Thursday, April 26, 2012

Report from the Funny Farm

"O snap"
Hate to have his co-pay. 
Day 16 post tendon repair. I thought I would recap the two week status. This is boring stuff, I've lost my staff photographer back to work and I am not above sprinkling in cute animal pictures. I had planned on my return to work yesterday at the onset of this adventure. The surgeon indicated 2 weeks or 3 on the outside for returning to the 

old grind. After the surgery my HR department forwarded me a return to work release. My job requires mobility and the ability to lift heavy machine parts while repairing broken behemoths. The work release is very specific on the criteria needed to return and, at the moment I don't measure up. I will not write towards specifics regarding my company on the internet without clearance, but suffice to say that the inability to get wet is a major strike against my return. Since the cast has to stay dry, rain is now a job hazard. I am weight lifting a lot, 2 days on 2 days off, upper body which I hope will help me overcome some of the mobility requirements. Of course, I am not allowed to sweat so the reps are 5 minutes apart. 

This whole experience has been bull *%#@
I hate being grounded
 I plan to pressure the doctor at my next appointment for the quickest return possible. I have been employed on and off since I was 12 and continuously since 15, excluding a brief year at college where I subsisted on college loans and Ramon Noodles. I am not cut out for this much slacking. If I could work in the yard or elliptical or even bike I would really enjoy this break. Just, please,  let me outside. Although, I imagine biking or kayaking probably negates your disability status. I had planned on making the dangerous trek to the grocery store today, but mother nature intervened with some showers so instead I shall dine on all of the mustard and jello left in the fridge. 

This cast is making me prickly.
Even an old goat can have trouble on trails.
Pain levels are great. Less than 3 winces per day now, usually when I first put my weight on the leg. Some cramping has started, mostly in the calf which I fear has all of the tone of a spaghetti noodle now. Angel Hair. A deep ache in 

the tendon area remains whenever I am out of the prone position. Fatigue levels are almost normal after 2 weeks. I am having trouble falling asleep, but I think that may be from the horrifying itching. Benedryl remains the only medication, other than insulin, I still need occasionally. Blood sugars are trending way better than I anticipated, but I continue maintaining a very low carb diet. My total daily dose of insulin is down 30%. Total daily carbohydrates under 75. That is less than 90 milliliters of Aunt Jemima syrup. I miss you most of all Aunt J. Some depression, but light. I think the loss of cardio and endorphins play an equal role with loss of mobility. So far, I think I remain ahead of the recovery timeline. I am looking most forward to a proper shower, clearance for the stationary bike and my return to work. Overall I am progressing well. I have no reason to complain, but will remain diligent in looking for one.
This is nothing but a big fat cat astrophe.

Every since I can't get my cast wet,  all I see are fire hydrants.
The medical bills are starting to roll in. I had estimated $2500 out of pocket on top of the lost wages and $1200 deductible. The insurance company is still processing my share, but I finally have the itemized bill from the doctor, hospital, anesthetist, hospital cafeteria, and MRI. Looks like a shade under $20,000. About $227.28 per minute for the 88 minute surgery. The anesthesia was almost $6000. I would highly recommend self anesthesia if you are trying to save money. Maker's Mark is only $20 per 750 mL. The hospital was also very pricey around $11,000. A clean garage, your wife's sewing kit, and a decent set of Craftsman tools could save you thousands.


Sunday, April 22, 2012

Can't Believe I Slept through this

Day 12. Today, my surgeon forwarded me the jpgs made during my tendon repair. I am usually not a huge fan of the health care system, but to date I have been really impressed by Dr. Nunley and his merry band of associates. And not just because he sent me these nasty pics. You really have to prepare yourself for appointments. He does not have a lot of time for formalities, but to date, he has answered all of my questions. I have a long way to go before I see the final product, but if you are in the market for peroneal longitudinal tear repair, at this point I would endorse Dr. Nunley & Associates at Duke. If you found this blog searching for information on peroneal repair, the most helpful site I found was a forum on Runner's World

