A 2 Mile Hike

Yes, you read that correctly.  Friday I was able to do a 1/4 mile with the dogs.  Hubby has been busy teaching, and we have a new 1yr old, so walkies are a necessity.  So, my first solo dog walk in almost a year!  Saturday we did another 1/4 mile, and then I went with my mother-in-law to check out the craft stores.  It felt amazing to be able to just go whereever we wanted and not have to consider how far we'd walked, how far away the parking lot was, etc.  Just like a normal person!  I had a totally pain-free day Saturday.  Narry a twinge.  It was incredible.  Sunday I figured I better take it easy, but it was one of those amazing, you should bottle it kind of days with sun and blue skies, so carpe diem.  When Ben suggested a walk to the river, I said yes.  Two miles on trail, with hills and roots.  My legs were shaking like noodles by the time we got home, but it was such pure joy to be able to do this walk again.  I haven't been down to the river trails in two years and have really missed watching the different wildflowers bloom, and checking out the changing sandbars.  The dogs ran like they had firecrackers up their butts.  A very good day was had by all.  And, I could still walk on Monday.   Actually, my back and hips are more sore than the ankle.  I just want to call everyone in the phone book, whether I know them or not, and tell them what I can do!

A simple walk in the rain

We all know we should slow down, enjoy the simple things, and stop occasionally to smell the flowers.  This week I got to experience the simple pleasure of a walk in the rain with my dog.  It wasn't very far, it wasn't very fast, but it was absolutely delightful.  I am so pleased by the progress so far, and excited about the future possibilities.  I'm now walking without any aids.  When people started bringing me my cane because I'd forgotten it somewhere, I decided it was time to put it in the closet - hopefully for good. 

Sat. we set out to do my PT homework for the week - determine how far I could actually walk.  As a precaution, I put on my leather gauntlet brace and my hiking boots.  Felt like a turkey trussed up for Thanksgiving.  I managed 1/4 mile my first attempt.  That included a short section off-trail, with a hill.  Going up was no problem - a HUGE change from pre-procedure.  The extra dorsi flexion is really paying off there.  Downhill was a bit trickier.  I think I just need to stretch things the other direction now.  I did feel very stiff, more like a popsicle stick guy than a Gumby guy.  Like, if I stepped on something uneven I'd just break instead of flex.  Sunday we went up Hatcher Pass and I decided to leave the gauntlet at home and just go with hiking boots.  I took a short walk up an actual mountain trail, just far enough to see over the other side.  Walking was much easier without the gauntlet and I felt much more able to flex with the changes in the trail.  My husband was taking video and even captured me walking back to the car.  I was hugely impressed by how even my gait looked.   Wasn't fast, but it was pretty fluid.  I'd like to screen capture that video and shove it down the throat of every VA doc who insisted we had to fuse this ankle.  Yeah, yeah, still working on that zen thing!

When we got home Sun I stood in the kitchen and made a cake.  No additional swelling.  No increased pain.  Certainly some stiffness, but 10-20 min of rest and its ready to go again.  It's not painfree by any means, and maybe never will be.  And I don't know how much of this is physical and how much is just an attitude shift, but now when I feel pain I think, oh, well, that's not so bad, feels better than a week or two ago.  Before the procedure when I felt pain it was, oh, see, the thing's falling apart.  Attitude really is a huge component of this whole procedure.

So, I'm 2 months into what is normally considered a 12 month rehab, and I am delighted by the progress.  The first few steps each time I get up can be quite painful, and sometimes I have to stand a few seconds and just shift my weight back and forth.  Quite amusing at the library when a patron is waiting for me to retrieve a book.  I'm hoping that dissipates over the next few weeks.  I hope to continue PT for a few more weeks, as we're just starting to work on balance and gait.  I'm looking forward to increasing my endurance over the fall, and wishing I didn't have this invisible timeclock ticking away signaling the end of outdoor activities and the beginning of six months of hybernation. 

