Friday, May 27, 2011

Rehab V: Pedestrian and Cycling Musings

Back to on-topic matters.

You know how when a good thing happens you think that it will happen again and again and become the norm.  With my rehab I have a good day and think the next day would be just as good, maybe better.  Alas, not necessarily.  A good day often means: "Oooh, the foot feels good, let's try more and new things on it."  Inevitably, this results in overdoing and more pain the next day than the day before.  Though the day after is better still.  The foot is improving, but it's not straight-line improvement, more of a jagged line with a general upward trend.  Sort of like Dow Jones average in a bullish market.

I tried wind trainer twice over the weekend, then did not get on the bike for the next three days because things have been busy at work.  Yesterday, I finally managed to go to VeloSF for a class, my first class in eight weeks and two days.

People there are like a family; you don't get that in other gyms.  We know each others' names and we bond because we suffer together.  So, Dave and Jeff and Danielle and others were glad to see me and asked how the ankle was.  It was a tough 90-minute class with some Zone 4 and 5 riding.  I was not going to ride in Zones 4 and 5.  I was firmly entrenched in Zone 1 and I stayed there for 45 minutes.  After a 15-minute warm-up, every five minutes, I unclipped my right foot and rode one-footed for a minute to build up my weak side.  After four or five of those the foot started hurting, so I stopped.  Rode for another 10 minutes, then decided 45 minutes was enough for a first time in two months and two days.  I climbed off happy that I managed 45 minutes and that the 45 minutes felt pretty good.

Walking is funny.  When healthy, I am a very fast walker.  I daresay, I am the fastest walker on the sidewalk.  Seriously.  I am competitive when I walk the streets.  By no means am I as fast as race walkers, the best of whom can do 6:30 miles for 30 miles, but among people walking to work and around town, I am the fastest.  But not now.  It hurts to walk fast.  It used to hurt on the outside, under the ankle bone -- stabs and jolts.  Thanks to my PT-ist Wayne, that pain is gone.  Now I have duller, but still significant pain across the top of the ankle, where it flexes, in the place where the shin become the foot.  If I try to walk fast, the foot flexes often and it hurts more often.  As the doctor in the well-known joke says, "don't do that."  So, I don't do that, at least not often, and, as a result, I walk slowly.  I am the slowest walker on the sidewalk.  Pedestrians zoom past me walking at a pedestrian pace.  I am a sub-pedestrian.  Instead of trying to scurry across the intersection as the light timer counts down the seconds before it will change to "DON'T WALK STUPID!" I look at the time, calculating how long it would take me to reach the street and slow down instead of speeding up.  Slowing down has an additional benefit of allowing me to focus on my technique -- rolling the foot from heel to toe rather than dragging it along in balletic First Position, which I do when I am in a rush.  (First Position walking minimizes flex and pain, but is a bad habit.)  I stand there, waiting with patience of a philosopher, for the light to change with no cars in sight, while everyone else jaywalks.  Then the light changes and I start across, hoping to make it to the other side before the light goes back to red, treading the thin line between speed and pain.

I reach my car, get inside and suddenly feel completely whole -- I am moving painlessly -- forgetting about my injury.  Then I park and realize that I will have to stand up and walk and remember...


Saturday, May 21, 2011

Rehab IV: Giddyup!

So, that was Thursday and Friday.  Today, Saturday, I decided to be careful.  And it's easy to be careful in the morning.  The foot is usually stiff and achy and I'm not completely awake.  I came down the three stairs from the bedroom to the living room with a crutch and settled in.  We had a breakfast at a cafe and I continued getting around with a crutch, but the foot felt good.  When we got home I started getting around without a crutch.  It was awkward and kind of ugly.  Later, someone told me I could play Frankenstein with that walk, but I was taking full steps with my right foot, rather than abortive half-steps that bolts and jolts of pain required just three days earlier.  This was a major breakthrough.  So, I continued walking without a crutch.  All day.  I even managed to walk down stairs almost like a normal person.  Oh, the foot swelled quite a bit.  By the evening it was aching and I was tired from the new activity, but how pleased I was, I cannot describe.  It was a day of breakthroughs.