My recovery ebbs and flows a lot. Two days ago, I announced myself fit for work. Yesterday, I tired myself out brushing my teeth. The incision pain has ceased for the most part. A throbbing emerged deep in the ankle. It shoots up the tendon occasionally, but stays isolated in the brevis area the majority of the time. A lot of weird sole pain began, which I think results from the new cast and the strange foot strike it produces. I have upped the walking around a lot and perhaps a too little quickly. My leg plans on elevation, insurance paperwork, job administration and a couple of paperbacks for the next two days. Just 12 days out from the pictures below, I think things are progressing a little ahead of schedule. 

The itch created by a fortnight's bath abstinence rivals water boarding torture interrogation techniques. I would confess the identity of D.B. Cooper and Coca Cola's secret formula for a reprieve. The benedryl tabs work wonders at relieving both the itch and consciousness, but both resume at the same time. 

Please finish digesting your breakfast before scrolling down.

This image shows the tear running longitudinally. Unfortunately, I had my eyes closed in this picture.

 A tad over 3cm. This may put me off chicken wings for awhile.

Trail running. Sometimes you reap what you sew.

The special today  is tough and a little stringy. I would recommend the sirloin instead. 


Wednesday, April 18, 2012

The Mummy Returns

So take these broken wings
And learn to fly again
And learn to live so free
-music by Mr. Mister
-performance by my surgeon's resident

Good riddance to ragged rubbish.

Day 8. My first post operative appointment. My open splint had morphed into a terrible monster; a creature feature of dishevelment and disgrace. I really wished to graduate to the latest running fad, the fiberglass cast, so I fended off my wife's best attempts to safety pin my current rags back to respectability. The original timeline called for 2 weeks in the open splint followed by stitch removal and then 4-6 weeks in a hard cast. Dr. Nunley moved my papier-mâché date up 6 days at the hospital in an attempt to protect me from me. The new plan was for a hard cast over the stitches today and then back in one week for destitch and reboot. 

The front desk tried to charge me a specialist copay, but luckily I know someone who speaks insurance. Appointments related to the original surgery are billed as part of the surgery for the first 90 days. Thanks mom! Penny and I got our callback to the casting room. Penny followed the nurse, I followed Penny, and my 4 foot bandage tail followed me to the gory unveiling. We were met in the bodyshop by the cast mechanics Mark and Mike. Abbott and Costello Meet the Mummy End Scene I.

Why so serious?
Prepping for Pupa stage. Soon I
will be a butterfly!

I was seated behind curtain #2 with Wayne Brady and a fabulous new dinette set. (Sorry overdosing on the daytime TV lately). Technician Edward Scissorhands had my leg naked faster than a college freshman can say Stawberry Boones Farm. I basked in the holy sensation of fresh air on my newly liberated leg until I saw the wreckage. Not the incision. The abhorrent, flabby, withered blob that had replaced my calf. Entombed for just over a week, my 26.2 ink now looks like a Salvador Dali tattoo etched on mashed potato. 

If you look closely you can see the Icarus wax residue on my
Hermes wings. I trailed to close the sun.
The incision itself had not completely closed, but Dr. Frankenstein pronounced it close enough. Lab assistant Igor cut the stitches out with what looked like an X-Acto knife. Penny and I thought it a bit premature and a little Abby Normal, but with a few butterfly stitches and not so much as a conjugal visit my calf was returned to its cell. Prickly heat was diagnosed from sweat inside the splint, resulting in some rather random raging red rash. In retrospect the floor exercises and nude sunbathing may have been a bad idea. Perspiration in the new hard cast is strictly prohibited, and after midnight may result in Gremlin growth. I am cleared for upper body lifting; high weight low reps, in the AC with a nice iced tea.

Prisoner ID No. 26.2. Ruled a flight risk
and danger to himself and others. Release
DENIED. Parole hearing May 7, 2012.

