Me and My Trimalleolar: A Life-Changing Tripulation

If you are here reading this post, I will assume you’re dealing with or have dealt with a Trimalleolar. Please, don’t suffer alone. Write in the comments section any questions you have.

Things will get better!

I’ve called this blog Travels and Tripulations and never before realized that my pretend word Tripulation could be anything other than a travel story.  A friend reminded me how this event now gives an entirely new meaning to the Trip in Tripulation. Hence, arriveth, Me and My Trimalleolar: a Life-changing Tripulation.

Trimalleolar Fracture - swollen ankle

Little did I know that having a dislocated talus for two days was a bad thing…

The Life-Changing Tripulation

On July 3, 2011 Scott and I were walking to the beach to watch the sunset.  It was just about 7:30 pm.  A fresh, clear, and cool Santa Cruz evening prepared us for what was expected to be a gorgeous sunset.  We were heading to a cliff that offered a stunning view of the surrounding area and a chance to see dolphins, sea lions or sea otters.  Barely 50 yards from the car and walking on a dirt path that was rocky and uneven, I took a bad step and sprained my right ankle.  Not a moment later I heard a cracking popping sound, and I was down for the count.  While my body was contorting and trying to correct herself from the right ankle sprain, I fell badly on the left.   VERY BADLY.  I knew something was acutely wrong when I looked at my left ankle and saw a bone attempting to pop out of my skin.

I was paralyzed with confusion and pain.

Scott, only steps ahead of me, heard the POP POP POP of three different bones and rushed over, pulled me off the ground, and got me into the car.  I was in the back of the car, on my back, with my knees bent, and holding both feet in the air.   Elevation was the only rational thought I had along with many other irrational thoughts such as ‘it’s probably just a dislocated joint or somethin’ and they’ll be able to pop it back into place at the ER’.  I told Scott, ‘Let’s stop off at home so I can change into cleaner clothes’.  It was Sunday, I hadn’t showered.  Naturally, he refused.  At least one of us was thinking clearly.  That two-mile ride seemed to last a long time.  I didn’t know if I was going to puke or pass out, and each bump on the road was an agonizing reminder that something was greatly amiss.

We arrived at a busy ER.  It was the July 4th weekend in Santa Cruz, and we were surrounded by firecracker victims, some guy who had a badly bleeding hand (knife wound?), a young, very ill-looking woman leaning against (I presume to be) her mother, families, and a bustling group of nurses.  X-rays were hell at best.  I thought that trying to hold my feet in various positions while shaking like a leaf from shock was the greatest test of my strength, but I was naïve.  There have been several tests since then including waiting 3 hours for any pain meds while holding my dangling, left foot, but even that paled in comparison to what I’ve since felt.

After two doses of morphine and some Valium for good measure, I began to feel some relief.  The Nurse Practitioner, a sweetheart, as were all the folks who helped me, came to me to set the ankle in a soft cast. She asked, ‘please point your knee forward’.  You see, she thought my leg was bent to the left because my foot was hanging loosely in that direction.  When she realized the dislocation of my foot, she excused herself and promptly dialed in to the Orthopedic Surgeon (OS) on call.    While she was on the other side of the wall from my bed, I could hear bits of her conversation:  “something something…lovely 44 year old woman (or maybe it was ‘unlucky 44 year old woman’.  My head was, after all, rolling in a blur of narcotics), dislocated something something.  Trimalleolar something something.”  The NP thought the Ortho should come and see me but she was instead instructed to relocate the foot and place it in a soft cast.  Timidly, she pulled my toes straight up and with the help of another nurse they put on the cast/splint.   They put an air cast on my right ankle, which was ‘badly sprained’.  I vaguely recall hearing the word ‘surgery’ and thought they must be referring to someone else.  The helpers went away for a while tending to others and returned to release me.  By this time, my left ankle sank back to the ‘falling to the left’ position and no one seemed to notice.  I was scheduled to see the OS on July 5 since the 4th was a holiday n’all.

Trimalleolar fracture, broken ankle, swollen foot

VERY swollen foot…but damn, my nails look nice, don’t they?

