Ankles: Surgery and Aftermath

ankle cast fracture
Two stories about dealing with perhaps the trickiest joint, the ankle.
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My Ankle and Me

by

Mikimi Steinberg

When I was 15, I lived in Atlanta, Ga. On Labor Day of 1977, I was picnicking at Stone Mountain when I slipped on small pebbles in such a way that I broke my ankle. I had surgery with pins put in to the ankle and a cast from below the knee to my toes. I actually don't remember much pain. I went home to recuperate.

In class when bored, I pulled loose threads out of the plaster and left the remains on the floor. At my 2-week check-up, x-rays detected a problem. A new cast was put on from the thigh to down to the toes. Now when I went up and down stairs my toes got scraped.

The following year at NCSY (National Council for Synagogue Youth) summer camp I sprained my ankle - of course it was the same one I had already broken.

In 1979, I made Aliya (immigrated) and finished my senior year of high school in Israel – without my family. I remained in Israel living on a moshav and in Jerusalem. I married, divorced and eventually made my home in Safed (in the Northern part of Israel).

About 18 years ago, the rainy weather affected my leg. I would feel vibrations inside the ankle. The orthopedist removed the pins and I carried on with my life as I raised my daughter and worked by families. My work was folding laundry and washing dishes.

A few years ago, my "weak" ankle weakened further.  It started to sprain two to three times a year. Each time this happened, it took longer to recover. Towards the end of 2005, the pain became unbearable.

I went to an orthopedist who suggested alternative treatments such as shiatsu. While having a treatment of reflexology, a bone was felt to be out of place and I was advised to return to the orthopedist. 

A new orthopedist had begun work in the clinic. He sent me for an x-ray. It revealed that I have Post-Traumatic Osteoarthritis. My options were to: cope with the pain and live with it; ankle fusion; or ankle replacement.

The last is usually done on elderly people, as it is not known to last more than five years. Ankle fusion, or in correct medical vernacular, arthrodesis, means time in a cast and physiotherapy and a loss of ankle mobility.

But PAIN is something that needs to be evaluated individually. When pain affects the way a person functions and their sleep as well as quality of life (in my case it meant my ordering a taxi home from work every time) then the option of surgery needs to be re-evaluated.

One of my jobs was after school child-care for a very sensitive toddler (afraid of anyone or anything new to his environment). I did not want to disrupt his schedule and I opted to "postpone" the timing of my surgery until the summer. That was until I realized how treacherous walking around the Old City of Safed and slippery cobblestones became for my ankle.

My surgery was scheduled for May 2006. At the last minute it was called off due to an elevated thyroid level. After consultation with an endocrinologist, additional medication and follow-up care I was rescheduled for surgery a week after the 17th- a fast day in Judaism. That's when War broke out with Lebanon. Safed was attacked by missiles. So surgery was postponed yet again.

 I left Safed the second day of the war when my daughter and her fiancé's family came to get me out of the War-path. I made many visits to the health clinic trying to arrange surgery in the Center of the country, calling Rabbis for medical advice on where to go based on my medical coverage, etc. I even traveled to Jerusalem. All this while in PAIN.

The war ended- but not before leaving a large impressionable hole in the wall of my apartment - 150cm from the front door when open - and it is the only way in or out of my home. My surgery was rescheduled for the end of August - when it actually and finally occurred.

Ankle fusion is a surgery that cuts/removes the round pieces of the ankle and place screws in their place. Surgery can be painful - don't let anyone tell you otherwise!  It was for me. My opinion is not to be a martyr and when offered painkillers accept it- unless one is G-D Forbid addicted to narcotics. I didn't feel pain once I left the recovery room but PAIN hit full blast the middle of the 2nd day. I was not on any painkillers. By the time I was prescribed one, I was almost delirious and emotionally distraught that I was practically inconsolable.

