An Open Letter to My Orthopedic Surgeon

No, I don’t have anything of value to add to the discussion on ED today. Instead, I offer you an open letter to my orthopedic surgeon: 

 

Dear Dr. H—,

 

Do you remember how I came to you, desperate, for a second opinion about my ankle after being told by a Stanford doctor that my MRI showed a torn tendon and that I needed surgery, and you not only agreed but encouraged the surgery, even pushing it up a month, and then, after the surgery, telling me that the tendon wasn’t torn and there was nothing structurally wrong with my ankle but a lot of inflamed synovial and scar tissue, and then telling me I’d be fine to walk within a week, but then when I wasn’t getting better by my next check up, wrenching my ankle around in several directions telling me to get over it, only I had gotten an infection from the surgery you did and that was why it wasn’t healing and still hurt terribly, so you put me on antibiotics that almost killed me because I was allergic to them, but you took one look at me when I was covered in huge, painful hives and actually denied that I was having an allergic reaction to the medication, and then, after having to do another surgery to get rid of the infection, you wrenched my ankle around a lot and sent me to physical therapy saying that I was fine and had no reason to be in pain, even though the nerves in my ankle wouldn’t stop firing and it hurt to put on a shoe or even touch the area near the scar, and then, after two months, when the nerve pain actually got worse you came into the office, wrenched my ankle around in a bunch of different directions despite the fact that I was crying from the pain, declared, “We’re done,”* and then walked out of the room (and charged me $30 for the less-than-five-minutes you spent with me)?

 

Well, this keeps happening:

Swollen ankle 5 months after surgery

 

“There’s nothing structurally wrong with your ankle.”*

 

Thanks, doc.

 

– K.

 

*Actual quote.

How I Got Here: Part Two, or A Photo-Heavy Meditation on My Ankle and Moving to California

Before we jump into today’s post, I just wanted to let you know that if you live in the San Jose area, the National Eating Disorder Association Walk is on September 22 on the Plaza de Cesar Chavez. If you want to walk, volunteer, or donate, please let me know! I’m going to be volunteering with the Eating Disorder Resource Center, and we’d love your support! Thanks, and now onto our regularly scheduled programming!

Airplane wing and clouds

On the wings of a dream…

At first, California was a dream come true.

I had transferred to a new Kool-Aid store, I had a bedroom in my mother’s house, and I even had a Bikram yoga studio five minutes from my new digs.

I lived in the mountains in a quiet neighborhood with spectacular views.

View from the mountains in Silicon Valley

The view from my house

There were multiple vegan restaurants in my town. And multiple vegans. I was no longer an alien.

I just continued to harbor this alien, inexplicable pain in my right ankle.

Fortunately (or unfortunately, such as the case turned out to be), Stanford University is under an hour away from my perch in the mountains–and Stanford University is where, I was assured, the professionals would be able to put an end to the by-then almost year-long journey on which my ankle had taken me.

Initial examinations at Stanford left me with this impression: a) there was definitely something wrong with the peroneal tendon and b) my doctor sucked at talking to people.

The Stanford doc was apparently the best of the best when it came to the orthopedics of the foot and ankle, but (and online reviews concur) awful at people skills. She ordered an MRI of my ankle,* and spent exactly six seconds going over the results before ordering another boot and sending me back home.

Peroneal Tendon MRI

Apparently it looks like there’s a tear in there…somewhere.

When I scheduled another appointment with her to ask her for an explanation, she pointed to a spot on the MRI that was sort of dark and said, “It’s a high-grade tendon tear.” When I asked what that meant (as in, prognosis? Treatment? Healing time?) she just replied, “That means it’s bad.”

And that was that.

So I went back on disability with the promise of maybe surgery/maybe not in six weeks upon reassessment.

And so I went for a second opinion.

