Sunday, December 15, 2013

Peroneal Tendon Surgery: Injury and Recovery

For the past few months I have been dealing with an ankle injury.  Way back on September 8th of this year, I simply got up off the couch, took a few steps, rolled over on my ankle and just like that I did some real damage to it.  We had neighbors over to the house that Sunday afternoon.  The sound that accompanied this injury was loud.  I actually passed out from the pain and my husband called 911.  I went to the ER where I had x-rays, received pain meds, got a prescription for more meds, and was given a pair of crutches.  I was told it was a grade 1 or 1.5 sprain.  There are 3 grades of sprains, with 3 being the worst.

after the injury - September 2013

A friend who had recently suffered a foot/ankle injury herself strongly recommended I see an Orthopedic Surgeon to be sure there wasn't anything else going on.  I was able to get in with her doctor a couple weeks later, which was great considering the doctor in the ER had told me to see an Orthopedic Surgeon if I wasn't feeling better after a few weeks.  Imagine the wait for an appointment after waiting til I wasn't feeling back to normal after a few weeks of this!

my friend and I together at church

I saw the Orthopedic Surgeon on September 16th, just 8 days following my injury.  He did more x-rays {different than the ones the ER had done}.  He agreed it was a bad sprain, but probably closer to a grade 3 than the 1 or 1.5 that the ER doctor had told me.  He put me in one of those lovely black walking boots and gave me a soft splint to use a little further down the road to recovery.  He set me up with a physical therapist and I began therapy right away.  He also got me set up with a follow up appointment with him for October 30th.  By this time, he hoped I'd be in the soft splint and off crutches.

On September 30th, I landed back in the hospital with a massive pulmonary embolism {PE}.  Yes, I'd been more immobile than normal because of this injury, but not bed-ridden.  I hadn't had surgery.  There was no major fracture.  Yes, it was a bad sprain, the doctors {including the Orthopedic Surgeon who I contacted as soon as I was home from the hospital} were amazed that a PE happened at all.  I've been worked up for all kinds of clotting disorders and there's nothing wrong in that area.  It is a giant mystery.  That said, when talking to the surgeon, he wasn't entirely impressed with the progress I'd made up to that point.  Things were improving, surely.  The swelling was coming way down but there was no way at this rate I'd be getting into the soft splint and off crutches anytime soon.  He went ahead and ordered an MRI on my ankle.  I had this on October 16th.  

Had it not been for the pulmonary embolism, I would likely not have gotten an MRI until after the scheduled follow up visit with the Orthopedic Surgeon on October 30th.  It was perfect timing.  By the time I saw him, he had gotten the results of the MRI - and they weren't good.  A bad sprain is one thing.  In time and with therapy, it would improve.  However, I had torn the peroneal tendon.  The type of injury I had is not likely {at all} to repair itself over time.  Surgery was indicated to repair this tendon as well as to tighten up a couple ligaments.  The cause of this injury was likely the result of having rolled over on my ankle several times over the course of my life.  This was just one time too many.  I know I roll over on my right ankle a lot.  In fact, I'd done it as recently as during the summer, after which time I had my chiropractor working on it.  That wasn't going to work.

Surgery was set for November 21st, pending consent from my Pulmonologist and Hematologist because of the massive pulmonary embolism I'd just had at the end of September.  A surgery with that in my recent history would be pretty risky.  I was called in to the Hematologist's office on November 11th - just 10 days from surgery - only to find out that the 21st was too soon for his liking.  He definitely wanted me to have the surgery based on the injury and the pain I was in, but felt that it was too risky being done within the first 8 weeks of having had the PE.  He would prefer if I waited until after the first week of December for the surgery.  

I had the surgery rescheduled.  The earliest date was December 12th.  With the pain I've been in with the injury, that just seemed like a horribly long time to wait, but in truth it passed by relatively quickly.  While I waited for the 12th to come along, the pain actually was growing worse once again.  By this point, I was in the soft splint and was not using crutches.  I was hobbling along ok but not without a lot of pain.  By the time December 12th came, I was actually back to wearing the walking boot a lot of the time because I just felt like I needed that extra support.

