Week Three - A bump in the road....

Today marks the 3rd week since my surgery and one week that I've been wearing a boot 24/7.  I knew I had pain the last two days on the inside of my ankle (the good side - where there were no sutures removed).  I took off my boot and stocking. There it was!  An ULCER. A pressure sore.  A hole in my skin. (If you want to see it, you can look in the Post-op photos page.)  How in the hell did that happen?  Crap! 

I'm not weight-bearing yet but somehow the metal brace on the side of the boot was pushing on the thin-skinned bone of my inner ankle.  This spot is where the two screws were left from my original surgery on January 13, 2009 when the ankle was shattered and put back together.  The screws have always been so close to my skin that I can press on the ankle and feel the head of one of them!  Dr; Royer removed the plate and screws from the opposite side but left those two screws on the inside of the ankle because screws needed to be in there somewhere - to stabilize the bone to support the new ankle - and since I already had these, he left them there.

I'm going to vent now:  I've been "good" and strictly followed my Doctor's orders - "toes above nose" elevation for 3 weeks, slept with my boot on (and I do use the word "sleep" loosely) and haven't put any weight on it.  Still an ulcer. A definite setback. 

When I called Dr. Royer's office and told them what I had discovered, they wanted me to come as soon as I could get there, and it just happened that my granddaughter Taryn was there to take me.  My Doctor was in surgery all afternoon, so we saw his Physician's Assistant.  She said that they haven't seen an ulcer in a TAR (total ankle replacement) patient before. (so...that means I am the first one?!!)  The sore has got to heal soon because I will be trying to weight bear and start PT in 3 more weeks. Which also means.....wearing the boot again.  The PA made an adjustment to the boot and placed foam higher up where the metal brace was eating into my skin, so hopefully when it heals, I won't have that area break open.  They don't want any infection anywhere near the new ankle so I'm taking more Levaquin and using an antibiotic ointment. 

Here is what I'm wearing now - a removable splint (which looks like a cast).  It has a hard shell on the foot and back of my leg.  I can take it off to shower, and wrap ace bandages around it to hold it on my foot and ankle.

So here we are.  I am trying to not let my thoughts overwhelm me and trust me - alot of them are dark thoughts.  My Mother, who was in excellent health contracted a sudden flesh eating bacteria (Group A strep) and lost her life to it.  There was a family friend who died a couple of months ago  from an open ulcer that didn't heal in her abdominal area.  I can't think about this or I will have the all-too-familiar panic disorder creep its way back into my life again. Ultimately, I have got to stay positive and believe that this is just a bump in the road.

As always, your healing prayers are most appreciated!

Week Two - First Post-op visit

Dana took me to my first visit with Dr. Royer since surgery two weeks ago.  I had a rough time with the walker just getting from the house - to the car - to his office.  I had to stop about 3 times and catch my breath.  That's what happens when you're in bed with your foot raised for two weeks straight - very weak. More than I had expected.

We were called back and one of his nurses came in and removed the thick hospital (post surgery) dressing and bandage.  There was a lot of dried blood (more than I had thought). Then when she got to the actual foot -oh, what a sight!  Bluish, reddish purple. I had a perfect straight incision in the center of my lower leg down to my foot.  There is also a side incision a few centimeters under my old one where he removed the plate and screws from the original fracture surgery in January '09.   She said that I was going to have a new cast today, and what color did I want?  After much debate and indecision, we chose the hot pink one.

I was wheeled to x-ray where they took two views of my new ankle and back to the room.  In x-ray the technician asked if I could move my ankle toward me a little, and though it was horribly stiff - it ever-so-slightly moved!  Everything in my left foot feels swollen and tight.

