11 weeks post surgery

Here's a brief summary of my surgery since I last posted after developing 2 blood clots in my right calf 5 weeks post surgery.

Overall - I'm happy with my progress thus far.  The pain levels are much higher than I expected and the two blood clots in my right calf are unfortunate and often tender/painful.  I started putting pressure on my leg during weeks 7 (50%) and 8 (67%) with crutches (I was non-weight bearing for the first 6 weeks).  I ditched the crutches during weeks 9 and 10, where I put full pressure on my boot.  By the end of week 10, I was ready to get out of the boot and was cleared to walk around with an aircast only.  I had my first physical therapy appointment during week 10 and he said that my ankle was very stable and barely swollen (helped by the very tight foot to knee compression socks I was wearing), so he said I didn't need the aircast anymore.  YES!  Freedom.

I started walking regularly and this was tough.  Having my heel chopped off and re-attached with two screws means that I need to learn how to walk again, and I particularly notice that my foot steps differently now.  My arch is flatter and I now step evenly on the ground vs landing on my right side of my foot previously.  I have been having pain in every step as I now land on my big toe/the toe next to it more (right foot).  Feels like I never used the muscles to step this way and also that the pain is getting a little better most day.    Pain every step, better in the morning, really bad a night.  My PT cleared me to swim and bike, so I did so for the next 4 days following my first appointment and had no pain during either activity (although I've lost all of my fitness after not exercising for 10 weeks).  The only pain I had was while biking, where my blood clots were very sore/tender.  I really hope they go away soon.

I tested positive for a gene mutation and saw a hematologist a few weeks ago.  She drew about 20 tubes of blood looking for other mutations, so we'll see how that turns out.  She said that the mutation alone (MTHFR, homozygous for the C677T variant) wouldn't lead to taking blood thinners long term, but she said that my inflammatory bowel disease (Crohn's Disease and Ulcerative colitis) may mean that I need to take blood thinners for life.  FOR LIFE.  Great.  All kidding aside, if I need to take them for life I will.  Apparently the biggest risk for a blood clot is having had a blood clot in the past, followed by certain pre-disposed blood conditions (most of mine were negative), then other factors, of which inflammatory bowel disease is one of.  The doctor says that my kids and my family members need to get tested for MTHFR also, which can lead to a number of maladies, including coronary artery disease.

Today - I'm 11 weeks post surgery and doing well.  I had my second physical therapy appointment today and it went well.  He worked on my scars to try and flush them out (painful) and also pulled on my foot/ankle to loosen it up (very painful)!  He added more exercises and had me walk backward on the treadmill.  I had no pain doing this.  He was pleased and said that I am very far ahead of where he expected me to be.  Good news.  He is trying to temper me from doing too much too fast.  I will ease in.

The two screws have been very painful and I can't wait to get them out, which probably won't happen for 4-6 weeks.  When I have them taken out, I need to go back in a boot for 6 weeks to let the bone grow back into the holes left by the screws and avoid a stress fracture.  Not excited about being in a boot 6 weeks, but given that I always feel the screws and that it is painful to put my heel down, I know it is the right thing to do.  My heel is so painful that you can see bruises on my heel where the two screws are.  Crazy.

I've tried to stay positive and set a goal of getting a little better everyday, which I've done with the exception of a few days.

3 weeks post surgery - still not allowed to bear weight on my right leg

Feeling better everyday. Foot still very swollen and sore, including most of the way up my leg along the peroneal longus tendon almost to the knee. I've included pictures here. Pain levels are lower too.

I'm very excited that I have made it 3 weeks! Only 3 more weeks of non bearing weight. The weather has been in the 60s and 70s with low humidity, perfect running weather. It is pretty tough for me not to go running, but I'm ok. Really.

Made an appointment for my first physical therapy session for June 4th (which would be 2 months and 1 week after my surgery).

