Surgery notes and 48 hours later

Morning of Surgery

On Thursday, August 9, my cousin, dad and I loaded up my car and embarked on the hour-long trip down to Fort Collins, CO, for my arthroscopy procedure. My cousin had been in town visiting for several days and was on her way to Denver. My dad came all the way from Florida to gladly be my nurse for the next week.

We left Laramie at 6:30 am. I had to be at my appointment at 8:00 am, and surgery was scheduled for 9:30. Much to my surprise, I wasn’t particularly anxious. Just thirsty. I had been allowed to eat solid food up until 11:00 pm the night before, and clear liquids until 5:30 am that morning, but I hadn’t actually had anything to drink since I woke up.

My surgery was scheduled with Dr. Houghton at the Orthopaedic and Spine Center of the Rockies in Fort Collins. Both he and another surgeon in Laramie had reviewed my MRI and provided the same diagnosis and treatment options. My insurance better covered the procedure in Colorado, which is why I traveled.

I was called back to the pre-op ward shortly after we arrived. I changed into my surgery gown and a hair cap, and had my earrings taped. Then I was put up in a bed to wait for my procedure and was administered an IV. My dad and cousin were then allowed to wait with me, which eased my anxiety and passed the time. At this point, I was mostly hungry. The nurse offered a relaxer drip and I gladly took it — “It’s gonna feel a little bit like you just had a couple margaritas.” It helped quiet the anxiety in my mind and stopped my extremities from shaking.

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I do like a good margarita or two

The doc was running a little behind schedule, so 9:30 came and went before he briefly appeared to initial my operative leg. It was around 10:15 am when the nurses collected me. I left behind my glasses and waved goodbye to my crew. The margaritas had worn off, but I was ok. At that point, you know you’re in good hands and that you’ll be unconscious in a minute anyway.

It was a short and blurry trip to the OR, my only impression of which was that the lighting was excessively bright. In about two minutes, I was moved onto the operating table as an assembly of people I couldn’t make out repositioned me, placed a gas mask over my face, and told me the anesthesia was coming. I could hear the beeping as my heart rate shot up, but the slow fade was right there waiting for me.

I woke up with that groggy confusion where you know vaguely what’s going on, but you feel like you’ve been asleep for years. I immediately asked what time it was, and wondered whether the surgery had happened yet. It was about 11:30 am. The nurse asked me how I was feeling, and I blurted out that I’d really like a bagel.

She helped me change back into my clothes and wheeled me out to meet my dad in the ward. She gave me a pain pill and briefed him on the next steps. I was still a bit too groggy to follow along. Eventually, my dad went to retrieve the car, and the nurse wheeled me outside. I remember smiling as I left, and feeling an easy, blissful happiness.

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Tip #1: wear a skirt and pack extra pillows.

24 Hours Post-Op

Once we got home, I spent the afternoon on the couch feeling very satisfied with the whole day. At the surgery center, I was provided a small walking shoe to wear with my surgery dressings and a pair of crutches. No boot! The wrapping and bandages will come off on Monday, four days post-op.

I was in very little pain and great spirits upon arriving home, which had nothing to do with drugs. For the first 24 hours, I took a pain reliever every four hours, and now I’m just taking it as needed. My foot was almost entirely numb until about 3:00 pm the next day, and when that wore off I could finally feel a dull aching sensation near the incision.

The surgery nurse instructed me to keep my leg elevated and do ankle circles and “calf pumps” as needed. I don’t have much range of motion due to the bandages, but I’ve been keeping pretty limber. I’ve also been doing calf massage manually or with a stick.

My throat was pretty sore from the anesthesia, but drinking water and echinacea tea helped with that. The first morning after surgery I opted for green tea instead of my usual decaf coffee, and my dad crafted a green smoothie for me to have with breakfast, using kale and mint from my yard.

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Tip #2: bring a buddy

48 Hours Post-Op

I am not one to enjoy mandatory bed rest, so the last 48 hours have slowly gotten boring once the novelty wore off. Lots of reading, naps, and endless scrolling. Sleeping has been relatively easy once my nighttime anxiety about blood clots settles down.