My friends Percocet and Valium got me through those days.  I barely recall going to the OS office and waiting to see Elisabeth Siegler, MD.  She looked at my dangling ankle, and had what I would describe to be a muffled, surprised look on her face.  She thought the ER folks ‘reduced’ it.  She informed me that she would have to do that straight away and that it was going to hurt.  With some local numbing on the top of my foot and Scott holding down my thigh, she confidently and forcefully pulled, yanked and twisted my bones so that my foot would be pointing in a near upward direction.  I have NEVER before in my life felt that kind of pain.  Scott told me all I said was, ‘Oh MY!’.  I don’t remember.  Dr. Siegler rewarded me with ‘good job’ and a nod of tough-girl approval.  The only good thing I recall from that visit was Dr. Siegler telling me that I ‘must have good skin’ because that bone didn’t break through and a compound fracture would’ve been much worse.  And considering that I already had a (this phrase has been mentioned many times to me) “severe” fracture, I suppose some luck came my way.  Hooray for hydration!   I was diagnosed with a Trimalleolar Fracture.  Three broken bones that makeup my ankle.

The lateral malleolus is the anklebone along the outside of the ankle (away from the other leg), Bimalleolar means both the medial (inside closest to the other ankle) and lateral bones were broken. A trimalleolar fracture refers to fractures of all three malleoli of the ankle: lateral malleolus, medial malleolus and the bottom posterior (backside) tibia. This portion of the tibia is sometimes referred to as the posterior malleolus.

According to www.uptodate.com:  Over five million ankle injuries occur each year in the United States alone.  The vast majority of ankle fractures are malleolar fractures: 60 to 70 percent occur as unimalleolar fractures, 15 to 20 percent as bimalleolar fractures, and 7 to 12 percent as trimalleolar fractures. There are similar fracture rates overall between women and men, but men have a higher rate as young adults, while women have higher rates in the 50 to 70-year age group. 

The surgery was scheduled for July 12 ASSUMING that my swelling was down.  She showed me how she wanted to see ‘wrinkles’ on my feet otherwise she would have to wait an additional week to operate.

My next appointment on July 6 was with our GP to get the pre-op blood tests, chest x-rays, blood pressure and EKG.  Should’ve been a piece of cake, right?  Everything was fine EXCEPT the EKG showed an abnormality.  The nightmare turned into a night terror, and I was in absolute disbelief.  Turns out I may have an uncommon condition called WPW Syndrome, which is a slight mis-wiring from my atria to my ventricles. Whaaa?Supposedly I’ve had it my entire life and most people are asymptomatic, yet this didn’t stop our GP from scheduling an appointment with a cardiologist.  For two days I awaited that appointment wondering how my life could be turned so easily to upside-down in a matter of seconds.  And still I had small doses of optimism, because at that time I was certain the entire healing process of this fracture would be about 4-6 weeks. Frankly, I don’t recall where I got that info. It might have come from my two new buds Perco and Val.  I spent the week dazed and confused with the sole focus of reducing swelling.

Before we got the script for a wheelchair, Scott was rolling me around in an office chair.  Every day I elevated like the Chrysler building, iced, drank about 2 liters of water and consumed anti-inflammatory foods and spices. I found this supplement that includes a number of anti-inflammatory herbs and spices.  

It also comes in a tincture.

None of this would have been possible without my superhero husband who waited on me hand and foot – literally. With a severely sprained ankle and a Trimalleolar fracture that was to have ZERO weight bearing, who else do you think helped me skip to the loo?  He wheeled me to and fro, got me in and out of bed, brought me water, food, and ice, and rigged up the shower so I could take at least one shower that week.  I wondered several times throughout the week how folks who live on their own handle this situation.  How painful and difficult that must be.  Or for those who are not in good physical health or shape to begin with.  So very hard.

A consult with the Cardio, Dr. Potkin lead me down the path to two days of heart testing including a STRESS test (don’t ask) and a NUKE test.  Here I am a total anti-prescription, anti-toxin, eco-girl, and while I was doped up on prescription meds and actually allowed a stranger to fill my blood with radiation (enough to equal 50 chest x-rays) so that they could take several images (30? 40?) of different angles of my heart only to tell me what I inherently knew, your heart looks good!  I was good to go for surgery only it had to be rescheduled from July 12 to the 13th moving me from a surgical center to the hospital so that I could be monitored by the cardiologist…just in case my heart exploded.

