Thursday, June 13, 2013

Timeline of Recovery from A Trimalleolar Ankle Fracture

When I broke my left ankle in three places last January, I did plenty of internet research. Like all good nerds, when faced with a new and frightening situation my default mode is to gather information. I found plenty of excellent information, particularly from the American College of Orthopedic Surgeons. But what I couldn’t find, and rather desperately wanted, was a sense of what to expect at what time during my recovery. Instead I found plenty of people writing about how they still limped years later or otherwise had problems. I did find one very upbeat, positive writer from Hawai’i  who talked about completely recovering over an 18 - 24 month period, which is what my orthopedic surgeon had said to me during the first visit. But I wanted dates, times, milestones – some kind of map for this new and unexpected journey. I never found one, so I am writing one now.

Acute Injury and Surgical Repair

26 Jan 2013: My husband and I decided to go ice-skating for our date night. It seemed both wholesome and romantic. I had visions of us gliding around the ice hand in hand. In reality I was on the ice for less than 5 minutes when I fell, badly, and was unable to stand up again. I don’t recall the actual injury much and I wasn’t in extreme pain afterwards, although I knew I couldn’t stand on my left ankle. My husband helped me hop to the car and off to urgent care we went. I was honestly quite surprised when the doctor told me my ankle was badly broken. The nurse splinted it up for me and they sent me home with crutches, painkillers and a referral to orthopedics for Monday morning. I iced it and went to bed.

28 Jan 2013: My first orthopedic appointment. My ankle was too badly swollen at this point for the doctor to operate, so she set it back in alignment in the office (ouch, ouch, ouch) and splinted it a little more thoroughly and sent me home to elevate and ice for the next week to get the swelling down. I was told not to put any weight on the ankle for at least 6 weeks after surgery and believe me, I had absolutely no desire to do so. My husband and I decided to buy a knee scooter from Amazon (our insurance didn’t cover one, although it covered everything else) because I felt very unsteady on the crutches. I started writing online for something to do while I was stuck on the couch.

31 Jan 2013: The knee scooter arrived! I could now get around our one story apartment relatively easily, which was a huge relief. We taught our two year old daughter not to touch Mommy’s “boo boo foot.”

4 Feb 2013: I had surgery to repair the fracture, which required a screw on the tibia (bone on the inside) of my ankle and a plate and multiple screws across the fibula (bone on the outside, which was cracked clean through and misaligned). My doctor resplinted me after the surgery and sent me home. I had the surgery under general anesthesia which I would not recommend; I was extremely ill afterwards. I had requested an option for local anesthesia and sedation but the anesthesiologist talked me out of it. I should have stuck with my own instincts because I threw up multiple times that evening and felt groggy and out of it for about 48 hours. The surgery itself caused quite a bit more pain than the actual fracture and I needed pain medication every 4 hours for about five days and then about every six hours for another 5 days or so. I did try to do some ear based acupuncture on myself but found that I couldn’t place the needles properly by feel or using  mirror. I noticed that the pain was consistently much worse at night than during the day, which accords with what other people have told me about pain. My mother and brother in law both came to stay with us in the first week after surgery to help my husband as he cared for both a toddler and his invalid wife.

15 Feb 2013: I took my last dose of narcotic pain medication, after this point all I have ever needed was Tylenol.

Early Recovery

22 Feb 2013: I had my post-op follow-up appointment (with a different orthopedic surgeon as mine had the flu) and the heavy splint was removed. I was put in a hard plastic CAM walker (although no walking yet for me!) that I could remove to shower, which was a huge relief. I did still need to sleep in the CAM walker. My leg had all kinds of multicolored bruises all over it, from the injury, the surgery and from the pressure of the splint on my leg. I also still had ink and betadine from the surgery. Bleah. But at least I could wash my leg now!

25 Feb 2013: I returned to work after 4 weeks away, although I took it pretty easy the first week and focused on administrative projects. My coworkers kindly helped me out as I was still unable to bear weight and was getting around on my scooter. My husband and daughter took me to and from work every day because I couldn’t stand alone to get the scooter in and out of the car.

8 Mar 2013: I was able to actually go down to the ED on my scooter and see a patient there, which felt like a huge personal victory. It was amazing to feel that sense of capability and confidence again as I did the work I care so much about. I received a lot of sympathy and condolences from the staff in the ED too, an added perk.

15 Mar 2013: BIG milestone – able to walk again with my left foot in the CAM walker for support and protection. My orthopedic surgeon was pleased with the x-rays and stated everything was in alignment and healing well. So I was able to put weight on my foot for the first time in about 7 weeks, but only in the CAM walker. "No unprotected weight bearing!" said my surgeon. I needed crutches and walking definitely hurt. I had to concentrate on putting my ankle firmly on the ground because I had been focusing on keeping it up and off the ground for the past month and a half. Once I started walking though I made pretty rapid progress, moving rapidly from needing two crutches and going only short distances to taking longer walks to needing only one crutch.

18 Mar 2013: I drove myself to work for the first time since my ankle fracture. My mother had kindly swapped cars with me (my husband and I both drive manual transmission cars but she has an automatic transmission car she let us use) so that I could drive. It was amazingly liberating but I did miss the extra time with my family. I know my husband was relieved.

21 Mar 2013: Off crutches! I was able to walk in the CAM walker without any other supports. It was amazingly freeing to be able to move around and hold things in my hands at the same time. I actually enjoyed helping my husband tidy up our house that evening, moving fairly easily from room to room. My ankle did get tired easily and I often needed Tylenol after a long day, but at this point I had very little pain. The CAM walker had a slightly rounded bottom that rocked with my steps which allowed a fairly normal motion, and I made sure to wear a thick soled shoe on my right foot to keep my leg lengths even.