My new ride is a 3/4, candy apple red, fiberglass, open toed chassis, accessorized with a two inch Franken foot boot. I am allowed to stand or hobble on it to pain tolerance. The nurses indicated I should be able to stand within 2 days and walk on it with crutches in a week. I worked out the leg atrophy within 24 hours, but the open incision keeps healing to the inside of the cast making my first couple of steps lively. The underfoot height of the cast when combined with the Franken boot now measures a 4 inch drop. I was lumbering around on my right leg's tip toes like a sea sick pirate until Penny proposed a solution. I said no to the matching red stiletto, but now find myself modeling her platform flip flop down the catwalk to the kitchen. From the front my feet look like Attack of the 50 foot Woman dancing with Herman Munster. Now my left foot demands beer, bacon and beef jerky while my right foot craves Riesling and bubble baths. (Photo documentation below. Warning: may disturb Republicans.) 

Jealous much?

Hopefully the cast will make me a little more mobile. I am relieved to be able to sleep in my bed without tying my leg to the ceiling fan. I have convinced the doctor to allow me into a boot in just under 3 weeks. On May 7th, if all goes well, I will shed the cast and borrow Forrest Gump's leg brace.  At this point the most frustrating issue is skin care. I just want to bathe my leg under the knee. Helpful hint: use benadryl caplets for itching instead of coat hangers, steel wool, or puppy teeth. 

The state of NC officially recognizes me as temporarily gimpy now and has bestowed upon me the privileged parking honors associated there with. Blood sugars have been on the straight and narrow, controlled by my all meat all the time diet. I am finally mobile enough to add some greens to my diet. Yeah spinach! I discontinued the ibuprofen and am controlling pain entirely with sniveling and secret Tom Cruise Scientology rituals. Physical discomfort is down to a 3 on a 10 scale, but I can see atrophy is going to be a big challenge when I finally become booted. My weight has stayed pretty constant. I am trying to maintain my UFC Welterweight status. Currently at 156.5, I was 159 at surgery date.

Filling out insurance forms turned a 2 hour appointment into 3 hours. We were smart to review and flag all of the pages requiring doctor's entries the night before. It saved some time. Running shoe gossip with the cast constructor probably added another hour. Six years ago Mike everted where I inverted and recovered over 2 years. That injury is significantly more damaging than the one I suffered. It cheered me to see his NB minimus kicks. While my cast set he showed me his favorite running shoes on the internet. He runs now as part of his fitness program, and although he has unrelated knee issues, his ankle is sound. It was encouraging to talk with someone who had made it successfully to the other side of ankle surgery.

Please try to limit catcalls and refrain from whistling in the comment section. I'm Sexy and I know it. I work out.


Tuesday, April 17, 2012

Outing to a Wedding

Day 5 through 7.

The ruin of dogs and diabetics: Candied maple bacon cupcake.
Surgery day +5 found me stir crazy and overconfident in my abilities. With the open splint I was susceptible to rolling the ankle, sudden rainstorms, clumsiness, and determined burrowing animals. The leg had to be elevated for the first 96 hours, but after that only protected and kept dry. What better safe harbor than an outdoor wedding? Still alive when she returned from shopping yesterday, I lulled my wife/nurse/prison guard's better sense of judgement into letting me escort her to her friends wedding on Sunday. She carefully wedged me into the back of the car with pillows, bubble wrap and some fluffing. We arrived for the brief ceremony and stayed through the reception. I enjoyed the best wedding fare I have ever consumed. Although dry eyed through the ceremony, I teared up over my second plate of Backyard Bistro BBQ. It was an excellent test of my crutching abilities as I completed my 7th marathon distance from the curb to the backyard along what I estimated to be 26.2 miles of loose gravel interrupted by a few mountains and a bear or two. The sun was strong and we probably stayed an hour too long as my stamina is still quite low. I considered a few Cliff Shot Blocks for strength, but rejected them for for a Daisy Cakes candied bacon and maple wedding cupcake.  All told about a 3.5 hour excursion. Congratulations Chris and Drew. I enjoyed your nuptials almost as much as the brisket and home brew. 