There was one more breakthrough.  During my PT visit, Wayne had told me to get on a stationary bike to increase the range of motion.  Now, not in another week.  Well, OK!  I hadn't had the time to do it on Thursday and on Friday my foot just didn't feel well enough to attempt a ride, but today...  I set up my bike on the trainer and changed into shorts.  I could barely get my left foot into the cycling shoe.  Once it went in, it felt good.  I gingerly climbed on the bike.  I had no idea how clipping in and out would feel, but it didn't feel.  It was absolutely painless in and out.  Riding was a bit odd, though.  I tried to pedal smoothly, yet leg strength imbalance was such that after 15 minutes my circles turned to squares.  Because of the two compression socks and the still-swollen ankle, my foot rubbed against the crank arm, but I didn't mind -- I was on the bike again!  And it felt great and so familiar and emotional.  I stayed on for 25 minutes.  By then the foot had had enough.  It was a great start.  More riding tomorrow, assuming the foot feels OK after such an active day.  Velo SF, I'm back, baby!  I'm back!


Rehab III: PT1

The first week of weight on the foot was rough.  As I described in the last post, my foot was acting criminally, shooting and stabbing, mostly below the outside ankle bone.  Advil helped significantly, but my home supply ran out and there never seemed to be a convenient drug store or I didn't remember to pick up a bottle, and with a new job (oh, yes, I started a new job this week!), I just did not have proper pharmaceuticals to ease the pain.  Day after, I hobbled with a crutch in my right arm pit, listing precariously to the right to ease the weight and the pain on the left foot, my lean exaggerated by the two-inch thick sole in my medical boot.  On and on this went without improvement and I looked forward to my first physical therapy appointment on May 18.

The appointment was with Wayne Diamond, whom I've known since his kids were to pre-school with Sophie.  He treated Jessica successfully for back and hip problems and I requested him specifically when the time came to make an appointment.  On the morning of the appointment, I took the last dose of Advil in the house, put on two tennis shoes, leaving the Big Black Boot at home, and headed to Kaiser.  After I waited for a brief period, Wayne came out and motioned me in.  I hobbled in on one crutch, noticing that Advil was working.  As we entered a long hallway, Wayne said: "Let me see you walk."  I tried walking and I wasn't bad at it.  Wayne was mildly impressed, but he also told me not to try so hard, as it was obvious I was hurting.  We came into the examining room and talked for quite a while about what hurt and where and what caused the pain.  I lay on the table and he started manipulating.  I was nervous: my range of motion was limited and, though I tried working on it, I expected a return to the Woyld of Hoyt.  But no.  Wayne bent my foot in directions I couldn't imagine it would be willing to move, yet it followed obediently and willingly.  There was a minor jolt of pain in the usual spot once, but that was the only time during the several minutes of work.

Wayne was pleased.  He thought the foot moved well and was encouraged by the absence of pain.  He gave me a exercises to do five times a day: seated calf raises for strength and child pose to increase for range of motion.  With passage of time, I'm to add resistance to calf raises by pressing down on my knee with both hands.  He told me to increase my daily water intake by one glass to help healing.  In theory this is great, but is difficult to implement in practice.  Walking to the water cooler involves walking and hurts.  Drinking more involves walking to the bathroom and hurts, so it's hard to motivate myself to drink more, but I'll have to.  Wayne also gave a compression sock to wear all day and told me to ice the ankle every evening.  Since I arrived wearing compression socks, I left his office wearing three of them.

I went to work and as I sat at my desk I did calf raises.  My desk has a center drawer and my knees nearly touch it when I sit, so I did two or three sets of resisted calf raises, pushing up with my knee against the bottom of he drawer.  Which is dusty, as I discovered when I saw a brown line on my pant leg, above the left knee.  The calf raises felt pretty good, though toward the end of each set my leg would begin to shake -- a reminder of its weakness and the work that lay ahead.  Nonetheless, I felt encouraged.

I arrived at home after work and, with a crutch in my arm pit, began climbing stairs up to the house.  For some bizarre reason, I stepped up with the left foot.  I cringed as soon as I realized what I'd done, expecting a bolt of pain, but it didn't come.  I stopped, flabbergasted.  It didn't hurt.  I processed that.  Then, I took another step up with the left foot and that felt OK.  It ached, but nothing worse than level 3.  Thrilled, I walked up the stairs like an uninjured person, alternating feet, and carrying the crutch in my right hand.  At the top of the stairs, I took a normal step and that didn't feel so good.  On flat ground, the foot has to flex.  On the stairs, a peg leg suffices.  And a peg leg is what I had.  But hey, a functioning peg leg on which I can climb stairs is a dramatic improvement over what I'd had for the week since I started putting weight on my foot and I couldn't be more excited about the improvement.

Wayne had written me an e-mail, summarizing what we'd discussed, explaining the exercise regimen, and cautioning that the next day would be painful because of all the manipulation the foot had undergone.  I responded excitedly with a description of my ascent.  "Wayne Diamond," I thought, "you are brilliant!"  A thrilled text message went to Jessica.  Ten minutes later, it was time to pick Sophie from school.  I tried walking down stairs and that was not happening.  Stepping down with the left foot produced unwelcome level 6-7 pain and I decided not to push it.  After returning home with Sophie, I demonstrated my recovered skill to her and she was as excited as I.