Surgery

This was rescheduled for 5:00 pm on July 13th.  The surgery is called ORIF (Open Reduction, Internal Fixation).  After a few calls back and forth between the OS and a radiologist the night before, it was confirmed that I could actually eat a piece of toast that morning at 8:00 and drink water until 9:00 am.  I’m such a water-aholic I was freaked out about not drinking throughout the day, yet my worry of surgery overrode all the other anxieties.

Scott and I were sent to a hospital room, because they weren’t sure if I would be admitted after the surgery.  There I adorned myself with one of those lovely snap-button hospital gowns.  I recalled a story my Dad told us after he had surgery:  He was walking down the hall with his ass hanging out the back.  A nurse approached him and said, ‘Mr. Swartz, would you be more comfortable if I button this up here in the back?  He replied, ‘No, would you be more comfortable if you buttoned me up in the back?’

I was wheeled out to wait in the recovery room and Scott was sent to the waiting area, which vaguely resembled an isolated hotel lobby and looked comfy.   I gave Scott my good-byes…ya know.  Just in case.  And off I was sent to a little corner of the recovery room passing two others who had just emerged from surgery.  A curtain surrounded my little space.  Mind you, I still, at this point, didn’t know if my swelling was reduced enough to actually undergo the surgery.  I suspected so, though, given all my efforts.  I was correct.  The OS came in, tested my wrinkles, and I was given the ‘okay’.  The Radiologist, whose name escapes me, was funny.  He asked if I had any questions, and I did; yet they were for the OS and not for him.  He called her back, and to my astonishment, she was abrupt with me.  Curt.  Basically appearing from behind the curtain and asking, ‘What?  I felt my anxiety rise and after a moment of speechlessness responded with, ‘Oh.  You asked me so abruptly I now can’t remember my questions!’  Eventually I did.  Everyone departed, and I dozed off.  I was rolled into the operating room, a very sterile place, which is exactly how I would want it to be given the stories I’ve heard about folks getting infections while IN the hospital.  The two nurses were rummaging about their tools n’such and prepping me.  I was still concerned about the skill of my OS, because I had a difficult time finding info on her success rate.  The one nurse told me, ‘As far as I know, none of her patients have been brought back to correct any problems and she is very careful and takes her time.’

The radiologist came back and told me he was going to move me onto my stomach in order to give me a behind-the-knee shot called a popliteal block.  He said this would make my life easier for the next 18 hours as it numbs my entire leg from the knee down.  Right on!

Post ORIF, trimalleolar fracture

Post ORIF

Next minute, I awake in the recovery room chatting, babbling, really.  The nurse waiting on me said I had been talking before I was even conscious.  I’m sure that doesn’t come as a big surprise to those of you who know me.  Her name was Hari and she asked, ‘How are you?’  At the time, I was feeling pretty darn good and asked, ‘How are you, Hari?’  Somehow we landed in a discussion about her grief around the recent death of her father, and I recalled the grief counseling I had done in the past with a strong desire to help her.  Really, though, I remember very little of the conversation and according to Scott my speech was very slurred, but in my world Hari and I had a very healthy and healing discussion.  Scott suddenly appeared as if he had been beamed down, and that might have been one of the happiest moments in my life seeing him.  I was dressed, wheeled out and sent home about 10:00 pm.

Post Surgery

I awoke the next morning at 7:00 am feeing amazingly refreshed regardless of the plate with five screws on one side of my leg and the torn ligament screw in the middle and the other screws on the right.  I seriously couldn’t believe how great I felt, and NO real pain – just a kind of heavy discomfort.  But workable!  I felt very optimistic about my recovery and healing – big ‘ole fiberglass cast on my left ankle n’all.  That euphoria wore off about 12:30.   I was able to squeeze 19 hours of numbness out of my popliteal block, and then my current reality set in.  Pain.  A progression of pain.  I was prescribed Norco (hydrocodone) that I discontinued 3 days later as it made me ill.

One week post ORIF, incision with two screws

One week post ORIF: Left foot – right side: incision with two screws

Left ankle: One week post-op and Right ankle: Still sprained (swelling mostly on the right)

Left ankle: One week post-op and Right ankle: Still sprained (swelling mostly on the right)

ORIF post-op, Trimalleolar fracture

There’s a plate with five screws behind those bandages…oy – and the bruise beneath my knee. I have no idea where that came from.

Tanya, at the OS office called to schedule my first follow-up visit for one week after surgery, July 20.  I was informed that if my swelling was reduced enough, they could get good x-rays otherwise I’d have to wait another week.  Again, I went on my de-swell journey.  This time I visualized the OS saying in astonishment, ‘This looks GREAT!  I can’t believe how little swelling you have!’