The tortoise

Continuing a slow but steady improvement.  My PT assures me its better to be the tortoise now than the hare.  Seem to have little spikes of improvement the day after a pool session.  Now primarily just using the cane unless I really overdue it during the day.  Still not much endurance, but strength coming along nicely.  ROM improving a couple cm a week right now.  Have just a little more dorsi, first thing in the morning, than pre-procedure.  A little less by evening because things are stiff and swollen.  Starting to get out and run errands on my own a bit more.  Walked across a grass lawn today at the library's summer reading program finale picnic.  Very tough, just that bit of uneven ground, but I did it.  Paying for it tonight, but I did it.  And still doing everything w/o a brace.  So that in itself is an improvement.  Think I'm going to tackle a return to yoga next week, since I can get off the floor now without having to do the dying cockroach roll onto the couch.

Swimming

Finally got to go to the pool.  Little tricky getting in and out with crutches.  Have to be very careful of the slick floor.  But once in, it felt great!  Able to walk between 4' and 5' marks.  Even did some flutter kicking.  Really have to concentrate on allowing the ankle to be soft, and it takes a lap or two to warm up, but for a few moments I was outpacing the toddler swim class.  First few steps walking are quite painful, and still mainly using 2 crutches.  But discovered once I'm warmed up around the house, I can 1 crutch it pretty well from room to room.  Even managed a voyage from kitchen to living room and back w/o crutches.  Only been a month - not the 6 they recommend, but I'm ready to declare it a 90% success.  Really feel there's more freedom of movement in the joint, and certainly smoother and more fluid.  Once the ROM releases and the healing pain subsides, I think I'm going to be a happy camper.

14+ weeks

PT continues.  I actually enjoy it.  After not doing anything for 12 weeks, it feels good to move things.  ROM increases slowly ... but measurably, which is what counts.  Ankle got T-boned on my knee walker Wed at the library by some out of control kid.  He was lucky to walk out under his own power.  Really sore Wed and Thurs, but no damage done it appears.  I discovered Friday that I can 1 crutch it for a few steps, or even use a cane.  But it doesn't last long.  Has made it easier in the kitchen.  I don't strand myself as often.  Going to take the regular walker to work tomorrow to use while there.  Try to leave the knee walker at home for late night potty runs only.  Hoping to hit the pool this week.  Otherwise, just keep on hobbling along.

PT

First PT session.  They're already planning to ask the VA for an extension.  I guess they figure its going to take us more than 8 sessions to get from here to there.  My whole body is achey tonight, but it felt good to move things again.  Still no dorsi flexion, but plantar has returned to nearly normal.  My 'good' knee is a swollen unhappy camper.  Not injured per se, just exhausted.  Trying to weight bear with crutches has made life harder for it the past few weeks.  Not fully weight bearing.  PT did say I could transition out of the Frankenstein boot whenever I wanted, as long as OK with my doc.  So I came home and put the darn thing in the closet.   It doesn't encourage me to use dorsi flexion, and wasn't relieving any pain I could notice.  Transition complete.  Still using knee walker at work, because I'm useless on crutches.  I save them for weekends and off time.  Coming along slower than I'd hoped, obviously, but not surprisingly so.  It does improve incrementally every day.  Still hoping to be down to a cane by July 4th weekend.  Just my own personal carrot.

Melt Down

I suppose it was inevitable.  I've tried so hard to remain positive and flexible through this whole thing.  But, a week out of the frame, and I just can't get over the idea that a walking boot meant I could walk.  Reality is somewhat different.  So, still using the wheelie and ankle is stiff as a brick.  No pain - as long as I don't try to move it!  Yesterday I had my husband set me up on the front deck with my newly purchased flowers and my hanging baskets and dirt, so I could do at least a little gardening.  In Alaska, this is a really BIG deal every spring.  And about halfway through the project, I needed things that weren't there in front of me.  He, meanwhile, had gone off to do something else and couldn't hear me call for him.  So, then I tried to get up off the deck, only to realize it was too low for my poor tired "good" knee to support.  So there I am, stuck like a turtle on its back, surrounded by plants I didn't want to crush.  Not a pretty picture.  I did finally manage to get myself up and back in the house, where I promptly had a meltdown worthy of any 3 year old.  So I sent myself to bed, dirt and all, pulled the covers over my head, and slept for 45 minutes.  I woke up feeling better and decided I could probably tackle the gardening again tomorrow.  I guess the point is, this ain't over till it's over and the fat lady hasn't sung yet.

