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trimalleolar six month update

Linda's Staple Contest

trimalleolar fracture w/dislocation

Six Month Review


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Then-What came before (from March 30):

morphine & splint for the ride to the hospital

2 weeks in a wrapped splint after surgery

4 weeks in a fiberglass purple cast, non-weight bearing

6 weeks Ugly black contraption, gradually weight-bearing, moving/rotating ankle (brace/removable cast: not an aircast)

4 weeks in a removable brace & walking with a cane

3 months physical therapy

{click here for 3 month timeline} or {click here for the beginning} and {click here for how it happened}

Now-Six months later (to September 30th):

I can walk. Gimp-free!

hurt

This whole thing is my mother's fault. She didn't name me Grace.

When these pages (the staple contest) began in April 2004 , it was with frustration and as a depression-diversion. I did not want to deal with accepting what has been identified as a debilitating injury. The pain had been excruciating (yes, it subsides). The process of recovery is unlike any other of my broken bones.** It is unlike any other injury I've expereinced.

My surgeon has felt the need to tell me each time I see him that this is a severe***** fracture, because of the damage. And I've been told each month that the swelling and pain will continue. It does.

I can walk. Gimp-free.

The pages you see here pertaining to my ankle have elicited numerous contacts. While it was initially intended for my family & friends, it was found by folk serching for information, as I did. I've received email from people simply looking for information on what to expect in their trek to walk from a trimalleolar fracture. I've also received email from individuals to whom my heart goes out, their ordeals have been so discouraging. I've met people who, two years and more after surgery, have had incredible challenges coping with the pain interferring with their lives, one with osteonecrosis (bone death). One told me of a special pair of shoes she found, with springs on the heels, that enable her to stand: not for hours, but long enough to cook a meal.

I feel so fortunate! I've had lots of TLC. I sometimes jump out of bed and rush to the shower. a spring in my step, then I'm slowed by the cautious motion to step inside. I get all ready for a brisk walk: some days it works, other days it doesn't. I've not yet managed to go shopping for a decent amount of time without inducing major swelling.

Speaking of swelling: I expect my ankle to puff, but it's so wierd, the ways my foot will swell. There's an area on the top of my foot, in a numb zone that only pains and shoots electricity (to power something I don't have), that swells rather oddly. Theres's also an area on the bottom of my foot which will form a 1" ball that doesn't like to be touched. I've been told it's all connected to the (damaged) nerves, mostly in the front part of my foot where the incision is.

One day it will hurt here, another day, there. I still use ice, although less and less frequently. And I still keep the thing elevated. I can feel the screws (from the outside, with my fingers) when it isn't swollen so much.*** The two screws holding the back of the tibia (going in through the front incision) seem to be preventing my ankle bending completely.

* Trimalleolar fracture is defined as fracture of the medial and lateral malleoli and the posterior tip of the tibia. As described by my doctor: one fractured malleolas is a simple ankle fracture; a bimalleolar fracture (involving both malleoli) is serious and a trimalleolar fracture, severe. (There are really only two malleoli; the third one is really the tip of the tibia similar to the malleoli.)

** My right tibia was broken when I was 12, and I never regained full use of that leg. It was in a full-leg cast for 3 months. My knee never could bend much since then, and with age, arthritis has set in, both in that knee and hip. As a small child I also had a broken collar bone.

*** Whether the screws will be removed will be determined at a later time. To remove them will require another surgery and another six weeks in a cast. I do not plan on letting the screws interfere with anything!

 

Depressionballerina

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Today will soon be tomorrow's memory.

By definition not encouraging, depression has been a constant harbinger of the unhappy aftermath of today's happy activities. It comes with the following: pain, sense of helplessness, dependence and interference with work. Good news, tho. I can now walk without a limp now!

To suddenly be unable to barely navigate oneself is, on top of everything else, distressing, humiliating and inconvenient. When a simple trip to the bathroom becomes a time-consuming, each-hop-painful task, it's hard to maintain a smile. When most of the information found about a trimalleolar fracture is so discouraging, hope is fuzzy. In the beginning, not now. At this stage, six months after surgery, it's just stiff and sensitive. Sometimes, it feels like the screws must be loose, irritating the insides.