The Palo Alto Medical Foundation came just as highly recommended as Stanford, and my second-opinion doctor looked at the MRI and concurred with the high-grade tendon tear diagnosis. He, fortunately, took the time to explain to me what that meant:

There are two peroneal tendons that run down the lateral side (the outside) of the leg and around the ankle bone: the peroneus longus and peroneus brevis. The tear was in the peroneus longus and, apparently, only partial (meaning that the tendon was not entirely severed, which would have explained why I had been able to walk around on it for a year). If it was really a severe tear, however, no amount of sitting around on my rear and waiting was going to coax the tendon to repair itself. (Tendons and ligaments, unlike bones, do not have access to the blood flow of the vascular system, and so they are notoriously bad at repairing themselves. This is why people say it’s actually less of an ordeal to break an ankle than to sprain it.)

Rock tape, kinesio tape, ankles

Mom’s Rock Tape was no match for my ankle pain…

I had apparently been trying to live my life on a partially torn tendon for almost a year. The explanation was a relief: at least I wasn’t crazy.

He recommended surgery. And so the wheels were set in motion.

The date was to be July 20th. It was only the last week of June. I was prepared to hunker down in my cam walker and wait. And wait. And wait.

But after only a week, I got a call from the nurse. There was a cancellation for this Friday. Would I like to come in for surgery on Friday? Heck yes, I would.

My foot before ankle surgery in the hospital

Last views of an intact ankle

And so I went in for tendon repair surgery (as well as a just-in-case arthroscopy of the talus to rule out any operable dysfunctions in there) on Friday, July 6th. I was expected to be good to go back to work by August.

It’s September now. And I’m still sitting in Starbucks, typing away, my ankle only just out of the cast after a second surgery.

The first surgery was semi-pointless. Apparently the MRI was wrong. There was inflammation & scar tissue but no tear.** So it was back to feeling like I was crazy. Why had my ankle still hurt so much? The procedure did little but give the doctor a chance to debride some inflamed tissue–and introduce a rare Staph infection into the wound. I found that out while trying to limp around Chicago while visiting my family recently. I was walking by that point with only one crutch and doing my rehab exercises every day to only slight improvement of mobility. By the end of the trip, however, I found myself bleeding through my sock nightly, even though the wound should have been closed by that point.

Post operative view of my ankle

Not for the squeamish…sorry for the ick.

A reexamination by the doctor and PA heralded the revelation of my third cellulitis in a year and reintroduced me to heavy doses of antibiotics.

And, as you all have probably gathered by now, not only am I allergic to the antibiotics I was given, but they also did diddly squat in killing the Staph. Hence, surgery number two.

Swollen ankle after surgery

Swollen a month after surgery, with no sign of abatement…

And that’s where I’m at. My ankle, which has pained me in more ways than just physically for the last year, is atrophied to a point where the difference in size between my two legs is almost comical. I am out of my cast as of Monday, but the new wound is still open, so I have to sit here on my rear with my leg elevated above my heart as much as possible.

I start physical therapy next week, provided the wound heals correctly.

And then…what? I don’t know. Getting stronger, I suppose. I still don’t have an explanation for the pain, but maybe getting an explanation isn’t what’s important.

At this point, as horrible as this year has been, I’m nothing but grateful for the problems with my ankle. Because if I hadn’t felt that little tweak, hadn’t had to change the way I worked out (the intensity, the frequency, the type), hadn’t had to spend days sitting on the couch, hadn’t had the impetus to start this blog…well, I might very well still be in Florida, wishing for a different life.

I joke, when people try to express sympathy for my now-scarred, lame ankle, that I’m glad that all I had to give up was one limb in order to get back my whole life. And this too shall pass…

So today I am grateful for injury. I’m grateful for being forced to slow down. I’m grateful for being forced to own my experience in my own body and for learning that even with its imperfections, it’s still a pretty good body with a lot more strength than I ever thought it could have.

Today I am grateful for baby steps. And I’ll keep on taking them, one tiny step at a time.

-K.

*For those of you keeping score at home, I’ve had, to date, two X-rays, two MRIs, and a bone scan on my ankle.