I have a JAS splint on order that will assist me in regaining my ROM, and am waiting on my PT authorization to be approved.  I'm fairly confident that once I can get into the jet tub or pool things will loosen up more quickly, but that's still several weeks away.  Meanwhile, I have to accept that I'm still reliant on the knee walker to actually get around, and just keep trying to stuff my foot into the boot at home and make voyages up and down the hallway.  Grrrrr....

And then there's all the helpful folks who keep saying "oh, you must feel so much better without the frame" and "what did the doctor say, is he impressed"  I know they mean well and I do appreciate it.  But the truth is, no it doesn't feel better out of the frame because the frame was supporting the ankle joint.  I don't miss the pins or sleeping in it, but I do miss the support.  And the doctors didn't say anything because from here on out, it's a total Hail Mary pass and it's going to be awhile before we know if anyone caught the thing anywhere close to the end zone. And this week, that end zone is a long way away.  So, I just smile, grit my teeth, and say "Yes, feeling better, thanks."

Cage Free!

Frame came off yesterday.  Very quick, simple procedure, which I slept through.  Foot pretty achey, with some sharp pains in the inside heel area where the heel pins were.  They have it compression wrapped for air travel, so I can't do much with it until I get home.  Then walking boot for two weeks, and whatever feels good thereafter.  I haven't tried walking on it yet.  With the compression wrapping, the boot is pretty tight and uncomfortable, and puts stress on the bones if I wear it while using the knee walker.  I decided to stay off it another couple of days and get as much swelling down as possible before travelling home.  Then I can experiment in the comfort of my own home.  Sleeping is really nice without the frame.  I don't wake up to readjust pillows and props every time I change positions.

Counting Down

Yes, I'm counting days.  8 and a wake up to be exact.  Past few days pins have been hurting all the time.  I sneezed yesterday and nearly cried at the pain.  Strange since its all been fairly pain free.  But others have told me its like this when the end is near.  The pins are ready to come out.  I skipped ROM and weight bearing yesterday.  Just tried to keep the foot really still and iced.  Even hitting small irregularities on my scooter was painful.  Today a bit better, but still stinging pretty good.  And I'm tired again.  Suddenly sitting with the foot up and taking naps again isn't such a bad idea.  Very interesting the phases this process goes through.  Looking forward to joining those of my on-line chat buddies who've recently had their hamster cages removed.  Really looking forward to moving the body again, in whatever capacity.  Feeling confident this part of the process has been successful and will work.  Anxious to hear what kind of physical therapy is in store.

Cinco de Mayo

Not sure what that has to do with ankle distraction - I just like saying Happy Cinco de Mayo.

Not much new to report this week.  Didn't have to go to the doctor, which was a nice relief.  Doing my own pin care since my nurse neighbor went on vacation.  Need longer arms for those outside heel pins.  But everything looking good.  Talked with Phoenix doctor and he only plans to remove frame while I'm there.  Leaving permanent pins and spurs alone for now.  Was able to call and arrange a knee scooter for the week I'm there.  So, now just continue ROM and weight bearing for a couple of weeks and then we'll see what's in store during Phase II of this project.  Had a chiropractic adjustment yesterday.  Seems to have done wonders for the attitude. :)  Also fell yesterday.  Just stood up, lost my balance, and realized I was going down and had to hold up caged foot and not fall on dog in the process.  "Good" knee hit pretty hard, but it still works so I guess we're OK.  Like I said, the going slow thing has gotten old by now and it's hard to be patient with myself.  Guess this was a sign I need to pay more attention.

Still Cooking

Week 6 - just 3 to go, and yes, I'm counting!  Doing better this week.  Really hoping I'll be able to start walking once the frame is off and the walking boot is on.  Persuaded the doctor that we could pass on the last injection and not negatively affect the outcome.  I think he's as tired of trying to find the joint space as I am of getting poked.  So, just x-rays and re-dressing from now until frame removal the end of May.  Doing lots of visualization of joint space and cartilege rebuilding.  Pin sites look good.  Range of motion doing OK, in my opinion anyway.  Weight bearing OK.  Just keep plugging away.