Wear white to a wedding and you could get hurt.

Viewer discretion is advised. Contains
scenes that some viewers may find
Day 6-7. The strenuous half day of sitting and eating left me completely wiped. I slept almost all of day 6 away. Blood sugars were pretty constant, but I am noticing my insulin resistance is creeping up without my normal cardio routine. Day 7 was better, but more than half dedicated to napping practice. I attempted the 30+ pages of insurance paperwork and work required administration in preparation for tomorrows post operative appointment. After reviewing the work release form requirements just received from my HR department, I am a little concerned about my Doctor releasing me back after 2 weeks as promised. The document is quite specific and maybe a little out of reach for the pirate-like (1 legged). I am still shocked by my quickness toward fatigue and my bodies demand for extra sleep. Most of the pain is limited to where I think the incision was made. I cannot wait to see if my wing tattoo is clipped. Goodbye trendy ink, hello cool scarification. I hope he didn't carve it in the shape of a butterfly or a Chinese character that translates into karma or nirvana.


Saturday, April 14, 2012

Calf Hurts like Moses got to it

The chair represents the x axis: time without Oxycodene. The
side of the house represents the y axis: pain level. My leg is a
linear function of ouchiness.
Day 3 was challenging, as promised by all of the reviews I've found on the internet. Very similar to the famous bonk around mile 22 in an all out marathon, I was feeling far better than expected until I wasn't. And then I really wasn't. On a  pain scale, de uno a diez, I jumped, without warning, from 4.5 to ¡Qué demonios! I ran toward exhaustion all day and slept a good part of the day away. Fatigue has been up noticeably since the hacking, but the 72 hour mark had me zonked out. I am still olly olly Oxycodene free, relying on about 800 mg of ibuprofen per day.

I love outside this much.
I woke slowly and still tired on day 4, but with a 60 blood sugar its hard to fairly place the blame entirely on my recovery. When I finally attempted the harrowing staircase of certain death to the kitchen it felt like a good time for a nap. The carbs in a whole grapefruit and 2 liters of coffee immediately perked me up. So, probably the blood sugar. The pain is around a 5.5 (could have been better if it stuck the landing) today.

My wife's essentials kit for the single-legged. I think
she downloaded the list directly from the NRA website.

Penny had 4 days of stacked up errands to run and decided my hopping skills had advanced enough to trust me to my first solo. Also, the post-op instructions insisting on constant elevation for the first 96 hours, finally expired. Those 4 days died harder than Bruce Willis. I passed Penny's first test, successfully making my own coffee (including grinding) and grapefruit. She left me on my own with the windows open and armed with 3 remotes, my computer, sweet tarts for low blood sugars, my meter, water, an energy bar, a book, and my .40 caliber Springfield Arms XD Sub-Compact. The XD deters overly aggressive Girl scouts and their habit-forming, carbohydrate-laden, scary yummy Samoas. Shopping is Penny's favorite form of endurance exercise so I settled in for the long haul.

"Get those kids off my d*#% lawn." And yes, I am wearing a
brown crew sock and sandel on my good foot.
It was beautiful outside today. Its hard to believe I am going to be a mummy from the knee down all spring and summer. Since I was over 72 hours without pain meds and over 100 hours out from Mr. Jackson's favorite form of sleep aid (too soon?), I decided I deserved a Mich Ultra. Mysteriously enough the 6 page post operative surgery booklet is completely silent on ale consumption. Smoking is prohibited, so I denied myself the Cohiba Behike. I managed lurching to the back deck with 2 crutches, a book, a beer, my mp3 player, and a body significantly whiter than I am used to at this point in the year. Presently, I am slightly darker than the the Trix rabbit. My first time outside since Tuesday felt heavenly. I reclined in my collapsible Captain's chair and propped my feet up on its first mate, another lawn chair of dubious ambition. The UV rays put my mind at ease about any remaining hospital MRSA hitchhikers.