**The post-op report says that the arthroscopy revealed softened but not deformed cartilage in the central talar dome (probably from the lack of use and the the extended time in the cam walker). There was also a build up of inflamed synovial fluid around the tendon, as well as scar tissue that needed to be removed from the tendon. In order to facilitate healing, the doctor removed the scar tissue and then introduced micro-tears into the tendon, which actually force healing–much like the micro-tears introduced into your muscles every time you work out forces the muscle to heal stronger and grow. He also noticed that the belly of the tendon is positioned lower than anatomically normal, which can cause a higher rate of injury, so he shaved that part of the tendon as well. For a REALLY great resource that explains a lot of this in an easy to read an understand way, check out this link. (I just found this, but I wish I’d had it when the doc was explaining my situation to me…)

And just because I found this interesting, a direct quote from the post-operative report: “There was abundant anterior lateral synovitis which was beefy red and irritated looking.” I don’t know why that particular description made me chuckle, but it did…so there you have it.

How I Got Here: Part One, or A Photo-Heavy Meditation on My Ankle and Leaving Florida

I became a vegan partially encouraged by the claims of green smoothies curing everything from cancer to hangnails.

I didn’t have cancer (thank god), but I did have an ankle that refused to heal. I thought that, perhaps, by detoxifying my insides I would be giving my body the impetus it needed to start healing.

The yoga certainly helped; in fact, doing Bikram seven to nine times a week greatly facilitated my ankle mobility and reduced my ankle pain. However, I could neither financially or temporally support my yoga addiction, and when my hours changed at work, I had to give it up almost entirely.

When I went back to the gym, besides the fact that the guy at the front desk was seriously concerned about the extent of my yoga-and-green-food-induced body mass loss* over the last two months, I had trouble doing lower body exercises without pain. Standing for hours at work made everything worse. More and more often, I was being sent to the back of house to answer the phones so I could sit during my shifts.

Yoga thin

Without yoga, I was depressed. Without exercise period? Well, not even kale could make things better. And with both my roommate and financial situations definitively headed south–along with a major burnout impending at the Kool-Aid job–I took a much-needed vacation.

I flew across the Mississippi for the first time in my life so that I could visit my mother. In California.

In California, life was beautiful. In California, I felt calm and relaxed. In California, I felt change.

Visiting Apple Campus, the Mothership at One Infinite Loop

Visiting Apple’s Campus (“The Mothership”) with Mom in California

When I returned to Florida, I found out that my roommates’ guest was throwing a party for my roommate in our house (an event about which I hadn’t been consulted). I retreated to my grandmother’s house with my dog that night, and placed a phone call to my mother. I was going to California. To live with my mother. For good.

Fortune cookie, Moving, New home

A fortune cookie on my birthday…It was a sign.

That would take care of my roommates and my finances, but what about my ankle?

I wouldn’t be able to leave Florida until the new year, and it was only October. I still had to stand on my feet for nine hours a day, forty-plus hours a week.

And since my orthopedist had been no help, I went to a podiatrist. I was X-rayed and examined, but nothing showed up to conclusively explain my pain. My ankle ached constantly and hurt acutely when I tried to run or jump. My heel started swelling whenever I wore shoes.

And so I went into a boot. (If you’ve never worn one of these evil contraptions, consider yourself lucky. They’re also known as “cam walkers,” and they have a rounded bottom–kind of like those horrifically ugly Shape Up shoes–which reduces the pressure you put on your bones and joints when you walk. They also make walking a chore, and so you do less of it as a result.)

Cam walker, ankle boot

The boot…

An MRI showed that I had “bone marrow edema” (swollen bone marrow) in the three major bones in my ankle: the tibia and fibula (the two major lower-leg bones) and  the calcaneus (the heel bone), and my doctor was also concerned that my boot was causing dysfunction in the subtalar joint (the hinge that moves your foot up and down) I went on disability and started seeing a physical therapist.

A bone scan in late November confirmed the edema. The PT did nothing except a few joint mobilizations, which were basically useless.

As my ankle situation devolved and my workouts remained at a standstill, I let the depression envelop me like a thick blanket, suffocating in its heat as the Floridian “winter” dragged on. My holidays were joyless, and my days monotonous.** I gained weight, despite the fact that I reduced my overall calorie intake and started substituting food with vegan food powders as often as I could. Being a vegan hadn’t cured my ankle, and it hadn’t cured my ED. The only thing I had left to do was juice some more chard and wait for California.

Dog on Suitcase

Packed and ready to fly. (And, no, Frida, I wasn’t going to forget you!)