For the most part, the week was challenging.  I was either on the meds or confused, unmotivated and unfocused, or off the meds and in pain and not sleeping.  Somehow I still managed to do some work. FINALLY on the day of my follow-up appointment, I was feeling very little pain.  Just that constant discomfort that I will describe shortly.

The Follow-Up Appointment

We waited in the OS office for two hours before we were seen.  The wait lent itself to our hearing some interesting stories.  One guy with a shattered heel from chasing a fugitive out of his house, one woman with two broken arms from dancing at her nephew’s wedding.  My story was boring.  Still, I was very anxious and eager to see what was lurking beneath that massive and oddly-shaped cast on my foot.  I actually thought there was some type of draining device in there, because it was so heavy.  While there were draining pads, there was no device.  I anxiously watched Tanya cut away at the cast and pull off those pads, I felt some fresh air on my skin and looked down at what could’ve been Frankenstein’s foot.  YET Tanya was surprised at how little swelling I had.  It was almost exactly as I visualized only it was the assistant and not the OS sharing the good news.  The new x-rays showed the plate and five screws on the lateral part of my fibula and a long screw (a syndesmosis) used to repair a torn ligament and the other two screws on the right.  I was informed this screw would have to be removed in 12 weeks.  I forgot, however, to ask the reason but later discovered that 12 weeks is the necessary amount of time to heal the ligament.  This means I have to undergo another surgery in 12 weeks, and while it is a less debilitating surgery, it is surgery nonetheless.  I will also have the option in about a year to remove the other hardware should I choose.

I came armed with questions for the doctor.  And while she seemed like she was in a hurry, she did take the time for my questions.

Devastation smacked me upside the head when she told me I would not walk for FOUR months.  As in, I will be only taking steps in four months, not even actual walking.  I have since discovered that actual walking without a walker or cane or limp could take up to NINE months (don’t worry folks, this is a crazy conservative estimate and now know it’s certainly not at all true).  I was blown away and trying not to break down.   At that moment, my heart was more broken than my ankle. The instant Scott got me back into the car, I sobbed uncontrollably.

Dr. Siegler departed and Tanya returned to put me in a boot, because my ankle looked ‘great’ according to the doc (again, visualization does work!).  Das boot is a 3-pound ski boot.  My heel had to touch the bottom, which meant it had to be turned back up from a pointing forwarding position to a near 90-degree upward angle.  Scott said I was levitating with the pain.  I seriously thought I had a high tolerance for pain, and this entire event is making me question that assumption.  But we got the foot into the boot managing the trick of pushing it in while not bearing weight.  I was scheduled for another appt. in 4 weeks and told STRICTLY NO WEIGHT BEARING.  I was also scheduled for physical therapy the following week:  Gentle flexing only.  I was in agony the rest of that day and night.  I even took drugs that night and couldn’t sleep.  Add insult to injury, I had a webinar scheduled for 7:00 am the following morning.  Scott got up with me at 5:30 to get ready.  He reconfigured my office so I could elevate both legs while teaching the class.  I was essentially spread-eagle sitting at the corner of my desk and laughed to myself because the learners could only see my face and had no idea what else was going on around me.  The training could’ve bordered on unethical had they seen me as a whole person.  Which brings me to this…being a whole person.

A Shift in Priorities:  An Ankle-Altered Reality

It’s not good days and bad days that I have, it’s good moments and bad moments. And they shift continuously throughout the day fluctuating between total despair, fatigue from inactivity, pain, discomfort from poor posture elevation, the makings of acceptance, nauseousness when I feel the screws in my leg, anxiety, fear, fleeting thoughts of opportunity and dashes of hope.   Many folks have told me this is the ‘universe telling me I had to slow down’.  While that may be true, surely there could’ve been a less traumatic, painful, or depressing way for the universe to deliver the message.  Did I really need to be smacked down like this?   Was I really that unconscious?  All signs point to YES.  I was given an opportunity in May after receiving a speeding ticket driving back from Southern California.  A trip that should’ve taken 6 hours took 9 because of traffic in…you guessed it, LA.  Clearly, I wasn’t ready for the message, and that one cost me $250.00 and traffic school.  Well, I hear it now.  I, indeed, slowed down.  I went from 100 to 0 in an instant, much like getting pulled over by CHP, only there were no flashing lights involved in this go-around.