Boredom

For the past week, my main feeling has been boredom.  I'm tired of dragging around the hamster cage and tired of everything associated with it.  The unique-ness has definitely worn off.  Its getting harder to be patient with myself and do things slower.  I'm tired of telling everyone I'm doing fine and there's nothing new to report.  I'm tired of wearing the same two pair of pants!  Its hard to force myself to take the down time I need to be fully rested.   My husband has taken to putting me down for a nap daily!  If I don't go willingly, he threatens to take my wheelie away from me.  I'm ready to get this thing off and start some serious physical therapy biking.  Just another stage in the process, I'm sure.  One of my fellow frame wearers gets his frame off today.  I'm very anxious to hear about his experience.

ROM going OK, I guess.  Don't really have anything to measure it against, but it increases every few days by 1/4" or so.  The joint is moving, and without much pain.  Mostly its the heel pins that prevent me from doing more.  Weight bearing is going fine.  I'm convinced I could walk with the frame if it weren't for the heel pins.  I'd also probably be tripping over it every other step!  The joint pain is minimal compared to pre-surgery.  So I think the frame is doing what its supposed to do.  Just trying to maintain a good diet and positive frame of mind, so the body makes that holy grail cartilege that will allow some pain relief when the ankle no longer as this suspension bridge to support it.  I really think if there was a Star Trek device to miniaturize this whole contraption, so it could be installed internally, we'd have a permanent fix to the problem.

Balance

Played hookey from ROM and weight bearing yesterday.  Heel pins just too sore to want to move anything.  Today played hookey from work so I could concentrate on ROM and weight bearing.  Bottom line is, think I overdid it this weekend.  Trying to find balance between normal activities and extra rest; and between taking or not taking pain meds.  I suppose by the time the hamster cage comes off, I'll have it all figured out.  ROM did improve today, so yesterday's hiatus might have been a good thing.  Up to @1.75-2" total movement measured against the hinge rod.  Not normal, but moving smoother and improving steadily.  Think body still needs several hours down time couple of times a day.  I tend to forget that riding in a car or being on the scooter counts as activity because the foot is down, not elevated and resting.  Just as being at work, even if sitting with the foot propped, isn't the same as being at home with it elevated.  Another doc appt. and injection tomorrow.  Only counting how many injections are left - not how many days in Hamsterville - yet.

Fourth Appointment

Doc finally has a routine down that is providing tolerable joint injections.  Requires numbing the skin, then numbing the muscle, then doing the joint injection.  But, whatever works is good by me.  X-rays show consistent joint space.  ROM is proving a challenge.  Makes the heel pins very unhappy campers.  But my nurse neighbor has suggested a new routine of pain meds that will hopefully help.  Hard to pursuade yourself to do ROM when its painful.  Otherwise, all going well.  Feeling a bit stir crazy and bad case of Spring Fever.  Would love to get out and walk dogs or bicycle.  Just keep thinking how good it will all feel when its done and how much more pleasant the fall walks will be this year.  Fingers crossed.

Range of Motion

Got an e-mail from my doc instructing me to begin range of motion and weight bearing.  You just gotta love modern technology.  Must admit, pretty intimidating to unlock the frame for the first time and try to move this thing you've been protecting so hard the past 4 weeks.  One of the down-sides to trying to do this long distance.  I think there's a great psychological comfort in having the doc tell or do these things to you in person.  At home, I just have to trust nothing is going to fall off!  Also have to admit, not much motion.  Lots of stiffness, and lots of pain trying to dorsi flex.  I have some serious work to do over the next 7 weeks.  Since we're still a few days shy of a full 4 weeks, I decided to ease into the weight bearing by having it on the floor when I sit.  The "weight" is just the weight of my leg.  Achey-est day so far.  But as with everything else, should improve with time and patience.

Really wish I could go to the pool, or at least soak it in the jet tub.

