defeated my arch nemesis yet again.

I don't understand how drug addicts get addicted to drugs. You never get to poop!