I’m reading online about various people’s situations, and so many of them say they have pain and swelling for years.  Runners are no longer running.  Jumpers are no longer jumping.  Can this be real?  It hardly feels like it.  It has given me such a massive appreciation for people who live with chronic pain or who are confined to a wheelchair.  I refuse to believe there are not just as many success stories to match the dismal tales I’m reading online.  I also try to remind myself that my situation is temporary (even if months and months feels like a miserably long time), so can I really relate to those who are permanently in chronic pain or confined to a wheelchair?  Really?  Probably not.

I was a total neat-freak ensuring that every item has its place in my home.  Dust was dusted, plants kept well-watered, and dog hair was found mainly on the dog.  Now, I must accept the fact that things I need have to be within reach, and disarray has to be okay.  Scott can take on only so much.  I don’t want both of us to lose our emotional stability.  And he has been amazing taking care of me, the dog, and the house.

A visit to the bathroom can take 15 minutes (with the getting there, dropping trou and returning being the most time-consuming part).  A shower is an event. It involves plastic bags (yes, they are biodegradable) duct tape and strategically placed chairs with towels.  Water covers the floor on the outside as well as the inside of the shower.  I only shower now twice a week and would probably do less if I could stand the smell of myself more readily.  Getting to my office (the only room in the house that is upstairs) means scooting around on my butt (I call it ass-taxi) with my left leg in the air and asking Scott to lift me into my chair.  I no longer worry about getting dog hair on my clothes, because I spend a lot of time on the floor getting from one place to the next especially when I want to switch things up from using the wheelchair.  Oh, and the wheelchair.  Turns out I’m not good at driving that either.  I have banged up every corner and door jam downstairs.

What was once an obsession with moisturizing my hands and face has completely disappeared.  I haven’t touched hand lotion in three weeks.  Flossing is now a luxury, and wearing the same clothes everyday for 3-4+ days is commonplace.  Yes, I am changing the essentials.  I haven’t seen my face or hair in the mirror up close for three weeks.  I have a 20-second moment between brushing my teeth and wobbling on the right leg to spit when sometimes I check myself out.  It ain’t purty.   I wash my face and hands less because the sink is so high that even reaching over to wash my hands takes effort, and sometimes I just don’t feel like pulling myself up on the sprained ankle.

One of my new goals is seeking comfort – morning to night I try to find a good elevated position for my foot.  One night, shortly after surgery and after several pillow rearrangements, I was so desperate for additional comfort that I wheeled into our master bedroom closet in search of another pillow.  It was about 2:30 am, and I got stuck in there.  It took about 30 minutes and a 100-point turn to get myself out.  I didn’t want to wake Scott, who is in the guestroom with Stella, but the expletives poured out nonetheless.  I sometimes find myself envious when I see people in the news or in a movie who are walking and especially engaging in higher impact activities.  I daydream about weeding and walking Stella.

Oh….night sweats and nightmares add to the bedtime fun.  For some reason, I am operating on the ‘warmer’ than usual side.  I can only hope it’s my body’s healing system all fired up and working her magic.  The other night I had a dream…a dozen or more small, alien-like animals came into my bedroom, only it was my bedroom from childhood.  They pulled up the mattress and knocked me off the bed onto the floor.  They were scurrying all around me as I was trying to get them off of me.  I grabbed one in the comforter and when I saw it up close, it was a Dachshund.  In my dream, I thought, ‘This is just a cute little dog?  Why am I getting so upset?’  Then one began biting at my foot, and I kicked my leg out really hard (in my dream and in real life) as I was trying to yell for my Dad, only there was no voice despite my efforts.  I awoke with a very sore leg in the air.

My darling and wonderful husband waits on me constantly.   Have I mentioned yet how amazing he is?  Still, I feel guilty about this.  His days are filled with making sure I’m fed and watered and taking over most of the chores at home.  There are some things we just have to let go.  The only fortunate aspect of this situation is my timing:  1) Scott took early retirement from Cisco, and that began July 8 which means we really only had a couple days of his dealing with finishing up work stuff and helping me and 2) My current contract has slowed down dramatically and my next month of work can all be done at home.