22 Mar 2013: First visit with physical therapy. At this point it was just stretching and some resistance band strengthening. I was shocked at how stiff my ankle had become and how limited my range of motion was. It was a little frightening, honestly. But it came back fairly quickly over the next 6 weeks and I progressed rapidly through the different strengths of resistance bands. I was very faithful about my physical therapy, doing my exercises at least twice and sometimes three times a day.

25 Mar 2013: Ooops… I took a few steps without the cast. I was getting into the shower and honestly I just forgot. It didn’t hurt although my ankle was terribly stiff. Shhhh… don’t tell on me… I did try very hard throughout this process to respect the limitations set by my doctor.

20 Apr 2013: My husband, daughter and I went for a hike on the Maryland side of Great Falls (an awesome cascade of rapids and waterfalls just west of Washington D.C. – well worth seeing if you are ever in the area). We walked for about 2 miles on the C&O Canal Towpath, which is a fairly level but graveled surface and I did well. I was proud of myself, although I attracted more attention than I wanted due to the CAM walker.

Late Recovery

26 Apr 2013: My third post-op visit and I am cleared to walk without the CAM walker! Still no running or jumping and I did need to use a supportive lace up brace recommended by my physical therapist. My physical therapy moved to standing single leg raises, standing calf stretches and balance exercises. I couldn’t balance on my left ankle at all (not even for 1-2 seconds) when I first came out of the CAM walker. My ankle was also very stiff and I actually was limping more and having more pain than I had a week previous.

3 May 2013: Even more physical therapy! I started doing a cross-over walk called cariola, lateral lunges, marching on an unstable surface, more single leg raises and more balance exercises. My exercise pattern shifted to a single longer period once a day, but I continued to be faithful about doing the exercises and again I saw pretty rapid improvement.

5 May 2013: I drove a manual transmission car (my husband’s) for the first time since my fracture. No problems.

7 May 2013: I was able to do yoga for the first time since my fracture. I kept it simple with a few rounds of sun salutations and moon salutations. It felt really, really good to move again.

10 May 2013: We drove down to my mom’s house to switch cars back.

12 May 2013: I stopped needing the lace up brace and was able to get around fine without it, although I still tired easily, had a limp, and experienced more pain than I had experienced in the CAM walker. The pain was not severe but did require Tylenol at times. At times I would get a deep pain in my left leg that meant I needed to stop and rest for a while.

13 May 2013: I was able to drive my own car to work again, which felt great.

16-24 May 2013: We travelled to San Francisco for work related conferences and stayed in a two story apartment. I was able to manage the stairs although I did hold on to the railing carefully, and when I was tired I stepped down without alternating feet, so that my good leg did all the bending and weight supporting. This was a very active trip, since I was walking to public transit each morning and then walking from public transit to the conference sites and then walking around the conferences. Plus doing some fun touristy things in the evenings, including an extended walk on the beach. All in all it went very well although I did have pain at times and I did limp more during the trip due to the increased activity. I noticed that carrying my toddler (piggyback is her preferred method) was a pretty sure way to ensure that my ankle would hurt, which makes sense, since she adds about 30 pounds of weight.

28 May 2013: I was able to balance on my left ankle for 30 seconds during physical therapy! My therapist moved me up to more challenging balance exercises including standing on my left leg while tapping targets with my right toes and throwing and catching a ball while standing on my left leg.

7 June 2013: Fourth and final orthopedics visit. My surgeon said she couldn’t even see the fracture lines and that I should have the hardware in for at least a year, but that if bothered me after a year she would take it out. I told her that it wasn’t bothering me yet and that no offense but I wasn’t eager to have more surgery. She laughed and told me I was released from all restrictions although she cautioned me to be reasonable and careful in returning to running. My physical therapist was more directive, telling me to practice walking quickly before I tried running and to start running in short intervals (15-30 seconds) when I did start.

13 June 2013: Today I was able to jog for a few short intervals (probably 15 seconds, about 50 steps) for a few times during my walk. I’m trying to walk 30-40 minutes daily, and although I can’t get walk faster than 3.3 mph right now without pain the jogging actually didn’t bother me at all. I can walk for about 2 miles at a stretch. I rarely have any pain in my ankle and when I do usually a few minutes of rest will take care of it. The screws in my ankle are not painful although I do feel them if I sit cross legged on a hard surface. My ankle still gets stiff especially after I’ve been sitting for a while. I don’t have full range of motion compared to the other ankle but I am not functionally limited. I can do stairs with alternating legs although I do hold on to the railing for balance. I expect to be released from physical therapy at my appointment next week. At this point, almost 19 weeks after surgery and 20 weeks after my ice skating accident, I feel that I am about 95% recovered and I am confident that I will continue to improve over the next few months. I am looking forward to a busy, active summer including biking, walking, jogging, and moving to a new house.

As I have written in other places, I think that the key factors in my recovery were: 1) Following my doctor’s and physical therapist’s instructions faithfully at all times 2) Basic good health and high activity level before my accident and 3) prayers and loving support from family and friends. I also made an effort to increase my protein intake during the healing period and to take a good multivitamin, a Vit D supplement (on instruction from my primary care doctor), an omega-3 capsule and a calcium supplement while my bones were mending.

So there you have it. If you are unfortunate enough to share this injury with me, I hope this timeline will help and encourage you. Contrary to some of the bleaker reports you might read on the internet, I have made a good, thorough and rapid recovery. You can too.

I wrote another entry on 27 Jan 2014, one year post-injury. You can find it here : One Year Update