Guess who needs reconstructive ankle surgery?

So here's the deal: I had this horrible left ankle fracture when I was 16. The bone was snapped in half and had to be screwed back together. (They removed the screws later.) It's always hurt when it rained and that kind of thing, which I figured was par for the course. Lately, as I've documented here, it has been giving out more and more frequently. I can just be walking along, minding my own business, and it goes over to the side without a warning. Working out on it or a moderate amount of walking causes pain and swelling. Everything hurts it, even just walking around the grocery store. It is one of the reasons I've pursued bariatric surgery with the degree of purpose I have in the past few months.

Back in 1985, when this bone was broken, the orthopedic surgeon just repaired the bones involved--that's what they did back then. They didn't have the technology then to see ligaments or even consider them a problem. I was really young and they probably thought I'd heal up just fine. My ligaments--the ones that provide necessary stability--have long since been shredded. The doctor could tell just by moving my ankle around with his hands that the ligaments there were basically gone and done for; the right ankle, on the other hand, felt just as it should. The difference was obvious in the movement and feeling, especially once it was pointed out and demonstrated to me this way. He said when the bad ankle just gives out now, it's just tearing at existing scar tissue, and the reason I can (thus far) still limp away on my own afterward is because of that scar tissue, but it will still need to be stabilized in a more permanent fashion. Future stabilization = not optional.

Reviewing x-rays taken today, the doctor said, "See now, your bones look gorgeous." (Not a sentence I ever expected to hear...)He could see on the film where the break had been with his practiced eye--right in the ball on the outside.

He said I will have to get this ankle repaired. Not necessarily today, but as soon as I can. It isn't going to get any better on its own, no matter what kind of strength training or exercises I do, and I'm "young" (ha!) and have a long way to go. "You had to know this was coming," he said. Well, yeah, I was afraid it was, but am still "young" (ha HA!) and stupid enough to think that maybe it would fix itself with my eventual weight loss, et. al. Pfffft. What they do is take part of my tendon and reconstruct the stability-providing ligament. I can't walk on it for at least three weeks, but I am allowed to drive an automatic. It's in and out of hospital the same day, no stay. After about a year's time, there is usually a lot of progress that has been made.

So--he said this, and I freaking knew it--walking is no good for me. The ankle can go over at any time--gravel road, crack in the sidewalk, step in a puddle, on a rock, off a curb. The elliptical is no good because you push off from your heel and that can also exacerbate things. Same with the Stairmaster. Since you are usually watching TV or listening to music to provide distraction from the exercise, you're all that much more likely to forget exactly how to compensate for the instability and go boom. I knew this too. Despite the crappy news that I do need surgery, it certainly felt fantastic to be validated. A doctor who listens! We talked about my pending bariatric surgery; he knows my surgeon. He encouraged me to "take care of me first", get stabilized from the GBP, and come in, maybe this fall, and get this taken care of, giving him about a month's leeway. He will write the necessary letters for me and fax his findings from today to my exercise physiologist and bariatric surgeon.

He also said these magic words: "Your weight has nothing to do with this. It is neither here nor there." I wanted to give him a big old hug, kind of like I want to hug the occasional (myopic) cashier who cards me when I buy Mr. Salted's beer at the grocery store. Oh hell, I wanted to kiss him on the mouth, just like a big old grateful hound. Why, thank you, universe! You have dealt me a doctor with a clue!

The bad news is: this puts me out of commission for longer, and I don't know how we will afford it. We'll manage somehow, I'm sure. I don't see what good waiting any longer to fix the ankle would do--it would just mean I had to take time off from a new job (should I be able to find one), and in the meantime, the ankle can still go out whenever it wants to. And it means no school, at least not this year, but I had pretty much given up on that, at least for this year. Maybe the economy will rebound a little by fall 2010.

Day 106

According to my painstaking record-keeping efforts in the food journal, Day 106 was today. I notice as time goes on and I get sicker and sicker of writing down everydamnthing I eat and its nutritional content, my writing gets sloppier and sloppier in the food journal. I can't wait to set it on fire and dance wildly around it with reckless abandon.

There are many handy websites where I get my nutritional info for the food journal; most major restaurant chains have nutrition information for their food online, and there are all kinds of nifty sites, like nutritiondata.com, where you can look up the nutritional content of just about anything--fruit, whatever. I had to laugh--tonight we had sloppy Joes, and I had to take apart the ingredients and log them all. When I looked up ground beef, the number of choices was insane. Knowing the lean percentage of the meat was far from enough--was the cow grass-fed? (Did its stall in the barn have north-south exposure? Did it poop rainbows?)