Week Three

Everything looking good.  We've decided the redness was an allergic reaction to the betadine, and its much improved this week.  Pin sites look good.  Very little pain most of the time.  Joint injection was much less painful this week.  I takte that as a hopeful sign that the joint is adjusting to having space and fluid in it again.  Mostly its just a bit of a hassle dragging around a hamster cage.  Hard to get comfortable anywhere but in my own home.

The Hamster Cage

Had my neighbor, a nurse, come over yesterday and inspect and clean the pin sites.  Finally remembered to take a photo while the hamster cage was naked and exposed.  We're trying to figure out what the redness is.  Looks and feels more like an allergic reaction than infection.  Pin sites themself look good.  Taking precautionary antibiotics just in case.

Overall still feeling good (unless I think about the next injection).  Bit worn out physically and a bit restless.  Hopefully returning to work a few hours next week will help.

Second Week Follow-up

First set of post-op x-rays.  Beautiful joint space!  Seems the fixator is doing what its supposed to do.  Disappointing, but developed slight infection.  Seems more of a skin irritation to me.  Not unusual with all these pins, but still disappointing.  Had my first joint injection of Synovisc.  I expected it to be painful.  I didn't expect it to be the worst pain I've ever experienced.  Poor nurse.  Was standing too close to my good leg and he'll be speaking in soprano the rest of today.  It's going to be difficult to prepare for the next two visits, knowing I'll be getting another injection each time.  But I actually had to fight to get these administered, as the VA here does not approve, even though they were ordered by the Phoenix VA.  I reminded myself that I had begged for this as I was turning purple and swearing like a sailor.  My hope is that since the joint has been so collapsed for so long, as it adjusts to having space and some fluid, perhaps the pain won't be as bad next time.  The trial results on injections in the ankle vary greatly.  So, it's not a necessary part of the treatment.  But my doctor in Phoenix does believe they help, and after fighting so hard for so long to get this procedure, I want to cooperate and do everything possible to assist in a successful outcome.

I'm feeling well enough to want to go out and about, like have dinner with friends.  But I find it impossible to get comfortable anywhere but my recliner or bed.  My recliner and my butt are becoming much too friendly, I'm afraid.  The foot doesn't hurt, but there's just nowhere to put this hamster cage without putting pressure on the knee, or the hip, or the back.  Riding in a car any distance is the same issue.  The foot isn't happy on the floor for very long at a time.  You cross your legs, your foot falls asleep.  You put it on the dashboard, your hip falls asleep. 

I traded in the speed racer knee scooter I had rented for a little old lady model furnished by the VA.  At first it was disappointing.  Can't get nearly the speed with the new model.  But it has the advantage of folding up completely, is lighter weight, and turns in a much shorter radius.  It's much more practical for a small living space, like my house, and I think my husband would be relieved if I quit taking off the baseboard molding every time I ventured to a different room.  The knee scooter is an absolute must, I believe.  Crutches would severely restrict my activities and my independence, not to mention my arms would have fallen off by now.

I tackle the issue of clothing this week.  If I want to return to my job, even on a limited basis, next week, I need something to wear other than shorts or side snap sweats.  So I'm using the sweats as a pattern for side snap pants.  And of course, I'll need matching T-shirt footbags.

First Post-op Follow-up

Just returned from first post-up follow-up appointment with Anchorage VA.  You realize how sadly compressed your life has become when you look forward to a doctor's appointment as an excuse to get out of the house.

Pin sites look healthy.  I have to admit, I did "swoon" when they unwrapped this package for the first time.  Watching on-line videos of someone else's leg is a bit different than seeing these big honking rods going through your own leg.  But I am on blood thinners.  That must be a contributing factor.  I really can't be that much of a wimp.

I am convinced this was all designed by a couple of good 'ole boys in the garage one night after a six pack.  It is quite the erector set.

Pain meds doing their job well.  I'm able to start cutting back and often sleep through a dose.  Sleeping quite well considering this additional appendage.  Maddie the cat has become adept at curling herself into my lap without tweaking anything tender.  Purr therapy must count for something in all this.