Wayne was right about one other thing, the next day was a bear.  I had such a hard time that I decided that it would be a two-crutch day.  I had to go to court first thing in the morning and it was 10:30 by the time I arrived at the office.  I helped myself to the office supply of Advil and settled in.  I kept my foot elevated as much as possible and used crutches.  As the day wore on, I felt better, but I remained cautious.  As with everything else, this would not be a linear progression toward improvement.


Saturday, May 14, 2011

Rehab II: Woyld of Hoyt

I feel like Amy Winehouse: "They tried to make me go to rehab, I said, 'no, no, no!'"

Not quite, but I am discovering that Recovery was a day at the beach compared to Rehab.  Recovery was an inconvenience.  Rehab is a serious pain in the foot.  For those following at home, you will remember that I ditched one crutch three days ago and am getting around on the other one.  It's painful.  I have a choice of shooting pain or stabbing pain in the low-outside part of my left foot.  It's not at surgery site, but an inch to two below, where the foot is still blue and swollen.  It hurts when I lift the foot and when I put it down.  Relief comes when the foot is at rest either in the air or on the ground.  To maximize relief, I walk V--E--R--Y  S--L--O--W--L--Y.  That way, the foot stays on the ground and in the air longer and there is more time between the stabs and bolts of pain.  It's worse when I have a short walk, such as from the table to the kitchen.  Sitting at the table, the foot is at rest and it feels fine.  As soon as I stand up, pain starts.  I try to figure out a way to avoid or minimize it, then realize that I should suck it up and deal with it, but by then I'm at the kitchen sink, where I stop to rinse the dishes, and while I'm stopped, there's no pain.  It takes a few minutes to rinse dishes and put them in the dishwasher.  By then, physical and mental pain have abated, but I have to start a new commute back to the table or to the couch, and the ordeal begins anew.  Longer walks that last a few blocks are easier.  Yes, I have to put up with pain initially, but after half a block I develop a semblance of a rhythm, start breathing Yogically into the foot, and get myself to a mental place where it's fairly manageable.  A bit farther, and I seem to relax, also something seems to shake loose in the ankle and it feels better and I am more confident in my walking.  Then I arrive where I was going, sit down, it all stiffens again and we start all over.  The overall impression, however, is that the pain is as much in my foot as in my brain.

Advil seems to help a lot.  I am taking rather massive 800 mg twice a day and 30-45 minutes after I take it I feel a lot better.

Walking is not really walking.  The leg feels like a peg leg.  I swing it forward, put it down, shift m weight over it, swing the right foot forward and repeat.  Because of pain and massive atrophy, my left foot is not functioning.  It's just there every other step as a base of support, but I cannot use it to push off, stand on my toes, or, really, use as anything other than a peg.  I stood on the foot two days ago and thought of rising up onto my toes and simply could not fathom how to do it.  The brain could not imagine how to tell the body to execute the action.  I feel like a toddler.  Jessica says pilates on her reformer will help with this.  I haven't tried it yet, but I'm a believer for now.


Wednesday, May 11, 2011

Rehab I: I am Putting My Foot Down!

Had another x-ray this morning before seeing Dr. Jake.  He looked at it and said everything looks fine, but it's time to start putting weight on the foot, as my bone density is not looking so good.  Imagine that, after six weeks of weightlessness, my bone density is low.  Time to load up on mineral supplements and start walking.  (Walking?)  He said I don't need crutches anymore.  What?!  "Yes, it's graduation day," he said.  Holy crap!  I expected to have to crutch-walk for a couple of weeks, then walk with one crutch for another two to four, but quitting cold-turkey?  I was really anxious about walking, uncertain whether I could.  In two weeks I can ditch the boot and start wearing shoes.  And I can start riding -- at least indoors.  Hell, I may even try riding outdoors! 

[Bad News Interlude]
He also told me that trimalleolar fracture (have I mentioned that is the medical term for what I did to myself?) takes the longest of all ankle fractures to heal completely -- up to two years -- and patients with this fracture have the greatest risk of developing arthritis.  Not much to be done with that information, so I said: "Well, if I develop arthritis in my ankle, I'll know why."