December 12th finally arrived on Thursday of last week!  I was not at all afraid of the surgery.  I was anxious to get it going.  I just wanted to be on the other side of the surgery so I could truly get on the road to recovery.  My surgery was scheduled for 2:30pm, but had been moved up by thirty minutes, twice, so it was to be at 1:30pm with an arrival time at the hospital of 11:30am that morning.  I had strict instructions on how to handle my blood thinners prior to and after surgery.  Consents had been sent to the Orthopedic Surgeon.  I was anxious to just get this going.  The surgeon seemed to be running long that day, so it turned out the surgery was going to happen at close to the original time anyway.  No big deal.  I had to fast after midnight {nothing at all to eat or drink}, but actually hadn't had anything since about 6:30/7:00pm the night before so I was hungry.  I was ready to be put under so I didn't have to hear my stomach growling!

getting prepped for surgery

The time finally came.  I got some Versed to relax me and we headed out the door into the hallway.  Ron said his goodbyes and went back out to the waiting room.  As soon as he was gone, we stopped right where we were in the hallway.  No consent from the Hematologist in the hospital file.  What?  Really?  There was a few minute delay there before I was wheeled back to the room I'd just left.  The guy in the room next to me wound up being swapped with me.  He went to surgery and I stayed behind.  Prior to the surgeon going in with that guy, I did hear him on the phone talking to my Hematologist {on speaker phone}.  Long story short, they now at least had a verbal and were awaiting a fax.  I don't know if the previous consent expired or what the story was, but they didn't have what they needed in my file and they couldn't proceed without it!

At 4:35pm I was finally moving in to the OR.  They'd already given me some Versed so for the next couple hours or so I'd been feeling sleepy but was not "out".  I remember the OR and some of the details from before the surgeon came in.  I remember being told to take a couple deep breaths.  Next thing I know, I'm in recovery at about 5:50pm and in pain.  I was home by about 7:00pm or so that night.

The surgery went well.  I am now in this really bulky soft cast until I see the Orthopedic Surgeon for a followup on December 27th.  It weighs a ton!!

When I got home, the pain wasn't so horrible.  Ron got me situated and then went back out to get my prescriptions filled.  I was in and out of sleep through the night.  By morning, I was in so much pain I couldn't bear it.  It was getting worse.  I had Ron call the surgeon's office first thing Friday morning because the pain meds just weren't working well enough.  He left another message or two during the day and finally spoke with someone at about 4:00pm Friday.  Let me tell you this.  It is not fun at all to be in that much pain for that long with no one returning your calls!!  What I thought was "bad pain" first thing in the morning was nothing compared to what it felt like by 4:00.  I was in tears and shaking.  It was horrible.  In fact, I think I'd have done just about anything to not have to get up to use the bathroom by that point.  There's something about standing up and the blood rushing to that extremity that causes a lot of pain as it is.

Once Ron was able to speak to someone {the doctor had been in surgery all day}, they determined that the dose I had for my pain meds was ok - it's pretty high - but that the timing needed to be adjusted.  I'm in such a fog it's been really difficult to keep everything straight.  However, by Friday night I was feeling some improvement finally.  Saturday morning was a little better.  I had some more painful times on Saturday earlier in the day, but by Saturday evening it was even better.  That said, the pain is pretty significant, but compared to what I was going through all day Friday, it's nothing!

My sleep schedule is way off now as a result of being in and out of sleep for a couple days.  I am trying to get myself moving every hour or so.  There is great concern regarding a recurrence of the pulmonary embolism even though I am on blood thinners.  As much as I want to lay in bed, I have to get moving.  No weight-bearing at all on that foot, but moving nonetheless.  Even if it's just to the bathroom and back.  I've also been experiencing nausea since I got home.  I have meds for that too.

I'm told that the first 24-72 hours is the worst.  I believe it.  I believe the worst is behind me and I believe I'll be feeling significantly better each day from here on out.  And so, here I am on this side of the surgery - the side that has me on the true road to recovery.  

I am grateful!

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