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.

One of the two incision spots from last Wednesday's surgery. The medieval torture device stays on until the next surgery.

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).

X-ray showing a couple of the rods of the external fixator.

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).

CT scan of my Pilon Fracture.

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.

Another X-ray.

Another CT scan view.

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~ by Kelly Cordes on February 22, 2010.

25 Responses to “Surgery Update (gnarly images warning)”

  1. Wow, I had imagnied “dust” was a little more of an exaggeration. Glad the first one is done. I like that the warning for gnarly images is about two inches from the clown foot.

    • One question. So your Talus is fine(relatively) despite acting as a battering ram? If so that is pretty damn impressive.

      • yeah, that’s right, John. pretty incredible, really. neither the X-rays nor the CT scans showed any talus damage. helluva strong talus bone, i guess.

        and yeah, ha, oops, sorry ’bout that photo placement. guess the ol’ warning didn’t do much good!

  2. Sounds like you are on the road to recovery Kelly. I hope everything continues to go smoothly and without further complication. Keep up the good spirits (pun intended with your margarita hobby).

  3. Yikes Kelly! I forgot how gross external fixations look on a leg. Kind of alien like. Thank you for the update and we all are thinking of you. Keep the good spirits up, I know it gets hard too, and Wed is the Big Day!!! Yay, on the road to recovery.

  4. watch the space between the Talus and the Tibia, ya need that.

    disclaimer reminds me of the news article last week which was about folks being upset over the video of the luge crash. The kicker being the article had a large photo of the crash. Then there was article upset over the article that was upset over the video of the ,,,,

  5. I can’t comment on this Kelly. I’m shocked.

  6. Hey Kelly,

    You don’t know me but I said hi at the BRC a week or two ago and told you that I did (crushed) my ankle (talus) in October in an avalanche. Glad you’re getting the surgeries underway and I hope having some goals to look forward to help a lot. I know laying around has to be torture, it was for me.

    Will be sending good vibes your way and I hope the docs fix it all up.

    • hey chris, yeah, i remember. was great to see you up and about so relatively soon after your wreck. indeed, the laying around will get old real fast (has been a little so far, but somehow it’s going ok so far, guess i’m just too preoccupied on getting better; after the surgeries, when facing the long grind ahead, i think it’ll get more challenging — so it goes).
      thanks for the good wishes, and i hope you’re well.
      kelly

      • Your recovery will certainly be a bit different than mine but I was lying down for nearly 5 weeks. I raced 135 mile snow bike race at the beginning of February and I’m off to Alaska on Thursday for some more riding. The ankle isn’t 100% but it keeps showing signs of improvement and in each phase I got to do a little more. Stay strong through all the dark moments and you’ll be crushing again in no time. Time will eventually start speeding up again…

  7. Damn Kelly that is gnarly. Stay positive and keep up the good fight bro.

  8. Bro,
    I’ve been following your oddysey with deep compassion. A Unitarian godspeed for your recovery. Thanks for your courage in writting about your ordeal.

  9. Kelly, I’m glad they’re putting you back together again. May your meds be powerful and your recovery speedy. It’s hard to believe you did that falling off a bar stool.

  10. All I can say is, Holy Crap. You’re the man for having a positive outlook about this. If you need a book during recovery, try This Game of Ghosts by Joe Simpson. I wrote an article about climber recovery last year, and Simpson beat himself up more than anyone else, yet managed to pull through. Best of luck, and if it’s okay to quote you, “Be mentally strong. Suffer well, it’ll be worth it.”

  11. It is amazing to me that you are able to share all of this as it happens. Your mental/psychological capacity to take things as they come really shines through right now. Sending healing vibes your way.

  12. thanks much, everyone. scott, would love to see that article — doesn’t ring a bell, so i don’t think i saw it. kcordes at sign thingy yahoo, if you get a chance.

    damnit, though, you’re using my own words against me! i mean, i didn’t really think i’d have to actually live up to those words. ha! indeed, it’s interesting to consider the parallels in mental toughness from something like that great trango line, and other challenging endeavors, and this one. for me, there seems to be some sort of relation. i’ve scribbled some notes on this, and might write some about it.

    thank you, janet. it’s weird, but i enjoy the sharing much more than my sometimes-crusty-self would have thought. the blog is like yoga — all these years of making fun of it, and then suddenly there i am, doing it myself (though still making fun of it). do the yoga for my spine, part of my rehab, and the writing just helps to sort things out in the way that talking things over sometimes helps. i also get the terrific benefit of encouragement from so many, which truly helps.

    peace, kelly

  13. Hey, Clyde well lend you his head cone, too, if you want that. He’s not using it at present!

  14. Kel, bet you’d forgotten all those terms and anatomy, huh? So glad you posted pics (the part of me that likes gore!) Seriously considering taking my elective rotation in trauma. I find it helpful to look at all of it somewhat objectively, “No WAY man!! My talus did THAT to my tibia?!” vs. “Oh shit, my ankle is dust…” Then get on with telling them damn bones to KNIT. Keep it all up pied piper. We’re all hangin’ on your words. peace, K

  15. Hi Kelly, I snapped my talus bone a few years ago (2002) warming up on Ironmonger, pesky 2nd pitch roof. Anyway, stay positive. As you know, recovery is a journey that makes you humble, frustrated, angry and ultimately better. There is not a day that goes by that I am not thankful for that injury. I am a much better climber because of it, despite the medical bills sucking. My wife excelled in the “put up with bullshit because she married my lame ass department” and without even trying made me love her so much more. My 4 month old daughter and I learned to crawl together, I will never forget that. Celebrate the minutia and stay strong brother. Oh and try Pilsner Urquell and your pain meeds. Worked for me.

    fred

  16. Thanks for the photos and the update Kelly. I’ve been thinking about you and sending good vibes your way.

    Probably not the best choice of words to say you’ll be back to “crushing” in no time ;^DDD (in fact let’s hope you don’t crush anything else for a while), but I’m sure you’ll be impressing us with your amazing lines and entertaining stories about them (almost) before you know it. I know it’ll be tough, but as you say, you’re on the path to recovery now; so it’s all uphill from here (uh, in both senses of the word I suppose ;^) and you’ll reach this summit too! All the best…

  17. Thanks for the update Kelly. I was wondering how it went.

    Digging the x-rays! :-)

  18. We have been thinking about you these days, Kelly. Good recovery. Henry

  19. Holy Damn, KC. I think you voided the warranty on that ankle. Time to see if you can kick ass one-legged (until healed), whatever form that takes. Good healing vibes, brah.

  20. Kelly, thanks for the update, OMFG, nice to know they can repair this kind of damage. I just finished reading Joe Simpsons “Beckoning Silence”.As you know they said he would not climb again after the “Void”.In this book he ruminates about his past and is great at expressing all the fears and passion of climbing.As a climber and SAR guy I like to understand accidents and how they happen, looking out for the report on this.
    Thanks for openly sharing this stuff.I see allot of swimming in your future.

  21. So much for worrying about the lump on my big toe, what’s a little arthritis . . .

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