– K.

*I didn’t just lose fat. I lost a ton of muscle. I was becoming “skinny” in a way that didn’t look “strong.” And yet: I was thin enough to feel like I was made of air.+ I wasn’t thin enough for my black shorts goal, but I was getting there, and that felt like progress.

+When I was going through my New York anorexia experience, I read a book about Orthorexia that made me aware that there was a group of disordered eaters called “Breatharians.” Otherwise known as Inedia, or Fasting, Breatharianism is about starving yourself to break free from the heavy, cumbersome bodies to which our souls have been chained. It’s a steady diet of air to become air.(In other words, it’s killing yourself while justifying it through pseudo-philosophy. I don’t recommend this.) At no point did I subscribe to this practice (hypoglycemia was too terrible an ordeal for me to try it) but the idea of transcending the physical body to become lighter than air was often on my mind. The heavier I became, the harder I worked to become lighter.

**The only good that came out of this period was the fact that I got to spend a lot of time at my grandparents’ house. I honestly don’t know what I would have done without them keeping me sane and grounded!

Grandfather on Facetime, Funny Face

My Papa on his first FaceTime call

Grandma Learning to use iPad

Teaching Grammy to use her iPad

Pain Is Weakness [Entering] the Body

To the squeamish or the faint of heart, I apologize for following (especially since I count myself among your numbers):

Cellulitis is a really serious skin infection that, left untreated, can cause blood poisoning and death.

And I had cellulitis. For the second time in a matter of months.*

Cellulitis, infection, knee

Day one

My immediate concern was to get my fever down, get the swelling down, and get my knee back to working order. I had to explain to ED that, while I couldn’t work out, I was at least benefitting from my bed rest because I wasn’t in the mood to eat. It was lose-win, but ED would have to deal with it.

Now, I know it comes as a surprise, but I didn’t die. The antibiotics did their job, and I was back on my feet…foot…in a few weeks.

Cellulitis, Infection, Knee

The worst of it

My ankle still felt weak, but I figured that weakness was just a signal that I needed to start getting it back into shape. (All of those fitspo pictures telling me that “pain is weakness leaving the body” couldn’t be wrong…right?) So I bought a pair of Vibram Five Fingers, since traditional footwear had failed me, and I got myself back into the gym and back on the road.

Vibram, Five Fingers, Running, Barefoot

Monkey shoes

I will say that I really love those shoes. There is something magical that happens when you can actually feel the road under your feet, and when you can include the earth as an ally. You feel balanced. You feel reactive. You feel powerful.

Unfortunately, I took that feeling as a green light for pushing harder. My runs increased again in time and duration, and I started going back to the gym. On days when I wasn’t lifting weights, I was performing plyometric exercises like burpees and box jumps until my ankle literally gave out.

I was unhappy at home, I was unhappy at work, I was unhappy in my body, but I had the earth under my feet and so I had hope.

And hope is a beautiful thing–except when the higher power in which you’ve placed it is an utterly controlling disorder that’s seeking to do nothing but ruin your life. And my hope, no matter how I tried to explain my way around it, lay directly in ED’s hands.

I consigned myself to getting fat. I had, after all, a chance at getting that promotion at work. My roommates were still talking to me. I had a pair of really cool shoes.

Maybe ED would let this one slide.

Foam rolling

Foam rolling my unhappy muscles

– K.

*I have the world’s driest hands, which, when confined to the frigid, tundra-like environment of the air-conditioned mall for 9+ hours a day, crack with even the slightest movement. And I work with these dry, cracked hands all day in a very public environment, where I am forced to shake hands and share various pieces of technology with hundreds of people a day. If ever there were a case for wearing gloves to work, this would be it: I ended up with a cellulitis in my right middle finger in the early spring due to circumstances unknown but pretty much easily inferred. The good news was that I could practice a little covert passive-aggression by keeping my middle finger raised throughout the day.+

+I’m kidding. ++

++Sort of.

No Pain, No Gain

Physical pain is a funny thing.