 It turned out that the foot had swollen inside the cast (not an uncommon occurrence) and the cast needed to be opened. Once I was on "regular" painkillers I was a lot saner. Every individual has to find what medication works for them. In my case it was Oxicod. Bone surgery is “known” to be very painful for at least 6 weeks. I wish the doctors or nurses had thought to inform me of this crucial detail.

As I had no "home" to return to (the government was repairing the damages), I returned to the Rimonim Hotel in the Artist Quarter of Safed to recuperate where I had gone after the ceasefire. One cast was put on at 110 degree angle instead of 90. I complained that the cast felt too heavy and a doctor had the gall to tell me I didn't know what I was talking about and if he were to cut it, it would fall apart and not do its job. The following day I returned to my orthopedist and he saw the problem.

Each time the Nurse-technician puts a cast on me it get bigger and bigger!  I took to talking about my “casted” ankle as a separate entity and named it Godzilla.

I had a few mishaps while at the hotel in the first eight weeks after the first operation. I paid a physiotherapist privately to teach me some "basic life skills" - getting dressed without falling and bathing on my own unassisted as I was not entitled to "home care" through my health plan. I was on my own in a hotel room. Just opening the window was a hazard. All too often I opened the window over the bed and lost my balance. I fell to the floor next to my bed at 6:45am. No one to hear me or help me! I couldn't get to the dining room of the hotel on my own. In any case I wasn't mobile enough and certainly could not negotiate any steps. I couldn’t do my own laundry.

Friends came yet again to the rescue for these and other errands I needed - medicines or assistance in getting to doctor appointments. I tried to have my friends "rotate" the kindnesses they did for me.

The duration of my "residence" at the Rimonim ended November 1st. My apartment and elevator to ascend 4 flights were not yet repaired. I had to find a place to "live" but without stairs - or else with a functioning elevator. After a few "blips", another good friend offered me to stay at her home. The question in the back of our minds was always "for how long?"

While at my friend's home, the course of my orthopedic treatment was to begin PWB (partial weight-bearing) on the cast with the aid of the walker or crutches. In my efforts to be “independent” and doing things for myself, I opened a window in the bedroom to allow fresh air into the room. In so doing, while using my crutches, I lost my balance when a crutch landed on the strap of one of my bags on the floor. It skidded throwing me off-balance. Clunk went my foot. Obviously the one in the cast!

At the next doctor's appointment I informed him I had "fallen". He sent me for an x-ray. It revealed a broken fibula. I was already in a cast and it wasn't due to be removed for another 4 weeks. Just 2 weeks later, I "slipped" yet again. This time, after "my heart came up from my stomach”, I asked that the floor be swept. A small screw was found. I surmise that my crutch ricocheted off of this tiny screw and it was just enough to alter my balance. Or maybe I'm just a klutz!

Anyhow, when I next saw the doctor I told him what happened and I was sent for another x-ray even though I wasn't due to see him for another week. This time the x-ray showed a fragmented malleoulus (the round piece of the ankle). "Surgery again " I was told. I did not question or argue the matter. I trust the two doctors covering my case. 

At my last visit to the orthopedist it was decided that I invest in a Walking Cast - a medical shoe-boot with Velcro straps that immobilizes the foot.  I hope to get mine from the States next week. Most of the pain is gone but not so the frustration and helplessness (at times bordering on hopelessness) that accompany almost every waking moment. Every move I make has to be thought out in advance. To walk NWB (non-weight-bearing) is a hard task in concentration and balance.

But my ordeal has not ended. I am still in a cast (# 8) even after all this time.

I talk to G-D a lot. I pray that the doctors know their medical training and know what they are doing and that my body will cooperate. My body seems to be on its own system that does not always coincide or co-operate with the doctors. I sometimes feel betrayed by my body and its healing methods. I have Faith in my doctors' capabilities, especially, as I talk to G-D each time throughout these many months of visits to all the doctors throughout the country. I cannot afford to let doubt creep into my thoughts. I have to be optimistic and trust in G-D and my daily talks with Him that “all will be for the best”.