The hardest activity by far has been bathing. I might not try it again for a minute. It was mild chaos — just, like, flailing around while keeping one foot above water in a plastic bag. And I have pretty good balance, but that’s a lot of faith to put in my right leg while maneuvering out of slippery porcelain. Ya know, hygiene is overrated anyway.

To recover from something like this requires a sound nutrition plan. I’ve been eating well and with intention. Lots of veggies, grains, and protein. I know the prospect of immobilization scares a lot of neurotic runners, but you have to respect what your body is going through, and retaining your runner physique is far less urgent than repairing the injury completely. Now is not the time to pass judgment. There’s not much you can do about being restricted from bipedal movement; don’t make things harder by restricting your diet as well.

I don’t know how long the non-weight bearing phase will last. Could be 2 weeks, could be 6. The shoe makes me optimistic that it’ll be on the shorter end. I am ok with not knowing. I am ok with trusting the process. I am ok with the temporary loss of physical activity if it means I can have it all back eventually. Embracing the unknown is hard, but remaining positive that your patience will pay off is the only way to see this stuff through, in my experience.

Do you have advice or tips to share?

T-minus

It’s the home stretch, and I’m so excited. I am ready to get this over with, make it to the other side, and prepare for the long, slow return to running (maybe by like… 2019?). If you are faced with an unfathomably long break from running, you may be wondering what kinds of new hobbies could possibly be out there to compete for second fiddle. I know there is no way to completely fill the void, but in the last few weeks I have discovered a couple substitutes that work for me.

Gardening. I’ve been trying to makeover a previously neglected and overgrown yard since the early spring. I spent weeks raking, chopping down tree shoots, and digging up grass in order to make way for flower and vegetable beds. Some tasks are a decent workout, even if tedious, but runners who know the benefits of getting the small things done will find a lot of satisfaction in the end result.

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Biking. Though I had to part ways with it eventually due to pain, it’s still the next most enjoyable form of exercise to me. Find routes that are challenging, and your runner brain will love the endorphins. It’s also a great way to revisit running routes that you are sorely missing, and feel some wind in your face. Bike while running errands or commuting to work to sneak in extra cardio throughout the day.

House therapy. Ok, I’m not, like, some HGTV maniac. But a year ago I refinished my dining room table and chairs, and after that I was kinda hooked on home improvement. This spring, I have also done things like paint my entire house, install new light fixtures, and replace cabinet hardware. Stuff like this can be tough to fit in when you’re spending your free time running and recovering from running. Let those creative juices flow and challenge yourself to learn a new trade.

Hitting the gym. I’m more of an out-the-door runner, and in case you missed my last post, I hate the gym. But being injured makes a strong case for going. I used the elliptical until I couldn’t stand it anymore, and currently I’ve been acquainting myself with the pool. I also started lifting weights again. There are group classes to take advantage of, like pilates, which is a fun way to sneak in your PT work without even noticing. Yoga and barre offer core and muscle conditioning that can aid the return to (or continuation of) running. Find alternatives that work for you. A sweat is a sweat.

Reading. By far my healthiest sedentary habit. I’ve been tackling a list of “feminist” reads that I made up myself — it’s almost 100% stuff written by women of color, LGBT women, or women suffering from mental illnesses — sometimes these categories overlap. We’ve all read the “traditional” bullshit they feed you in high school and college. Patriarchal garbage IMO. I’ve enjoyed all of these books so much more. Don’t forget to exercise your mind.

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I have a lot of gratitude going into surgery. It’s a relief, and I’m fortunate enough to be able to consider it as an option. It’s also given me a new perspective on time away from running, and with that the realization that life goes on, that the absence of running is tough, but not impossible, to endure. This is a time to heal, to reflect, to set new goals, to remember not to take running for granted when I get the opportunity to return. The next few weeks are somewhat unchartered territory, and a few of my newfound hobbies will be impossible to stick with while I’m recuperating. Gonna have to learn some couch hobbies. That’s why I haven’t started the new season of Orange is the New Black yet — you gotta give yourself an automatic win sometimes. But there will be PT appointments, and small sprinklings of normalcy that return slowly as I make improvements. I’m optimistic, and one day all of this will be a thing of the past.