But what next?  And how fair is it that my husband should be working so hard when he’s supposed to be enjoying some time off before delving into his next thing?  And furthermore, while it’s been a few years since I was an athlete, I am (was) still an active person.  Sure, I haven’t skated 50k inline races or tackled trail races up Mt. Diablo (17 miles up and down a mountain) for a while, yet I had the goal of getting back to regular running this summer when things slowed down, and regardless of the day, walked a couple miles with Stella every morning.  But that is no longer, and I may not be doing that for many months to come.  It’s simply shocking as is most acute tragedy, I’m sure.  One really doesn’t know from any moment to the next what will happen.

And what about my work?  I’m a corporate trainer spending much of my time on-site in front of an audience.  Hopping from table to table during breakout sessions.   Up and down and all around.  Carrying loads of supplies and bursting with energy on my feet.  I work for myself.  There’s no disability for the self-employed.  No work = no pay.

While it used to be a joy to hit the hay, now each night, I have to build courage to go to bed to face the battle between comfort and my boot.  I am unfortunately a very light sleeper.  Admittedly, I went back on the pain meds a few nights ago, because I needed sleep so badly.  Finding a comfortable position with this boot is challenging.  I feel sharp pains around the incisions and screws, numbing in my toes, poking, pulling, tearing, searing, aches on my heel.  The pain meds definitely help, yet I’ve begun to back off again starting last night.  Somehow I need to figure out how to be with this, because I’ve learned I can expect to have this discomfort for a long while.  I don’t think I’ve had one moment since this ordeal in which I was unaware of my discomfort – even that morning after surgery when I felt the best.  It seems like there is very little escape from it.

Many mornings seem just as challenging as bedtime, because I have to get up and face my day.  Folks are saying, ‘Four months, it’ll fly by’.  I know those words come from good intentions and are meant to ease my pain, yet sit on my couch day after day and try to focus through the agony of this situation and share that sentiment.  Sadly, turns out this thing will last longer than four months. Rationalizations from others just don’t work at the moment. Not now. Not yet. Not at this very moment.  Just acknowledge my situation with me, and that will help it dissipate much more quickly than dismissing it.  I realize that one day I will look upon this time with great relief and think, ‘I guess that really wasn’t so bad’.  For now, at this very moment, it’s a challenge.  And yes the challenge now is a bit less than it was three weeks ago, so I get it.  I can see how this whole ‘time heals all wounds’ thing works.  And I have certainly been there with other painful or grief-ridden events.  It’s just…for now…theory and reality are not aligned.

Why Me? And Other Tough, Whiny, Anxiety-ridden, Bitchy, Questions

Sometimes I have a big ole WHY ME pity party and the different parts of myself and I cry together in persecution.  There are some folks in my life who think that perhaps my veganism has diminished my bone density and lead to this demise.  That is absurd. One thing I can make clear, my calcium levels are very good, not that I have to defend the healthiest diet on the planet.  Almost everything I eat throughout the day has calcium in it, and I am not lacking vitamins.  My last blood test showed my calcium on the ‘high’ end of the standard range, and the only thing that might have been low (but still in the acceptable range) was Vitamin D.  This goes for most people.  And of course, I have since learned that this fracture has little-to-nothing to do with bone density and is simply a fracture from torque (as opposed to impact). And I suspect the order of events began with the dislocated talus rendering my ligaments unable to hold muscles which were unable to hold the bones. If anything, this injury is a result of my placing a priority of work over exercise.  And now that I know weak muscles can wreak this kind of havoc on my body, those priorities are going to change.

I have read that folks who have issues with ankle spraining are more prone to ankle fractures.  Turns out I have had a lifetime of ankle sprains and rolls.  I estimate about once a year I sprain or slightly roll an ankle.  I’ve grown so accustomed to it and for the most part they have been so mild. In some instances, I used to RICE:  Rest (R), Ice (I), Compress with a tight sock (C) and Elevate (E). In other instances, I just dealt and did nothing.  They recover, and I move on.  Perhaps I have not treated them properly enough or taken them seriously enough.  A shout out to those of you who are also prone to ankle sprains, do some research on strengthening those ligaments and perhaps check in with a PT about how to avoid a future ankle fracture.  Tanya at the OS office told us that 80% of the ankle fractures they see are from regular folk like us taking one bad step.

