PICTURES AT 11! CHAPTER EIGHT

Below are photos showing how quickly I healed once I was in my walking cast at Week 6 (Note: Walking casts do not automatically mean one gets to put full weight on the new ankle...this was a gradual process that took a week or two.)  I am at Week 13 post-surgery tomorrow, and as you can see from the photos the scarring is minimal.  Dr. P. seemed extraordinarily pleased with himself when I saw him today...as he well should be!  Because I am, too.  The photos below depict Weeks 7, 8, 9 and 13, and the walking cast, from the bottom up.  

Sexy walking cast : )

Week 13 - hardly any scar left!

Week 9

Week 8

Week 7

I know everyone wants to see photos of what my ankle looked like along the way, so I’ve posted the ones I took every time they changed my cast below (ah, the wonder of phone cameras…). Depicted are Weeks 4, 5 and 6 of the healing process.

Week 6

Week 5

Week 4

The joint installation involves a lot of what looks like Home Depot hardware; the best place to learn more about the process is the manufacturer's website, which they have recently re-designed so my really cool video link doesn't work anymore, but the Patient Information is on the right side for you to explore yourself at http://www.inbone.com/.  

Once I graduated to a removable cast that I could take off to shower (which is something I REALLY looked forward to), I began using scar-reduction medication. I used a new product called “Silvion” that worked very well; they have spray-on products for post-surgical cleansing and anti-scarring and moisturization.  I can say that both work extremely well.  

THE LONG WEEKS AHEAD: CHAPTER SEVEN

I was told to expect to be on non-weight-bearing status for six weeks minimum, nine weeks maximum, which meant laying on my back in bed or sitting in a reclined position for a very long time.  While it is hard to stay entertained, I am lucky because I love to read.  I stocked up on used paperback books and kept my favorite not-terribly-challenging-or-time-consuming board game nearby so that when friends stopped by we weren’t just sitting there staring at one another after we ran out of news to share.  If you are planning to undergo any kind of surgery where you will be limited in your mobility, be sure to ask your friends, neighbors and relatives for assistance and support during this time…it’s not a sign of weakness to need help after surgery.  They all want to see you get better, right?  I know I needed help with cleaning the house, changing sheets, doing laundry, getting groceries and mail and medical supplies, caring for pets, and with transportation.  This is when I found out who my real friends are.

I borrowed a laptop from work and once I started feeling a little more alive, it was nice to be able to log-on and keep friends and loved ones up-to-date on my progress, and it makes for decent entertainment, too.  At about 7 weeks, I felt like I was going to go a little crazy from lack of brain stimulation, so I checked in with work to see how things are going...and found out I had done an admirable job of setting things up so I did not have to be there!  Anyway, other alternatives are game magazines, art supplies, whatever will amuse you quietly for a while.  Pretend you are Rapunzel and that you are going to be held hostage in that tower until the prince shows up, so you best learn to entertain yourself.

And even though I am not a tough person and tend to be on the demanding side, I tried hard not to fight, complain, or whine out loud, as experience has taught me that behaving like that repels even the most patient of souls. Like Mama taught me, I always remember to say please and thank you, and be genuinely grateful for things people did for me along the way.

FIRST POST-SURGICAL VISIT: CHAPTER SIX

After 6 long weeks, I finally got to see what had become of my leg.  I was excited and nervous, anticipating a really ugly encounter.  I wasn't disappointed.  My poor leg was crusty with yellow ick and I was appalled at the dried blood, hair growth and skinniness of my limb.  Doc said that my stitches were in a "vulnerable location," so I got to keep them longer than usual.  But that’s okay…I left with a nice, clean, new half-cast that was lighter and harder than the post-surgical one, made of fiberglass.  I asked for extra cotton padding to combat swelling pressure pain, as I was told the ice packs no longer work with a fiberglass cast (which is unfortunately true).

Here is what my leg looked like fresh out of the post-surgical cast...euwww!!

And here is what my spiffiest "designer" cast looked like:

PAIN: CHAPTER FIVE

Yes, there was pain.  It was no fun the first week/10 days, but after I got the post-surgical cast off, it got a bit better.  In fact, I observed that while I was indeed in post-surgical pain, the arthritis pain was gone. Surely that was the first noticeable good sign!

I took my meds religiously and minimized my suffering as much as possible by not allowing the meds to wear off.  Only trick is not to lose track of the dosing.  But hey, that was the only thing I really had to keep track of at the time, right?  I kept my leg up as much as possible and kept Blue Ice handy.  I also learned to choke down as small can of prune juice every morning, which made it much easier with the BMs, as pain meds tend to clog a body up in short order.  Advice about prune juice would include mixing it with pomegranate or cranberry juice to make it (almost) palatable...otherwise it tastes pretty much like dirt.