I am extremely thankful for Apple's cutting edge products and the internet's proclivity to enhance American productivity. Personally, engulfed in essential work, I now have personalized ring-tones for over half of my 226 phone contacts. I am particularly fond of REM's It's the End of the World and Waylon Jenning's Dukes of Hazzard theme. My chess game is solid again and most pigs quake when contemplating my newly developed angry bird launching skills. Don't even get me started on the thousands of Zombies I have eradicated.


Thursday, April 12, 2012

A leg up

Trying to break things 34 hours after discharge
Day 2 of recovery is boring. I am through the worst, I think, only 268 days left until I can lace up. After reviewing the web and following the advice of my friends and their recoveries, my neglected competitive streak kicked in. I took my last oxycodone at 3:10 AM on April 11, twenty hours after my cleaving for a grand total of 30 mg. I was thinking of unloading any extras at Middle School playgrounds after recovery.  I could trade 2 for a used video game or maybe 1 for a Justin Beiber mp3 at the current exchange rates. On further consideration, I am unsure how 1 legged insulin dependent drug dealers fare under state run hospitality programs.
3 limbed butt scoot lobster crawl.

I have been managing pain with ibuprofen since abandoning the big gun pain killers. Combined with elevation they have been very successful in keeping swelling to a minimum. As for pain, it is tolerable, but I am pretty sure my surgeon may have left his car keys in my ankle. On the plus side, not suffering from opium constipation, I am sure my protein consumption has resulted in at least 1/3 of my healing tendon's new construction. Envision a new strong cable, parallel lines of corned beef and cabbage fibers closely packed together, comprising the belly of my new brevis. I am hoping for Leprechaun speed or at least the capacity to banish all the snakes from Umstead park.
I wanted to create a loose template for anyone going through this procedure. In that effort I have composed a brief list of pointers which helped me acclimatize to my new situation. Immediately following are my suggestions for one to consider before a tendon repair.

1. Shave your head. Ladies this is especially good advice for you. Having spent the last 48 hours on my back in various unheard of yoga poses, my head has rubbed into couches, beds, the floor, and pillows constantly. Add the difficulties of shampooing on one leg with the popcorn kernels and lucky charm bits that have ground into your hair while eating in a prone position and you have a great excuse to finally homage lieutenant Ilia's hair do from Star Trek: the Motion Picture.

2. Get fit. Think core over cardio here. I am very thankful that my 9 week running hiatus was partially filled with weightlifting, chin ups, push ups, sit ups, up-downs and 7up (diet). You really need to be in shape to be successful as an invalid. Focus on the stomach and upper body strength. I am very thankful for Penny's help, but if forced (and if the NC highway patrol did not look so unfavorably on driving after anesthesia) I think I could have muscled my way through this alone. Everyday tasks are exhausting on one leg so don't entirely neglect the cardio.

3. Move into a ranch style house or apartment. There are a total of 27 stairs in my house, each with an associated curse word. I have to do the butt-scoot boogie to get to my bedroom and the only bathroom large enough to encompass my stuck out leg with the door shut.

4. Butcher and prepare several large farm animals. Penny and I cooked pounds of meals and froze them into single serving sizes. I already wish we had more. When I return to work, everything is going to take longer. In retrospect I would have prepared a months worth of meals. A good suggestion may be to befriend an orphan baby pig. You can take care of him easily while he is small and then as he grows and you run out of food: ready made bacon. He might also serve as a comfortable foot rest to keep your leg elevated. Don't name the pig!

5. Trick someone into marrying you. (or be awarded a butler in an outlandish tv sitcom court settlement). Although I like to think I could have handled the last few days alone, I have a long track record of idiotic ideas. I transitioned from Forest Gump type footwear to 8 miles in KSOs on my Vibram debut. I ran Grandfather mountain as my second marathon. Last year, I misdiagnosed a pressure abrasion from my heavy courier bag as a melanoma. There may be a few other examples. A good nurse is indispensable, and easy on the eyes. Note: your nurse should not be dressed like you (see hint 6). If your personality is really lacking or if you are overly heinous looking I would suggest getting rich as your first step.