When Dr. Royer entered the room, I hugged his neck and smiled and thanked him!  I hadn't done that yet because I was so groggy in the hospital.  He went over everything with Dana and myself, I told him that I was writing this blog and had connected with other people that had TAR's and he was kind enough to take the x-ray pics that are posted today.  He said if I will bring a jump drive next time, he would put all of my x-rays on there!  The STAR (Scandanavian Total Ankle Replacement) system has only been approved by the FDA since November '10.  I am Dr. Royer's 15th patient using the STAR.  Of course, he has done other types of systems, but this is the latest and hopefully the greatest of them all!  Dr. Royer looked at the x-rays and I saw my new STAR ankle on film for the first time!  Beautiful!  He then examined the sutures and his Fellow, Dr. Ding, removed them.

Everyone was surprise whenI wasn't given a hard cast, but a boot. (Every TAR Surgeon does things differently.)   I have to wear it 24/7 and can take it off when I shower.  I will see him in 4 weeks and be re-evaluated.  The mission now is to have the bone start to grow around the prosthesis.  That is essential for this surgery to be a success. I will not be working during the month of June so I continue to elevate my leg and this crucial healing can continue.  This is my last chance for mobility.

I will post photos but not on this page.  Look at the other pages under "Post Surgery photos" and you'll see all you want.  I pray each day for this total ankle replacement to be a complete success.  I appreciate your prayers too!

Week One - Random thoughts at 4 am

One word ------> Pain.

Who the hell knows what is normal and what's not?  Everything seemed to be doing pretty good with a minimal amount of pain....until Thursday.  I started feeling more.  I was taking a couple of Motrin, now I'm taking two pain pills every 4 hours. This is pain where I can't keep my leg still.  Oh, I expected pain.  But why did it start 10 days after surgery???

Since I have all this time to think, I have come up with a few ideas.  I had virtually no sleep last night.  Why?  Pain and my position.  There wasn't a comfortable one. I had a shower today.  Maybe that's it..  I swear I can feel sutures on both sides of my leg where he must have removed the plate and screws on one side and screws on the other!  I haven't felt the long midline incision yet .... maybe that's still hiding until it rears its ugly head.  Also the cast is HEAVY.  As in very heavy.  I am having a whole conglomeration of pains, sharp, dull, knawing pain, lightning bolt pain. Honest to God, I don't remember the original fracture hurting this much after surgery.  Holy crap. Tri-malleolar, broken like pieces of potato chip, with a dislocation.  Dr. Doom (nasty first surgeon) said, "Well, you can't make chicken salad out of chicken shit."  Thanks.  Wonderful bedside manner while I'm laying up in the E.R. you jerk!!!

And this hour of the morning, pain pills and an anti-anxiety pill, plus different positions aren't helping.  Okay. This is where I have to say it.  It's times like this when I miss Gene.  He would know what to do and what to say to comfort and soothe me.  Can he see me?  Because I sure don't feel him!  I think he would say, "Baby, it's all going to be every bit worth it.  Just hang in there."

I'm hanging.

Sexy Leg all bandaged up

Healing at home

I went home on the morning of the 3rd day post op. I went packing with an antibiotic, pain pills, anti-nausea pills, a spirometer, flowers, bathroom commode and walker. I said my goodbyes to the wonderful nurses that took care of me and two of them wheeled me down to the car. The ride home wasn't bad at all.

I did forget to mention something about the afternoon of the 2nd day.  The pain block thingy that fed anesthetic to my foot wore off suddenly.  I had usually reported my pain level being about a 2 or a 3 on the pain scale.  Let me tell you - it went from a 2 to a 10 in a heartbeat!  I called the nurse's station and asked for something.  It was about 20 minutes until someome brought me a pain pill.  During that time, I lay in that bed and felt like I was in labor!  Relax....concentrate.....breathe......deal with it.......dig fingernails in hand.......close eyes.....are you kidding me?????  I never went without something on board after that.