Picked up a knee scooter today.  A bit painful to put weight on the tibia, but the tibia rods have been a bit tender the last day or so.  Sure beats waggling about on crutches.  I guess its either sore arms or sore leg.  The scooter has a basket, so I can actually carry things from room to room.  Does pretty well in my small house.  I imagine the cat will be riding around in the basket in no time.  I got up some impressive speed with it along the long tiled hallways at VA.  All the old guys were jealous.

The side snap sweat pants worked great for appt today.  Can't get anything else over it but shorts at this point.  Also found that the foot bags I made out of men's T-shirts are working well to keep the foot covered, prevent damage to furniture, and keep the gawking to a minimum.

Seems like all I need to do now is rest and heal for another 3 weeks.  Then we loosen the hinge on the frame and begin dorsi-flexion and weight bearing.  I think I could get used to the mid-afternoon naps.

24 hours post op

The hard part's over and now begins the healing.  A huge debt of gratitude to the Phoenix VA.  Without exception, every staff member I dealt with (and it was considerable over 2 days of pre-op and op) was friendly, professional, efficient, and really seemed to care.  Their system works beautifully and I felt well cared for at each stop.

My podiatrist is like a mad conductor in charge of an orchestra of cats.  The podiatry clinic is nothing short of controlled chaos.  But they make it happen and see an incredible number of patients.

Surgery went well.  Doc was very pleased.  So pleased, he cranked the frame up to 9mm distraction instead of the typical 5, just to be on the safe side.  Anyone remember getting their braces adjusted?  Had a bit of trouble in recovery, but felt considerably better once released and away from all the other sick people and their issues.  Glad he allowed the day surgery option.  Lots of pain initially.  Several elephants sitting on my foot kind of pain.  But pain meds are controlling it fairly well.  He didn't do any clean-up or pin removal at this point.  If he decides to do that, he'll do it when the frame is removed.

Crutches are the pits.  Definitely made for 20 year olds, not 50 year olds.  I'll be renting a knee walker when I return to Alaska.  And I do believe I'll be able to fly home as planned.  Might not be the most comfortable thing I've ever done, but its definitely doable.

No idea what this monster looks like.  They wrap it all up in gauze and then cover it with a giant ACE bandage.  Looks like I stepped into a cereal box and then taped it to my foot.  Not supposed to unwrap the package until I see my doc in Anchorage for re-dressing.  Cuts down on pin site infections that way.

Slept fitfully, but did sleep.  Unlike most others I've chatted with, I was able to lay on my sides immediately.  And surprisingly, bumping the frame doesn't seem to add to the pain.  Mostly its just a deep ache in the joint, and then sharp, burning sensations in the heel area that come and go.

I started my healing meditations last night and am looking forward to resting and giving this all a chance to work now.  It's much easier knowing what I have to deal with, what the pain level will be, and what I can and can't do.  That unknown black hole stuff is scary.

One week until surgery

So, here I am, one week before surgery after a year of maneuvering.  BTW, did I mention I live in Alaska and am having this done in Arizona?  Just to add a little interest to the whole procedure.  The VA agreed to pay my airfare to Seattle and back, since that's where their doctor offered treatment.  Everything else not directly medical, including lodging and transportation, is on my dime.  However, I didn't have to mortgage my house, and for that I'm grateful.

Over the past few weeks I've developed what I think is tendinitis, which is proving very painful and frustrating.  We've also had weeks of high winds and very cold temperatures, which adds to the pain factor.  I don't think I could walk around the block at this point.  I can't walk without a brace on.  My dorsiflexion is probably down to 5 degrees.  That's important because you need 10 degrees to walk without a limp.  Most steps feel like I'm walking on broken glass.  Last year this time I journalled that most steps felt like I had a rock in my shoe, except the rock was internal.  This past summer I really struggled to walk a mile, and uneven surfaces are murder.  My husband says I'm like a bear now, I can't do inclines at all.  Bumping the ankle or foot lightly on the floor mat of my car, or the door frame, causes excruciating pain and a couple of times I've had to put my head between my knees to keep from passing out.  There just isn't much give in the poor thing at this point and something definitely has to change.