There is one other thing that I have not yet mentioned:  I was wearing two different shoes on that day.  And while both shoes were sturdy and both were the same height, it might have been a contributing factor even though some experts don’t think so.  And why was I wearing two different shoes you ask?  This is embarrassing and a clear sign of my acute sensitivity and complete disregard for fashion…so a couple times a year I treat myself to a pedicure.  July 1 was one of those times.  I mean, a real pedicure at a real place that brings a bowl of hot water dressed with orange peels, garden roses and essential oils to soak my feet.  This was not a cheapo $12 in and out the door kind of place where you wonder if the pedicurist is talking about you to her friends.  It was like a spa kind of place.  Well, I told my pedicurist that I like to have my toenails very short, because they grow fast.  She took me seriously and cut the first toe (the big one on the left foot) so low that it was below the pink part.  Ya know, the underneath part of your nail that is not to be exposed.  For two days I couldn’t touch that toe to anything. I couldn’t wear a sock or even have the bed sheet touch it.  It didn’t hurt, it simply skeeved me out.  That evening, July 3, was cool here in Santa Cruz.  I had been wearing my hiking sandals all day (to keep my left toe exposed and unskeeved) but decided I needed to wear something warmer on the other foot.  Thus I put on a sock and a walking sneaker.  Granted, I don’t know if the shoe-thing contributed, because the foot I first twisted was the one with the walking sneaker and besides my Chaco sandals are very sturdy.  They’re made for hiking and being in water.  Needless to say, I no longer feel that irritation on my big toe.  I will never truly know the answer to the question:  What’s the most expensive pedicure you ever received?

Other questions I hear myself asking:  What about when I do start walking?  What if I slip and it happens all over again?   Is it possible to get a Trimalleolar on the same ankle twice? What about my other ankle?  Could it happen to that one too?  What about Scott or other people I love?  What if this happens to them?  Will I ever run again?  Will I regain my confidence?  Will I regain a ‘normal’ life?  Will I have the strength and fortitude to make the best of this situation, to face the next several months?  Did I get a good OS?  How do I keep my incisions from getting infected when there is nothing protecting them but this boot that I wear 24/7?   Will my atrophied muscles build back up?  Why don’t I have an appetite? Will I be able to successfully complete physical therapy?  When does it stop hurting?  Will I be profiled and patted down in airports for buzzing through security with all this metal in my body?  Why am I getting anxiety attacks?  Will I be able to look back at this time without fear or PTSD?  Who am I?

I know.  Enough of the bitching and whining already and pull up my bootstraps.  Well, it just so happens I have a boot and while the straps have Velcro, I can kind of pull them up.  Unfortunately, these boots are not made for walking.

A Focus on Healing and Making the Best of a YUCK (You Understand Crap, Kid) Situation

Now, three weeks and one day from TF (Trimalleolar Fracture) day, I have to focus my energy on healing.  A couple days ago, I had a fabulous conversation with a highly skilled PT who was trained at the Mayo Clinic.  His name is Dan Vold (best friends with my friend and colleague, Bob), and he told it to me straight and explained in greater detail the technical aspects of my situation.  I can expect to bear weight in 8-12 weeks post surgery and begin walking in about 4 months.  I can expect to be walking without assistance or a limp in nine months.  Dan also suggested I get a knee scooter which I will do as soon as I have my right ankle sprain healed properly.

I do believe the pain is subsiding and while I still feel those zinging shots of pain around my incisions and the plate/screws (almost like little electrical jolts), and while my toes for the most part have to be wiggled constantly in order to prevent them from feeling like they’re falling asleep, and while I need to keep the foot elevated thus it begins to feel very heavy and throb, I really do believe things are getting better. For one, my ‘severely sprained ankle’ can hold all of my weight without wobbling and shaking.  I have learned to go to the bathroom and put on pants while holding my left leg in the air.

For folks who have taken too many NSAIDs and worry about leaky gut or get sick on narcotics, an alternative to pain meds is Metagenics Kaprex. This will also help with inflammation.
Do not expect it to be as efficient as the narcotics, but it will be a whole lot gentler on your body.  

– Food
I am eating three times a day even if I don’t feel like it.  My focus is on bone healing, and the good news is that many of the foods I like and that are already good for bones, are foods I eat regularly:  Kale, lentils, almonds, beans, chickpeas, whole grains and apples.

– Water
I drink lots of it. All day long.  And yes, while it may mean an extra trip or two to the bathroom, which can be such a hassle, I still do it.  Caffeine is a goner now too, as I’ve recently learned it’s not good for bone growth.