Today is a day of some sharp nerve pains in my foot.  Even the bottom of my foot.  They go away as quickly as they come and I find that interesting.  None of the pains seem to be where the STAR system is located but if you go to YouTube and search for ankle surgery, you can see where your entire foot is manipulated, twisted, poked, prodded and almost turned inside out.  No wonder there are some pains here and there.  That being said, I rarely take more than two pain pills each day; however, I can supplement with Motrin.

My days are spent reading, watching TV, doing computer stuff, and the #1 priority is keeping that leg elevated high. "Toes above nose." I'm doing it. I want this to be the best surgery and recovery as humanly possible.

Second night not so good

I had some great nurses and nursing assistants in the hospital.  Physical therapy came by early the next morning with a walker and had me walk.  I went to the break room across the hall from my room and back to my bed.  I was exhausted.

I hurt.  I hadn't slept too good the night before.  My foot was elevated very high but my spirits were good and Dr. Royer came by at 6:00 a.m. to make sure that I was going to be laying on my butt at home.  He kept emphasizing that the first two weeks are the most important in the healing process.  "Toes above nose." That night about 12:00 midnight, the night nurse brought me two pain pills and two Ambien for sleep.  Sometime in the morning hours, the nurses ran into my room and said that I needed oxygen because I was throwing PVC's (premature ventricular contractions) of my heart and my oxygen level had significantly gone down.  Once they got me stabilized, I went back to sleep and the same thing happened!  I was afraid to go back to sleep. I think it must have been all the drugs I had that made me not want to breathe.  I didn't take any more sleeping pills after that.  That afternoon, I was on the walker up to the nurse's station and back to my room. I was running a low grade fever for a couple of days from 99.1 degrees to 99.8 degrees.

Tomorrow, it will be one week since surgery.  Only another week to go before I go back to Dr. Royer for suture removal.  I don't know what's next after that, but stay tuned!

The big day arrives

My surgery was at Baylor Medical Center at Uptown (Dallas, TX).  My daughter and I arrived at 5:30 a.m. for the 7:30 surgery.  I had already been pre-admitted and early that morning I just went straight to the surgery suite and checked in, got my hospital bracelets, went over my allergies (again) and gave my consent (again).  While we were waiting, I realized that I wasn't really nervous.  Big milestone for me.  I was ready for this surgery!  I was more excited than fearful.  I kept hearing Dr. Royer's words, "This will be a good thing for you."  I rested in that, and in God.

I was called back to pre-op where I was instructed to take off all my clothes and changed into a large navy blue hospital gown that tied in the back and had a pocket in the front.  The nurse had me put a tight white compression stocking on my good leg and when I was all dressed (or should I say "undressed") she started an I.V. flawlessly, thank goodness!  It was then that they let my daughter come in with me.

[At this point, I have had to ask Dana some details about what followed because I was given some Versed and couldn't remember some things.)

The Anesthesiogist, Dr. Kwan, came in and put some Versed in my I.V.  I didn't feel a whole lot different afterwards except that now I have a little memory loss about some of the events.  Other Anesthesiologists came in and had me roll over on my stomach because they were putting a block in my left leg which would go down to my foot. The Doctor said that my leg and foot would be twitching and moving but not to worry because it would be him doing it.  It seemed like 3 Doctors were working on that leg and they attached a pump of anesthesia via a small tube that would deliver the medication. When they were finished, I turned on my back.

Dr. Royer came in and said Hi and met my daughter.  He asked me which leg we were working on and my daughter said that I lifted my left leg.  (Ha!)  Then he put a mark on it with a Marks A Lot.  (Really???) Soon, they were finished and escorted my daughter out and me into the O.R.  Getting in there, I remember looking around the room and seeing the Operating table.  They asked me to scoot over onto the table, I did, and then the Anesthesiologist put a mask on my face and I WAS GONE.