Different strokes for ridiculously anxious folks

You never realize how difficult it can be to do certain things until you develop an anxiety disorder.

Oh fuck, I thought this was a running blog and now it turns out she’s also going to lecture us on mental health awareness.

I suffered my first panic attack two years ago, seemingly out of nowhere, and was reborn as a severely anxious person. Although, if I look back at my disposition towards certain things growing up, to me it seems rather inevitable. Take swimming for example.

I’ve never been a good swimmer. In first grade, I won my heat in a kickboard race at the school swim meet and that was the pinnacle of my swimming career. Then it was like —  you know how some people grew up dreading The Mile? I grew up dreading the swimming unit. On the first day of a new school year, I’d be like fuck! we have to swim again in February. I don’t really know why — maybe I got too much water in my ears once or felt uneasy learning flip turns. Maybe other kid swimmers were assholes, and the ones who took lessons and got to be good at it were fairly unrestrained in their need to show off. So maybe I hated it because I couldn’t brag about it. And when you’re generally athletic, it sucks to be bad at an athletic thing. And when you’re me, you turn lots of negative experiences into opportunities to be ridiculously nervous.

Let me clarify that I enjoy using pools for leisure. What I am referring to is lap swimming, where you employ complex strokes and earn the opportunity to breathe again by succeeding at not drowning first. Breathing is never guaranteed! Because I have the lung capacity of a potato, and I never mastered the art of opening my eyes underwater, swimming was always more like thrashing around blindly and choking on water. I think I always lost my goggles diving off the start board.

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Does this count as exercise?

I remember once in middle school I almost passed out after swim class. I’m sure it was every bit as dramatic as it sounds, but I swear between the chlorine fumes, the water-logged dehydration, and the breath-holding, swimming has a tendency to make me dizzy.

Well, once you’ve suffered enough panic attacks to be wary of anything that might cause dizziness, swimming gets even harder to do, too. Pair that with venturing to the middle of a deep pool to purposely overexert myself, and my claustrophobia is like WTF ARE YOU DOING?! I’ve triggered panic attacks while biking or using the elliptical too hard, but you see, if you panic and faint while swimming, you, um… you die.  

This is really what it’s like to have irrational anxiety. Do I really think I might die while using a community pool with lifeguards around? No. Have I ever actually passed out while panicking? No. But I do find myself providing handicaps that I never used to consider. I’ve logged hours of my life aqua jogging, but now I wear a flotation belt like the ones old people use for water aerobics class. Just in case. Which means that, as if the lifeguards didn’t already think aqua jogging was baffling enough, now they definitely think I am some poor turd who must not know how to swim, and they move to sit in the chair right above to me. I mean, that’s not subtle. But it does make me feel better.

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Bootin’ around Jackson over the Fourth

With my surgery scheduled for August 9, I still have some time before I endure 2-6 weeks of non-weight bearing and post-op recovery. Of course, to test a conservative treatment plan, I spent the first two weeks of July in a walking boot, and if you’ve had the misfortune of wearing one, you know how alarmingly fast your body atrophies. So I am using these interim 3 weeks to re-strengthen some musculature that I lost while in the boot. This includes core work and some easy cardio. It might seem pointless to beef up a shriveled leg that is destined to become shriveled again, but if you could choose to go into surgery shriveled or ripped, wouldn’t you choose ripped? Might as well be functioning above average to start with.

Hence the pool. Regardless of how uncomfortable it makes me, swimming and aqua jogging will be my primary forms of exercise for several weeks once I’m on the other side. It will get easier as I reacquaint myself. I usually feel very anxious on my way to the pool but end up feeling fairly relaxed once I start moving around. I like breast stroke because I can leave my head up, but I’m challenging myself to do more and more lengths. My record right now is 30. Runners like records. And people with anxiety like any small accomplishment.