I've done a lot more Internet research and talked to a few more doctors.  I'm feeling gut level positive about this whole plan.  I've also checked out a couple of on-line blogs about external frames.  It's been educational and provided info for more questions I might not have thought to ask.  But I've also scared myself quite badly.  I've come to the conclusion that the folks on those sites are up in the middle of the night pecking away because they're worst case scenarios and they still really need that on-line support.  I believe the folks who've had good to average results are all off living their lives.  So, be forewarned.  They're interesting places to visit, but I think taking it all with a healthy dose of perspective is really important.

I feel as prepared as I can be.  Because there are so few cases, and everyone has an individual experience, everything that happens after the actual surgery is a great black hole of unknowns.  I do know that my doc plans to do the procedure arthroscopically, which is good because we'll avoid the previous scar tissue, healing will be faster, and the chance for infection less.  Also, it will be considered day surgery and I can fly home 48 hours later.  We'll see how that all works out.  Since all we've done so far is e-mail, he won't really know how much housekeeping will be required until he actually gets in there.  The plan is to wear the frame for 8 weeks, and then a walking boot for 8 weeks while the holes in the bone fill in.  I'll be in an SBI Rad frame, which is designed specifically for arthritis patients, and does not have the dreaded midfoot wire that everyone complains is so painful.  Their site has a great video that shows exactly how the frame is installed.  I have to say, it really looks like something the neighbor guys came up with in their garage late one night.

I intellectually understand that I can't expect to judge results for at least a year, and that it may actually be more painful for awhile.  We'll see how well I physically and mentally incorporate that knowledge when the time comes.  I understand that pinsite infections are a concern.  Otherwise, everything is pretty much up in the air.  No one can tell if I'll be able to weight bear while in the frame, or able to tolerate motion.  My plan is certainly to try to flex the ankle as much as I can to avoid it freezing up.  We also have a series of joint injections planned, but since my local VA doesn't allow injections in the ankle, I don't yet know where we're doing those.  I'm really hoping I don't have to jump on a plane to Phoenix every two weeks.

I'm concerned about returning to work.  I'm concerned about the flight home.  But mainly I'm just looking forward to waking up each morning knowing I'm doing something positive instead of just watching it and my quality of life deteriorate.  I'm hoping the tendinitis and my back both enjoy the time off and heal.  And that I don't run out of movies and books!

Introduction - Part II

I'll save you all the bureaucratic stuff.  If you're a veteran and need encouragement, leave a contact in the comments section and I'll e-mail privately and try to share what worked and what didn't work for me.

The interesting bit started last year when I finally decided something had to be done.  My VA orthopedist gave me an article about the latest ankle arthritis procedures, and the VA offered to send me to a podiatry specialist in Seattle.  I didn't think much about the options at the time.  Kind of figured the specialist would tell me all I needed to know.  But then I started getting a funny feeling and decided to at least google all the weird procedural names.  As time for my trip came nearer, I decided if I really wanted to make the best decision, I needed to see a specialist in each procedure.  Naturally VA wouldn't pay for any of that, but hey, we're talking quality of life here.  So I started researching doctors and found a specialist in allografts and a specialist in arthrodiastasis in San Diego.  I also googled the guy in Seattle and found he mainly performed fusion (arthrodesis).  So I called the two San Diego guys, figuring top notch specialists would never agree to see me without a referral or on such short notice.  And both of them re-arranged their schedules to accommodate me!

I'm really glad I paid for the extra leg on the trip.  I basically discovered that ankle replacements are still lagging far behind hips and knees technologically.  I wasn't a good candidate.  The allograft proved to be less than I had hoped.  As described to me, it wasn't a permanent solution, tending to fail in about the same time as a replacement.  I was really intrigued by the idea of the ankle distraction, or arthrodiastasis though. 

For those of you unfamiliar with the option, there are a few good scholarly medical articles available online.  Just google the term.  Basically, it is a procedure using an external frame that manually pulls apart the joint, creating space.  The doctors will be the first to admit they don't really understand why it works.  But offloading the joint with the frame, and then doing some weight bearing creates a chemical reaction in the body that can produce new cartilage to cushion the joint.  It's not the same cartilage you were born with but it seems to be effective in producing some degree of pain relief.  Even if the joint space collapses when the frame is removed, patients can still experience pain relief, sometimes for many (10+) years.