I have been stretching my tendons every night as the doctor prescribed, inverting and ex-verting the foot. I've noticed that my mobility seems limited , about the same as before the surgery. I really have a tough time extending my foot outward (to the right). I have much more flexibility moving my foot to the the middle (inwards).

I have been in my boot for about 23 hours a day. Sometimes at night I take off the boot because it is still pretty painful at night. Taking it off seems to help.

My shin pain from my knee walker scooter is better but not gone. I've been scooting to and from work, about 1.7 miles each way. Great exercise for sure, I'm usually sweating a lot by the time I'm done scooting. When it gets warmer I'll need to bring a change of clothes.

My friend Jarrod stopped by today, which was great. We enjoyed catching up and my daughter Kaiya (4) really really enjoyed playing with Jarrod (see attached pictures). My friend Shane sent me a 700 page book by Bill Simmons called "The Book of Basketball" that I'm really enjoying.

I'm am deeply saddened by the bombs that hurt/killed so many people at the Boston marathon. Many people are doing runs in honor of those the were killed/injured. I wish I could do the same for them.

2 weeks post surgery - first scheduled doctor's appointment after thesurgery

I saw Dr. Elliot today, my first scheduled follow up after my surgery (3-26-13). 2 weeks and 2 days later.

First, they cut off the my cast and then took 3 X-rays (see the attached pictures). The swelling looked pretty good given the surgery was two weeks ago everybody said.

Next, they cut off the stitches, cleaned the foot area, and put on small band-aid looking strips, which they said to leave on a week.

Next, Dr. Elliot examined the foot. He said that I will now be in a boot vs a cast and should not put any weight on it for the next 4 weeks. He said that I can sit down on a chair in the shower and can put my foot down on the ground to let the foot sit. Overall, he wants me to have the foot sit in the hanging position now vs. elevating it (unless in a lot of pain, then I can elevate it to relieve the pain). I still have a fair amount of pain in the foot, which he said is to be expected. My pain is worse before bed and I take pain medication when needed. He also wants me to rotate my foot in and out a little bit everyday to stretch the tendon. Overall, he said that I should be in the boot 23.5 hours a day for the next 4 weeks with no weight bearing activities.

I'm getting a little better everyday and I'm excited about that. The last 2 weeks have been much tougher than I thought they would be, but I know I did the right thing by having the surgery, as Dr. Elliot has pointed out a few times.

I asked the doctor about when I can expect to so some endurance events. He thought a year or 18 months to a marathon and that waking the NYC marathon in November (7 months) is extremely ambitious and 26.2 miles is
a long way".

I also asked him if I would be able to walk some 3-5 mile races so I can get my 9 races in to qualify for the 2014 NYC marathon. He thought I would be able to start doing this in July/August.

Check out the pictures below from today. I was particularly surprised at the size of the screws in my heel used to fuse my heel back together after the doctor broke the heel and moved it over (he said he used an electric saw to break it). Crazy. He said that it is likely that I will need to have the screws removed because I will likely be able to feel them when walking/running. I can probably have them removed in 4 months, which would be the end of July. I think I can feel the screws now.

The "scooter" I use to get around is absolutely critical for me. I love it and don't know what I would do without it. I've been scooting all over the place. Today, I scooted from my apartment (66th and West End) to my doctor's office (72nd btw 1st and York), about 2.2 miles, and back home. Well over 5 miles overall. This is definitely good exercise and my glutes are getting serious exercise. Hopefully this will benefit my running in the future!!! :-)

Going back to work tomorrow (4-12) after 2.5 weeks off.
A few videos of my foot/ankle from today:
Dr. Elliot said that physical therapy will start in 2 months, twice a week to seat out.

Days 1 and 2 post surgery.

I received my new toy today, a scooter that allows me to put my knee up and cruise around. My doctor highly recommended it and I love it! It is so much better than using crutches.