– PMA
I’m fully aware that my positive mental attitude plays a vital role to healing.  I am working on it when I have the energy.  On the same token, I let myself have those down moments, because I know if I resist the anger, sadness and fear, they will only grow larger.  I have never seen myself as part of the ‘norm’.   I don’t mean that in an arrogant or self-effacing way.  I have simply had the belief that 1) there are always options despite the difficulty of a problem and 2) I believe in the healing power of the mind.  So if normal means beginning to walk within 4 months, I envision myself walking before that.  If normal means walking without a limp or pain in nine months, it will be less than that for me.  If normal means swelling for the rest of my life, that is absolutely not an option for me.  I will be one of the success stories. I’ve already made up my mind. There is no other option.  Hmm….now…where again did I place the courage to help me meet that goal?

-Prescription for perspective

A dear friend and physician, Dr. Anteneh Roba, of the International Fund for Africa, gave me a dose of perspective today.  He takes groups of doctors and nurses to small villages in Ethiopia to administer healthcare to folks who may never otherwise receive it.  Here’s what he shared:

On my medical mission in March, I saw a young man who fell three months before and broke his hip, he lives in a small village in the middle of nowhere, the nearest hospital is 100 km away and they don’t perform surgery. He fell 3 months prior to seeing us with no pain meds whatsoever hobbling on one foot for three months with a hip fracture. When I saw him he was wincing in pain. Imagine the kind of pain he is in everyday with no chance of being treated. Condemned to hobble around for the rest of his life. The only thing I could do is give him Motrin.

Surely, I am not experiencing pain in isolation.   And perhaps you, the reader, has no clue about my particular experience with this particular injury.  Yet I know any person reading this sentence right now knows pain.   Just as you know healing.  Just as you know about the inner strength that somehow emerges even when you’re feeling weak, tired or ill.  I realize I will need to muster up some courage and find that strength lurking in the recesses of my soul and then share it with my psyche. I realize I have to deal with the existential element of this situation and overcome the fear about how one instant can dramatically change a life, and it’s not always bad, permanent or depressing.

-Where’s the opportunity?

And perhaps it is time for me to work more toward the change I’ve been talking about for years.  Writing and painting have played major roles in my life – in the past.  And while painting currently feels out of the question (too much up and down getting materials, cleaning brushes, etc), writing is a possibility given my new immobility and small laptop.  I have my new kids book coming out September 15 and since Scott and I won’t be taking that campervan trip up the coast to Vancouver that month as we had planned, perhaps I need to work on another book.  Just the other day an idea came to me…

– Dealing with the present

In the meantime, I will try my best to focus on the work I have and work toward becoming an armchair marketer for my book, and I certainly welcome any assistance anyone can offer in getting the word out to your local bookstores for ordering it.  Ironically, the book is called Well Earth Well MeFunny, given my current state of wellness.

First day out in the hood…the sun did wonders to my spirit.

If there are any immediate lessons, they are to cherish any good health you have, embrace the love that surrounds you, and be present.  I feel very blessed with the love and support that have been offered to us.  Oh, and if there’s another lesson in this… watch your step!

Today, Scott and I took the wheelchair down the street.  It was good and refreshing to see some of our sweet neighbors, to move around a bit, and get some sun.  Physical therapy begins next week…looking forward to that milestone.

To see all the  posts in the trimalleolar series, click away!  Things DO get better!

This is Post #1 Me and My Trimalleolar:  A Life-Changing Tripulation
Post #2 Me and My Trimalleolar:  Transcending the Funk
Post #3 Me and My Trimalleolar:  Tiny Bubbles of Progress
Post #4 Me and My Trimalleolar:  A Healing Ankle
Post #5 Me and My Trimalleolar:  Talus All About It
Post #6 Me and My Trimalleolar:  A Week of Firsts
Post #7 Me and My Trimalleolar:  Cast of Characters
Post #8 Me and My Trimalleolar:  9 1/2 weeks…
Post #9 Me and My Trimalleolar:  The Screw, Some Scars, and a Busted Uvula
Post #10  Me and M Trimalleolar:  Walk a Mile in My Screws
Post #11 Me and My Trimalleolar:  11 Months and Moving Right Along
Post #12:  Me and My Trimalleolar Go to Mexico…with my husband and our pooch