I do not think I ever really questioned the "why" of the difficulties happening to me. I know it is all from G-D. I just sometimes ask Him "what next?" I guess that is pretty much my motto in life.  I don't always see or understand the answers but I hope I'm doing the right things in this world. Everything comes from G-D. And He keeps testing me. I guess I can handle it because I'm still here - and writing about it.

Just One Step

by

Kathy Rembisz

It was just one step. More accurately, it was one lousy, unfortunate misstep. But, that was all it took to change the course of our lives. Married just five years at the time, we hadn’t experienced enough “for better” to be moving on to the “for worse” just yet.

My husband, employed in the shipping industry at the time, spent his days in and out of a truck, up and down steps.  He was 42 and in good health.  He never even mentioned the fall until the night after it occurred.

"I slipped today on a railroad tie at someone’s house and my foot really hurts when I walk on it,” Brian said.

 "Maybe you should go to the doctor,” I suggested.

"What kind of doctor would I even see?” he asked.

After several similar conversations, I finally convinced Brian to see a podiatrist.  X-rays taken in her office showed nothing. It’s probably just arthritis,” the podiatrist assured him. He was fitted for a pair of orthotics, which would relieve the pain. The orthotics helped for a few hours the first day.  By the next day, they offered no relief. 

Several trips back to the podiatrist and we still had no answers, yet the pain continued. Finally, an MRI was ordered just in case something was missed on the x-ray. Sure enough, it was actually a fracture. This unwelcome news came after he had been walking around on the foot for several months already. Needless to say, we were both frustrated that so much time had been wasted without a proper diagnosis.

Brian was put in a boot cast, which in some cases can help. Both awkward and cumbersome, the cast caused him to walk with a limp that ultimately led to back and hip problems.  It did nothing for his foot or ankle. Since there was no improvement with the cast, he was referred to an orthopedic surgeon.

"It’s an osteochondral fracture or defect.  We say defect because we’re not sure what condition the ankle was in prior to the fall,” the orthopedist commented. Two places on the foot were affected—the top, close to where it joins the ankle, had a “divet” similar to a pothole; that piece of cartilage then lodged itself at the back of the ankle. Both were problems that required surgical attention.  Yet, through the lengthy explanation of the procedure we heard things such as “No guarantees,” and “Sometimes requires multiple surgeries.” Despite seeing several doctors, no one offered much more.

Mounting frustration and confusion surfaced in both of us as no one in the medical community seemed to have any definitive answers for us. Unfortunately, surgery could not be planned for close to six month out—nearly nine months after the fall occurred. Until that time, Brian hopped around in the boot cast and waited.  The waiting did not bring out the best in either of us as we coexisted in limbo.

Not surprisingly, the surgery was unsuccessful in repairing the foot/ankle or relieving the pain. The plastic ankle brace they suggested was not the answer and actually proved to be quite painful to wear. We saw orthopedics in several other major cities over the course of the next year to get second, third, and even fourth opinions regarding what to do next. Several options were offered, but none were attractive or without risk. When one doctor expressed, “We can keep trying surgeries until something works.” I snapped. "You do know you’re talking about someone’s life here, don’t you?”  He stared at me blankly, as though that thought had not crossed his mind.  I had reached my limit with feeling as though Brian was merely a guinea pig for these doctors.

After a summer where our biggest feat was survival on a daily basis—how to get him bathed, food shopping done, and dogs walked—we had hoped for a better outcome. My own health problems worsened as the stress of our situation increased. Facing financial difficulties, a job my husband could no longer return to, and family that seemed uninterested, I have never felt more alone or deserted.

Five years after this fall occurred, the details get fuzzier as the days go on. What I am left with, however, are the vivid memories of the lack of understanding and compassion from doctors. While the details no longer matter as they once did, what I discovered about the medical community will remain with me forever. To date Brian’s ankle remains unrepaired. I would be lying if I said I didn’t think about it daily. But, for now, we continue on, one step at a time.

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