WAKING UP: CHAPTER FOUR

Don’t take morphine.  Yuck.  Take anything else they want to give you for pain but morphine WILL make you puke.  I have never hurled after surgery except for the one time I tried morphine.  Do not do it.

When I woke up, my leg was in a large, heavy post-surgical wrapping and I had it elevated as much as possible over my heart.  The sadists at the hospital would not let me eat until the next day, but I was ruthless in asking for sherbet and water and whatever other liquids they would allow me.  When the time came, I was asked if I wanted a bed pan or if I wanted to try getting up to pee the first time.  Since I was going to have to do it at home anyway, I couldn't be a wimp.  I got up and showed them that I already knew how to use an assistive device, which is something they make everyone do before they’ll let you check out.  I found that it was best to practice going potty with a little supervision at first; nurses sometime have tricks that make it easier and that you can utilize at home, like propping your injured leg up on something while you sit on the toilet.  I went home the day after surgery because hospitals are notoriously stingy with pain meds, and once you are home you can make your own schedule and avoid prolonging any visit from that old enemy, Pain. 

Once I was home and had changed into my pj’s, I suddenly become aware that the surgical team had coated my entire leg in a thick yellow sticky substance that did NOT want to wash off easily.  This is what the 91% rubbing alcohol was for, as that is the only thing I have found that works.  I had to scrub from my crotch to the top of my cast with a nice, clean, sacrificial washcloth, as this ick does not wash out of anything.

CHECKING INTO THE HOSPITAL: CHAPTER THREE

The hospital makes all surgical patients check in at O’Dark-Thirty a.m., no matter what time you are actually going under the knife.  This is so you can hurry up and wait, but I figured it was best to stake my place in line early, right?  Weird thing was, about 2 dozen other people were there that day for some sort of surgery, too.  It was like a casting call for the World’s Most Pathetic Chorus Line in that waiting room; the lady who didn’t even bother to get out of her pink bathrobe before coming in was undoubtedly the most comfortable, although I wondered what she was going to wear home.  Luckily, it got less weird after that, unless you want to count the warm-air blower they hook into the hospital gown you wear in pre-op, which I’d call kinkily pleasant.  And everything they put you in is purple.  I suspect this is to match their purple Nitrile gloves, but I digress.

Pre-op is where I finally met the entire primary cast of characters that was going to occupy my operating theater while I was unconscious, right down to the intern surgical tech.  Meeting the anesthesiologist was vital; but even more important was having my own surgeon there, marking the appropriate place to cut.  They do this with a purple marker (obviously to match their gloves).  Once that "X" was in the right spot, I could relax.  The "X" was right in the middle of the ankle joint being replaced…front and center.  I anticipated a lovely 6-8” scar at the end.  Having done this multiple times, I always ask for stitches to reduce scarring (staples being torture inside a cast).

BEFORE YOU GO IN: CHAPTER TWO

Gosh I wish I had thought of this:  For the two weeks before going in for surgery, practice with the assistive device of choice to build up appropriate muscles, and do sit-ups (if possible) to tone stomach and back muscles, as they are needed for sitting up...doing this might have helped me avoid pulling muscles and causing myself even more discomfort in my early recovery.

My ability to balance is very poor, so I was not embarrassed to choose a walker.  It is really much safer and more stable than crutches.  There is also a rolling knee walker, which I liked for trips for any length.  These can be rented or bought…your choice.  Unfortunately, anyone who rents or sells these things does not like to bill insurers…and would need to be "in network" too if you want to get your money back.  I chose comfort over financial reimbursement, and had to pay for the rental out of my own pocket.  So with that in mind, crutches and walkers can often be found at thrift stores for about five bucks…just be sure to clean whatever it with disinfectant thoroughly.  There are limits, i.e., I would NOT buy a used shower chair or raised toilet seat.  I also own a couple of canes that I've had for a while now; canes of a correct height are harder to find used, but maybe you have a friend or relative you can borrow one from.  Otherwise, it’s twenty bucks at the drug store for that piece of the puzzle.

For showering, I used a Rubbermaid step-stool, set in the tub, which put me at the correct height to perch my leg on the side of the tub and put the shower curtain over it (although I also wrapped it in a kitchen garbage bag and used blue painter’s tape to close it at the top, as that doesn’t pull your skin).  This was my $8.99 solution to the usual $30 cost of a shower chair.  It also helped to have a shower pillow or something firm on which to rest the weak knee on the side of the tub. And…I know you think you won’t need a grip bar forever, but once you get used to having one to help you step in and out of the shower, you’ll be amazed at how often you use it. 