My ankle is giving me a really bad time. It now pops when I move it at all, hurts all the time, and if I do something as simple as walk around a grocery store, I basically have to ice and elevate it afterward. I'm taking more ibuprofen than I would like. I'm probably going to have to bite the bullet and go have it X-rayed, but I've been waiting for this surgery to happen to see if weight loss would help it. We really cannot afford any additional medical bills. In terms of working out, I have been sticking to strength training and tai chi--better than nothing, I reckon.

Mr. Salted was on vacation the past two weeks--"use it or lose it"--so we've mostly been hanging out at home after our little bed and breakfast stay. We went and saw "Adventureland", which we both loved, especially me, I think. It was set in 1987, so it was our era, and the soundtrack was FANTASTIC. I downloaded it on Itunes and had most of the missing songs in my collection already. It made me wax nostalgic for my college-radio DJing days--my personal life wasn't at its peak back then, but the music was great! I (amazingly) avoided working for a carnival, but I had almost every other crappy job known to man. McDonalds, Godfather's Pizza, music store, pet store, convenience stores, movie theater, nanny, you name it. My favorite jobs were always work-study jobs in college; I got to work in several libraries, which I loved. I also enjoyed bookstore jobs and had a couple of those over the years. If the economy continues in this vein after I've had and recovered from this surgery, I may end up back in retail--God forbid. A bookstore is about the only retail job I can see myself doing.

I'm still looking into the whole Tech Writing Certificate thing, though I'm definitely more productive when Mr. Salted isn't home all day with me. I'd love to be in a room all day pushing paper, researching, writing, or what have you. I'd love to be writing. Writing writing writing. I'd love to be able to say: I write full-time; I'm a novelist; I'm a writer--and have it be true.

Tomorrow is Monday, so I need to get on my support group stuff, since it meets Tuesdays. The last round of exercises was extremely overwhelming for me, and I haven't wanted to look at it again since.

I also tried a few days without sugar, just using artificial sweeteners (sugar-free Jello, Crystal Light, etc.). It was not the most fun I've ever had, and I was jonesing the whole time. I finally broke down and had a few Ghirardelli squares. We are trying to finish up the food that is going to be eradicated--a lot of white pasta and the like. Mr. Salted has agreed not to have cookies in the house.

Ankle

So, four days after my appointment, my ankle still hurts. I had to stay off it pretty much completely for a couple of days, elevate, ice, and push the ibuprofen 24-7. It feels like it may be the Achilles as it affects the area around the back of the ankle as well. I emailed my exercise physiologist and told him I didn't think this was normal and that I was going to focus on strength training, tai chi, and when I felt up to it, shorter walks or aerobic DVD moments. I'm also going to check into pool schedules around the area. I know I need to do more to lose more weight more quickly but I also have to be for real. Frankly, the ankle situation is one of the reasons I decided to get this surgery in the first place. It will be a lot easier to work out after some of the weight is off, and some weight is going to come off post-op regardless. Even if the exercise I do isn't always cardio, it builds up strength and improves circulation so it's better than nothing.

Snap, crackle, pop

Yesterday my ankles were popping and cracking and felt a little weak, so I didn't want to go for a walk on the street in case the bum one gave out again. I decided to do one of my DVD workouts inside, so I did "Rockin' Body" with Shawn T--the "Hip Hop Abs" guy. (I can make it through about 15-20 minutes, which is to say, not much past the warm-up.) They move pretty fast, but as long as I march or move at the same pace, I call it good. (Obviously I'm not going to be as smiling and oiled up as the people on the DVD.)

So I made it 20 minutes and quit when I was tired and had a good heart rate. I felt okay at first, but about ten minutes later I realized my bum ankle was sore--sore enough to want to stay off for the day. Since it has given out several times, and always at an inopportune time, I wanted to baby it, and I did. By the time I went to bed, it felt just about normal.

So I wake up this morning and the pain has left my ankle altogether, but has traveled and settled into my hip. The bum ankle and hip are both on the left side--both have been broken in the past. The left hip has been enough of a bugaboo to warrant cortisone shots; I have a tight IT band. The orthopedists' solution was physical therapy and stretching, which were marginally helpful temporarily. They suggested surgery, but I just could not see that and would rather take the three cortisone shots a year or whatever is allowed, but it's been years since I had a cortisone shot in my hip. Mostly I just deal; if it's really bad, I take a muscle relaxer. Which is probably the course of action for this afternoon, after all the errands are done.

I have always felt like an old person on the inside, but somehow it was easier when the physical outside seemed young--at least it was a physical contradiction that was tangible and could be argued when I felt like an old shoe someone threw up in. Now my outsides are rapidly morphing to match the insides; I'm finding that a wee bit depressing.