Here are a few videos:



Day 1 post surgery (3/27/13)
Felt ok throughout the day. The numbing blocks in my leg were slowly wearing off and I could feel and move my toes today, something I couldn't do yesterday. As the numbing wore away, my pain level was around 9-10 for a while. I took some pain meds and this helped a little, taking the pain level down to 5-6. Yesterday I had some nausea, but none today.

In the evening I started to feel hot. So I checked my temperature and it was 102.8! I also had the chills. The doctor told me that it isn't uncommon for people to have a fever after major surgery. We called him at 130am and he told me to come in to see him the next day if I still had the fever. The fever hovered between 101.5 and 102.8 for the rest of the night.

The best part of my day was when my daughter Mikayla (6) made me a few cards (pictures attached).

Day 2 post surgery (3/28/13)
Fever hovered around 100.8 - 101.5 in the morning. Saw Dr Elliot around 130pm and he and his resident took off my cast to make sure that I didn't have an infection. Quite the contrary, no infection and the foot/ankle looked great (see the attached picture). The doctor said that I was doing a great job at keeping it elevated, which helps keep the swelling down. He told me that my Brevis tendon looked "very sick, was split in places, and must have been very painful." He said, you absolutely did the right thing by having the surgery. I expected my foot/ankle to be very swollen post surgery based upon the research I did. I was extremely encouraged by a low swelling level thus far.

I asked him if he thought I could walk, not run, this year's NYC Marathon, which is about 7 months away. He said "maybe", let's see how you progress, but this might be aggressive. I like to have goals, and one of them is to run the NYC Marathon every year, even if I need to walk it.

After I saw Dr. Elliott, I went to see Dr. Saha. He took my temp (100.5), bp (122/78), and put some tubes down my nose. He said I have a severe sinus infection with tons of puss. He said that if my fever goes up anymore I should go to the emergency room, as he was concerned that the infection is so bad that it might carry over to the brain. I'll watch out for it. So, I'll be taking Augmentin, a very strong antibiotic, twice a day for 14 days.

Right foot/ankle surgery

3/26/13 -

Day 1 - Surgery Day - No weight bearing allowed on my right leg for 6-8 weeks, on crutches

Today I had reconstructive foot/ankle surgery to repair my nearly completely torn/frayed peroneal Brevis tendon at the Hospital for Special Surgery "HSS". I had both a tendon transfer from the peroneal longus tendon to the peroneal brevis tendon as well as a calcaneal ostemy. I tore the brevis tendon over 20 years ago and lately I had pain so it needed to be fixed. I was told 20+ years ago that I needed surgery, so I made it pretty long before having it fixed.

I arrived at the hospital at 6am and the surgery started around 830am.

The surgery was per performed by Dr. Andrew Eilliot, who is a specialist in the foot, ankle, and orthotics. I really like him because he takes the time to explain things to me, particularly about how my arch and heel mis-alignment is something that I was born with and that if I just fixed my peroneal Brevis tendon without fixing my arch/heel mis-alignment, I would once again tear my peroneal Brevis tendon because this mis-alignment pulls at the tendon upon every step (even walking). He said that he sees this frequently after a patient has only the tendon surgery somewhere else. He said that also getting the calcaneal ostemy done would give my new peroneal tendon transfer the best chance to live/survive another 50 years. That is why I decided to get both surgeries done. Without them, he said that I shouldn't run anymore or do weight bearing sports, because I will likely tear the tendon completely and fray it from 5-10% left to zero. He also said that the peroneal longus tendon "is also stating to fray, which means if you keep running without surgery, you will tear/fray this tendon too, then you will definitely not be able to run again. Ever.". So the surgery, for me, was the only way to go. Not being able to run or do other weight bearing sports (like basketball) just isn't an option for me. Period.

Surgery went well. I received a spinal epidural for the procedure. The same epidural that women receive when having a baby!

The doctor said that the tendon was "really really bad, basically gone". They did a tendon transfer and broke my heel to move it over and then put two pins in it.

They also have numbed my leg from above the knee down for a few days, so the pain is moderate now but is projected to be severe in a few days. Pain meds, 2-4 mg of dilaudid are available for me to consume if needed.