Leg prop.  I was instructed to keep my leg up for a ridiculously long time.  Since I didn't want to permanently smoosh all my fluffy bed pillows, I got a firm back-rest pillow for maximum flexibility at lowest cost (I think mine was $10 at Ross).  Turn it on its back or front for a perfect leg prop and add or subtract bed pillows as needed.  

 Blue ice packs…I ended up with a few in different sizes.  I absolutely needed these for the first two weeks to calm swelling, which would sneak up on me like a recurring bad dream and is not solved by pain medication.  I kept one set frozen at all times, as night-time can be difficult for the first week or 10 days.  I learned to gently snug a smaller one into the open toe of my cast for maximum relief, and leave a couple of large ones under the cast, wrapped in a dish towel, most of the time.

Pain pills and antibiotics:  I am nobody's hero.  I pre-filled and was sure there were refills of the pain meds available.  I kept lots of small water bottles within reach…maintaining hydration is very important to recovery. When the pain starts in, there was no way I wanted to get up for a glass of water.

And, oh yeah, knee-high compression stockings.  I got my on-line from FootSmart.com.  It was nice to have a pair handy when the time came.

Okay, so to re-cap the list of supplies:

1.       Walker/crutches plus cane;

2.       Consider rental/purchase of knee walker;

3.       Shower stool with garbage bag big enough for your appendage and blue painter’s tape;

4.       Elevated toilet seat and/or grip bar (I have a small bathroom…I’ve installed my grip bar in lieu of a towel rack, and it helps me get up off the toilet as well as get in and out of the tub)

5.       Firm compression knee-high stockings;

6.       Pillows…you will need lots;

7.      Blue ice packs…again, buy multiples;

8.       Pain meds, antibiotics; 91% rubbing alcohol; preferred stool softener (prune juice works);

9.       Comfy, easy-to-change loungewear;

10.   Food, snacks, non-alcoholic beverages and lots of H2O.  

INTRODUCTION TO ME: CHAPTER ONE

Hi.  My name is Jackie, I am 49 years old, and I am a Wright In-Bone Total Ankle Replacement recipient. http://www.inbone.com/

I’m here because my physical therapist thinks that putting this info out there might help people who have ankle problems and do not want fusion, but aren’t sure what other options exist.  For me, I think that there are going to be a lot of “Boomers” who will need this in the not-too-far-away future, and since my experience has been a very positive one so far, I’d like to share it with others who want to know but don’t have anyone to ask.  PT Guy and I concur that it is still a fairly uncommon procedure and people are interested!  Unfortunately, kinda like a car loan, “not everyone will qualify…” but if you have an arthritic condition, especially like mine which was a result of a traumatic injury in my 30s, and consider yourself either too young or too active (or both) to get a whole lot o’ joy out of life with a permanent limp, I urge you to consult your orthopedic surgeon about the possibility this prosthesis provides.

My surgery was June 30, 2010 at Sharp Memorial Hospital in San Diego, CA.  I waited 16 years for this part to become generally available and be able to find a physician who would/could install it.  When I slipped down Sunset Cliffs on an evening fitness walk in 1994, I was assured by my first orthopedist that the ankle replacement would be available within 5 years…but the FDA works in mysterious and antiquatedly slow ways.  Fifteen years, and 5 surgeries later, my dear Dr. P. finally informed me that he could no longer keep me waiting…the part had been approved in May 2009, and he would like to begin evaluating me for replacement as soon as possible. 

Due to insurance snafus and my need to have plenty of money set aside in my FSA for such an undertaking, I opted to wait until the beginning of 2010 to start pursuing insurance approval from my group carrier.  Although initially denied, once Dr. P. clarified my need for (and determination to receive) this device to them, approval was gained and we began to try and schedule the time in surgery.  Since my doctor admitted that he was not terribly experienced in the replacement procedure yet, he asked to have an associate doctor in the Sharp system that had done several assist with my surgery, which sounded like an acceptable plan to me.  The factory rep was also going to be in there, which gave me even more security that things would go smoothly. 

If you’ve never done it before, there is a gauntlet of hoops you must navigate relating to the current state of your health before they will allow you to enter the hospital for any procedure that is not an emergency.  First there was the MRI and X-rays to get the best look available at the condition of the bone, etc.  Then there is the EKG, the blood tests, the Stop-Taking-Your-Medications Schedule (this is a good brain teaser for anyone who takes so much as a vitamin) and the half-day class at the hospital where you are orientated concerning your hospital stay and have the crap scared out of you concerning staph infections and the evil Warfarin/Coumadin they want you to take.  For me, the recommended course of blood thinners was not the right choice; you should consult your doctor as to the absolute NEED to have these administered to you at all.  Ankles are different from hips and knees.