It will at times have an invisible ice poker stab it again & again, then let hot pokers brand inside. The electric factory (at the ankle crease on the top, where the incision is) continues to randomly supply power throughout the region, with occassional black-outs to the down-town heel area. And when walking from here to there, the distance seemed olympian.

Never before had I experienced such a sense of helplessness! In the early stages, the muscles used to shift myself, or lift my leg, would result in a scream from my ankle that must have been loud enough to wake the neighbors. The ankle acted as though it considered itself royality and the rest of my body its subjects to serve it.

That pain wrapped in flesh at the bottom of my leg required at least two hands to move. Have you ever tried to groom yourself with two hands moving a lower limb and the rest of you careful not to disturb it? If you've ever tried to gather your clothes to dress yourself from that position, you'll know that the help of another allows time in a day to include another activity.

In regards to interfering with work and other plesantries: I was quite intent in understanding this situation. It wasn't so simple as having a cast put on after a wait wait wait for xrays etc. then going home to hop awkwardly on crutches. The information I found on the internet pertaining to a trimalleolar fracture was either blandly clinical or personally pessimistic. I cast my vote with the optimists, even if I must be the one to start the group.

Hawaiian Airlines

Physical Therapy

I was apprehensive about physical therapy, not knowing what to expect. Milton, my physical theraphist (40+ years experience) immediately put me at ease, explaining to me what to expect, how it would happen & why. He also told me what not to do.

The aim of physical therapy is to control the symptoms, restore flexibility and regain function.

Milton let me run my video camera while he talked to the camera about a trimalleolar fracture (it isn't a really common injury) but the file size was way too big to include here. He described his professional objective; release (releive the symptoms), re-educate (restore flexibility) and rebuild (regain function).

One of the first things Milton told me was to not limp and to not ignore the pain and swellling. Limping puts stress on the injured area as well as the rest of the body to compensate for the gimp. The pain and swelling indicate injured tissues, and reducing them minimizes their effects, A chronic condition can be created by limping, pain and swelling. Immediately I adjusted my "I want to do it all, now, never mind the result" attitude to a continued "let it heal" mind set. I'm glad I did, for I can walk without a limp!

My physical therapy consisted of tissue massage and stimulation, exercises to heal, strengthen and rehabilitate my ankle, and ice wraps with mild electrical massage before leaving to minimize swelling & pain. (Different doctors may prescribe a different course.) The nerve damage, (and hindered circulation) which for me results in numbness, electrical shocks and discoloration may, or not, diminish or desist. The damage to the tendons, muscles and whatever else is in there will heal with time: they're slow.

 

Progress geoman

I've had a few surgeries to recuperate from, as well as other fractures (collarbone, leg, foot). I've experienced a sewing machine needle stitching my finger to fabric (didn't damage the bone), have had numerous lacerations, some requiring stitches and others left to form their ugly scars), toe nails pulled off by a rabbit cage... and four children. None of my previous experiences prepared me for the pain of this, an excruciating trimalleolar fracture (but I'm so glad I have a foot!)

Physical therapy has not only taught me how to walk, and to minimize pain & swelling, it has also taught me to get around much less awkwardly than I was. I can go up steps normally, but cannot go "down" yet* without it being an acrobatic feat. I can stand on one leg (either one), something I wouldn't have thought to do on my own. I'm practicing lifting on my toes.*****

I can walk without limping.

While in the hospital I was shown how to navigate with a walker (Rosie), which I used for several weeks, then graduated to a cane when I wore the ugly black contraption. I found the use of crutches (which I'd used for prior breaks and sprains, so was adept) jolted the ankle too much, so I didn't use them. I also had a wheelchair, and appreciated the hint to ask my doctor for a prescription. I'm on the last month of the handicap placard, which has made shopping so much easier!