Procedure - Given spinal epidural, some versaid, 12.5mg of Benadryl (to combat my soy allergy), and 20 of propapol. Was totally asleep the entire surgery, where they performed a peroneal Brevis tendon transfer and a calcaneal ostemy to break my heel, move it over, and insert 2 large screws into the heel so it grows back together in this new position. Also took additional versaid and other drugs as needed during the procedure to remain "comfortable"

After surgery I ate a ton of fruit and drank a cranberry juice that I later determined had high fructose syrup in it, something I no longer consume. Bummer. My wife was there which was totally awesome. She took notes, because I couldn't remember anything the doctors told me after the surgery, I guess due to being still heavily sedated.

After the surgery had 2 Percocet and 0.5mg of dillaudid (IV) for the odd feeling of numbness in my foot

Discharged from hospital around 2pm. HSS is amazing. Extremely well run, everybody knows what they are doing and are efficient. They are helpful and made me feel very comfortable the whole way through.

When I got home, my kids Mikayla and Kaiya gave me a great welcome home by decorating the entire living room with colorful stickies.

All day and evening, I was unable to feel anything from about 1/2 inch above my knee down to my toes

Had mild Nausea in the afternoon

Drank a green machine smoothie I made in my vitamix blender the day before (kale, spinach, broccoli, peas, 1 large mushroom, baby carrots, apples, banana, pineapple, dates, water, and ice. I follow a plant-based (vegan) diet, which I strongly hope (believe) will speed up my recovery, particularly on the swelling side. .

Around 9pm took 2 Percocet for what felt like shin splints halfway up my right leg. I have a history of shin splints in this location, not sure why it was flaring up tonight.

Kept my foot elevated all day and evening. Slept on my back with my foot elevated all night. A little awkward as I normally sleep in my stomach, but not bad.

It was great having my mom in town from Wisconsin to help me out. We watched the first and part of the second episode of "House of Cards" in Netflix. I find it to be even better the second time (her first time).

Food/Weight tracking.
I plan on tracking my food and basic nutrients consumption as well as my weight for the next few months, as I basically can't exercise for the next 3 months. Will be interesting to see what happens, as I am used to exercising every day.

I weighed 180.1 pounds the morning of the surgery (using a Withings wireless scale which we find very reliable and beams right to my iphone and the web) and, according to my calorie/nutrient tracking, consumed 1923 calories today, as follows:

Breakfast - nothing consumed, not allowed to eat/drink anything after 5am.

Lunch - a can of cranberry juice and a bunch of fresh fruit provided by HSS, which was impressive that they could provide - grapes, banana, baby tomatoes, honeydew, cantelope, pineapple, and blueberries.
642 calories / 9g protein

Late lunch
Green machine - 352 calories / 11g protein

Dinner (appetite still low)
2 bananas/1.5 cups of fresh blueberries. 334 calories, 4g protein

Late dinner
2 cups of salted almonds, 3/8 pint of So Delicious cherry amaretto coconut ice cream. 595 calories / 14 protein

Overall
1923 calories (goal 2,000)
38g protein (goal 50, I usually consume 70-100 grams a day but was much less today due to not eating until lunch.

46g fiber (vs 25 or higher goal)
O cholesterol (vs FDA goal of 300)
Sodium 446g (vs FDA goal of 2400)
Sugars 204g (vs FDA goal of 50) - I strive to only consume natural sugars contained in fruits/vegatables and am regularly much higher the 50g, which is ok with me because it is all natural sugars. I don't agree with those who say that fruit in sugars is bad. I believe that we can't overdose on fruit (and my bloodwork confirms this)
Carbs - 371g (vs 300) - always high due to high fruit consumption
Fat 48g (vs 65)
Saturated fat 15g (vs 20) - I regularly run over 20 as many of the foods I consume are high in "good fats" - avocados, coconut, nuts, etc