6. Wear Cargo shorts. The more pockets the better. They are all I have worn. With your hands occupied by crutches they are indispensable. Not good for ice cream, open sodas, rice pudding, large cats, or popcorn. 

7. Install a handheld shower head. Handheld shower nozzle, milk crate, trash bag, and packing tape make for a decent field shower. Its slightly better than talcum powder and a mint. And if your at all European it doubles as a bonus semi-mobile bidet.  

8. Blog. You can literally make tens of cents blogging from the comfort of your own couch. Turn your sick leave into a lucrative second career. If you are attempting more than 1 pudding cup per week, you may want to try blogging about something more lucrative. Maybe pornography or cats on treadmills.

9. Bib. I prefer napkin. If you are fancy you may prefer linen. Depending on your cuisine every slurp is wrought with peril when eating off of your back. As showers require a harrowing staircase journey, try to limit the amount of soup on your shirt. Tuck into collar and hope for the best.

10. Lap table. Works well with bibs. Keeps hot computers off your wedding tackle.

The doctor said toes above nose for the first
four days.
I did post my first crazy high blood sugar today. No activity mixed with the siren call of 1/2 cup of Penny's dry Lucky Charms resulted in disaster. Hit over 200 for the first time in a long stretch. I wonder if the inflammation of the surgery is playing a role? I managed a trimmed down work out with the hand weights. Unfortunately, regular sit-ups feel like they are pulling on the tendon. Better safe then sorry, I resorted to lying leg straight raises. Its hard to make sure your ankle stays above your heart. Felt really good to move though and I quit before braking anything.  

Day time TV is this bad.
My Omnipod expired at 8 am and I will exhaust the 8 hour grace period any minute now. I have put a lot of thought into its position. The surgeon's pit crew had to prop me up on a bean bag pillow thing before knocking me out to accommodate it during the repair. It has been in my way more than once, anchored to my stomach/torso on my good side. I am going to place the new one on my gimpy side so I have a whole half of body to sleep on for the next 3 days.

Blood sugar correction.


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

Monday, April 9, 2012

Measure Twice, Cut Once

My diabetic status marks me with the health care system's scarlet letter, D. In my experience, doctors tend to judge diabetics at the same time very likely incompetent and probably guilty of something sinister. Maybe eating honey buns off of the floor or mainlining cotton candy. I was scheduled a phone pre-op after establishing my blood sugar history with my surgeon. One and a half business days prior to my tendon repair, Duke Ambulatory Surgery Center contacted me at the last moment and informed me I had to attend a pre-op audition to ensure I was a proper candidate for mutilation. I managed to shuffle around my schedule enough to create the appropriate bureaucracy sized hole and high tailed it to the last appointment Friday. Weighed, EKG'd, bloodletted, and measured, I was deemed worthy and awarded my CHG surgical hand scrub.

New party game: pin the scar on the ankle. Can't wait to see
where the surgeon adds his signature.
I spent Saturday prepping the house for a handsome, humble, charming, but clumsy invalid. I removed all of the rugs, built pillow stacks for elevating legs, and stocked up at the grocery store. My birthday fell on Easter Sunday this year and Penny and I cooked every protein save the Cadberry bunny to stock pile low carbohydrate friendly meals. 5 lbs chicken, 4 lbs ham, 4 lbs corned beef, 1 lb bacon. After adding Saturday's 48 cheese sticks to the inventory, I lightly wet a bottle of Lipitor pills, dried them together in the sun, added a string and hung them as a medicine lick next to the refrigerator door. 