In essence, it’s a biological reaction to anything that is thrown physiologically off-balance–a signal from the body that something shouldn’t be. The unrelenting spasms from a herniated disc. The stinging of air touching the torn skin from a paper cut. You know: pain.

Psychologically and emotionally, however, physical pain can take on different meanings depending on the person and the situation.

Have you ever heard the phrase, “No pain, no gain”? For the people who believe and live by this maxim, pain is an obstacle to be overcome or even a form of positive reinforcement. These are the people who thrive on increasing doses of hormetic stressors,* for whom the phrase, “What doesn’t kill you makes you stronger” rings perpetually true. (These are also the people who are also prone to overuse injuries, because they can’t differentiate between delayed onset muscle soreness and a torn rotator cuff–or just can’t bear the thought of taking the day off to let an injury heal.)

For these people, pain is seen as weakness, as surrender. And for people who try to control every aspect of their lives, surrender is not an option.

I was one of these people.

I did not want to stop working out, so I figured that I’d have to heal myself as quickly as possible. Before taking myself to an orthopedist, however, I spent a little time diagnosing my symptoms on “Dr. Google.”**

A picture that convinced me I was “too fat” to stop working out.

According to the internet, all of the symptoms pointed to a possible stress fracture…but for the fact that the fracture would have been in the fibula and above the ankle. A brief anatomy lesson should explain why that was pretty much improbable: The fibula is not a weight bearing bone, and I experienced no direct (so far as I could recall) trauma to my ankle. A trip to the orthopedist pretty much confirmed my un-diagnosis: according to the X-ray, there was no detectable stress fracture (which wasn’t really an argument against having a stress fracture, since they are usually undetectable until after they start to heal) and there was good reason to be skeptical for the anatomical reasons described above.

In other words, I needed to suck it up and stop whining.

The doctor did give me a pair of crutches to use if I needed them, and he sent me back out into the world to do some serious damage to myself.

So I did:

I used the crutches for a few days, but using them while working in retail (and in the most crowded and fact-paced store in the mall) was nearly impossible. I found myself stuck in a customer service role, confined to a stool near the back of the store–which only added to my emotional stress, because I was trying to work toward a promotion in a sales role. So now, not only was my ankle impeding my ability to work out, but it was impeding my ability to get a raise.

Dinner with the family…on crutches.

I combatted my frustration by going to the gym and sitting on the stationary bike for an hour every morning before work.

One day while I was busy helping some customers get familiar with their technology, my  right knee started to hurt. It was a strange pain, a burning, itching sensation that seemed to sit directly over my kneecap.

By the middle of my shift, there was a red, raised bump that seemed to be growing, swelling in size and making it difficult to properly bend my knee.

By the time my lunch hit, my knee was bright red. I was scared, in pain, and starting to seriously freak out. I found myself dissolved in tears at the Starbucks kiosk, crutches now doubly necessary.

By the time I clocked back in, I had some seriously concerned coworkers who were ready to wheel me out of the mall in a wheelchair. So I left early and drove to the hospital.

After many hours of sitting alone in a hospital room, waiting and waiting and waiting for anyone to bother to check on me, a doctor came in and told me I had a bursitis. Nothing. Just a little random, unexplained swelling. Go home and stop whining.

Injury photobomb?

I went home and I waited for the little red spot to go away. And instead, it got much, much worse.

But at least I wasn’t thinking about my ankle anymore.

No pain, no gain.

-K.

*Defined, hormetic stress is the introduction of a stressor into the system that, while dangerous or destructive in large doses, actually creates positive biological responses in low doses.

In the context of fitness: when you lift a weight, your muscle tears slightly. Now, tearing a muscle is not generally looked on as positive–if you’ve ever ripped a bicep while doing a chest press, you know what I’m talking about. But in low doses–i.e. lifting manageable weights in a controlled manor–these tears are actually beneficial. Once your muscle has come to rest, it begins to repair itself–stronger than it was before. Hormetic stress is the simple explanation for how muscles grow.

In another context: getting a chicken pox shot is a hormetic stress on the body, because even though you might have a small negative reaction to the introduction of a virus, your body actually builds up an immunity and can then fend off large scale attacks of the virus later on.

**A phrase stolen from the inimitable Robb Wolf.