Surgery Update (gnarly images warning)
“Oh sweetmotherofmercy, give-me-drugs!” For all my tough-guy banter about getting off the pain meds, I’m full of it. Twelve hours after surgery on Wednesday, I whined like Nancy Kerrigan.
The nerve block on my leg wore off way too soon. In addition to general anesthesia, they completely blocked-out (numbed) my leg, which greatly helps control post-op pain. So long as it lasts the expected 24–48 hours, anyway – through the most brutal period. But apparently the length of the block’s effectiveness can vary, due to factors like individual metabolism. Mine wore off after about 12 hours (damnit, shouldn’t my being a total couch potato for nearly three weeks have paid off in some way??), leaving me in excruciating pain, far worse than the no-pain-meds four-hour drag/crawl/carry out of Hyalite, with my bones grinding together. My little pain pump thingy by my bed seemed like a kiddie toy that didn’t work, and they injected me with a mg (?) of Dilaudid (hydromorphone), a super powerful synthetic opiate, apparently up to 10 times stronger than morphine. A couple of injections, combined with regular hits on my pain pump, got me through the night. They held me for an extra day, not wanting to release me until the pain was controlled. Sounded good to me. I got out Friday and spent the weekend sleeping (with help of oral pain meds) and sitting on the couch.
Can’t wait for this coming Wednesday, surgery #3, hopefully the last (at least until sometime a ways off when we might need to remove the hardware).
So, to review, the first surgery, a fairly minor one, happened in Bozeman, when they installed this external fixator contraption on my leg. My leg was too swollen to do the major surgery then, so this thing went in to hold the bones in place until the swelling would allow for the big surgery(ies). BTW, I figured they just tapped the rods a half-inch into the bone or something, but the X-rays show that the damned rods go most of the way through my leg. As the swelling has subsided (mostly), I can feel the metal going through my bones. Too weird.
This past Wednesday was the first big surgery. They installed two plates and 11 screws, if I remember right. One plate spans my fractured fibula (a slender bone on the lateral – outside – part of your lower leg), which is the simplest to fix. Fairly clean break, not into the joint, no biggie. I’m happy to have it bolted back together now, because as the swelling decreased, the broken bone ends shifted back and forth damn near every time I breathed, making it hard to sleep. Didn’t hurt, it just creeped me out big-time.
The other plate went in on my posterior distal tibia. The tibia is the big lower leg bone, commonly called your “shin bone”; distal means the “far end” (the end by my ankle); and posterior means backside (by my heel). The posterior plate (and screws) holds together the chunks on the backside of my tibia, down by the ankle. They moved the big chunks back into place and let ‘er rip with the power drill, basically (though a bit more delicately than hanging sheet rock, I trust).
My distal tibia is a mess. It’s where I have this nasty Pilon Fracture. The outer surfaces of my distal tibia form a spiderweb of fractures. Much of the inner part – like the inside of a cone – is “heavily comminuted” – medical lingo for pulverized. You’ll see on the CT scans that it looks like there’s no bone there, since the bone got turned to dust. In this type of Pilon Fracture (disclaimer: this info is mostly correct, but I might have a thing or two slightly off), my talus bone – big bone in the foot – was stronger than the end of my tibia, and when I smashed onto a ledge after the climb (accident analysis coming soon), it acted like an upward battering ram and shattered my distal tibia (and snapped the fibula in the process). The hugest problem, as I understand things, and what could threaten my future mobility, is that it pretty much destroyed the upper part of my ankle joint.
This Wednesday, in the next (and hopefully final) surgical stage, Dr. Desai’s big task will be to install a plate or two to repair the anterior, or front side, of my distal tibia – check out the images…nasty. Will post-up post-surgery images when I get them. Man, I’m gonna be setting off metal detectors all around the world.
So, apparently once things are puzzle-pieced into place with help of the hardware, the big bones fuse together, and the dust inside somehow gravitates toward the bigger chunks and begins to fill-in and grow back into real bone.
This takes time. I’ll likely be in a cast for 4–6 weeks, which is great. Anything to get out of this medieval torture device thing – ever see those dogs with the lampshades on their heads after surgery, and they’re always bumping into things? Right… And in 8–10 weeks I’ll probably be allowed to start walking again. Limited impact for 3–4 months. Beyond that? “We’ll have a better idea after about six months,” Melinda, Dr. Desai’s excellent PA, told me.
For now, this Wednesday feels like a big deal to me, because it will officially mark the start of recovery. And while it could take 6–12 months until I’m feeling physically capable again, right now I’m just eager to move beyond the surgeries and into the long, uphill grind to recovery.