Tuesday, April 10, 2012

Cut and Run (eventually)

New minimal footwear. Open splint to allow for swelling.
Diabetics do get all of the perks. I was scheduled as the first surgery of the day. We had to arrive by 5:45 for delousing and trussing. Surgery was scheduled for 7:15. Going into a peroneus repair on the MRIs findings leaves a lot to be discovered. I always imagined the MRI to show your leg in layers with the skin out of the way, a Gustave Corbert Realist rendition of damaged soft tissue against a dramatic back drop of rigid bone. Turns out its a van Gogh at best. The pretty swirls of the image indicated a torn brevis and a very rare longus tear. The surgeon considers the picture, manipulates the joint, reads a tea leaf and decides the leg warrants an up close look through surgery. My best case scenario was a tear with less than 50% of the tendon material compromised. The fix in this case results in the loss of some material, but leaves the patient with refurbished original equipment, instead of Abel Magwitch's recycled tendon. And as Dan Bedard noted, if you get some wronged prisoners cadaver pieces you may have to spend half of your time seeking the ligament's revenge. That only results in future PRs if the revenge is sought on another runner in my age group who is ahead of me.

Me on my way to the Chicago meatpacking
I arrived on a full fast from the night before. I was able to talk the anesthesiologist out of placing me on an insulin drip since the surgery was scheduled for just under an hour. She did make me suspend my pump because of a recent FDA advisory citing insulin mis-deliveries in the OR. Penny suspended insulin delivery as they wheeled me out and I delivered a last bolus of 1.15 U. My BS was 109. I figured with the stress and my normal delivery of .6 U per hour I would error on the conservative side. High blood sugars hinder healing both in the long term and the immediate, but I did not want a hypoglycemic episode on the table. It worked out pretty well, when I was revived I was showing 135. I bolused 1 unit and resumed basal delivery with Penny's help and never went over 140 for the day. Duke had a very modern outlook on blood sugar control. I was very pleased with their approach. They allowed me to keep control as much as a Propranolol connoisseur can expect.

Toes above nose for a minimum 4 days.
Now the great news. Dr. Nunley announced just one tear in the brevis a little over 3 cm long. The longus tear on the MRI was an artifact. They were able to excise (the power of the scalpel compels you) the debris in the brevis and sew it back together. A textbook case similar to the link in my last post. I will not hyperlink it here as some of you may have already eaten today. We hope that this will return the ankle stability and alleviate the tendon pain. The bad news, longitudinal tendon tears and repairs heal from outside in. No matter the length, the recovery time remains the same. Good to remember that a cadaver tendon anchored to a damaged longus would have taken years to recover from and would have left me with limping zombie speed.

Cute compared to Telly Savalas.
The day went pretty well. I slept off and on and evaluated myself as a real tough warrior. Everyone was crying on the internet about the painful recovery for this surgery. Piece of cake. I was peeing off of one leg and climbing the house steps (not at the same time) without any pain. I thought the oxycodone script was part of Duke's recreational outreach drug program. No nausea. I ate 4 crackers as a stomach test for lunch and then a corn beef brisket, cabbage and carrots for 2nd lunch. At this speed of recovery I figure I will be back at work tomorrow (despite the open splint) and running by Friday. I have left the foot constantly elevated and so far have little swelling.

High minded piggies.
7PM. Block on my left leg wore off. Enter PAIN upstage right, center, left, downstage, Every Which Way But Loose. If you are recovering from any repair that requires a block on the nerve, baby that leg until the block wears off. I took my first pain pill near 5 pm in an attempt to stave off the discomfort I was warned about. Everyone says stay ahead of the pain. By 3 AM I threw out conservative and upped my oxy dose to the full 10 mg per serving. I started with 400 mg of ibuprofen. 11 PM to 3 AM was pretty bad. Think angry hornets nesting in your bone. I finally fell asleep around 3. I am still pleased I opted for the repair, but not as cocky with the pain threshold as I was originally. I think it still hurts as badly, but as Penny pointed out, when the block wore off I went from 0 to ouch pretty quickly. You become used to the pain load and it is now more background than shock. The internet forewarns the horrors of day 3 and then slow improvement. I will see. Less than 11 months till Umstead Trail Marathon 2013. I am hoping for a pink shirt with a native Umstead flamingo standing on one leg.

co-author OxyCodone HCL


  1. Glad you made out with just the brevis tear. I look forward to following your recovery. When do you start PT?

    1. Thanks Andrew. PT starts after I get into a boot. Hopefully, within 6 weeks.

  2. I feel your pain brother! Don't be afraid to take the full dose of oxy. You have that script for a reason. The pain will settle down in a few days, but just try to sleep a lot in the meantime (the oxy helps with that).

    1. I wish I could give these Oxy's to my 21 year old self! I appreciated your thought to save some for PT.

  3. "Trussing." Love it. (That you said it... not the actual process of being trussed.)

    1. I trust that tight trussing takes terrible tolls.