When I woke up in the Recovery Room, the first person I saw was Dr. Royer.  My first words were "How did it go?"  He said, "It went great."  I was so happy to hear those words.  I didn't feel any pain from the block they had put in my leg and after a while, my daughter got to come in and see me.  Soon, I was transferred to my room.  I had a huge bandage around my foot and leg with a drain and with a board and foam that I can feel in the back. Cotton is stuffed all inside to make it very tight and yet cushy.  In my room, I was offered morphine via a pump but I declined it.  I have had morphine before twice and it makes me throw up, so I opted to take Hydrocodone.  It worked like a charm without the nausea.  After I was settled, I realized that I had a very dry mouth and I was extremely thirsty.  Also, I had a very bad sore throat.  I asked the nurse if I could have something for my throat pain and she suggested that I suck on ice.  It was from the tube that was down my throat during surgery.  I drank all kinds of liquids, and soon ate jello and had a normal meal that night. I felt a few twinges of pain in my foot that first night but luckily I had my little anesthesia pump that would deliver some numbness to my foot.  I used it religiously.  Soon it was 11:30 p.m. and was still awake watching TV and a sleeping pill was offered and I took it.  Now the thing about hospitals, you are awakened about every 3 hours for vitals.  So I had sleep, but interrupted sleep.  Thus ends the big day of surgery.

Setting the date

I had originally set the date of my Total Ankle Replacement for sometime in the first week of January 2011.  Unfortunately, I had to have a hysterectomy on December 8, 2010 and had to be away from my job a month, so that meant the ankle surgery would have to be postponed.
When I got back to work in the first week of January 2011, I called Dr. Royer's office and scheduled a new surgery date.  It was to be May 4, 2011.  I remember writing the date down on the whiteboard in my office "Jan's Surgery May 4th" so it would be a constant reminder that the date was set. 

Meanwhile, I did research into Total Ankle Replacements and support groups and found one.  It is called Blessed Ankles and there are alot of nice people who have had their own experiences in this.  The constant message I heard in this group were the famous words "toes above nose" immediately after surgery.  I would come to hear this alot in the upcoming months.

I'll back up a bit and tell you a little bit about the ankle/foot orthosis brace that I wore for many months, just to be able to walk.  It was pretty lightweight, but got hot in the summer because it covered my entire leg in the back and came up to the knee. Also, I had to get two pairs of shoes.  I wore a size 8 on my "good" foot and a size 9 on the foot with the leg brace.  Knowing that this was going to be temporary - even several months ago, I only bought two pairs of tennis shoes.  One white pair, one gray pair.  And I wore these shoes over and over and over.  What I would give to be able to wear normal feminine shoes again!  Every now and then I would wear a pair of flip flops to actually see painted toenails but they were off within a few hours.  I was simply hurting too much without the brace. I was embarrassed to wear shorts and capri pants because of that awful brace showing, so I wore long pants.  Always.

The last two weeks before my surgery, I trained everyone in "what I do" at work, because it would be at least 4-6 weeks before I would return.  Finally, I was ready for my life-changing surgery.

All roads lead to Baylor

After having made up my mind that I was going to find an Orthopedic Surgeon that practiced at Baylor Hospital in Dallas, I found something online about Orthopedic Associates of Dallas.  I called to see if they could get me in for a consultation ASAP, which they did. I had an apppointment with Dr. Christian T. Royer two days later!

I went to the appointment where they had me fill out medical history forms and I also brought my x-rays from Dr. "Doom" with me. (Note:  See post below this one. It will explain who Dr. "Doom" is.)  The nurses said they didn't need to see them because they were going to take their own complete set of x-rays. What was different with their x-rays?  They had me stand up on a platform.  They didn't do this at the other place!  I made a mental note: Already much more improved and state-of-the-art over here!

After waiting for just a short while, a man enters who announces himself as one of Dr. Royer's Fellows. What the heck is a "Fellow" you ask?  Webster's dictionary defines a "medical fellowship"  as the period of time spent practicing a specialized field after graduation. (It is an honor to be chosen for this position, and is considered a very good mark on your credentials.)  He got some more information from me, and said that Dr. Royer would be right in.  Another mental note:  They don't waste time over here!