It is not a permanent solution, but seems promising as an alternative to fusion for the purpose of preserving the joint, any available motion, and delaying more drastic procedures while we all hope that technology advances in the field.

I decided a year ago this was the procedure I wanted to try because it would preserve my original parts, would preserve my motion, and because my body has reacted well in the past to minimal medical assistance.  I'm all for trying the least invasive thing first.  I absolutely want to avoid a fusion at this point because even at 50, I'm considered "young" in the medical community, and because our bodies are meant to bend at the joints.  If you fuse one, that stress has to go somewhere, and in most ankle fusions, that's into the knee, back and hip.  I already have back/hip issues from limping over the past year.

My local VA knows nothing about the distraction procedure, but did agree I could have it instead of the fusion IF I could find a VA doctor who would perform it in a VA facility.  Wow.  Talk about a needle in a haystack.  Again, I won't bore you with the bureaucracy, but after six months, I realized if anything was going to happen, I was going to have to make it happen.  I started making copies of my X-rays and sending out letters.  I spent hours on the Internet researching possible candidates.  And within the VA system, there aren't many.  Actually, nationwide there aren't all that many.  Although the procedure has been in the US for at least 30 years, there just aren't many of us ankle arthritis patients around to practice on.

I was stunned to receive prompt, informative responses directly from some of the most experienced people in the field of podiatry.  I've had some great e-mail and telephone consultations.  About half the people I contacted didn't feel arthrodiastasis was a workable option, or hadn't had much experience with it, or didn't believe it had much benefit.  The other half were willing to try it for me, and a few felt it was the exact right choice.  And after six months of active investigation and contacting, only one VA doctor was experienced in the procedure and willing to do it for me!

Trust me when I tell you, you didn't want to be my friend or family member over the last year as I've battled to get to this point.  It has been a very long, frustrating road to find this one needle in the haystack.  But that's one of the main reasons I'm writing this blog.  If I can save anyone else the aggravation, I'd really like to.

Introduction

Greetings!  I decided to start this blog for two reasons.  a) I'm curious about blogs and have never done one before; and b) I thought my experience with ankle arthritis and distraction procedure might prove helpful to someone else.

As any of you with ankle arthritis no doubt know, it is not a commonly occurring condition.  Usually, people only develop it many years after a significant injury to the ankle.  So, there aren't a lot of us around to share information.  And the typical ankle arthritis patient, so I'm told, is over 75 years of age.  So for those of you significantly younger than that, a special welcome.

I am a 50 year old female who developed ankle arthritis as a result of a .22 caliber gunshot wound sustained during active duty with the US Army 30 years ago.  No, not one of my brighter moments!  Suffice it to say, a combination of a bad habit of resting my arm pointing down, and an illegally filed off firing pin I was not aware of, resulted in one of those moments you'd like to take back and can't.

I've been very fortunate.  For the past 26 years, I've been very physically active and most people who knew me had no idea I had this injury.  I played racquetball competitively, climbed small mountains, participated in martial arts, and denial worked very well.  This was particularly gratifying as the prognosis from the Army surgeons had been all gloom and doom.  First, they were convinced I would lose my foot to infection.  Then they were positive I would be wheelchair bound by the time I was 30.  I was delighted to prove them wrong.

A few years ago things began to change, and the downhill slide came very quickly.  It seems like I went from never thinking about the ankle to thinking about it with every step almost overnight.  As a variety of doctors began looking at X-rays, I got the sideways head tilt, the chin scratch "hmmmm" and the raised eyebrow glance from my foot to the X-ray and back again.  One doctor actually said he'd seen better preserved joints on 200 year old mummies!  I didn't need a medical degree to realize it wasn't pretty.

Because this injury occurred on active duty, it is a service-connected disability and the care and repair rests solely on VA.  Anyone with VA experience knows that adds a whole new layer of interest to the issue.