***** Several years ago I broke my left 5th metatarsal (Jones fracture), left foot (bone that leads to the little toe) and it never propery rejoined; it prevents my foot from bending normally, so going down steps has since has been challenging

 

 

Getting back to "normal"

Seven things I found to be essential for recovery, in no particular order:
1. The prayers and encouragement of friends and family who love me
2. Help of ones who love me (& my submission to letting them)
3. Positive attitude, a sure winner in any situation
4. Humor (When I felt I couldn't do anything, I kept focus: "I can wipe my bottom!")
5. My personal faith, which brings gratitude in the knowledge that my life isn't over (it may hurt like heck, but it's attached!) and peace that my life isn't determined by an injury, and the hope of healing. (Actually not "mine", rather the faith, peace & hope blessed by Grace.)

6. An excellent surgeon (I told him he put the implants in the wrong end--wrong kind, too.)
7. A good physical therapist

While I was casted and being a passive, compliant patient, Tinkerbell has been my constant time-keeper. Tinkerbell is my G4 17" PowerBook (Macintosh portable computer). She's been ported from Hawaii to Maine, from LA to Georgia and Tennessee (more travelled than some people!). She houses my graphic tools and supplies their power, and maintains my wedding information.

 

Recuperating while my regular activities have been curtailed, I've been still long enough to refresh my main wedding website, Marriage in Hawai.com, added photo albums atdotphoto, and created a flash (Macromedia) presentation of the Bride's story the day my ankle splilt Hawaii wedding album .



The Scars: I can't really complain about the bubbly, bumpy additions to my leg, at lest they're straight. Well, two of them are. The center one, at the front, is a glob. I'm considering which tattoos to camoflauge the scars. Suggestions, anyone?

I can now walk without a limp now! I say this over and over, but it needs to be qualified: I can walk without a limp: slowly, deliberately, carefully, llimited distance.

 

Leaving Fear Behind

Arriving unexpectedly was fear. For the first time in my life a debilitating fear, not just being afraid, but dictating my steps. A fear of repeating the pain, The first time I stepped onto a parking lot pavement (after being casted, of course), with Rosie (pink walker) I was gripped by fear. What a strange, awful feeling! I hopped on my right foot, trying to not jar my bound left one and felt my right foot conform (ever so slightly!) to the uneven pavement. (Did you ever notice that?) When I looked down on the pavement, each little bit of gravel loomed as a malicious trap to trip, waiting to inflict pain. I immediately retreated. And immediately derided myself for letting a few gravels dictate my direction. How ridiculous! Afterwards I made it a point to slowly, deliberately, proove to my foot that it wouldn't hurt just because I walk on a parking lot!

By the way...many triamalleolar victims have had repeated experiences with sprained/twisted ankles.

Fear, I discovered, can be debilitating and attenuate any goal. I'm too old to serenely allow an unpleasant, uninvited situation to dictate my life, to prevent me from doing what I love to do. I can do my computer stuff from anywhere, but to join couples in marriage I knew I'd have to eventually return to walking in the sand and in the grass, but was awash in the fear of again twisting my ankle.

That's all I did, really: twist my ankle, again. (The surgeon just wanted to practice?) I look back on the day the ankle broke and it was really like so many times before: my ankle twisted. I knew it would hurt for awhile, but it wasn't until I heard "crack" that it occurred to me that, this time, it wasn't like all the other twisted ankle experiences. Now, each step I take on any surface that isn't entirely smooth, I cringe, fearing another, common-to-me, twisted ankle that might become excruciating. But I've learned to tell the fear that it has to wait its turn, until I've done what I intend.

No, this fear isn't welcome here. I am not ready to limit my activity to the safety of level ground. I have been going to the beach for weddings. It's really good exercise, but still need the support of an ace wrap. A month ago I went with a couple to the same area in Hoomaluhia which, when I was last there, I waited on the ground for an ambulance. I didn't tell them until we were there what had happened before, and that the ground was wet then, too. No, the fear isn't gone, but the more I've not bent to its whim, the less it roars.

 


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This is page 4, like Paul Harvey's last page. I didn't gather the few pictures for this page but may incorporate them in the future. But, then again, maybe not.

If there's more I'm inclined to relay, it'll be the rest of the story of this injury.

Pau

many animations on this page courtesy of GeminiGraphics

P.S. If you're worrying about my disregard for color and fonts on the is page... you're right!

All images and content  2006 Windward Wahine all rights reserved.