Ankle injury diagnosis

Osteochondral lesion of the talus

I’ve been injured for a long time. For months. Actually, for the better part of a year. With no signs of improvement or relief. No timetable for a return to running. I’m inclined to share the entire months-long progression, but that’s not really useful to anyone. After exhausting all other options, I finally did what I should’ve done weeks ago and got an MRI.

Osteochondral lesion of the talus. There is a fracture in the cartilage that sits at the top of the talus bone in my left ankle, and the underlying bone has been damaged considerably. I remembered thinking once, “ok, it’s gotta be either a stress fracture or arthritis.” I wasn’t far off. And I was closer than most professionals had come.

An OLT is a tricky injury, I’ve now learned. Cartilage isn’t known for its ability to repair itself or regrow, and the talus is a very low-blood-flow area. A scope surgery is one of the only ways to treat this injury successfully. This procedure allows for cleaning debris from the injured area and drilling into the talus to create a microfracture. Ideally, this chain of events encourages new bone to grow and scar tissue will fill in for the cartilage.

That is the surgery I am now scheduled to have next month. That is the part I want to share. I spent months Googling my symptoms, trying to find a home for my injury, only to find very little reliable information and misdiagnose myself repeatedly.

I’m a runner. I’ve had all the “traditional” soft tissue injuries and a metatarsal fracture, too. But this is a new one for me, and the most difficult one for sure, especially when it’s been years since my last major injury. For weeks I wished it was a stress fracture – so straightforward! Almost guaranteed to run again in 8-12 weeks. Currently, I’m so far away from my usual place of fitness that going into surgery at this point is like “well, what’s another 6 weeks.” But at least I have a time frame, finally.

In the meantime, I’ll be updating throughout my pre-op phase, and then detailing the surgery and recovery plan. I struggled to find the information I needed, so I hope I may be a resource for someone else.

Predominate symptoms I experienced over the last 8 months:

  • A crunching, grinding, catching sensation inside the ankle joint
  • Shooting pain or a compressive ache in the ankle while ascending stairs or pedaling a bike
  • Midfoot instability
  • Sharp pain at the front of the ankle that was confused with both a cuboid fracture and impingement syndrome
  • Skin numbness across the bridge of the ankle, where you tie your laces, and behind the ankle on the lateral side
  • Joint pain in the medial arch of my foot
  • Swelling near the peroneal tendons
  • Pain and pinching behind the ankle on the medial side

Because of these symptoms, various physical therapists and doctors diagnosed me with a wide range of afflictions from plantar fasciitis to cuboid subluxation to tarsal tunnel syndrome – and keep in mind, none of these even occur in the same part of the ankle. That’s how much the pain migrated. I was able to run with it for about four months, and finally started to feel like the whole ankle was about to shatter, at which point I stopped.

Conservative treatments I tried:

  • Rest. Like, days, then weeks, then months of rest
  • Cross-training on the elliptical or bike
  • Dry needling, laser therapy, manual therapy, ice massage, NSAIDS
  • Air cast walking boot
  • Running? We all think maybe it’ll just “clear up”

Osteochondral lesion of the talus. I went to 4 physical therapists over this time. That’s maybe the most frustrating part. Every misdiagnosis made me feel like I wasn’t being heard. Like everyone was confirming their own biases instead of listening when I repeatedly said SOMETHING HURTS INSIDE THE ANKLE. It’s not the fucking plantar fascia! I often wish I had gotten imaging earlier. Thinking how much time I wasted beating myself up over useless rehab exercises, wondering what I was doing wrong… Knowing somewhere in my heart that it would lead to this. That it had to.

But I can’t dwell on that. That chapter is behind me. When I left the consultation with my physical therapist after he’d received my MRI results, I said, “You know, I actually feel excited. Relieved. A little scared. The hard part is over, and I see a light at the end of the tunnel.”

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If you have experience with this or another similarly drawn-out injury, please reach out! Constructive, supportive feedback is something you can’t find over at the LRC message boards.