Dr. Royer entered the room and I genuinely liked him from our first meeting.  He is a tall, slender man with dark hair, a friendly smile and a cheerful disposition.  He looked at my x-rays and we talked about my injury, the original surgery, what had developed and I told him what the previous prognosis was and that I felt my options were very, very limited. He suddenly looked very serious, as if he were deep in thought and I will never forget his next words as long as I live.  He said, "I think you would be a perfect candidate for an ankle replacement!"  A what???  I had never heard of this and it certainly wasn't ever brought up as an option before. He said that he was certain that I would be in a lot less pain, a lot more mobile and that I could do anything I wanted --- except run on it.  Why not run?  There is a greater chance of it becoming loose, shifting, and needing a revision.  Ok. No running. That was fine with me! 

Dr. Royer was very confident and reassuring that this was the answer for me because hopefully, I have alot of years left in this body.  He told me to take home some information and consider it and I told him that there was no thinking to be done - I was having it.  One more thing...he also smiled and said that he was prescribing me pain medication, signed paperwork for a Handicap Parking permit and HOPE!  Thank you Lord Jesus!!!  I left his office with a newfound purpose and resolve - I was going to be having a total ankle replacement!

Where the journey began ....

On January 13, 2009 I had a terrible fall down some stairs and ended up with a trimalleolar fracture of my left ankle.  I was transported by ambulance to a local hospital where x-rays were taken and I found out from the on call Orthopedic Surgeon that I had one of the worst fractures he had seen.  I had surgery with a plate and 10 screws, a couple of months of rehab.  It appeared to be healing and then shortly after the healing  - PAIN!   Within just a few months, the pain only got worse!  Going back to the "on call" guy (who happened to be on staff at a large orthopedic practice) he got very defensive and short with me and told me that (a) he didn't see any reason why I would still be having pain  (b) No, he would NOT give me a Temporary Handicap Placard (because I wasn't handicapped according to him) and (c) he wouldn't give me anything for pain. We had words and he raised his voice to me in the process of defending his position. I left his office in tears. From hereonin I will refer to him as Dr. "Doom". (It's alot better than Dr. "Ass".)  He handed me a large sample box of Tylenol Arthritis.  I went home and threw it in the trash! 

After two more months, I went back to him and could barely walk at all by this time, yet I was still working a full time job.  I insisted on another x-ray or a CT scan....something!  Reluctantly, he said, "Get her x-rayed!" I got the x-ray and he walked into the exam room and said, "I was afraid of that!"  You're healed perfectly and everything is where it's supposed to be (also known as CYA) but you have developed severe traumatic arthritis in the ankle joint.  It is rubbing bone-against-bone and it won't get better.  You will need either an ankle fusion and if that doesn't help.....amputation!  I was in total shock. What????  I thought I was going to faint from his heartless words and cold demeanor. My senses numbed and almost in panic, I left his office and vowed never to return again, no matter what!  I still owe his office money and I will never pay that balance off.  He ignored my pain, he acted like a pompous ass and took away the most important thing a patient can have.  Hope.

Then and there, I decided the next day at work that I was going online and look for anothe Orthopedic Surgeon in Dallas and Baylor Hospital kept coming into my mind.  Baylor Hospital.  Cutting edge.  I felt confident that I would find someone who would surely give me better news. 

Here is the start of the journey.....

The Starting Point

Since this is my first post, I would like to say that my experiences with TAR (Total Ankle Replacement) may not be the same as yours. These posts are merely a guideline of what you might expect.


When I decided that I was going to have the surgery, I looked up anything and everything on Total Ankle Replacement. Sadly, I found very little and even less when it came down to someone's experience after having had one.


So that is the story of how this blog began. I want to share information about what happened to me in hopes that you can have some of your questions answered and know more than I did when I started this incredible journey.


I hope that you will visit often!