The appointment was coming to an end.  "Let me see you walk," he said.  Holy crap!  So, I tried.  I stood up and stepped unsteadily with my right foot and tried stepping with my left, but the small boot's sole is so thick and the boot is so bulky that I could only sort of drag the left foot along, then shift the weight on it and step with the right.  I did that several times.  There were shooting pains on the outside of the heel, below the ankle.  Persevering (and with an additional two-month extenstion of my handicapped parking privileges and a referral to a physical therapist in my pocket), I proudly and happily gimped out of the examination room, down the hall, and out of Orthepedics to where the elevators are, carrying the crutches in my right hand.

Then, it was hurting more than I was willing to put up with, so I switched to single-crutching and that worked OK.  Seems like a good compromise:  it's painful, but less than going crutchless and I am putting weight on the foot.  I switched to the big and bulky boot and found that it is much better suited to walking.  I managed three blocks from my car to the office.  I am moving slower and a bit uncertainly.  The best thing is I have the use of my left hand.  I can open doors.  I can carry things.  I can hail a cab.  I can do everything a one-armed person can do.  I am in a great mood.

P.S. Switching to titling this series of posts to "Rehab" since I'm recovered from surgery...  Sort of.


Tuesday, May 10, 2011

Recovery VII

Less than one day until Dr. Jake appointment at which I expect to be told it's OK to start putting weight on the foot.  I've been cheating.  I started crutch-walking on Friday. At first, it was very awkward and from time to time, I forget that I've been doing that and ambulate one-legged.  Then, I remember and resume "walking."  It's not such good walking.  The boot's sole is much thicker than my shoe's, so I'm tilted to the right.  I'd be reluctant to put much weight on the left foot anyway.  The leg length discrepancy only exaggerates the lean.  I've also discovered that I'm slower on four legs than on three, but I am relearning.  I hear from others who've undergone similar surgery that I'll be walking on crutches for a month or two before I can finally ditch them.  Then physical therapy, which will include pain and frustration.  It seems that the hard part of recovery is only beginning, but I am looking forward to it as the next phase in my recovery.


Tuesday, May 3, 2011

Recovery VI

Dr. Jake said go have an x-ray, but he didn't expect problems.  So, I had the x-ray yesterday and Dr. Jake told me to exhale -- everything is fine.  BIG RELIEF.  Also, it occurred to me yesterday that I can start counting days before I can put weight on the foot rather than weeks, as I had since the surgery.  Now, it's just eight days!  Will try not to crash anymore in the near future.

Also, I had my first cycling dream in a long, long time.  I can't even remember the last time I had one.  I remember of the one last night is that I was riding from Antioch to Martinez with someone else and that I really concentrated on pedaling circles and my right foot, rather than the left was hurting.  In the dream, I concluded it was from overcompensating, protecting the injured left.  My brain misses riding subconsciously.  I like that.


Monday, May 2, 2011

Recovery V: Crash 3

Please don't tell my parents.

Everyting was going hunky-dory.  I was doing my flexion exercises and the injured foot's range of motion was much improved to the point that it was only about 10 degrees less than the healthy one's.  We were going out to dinner last Saturday.  I said, I am going to wait in the car and headed down the stairs (perhaps that's an unfortunate choice of words).  I descend stairs on crutches by carefully placing the crutches on the step below the one I am standing on, then stepping down, then repeating until completed.  Well, this time, I had a brain fart and stepped down with my foot before putting the crutches down.  My weight was still on the upper step, but now it was shifting down, while the crutches that supported it were behind me rather than in front of me.  Because the crutches were higher they kept my upper body from coming down with my foot, the foot could not reach the step.  I teetered briefly and descended rapidly.  There was no arguing with gravity and no way to stop my momentum: my weight was moving forward and the crutches were behind me.  The right foot could not find traction, my weight came down hard on my booted broken foot, which could not stop my descent either, as I tumbled down nine steps, first landing on my butt, bouncing on it for a couple of steps, finally coming to rest face down on the landing.

I was stunned.  Jessica came running out of the house thinking the worst.  Our neighbor rushed over from across the street.  I lay on my face, taking inventory.  My ass hurt and I definitely jammed my foot, but otherwise I was OK.  I didn't hit my head or other body parts.  I skinned my elbow and hip just a bit, but that was the extent of it.  Ass didn't worry me much, it was just a bruise and I hoped dearly that I didn't dislodge hardware or rebreak something in the ankle.  I turned over, got on my hands and knees, stood up on the still-good right foot, hopped over to the staircase and sat down.  Butt hurt, the ankle was a bit achy.  I reassured the family and bystanders.  After some discussion, I went back into the house and got in bed.  Enough excitement for one day.

Two days later, the ankle is better than immediately after the fall, but not quite as good as it was before it.  I get occasional level 2-3 aches in it.  Going to get in touch with Dr. Jake and see what we should do.  Fingers crossed.