Last flight of the Dodo. I got 2 barefoot miles in against
 medical advice 5 days presurgery.
Thankfully, Monday brought the normal distractions of work to speed the passage of the countdown to surgery clock. I drank 128 ounces of water to ensure hydration and an undisturbed night sleep. I cautiously avoided yard work, taking out the trash, washing the dishes and flossing to prevent any skin breaks. As part of my just say no to MRSA campaign, Penny scrubbed me down with a mop and the agent orange turpentine doctors scrub. I set 3 alarms for 3:45, 3:50, and 3:55.

Our self-starring Doomsday Preppers episode ended with my birthday present from Penny. A Roscoe Knee Scooter. I am hoping my bike helmet will complete the Easy Rider Captain America image.

I am still planning the custom paint.


Saturday, April 7, 2012

Curse of the blog

One sure way to ruin your running career; start a running blog. My internet medical diagnosing skills have proven accurate enough to earn me an honorific doctorate from Whimpering University. Almost three years ago, I pronounced myself diabetic 6 months before the medical system verified my cloud informed findings. They were still testing for stomach parasites and prescribing Aciphex while I embarked on my first low carbohydrate diet and started graphing blood sugars with my mother-in-law's expired meter and strips. And now after 9 months of whining, testing, doctorin', massaging and surfing the web, my keyboard divination has been substantiated by MRI and Duke University's Chair of Orthopedics. To be fair, I did misdiagnosis myself with a few brain tumors, an absorbed twin, and tryotoxism over the same time period.

Obviously not my MRI. I am taller. A good
stand in from the internet.
I have long suspected a torn brevis or longus due to ankle instability and pain along the entire chain on the left leg. Surprise! its both. Duke's Dr. James A. Nunley reads the MRI as a longitudinal peroneal tear of both tendons. The recent swelling across the front of the ankle following the Uhwarrie Mountain Run refocused my search for a resolution and ended at his office. The inability of the peroneals to anchor the ankle shifted the load to the tib anterior, which could not handle the stress and completely ruined the dapper silhouette of my injinis. 9 weeks cross training and running rest resolved the nerve entrapment and swelling, but the instability remains.

Nunley scheduled surgical repair for Tuesday April 10, 2012 with a projected running return 9 months from now. The tendons do not have the capability to heal lateral tears. I was rather relieved that I did not really have a choice. I could severe the remaining tendons exiting the car or foxtrotting and their condition will only degrade with time. I am announcing Umstead Trail Marathon 2013 my comeback race. I am hoping for a 100% return to function and an Umstead 100 mile 2014 debut.

My understanding of the recovery timeline.

1) Trained angry monkeys gnaw through my ankle.
2) Surgeon shows off Milwaukee tool skills.
3) A lot of debridement, excising, and removal.
4) Put Ryan Dumpty back together again.
5) Two weeks toes above nose with an open splint to for allow swelling.
6) 6 to 8 weeks in a weight bearing cast
7) A walking boot for 2-4 months
8) 3 months of physical therapy
9) At the 9 month mark, my first run.

Very similar to chicken tenderloin prep.
I am starting to understand vegans.
I hope to see a lot of my friends out there as I will now have to volunteer to feed my race shirt fetish. I started with the Umstead 100 mile endurance run and hope to have a write up for it soon, hopefully, with colorful hydrocodone induced  commentary. I am going to attempt to record this new journey through Blogger. I have scoured the computer webs for commentary on this process and not found a lot. I hope those before me survived and are all too busy running ultras to write. Just as I brought my finely tuned bloggers body to running, I now hope to utilize all of my running skills in recording my recovery by blog.  In between bouts of Tiger Woods golf 2006 and Gilligan's Island reruns, I will also try to get my diabetic page posted. I am anxious to see what Mary Ann looks like on a High Definition TV. 

This is what the MRI suggests. I am hoping for greater than  50%
material remaining, so as to save the tendon.
As this blog, which has already netted me $0.49, is my primary source of income for the next two weeks click on an ad before you leave and make it rain nickels up in here. Stay healthy and upright.

If you have eight minutes and a solid stomach click here for the full procedure on YouTube.