Day 1 (March 21)

Also posted on Health Board forum which is an excellent resource:  http://www.healthboards.com/

General:
I've decided to create a blog to help others understand what they may be able to expect post-surgery.  From what I understand, this procedure was more painful for me immediately following the procedure than for most people.  On the flip side, I've also been able to switch from taking pain killers all day to taking them on an as needed basis 10 days after surgery (most report 14 days at bare minimum).  I attribute it to a reduced effectiveness of pain killers due to other conditions (more about that below).  I've also been told it's typically more painful for men than women, don't know why.  This just gives you a worst case scenario (from a pain perspective) and hopefully some ideas to make your experience less traumatic.

I had a calcaneal osteotomy, lateral ligament repair (modified brostrom procedure), removal of bone fragments, and calf lengthening (gastrocnemius slide) on my left ankle.  If you're reading this and don't know what all of those are, here you go:

Calcaneal osteotomy:  http://www.footeducation.com/calcaneal-osteotomy
Ligament repair:  http://en.wikipedia.org/wiki/Brostr%C3%B6m_procedure
Calf lengthening: http://www.footeducation.com/gastrocnemius-slide-strayer-procedure

My surgery was Monday March 21, 2011 at 9 am.  I'll recap what happened Monday but first some background.  I will continue to update pages as I recall information.

Background:
I'm a 34 year old male and rolled my left ankle July 2010.  I'm 240 lbs and 6'5" tall.  Went to ER and x-ray was negative for fracture.  Gave me air splint and crutches.  Saw an orthopedic surgeon a week later who took new x-rays without significant result.  Tried conservative treatment (immobilization in cam walker) for 2 months followed by therapy.  At the beginning of October, the doctor said that we should revisit the problem in a year if there is continued pain and instability.

I saw a different orthopedic surgeon (a specialist focused on cartilage grafting, regeneration, etc.) for an ongoing problem with my knees (see below).  Asked him about ankle and had an MRI done that showed torn ligaments and fracture.  He recommended trying the boot again for one month.  He said he could continue treatment but recommended a foot & ankle specialist.

*I have a history knee problems including patella alta which has resulted in the wearing away of the cartilage within both knees.  There are grooves worn into the bone under the knee cap.  It is tolerable 95% of the time and I mostly have issues when kneeling, using stairs, or sitting for long periods of time.  I have had 2 arthroscopic surgeries on the left knee, one included patellar drilling to cause blood to fill in the hole on underside of kneecap (to serve as pseudo-cartilage).  I tolerated the procedure well and had limited post surgical pain.  I have an ongoing script for Norco (10/325) and typically take 1.5 and then the other half 1 hour later.  I don't usually take more than 2 per week.  I mention this as it may have impacted the effectiveness of the post-surgical pain killers.

I have also had 2 surgeries on my right ankle to repair ligaments damaged in a car accident.  I tolerated both procedures very well and had little pain.

The Surgeon:
The surgeon is a highly respected foot & ankle specialist.  He has been the president of the state board of foot & ankle specialists a number of times.  He is published and highly recommended.  He performed the two surgeries on my other ankle in 2002.

Pre-surgery appointment:
Doctor examined ankle and felt the ligaments were torn and stretched.  He had me perform a number of exercises and asked if I feel like I walk on the outside of my foot.  He also questioned how stable I feel.  He then said that he strongly recommends a calcaneal osteotomy.  He said it is not to the point that he would insist upon it but that it will greatly help my ligaments and overall joint health in the long run.  He said it is a realignment of the ankle.  Unfortunately, I did not ask very many questions as I was pretty sure I just wanted to get the ligaments fixed.  I told him I would like to do some research and would get back to him.  He also recommended the calf lengthening (gastrocnemius slide).  He mentioned it was not a common procedure when he performed my previous surgeries (on my other ankle in 2002) but highly recommended it.  I agreed to the surgery to fix ligaments and calf lengthening with the understanding that I would confirm the calcaneal osteotomy in a few days.  We scheduled the surgery for March 21st at an outpatient surgical center.  Recovery time was explained to be 2 weeks no weight bearing, 3 weeks walking cast, 3 weeks cam walker (boot).

I later discussed calcaneal osteotomy with a family friend that is a retired orthopedic surgeon.  He recommended the procedure.  At this point, I really should have done more research on the topic but I did not.  If I had known what it entailed, I probably would have decided to pass.  The recovery period (which I did not know until post surgery) is expected to be 8 weeks no weight bearing, 4 weeks in cam walker, and months of therapy.  I contacted the surgeons office and confirmed that I would like to proceed with the calcaneal osteotomy as well.

Surgery:
Arrived at surgical center at 8 am with procedure scheduled for 9:15.  Was told it would take just over an hour and then would be in recovery for a few hours before being sent home.  I completed paperwork and was led to pre-op area where a nurse put in IV.  Anesthesiologist visited and explained what would happen.  He said the doctor has recommended a nerve block to help with the pain.  He then gave me something to relax.  Next I rolled onto my stomach and he injected the back of my leg to numb the area.  He then inserted a larger needle and injected the area round the nerve with a solution to numb it.  All I really felt was some pressure, not bad at all.  The doctor then arrived and explained the procedures and what to expect.  He explained the calcaneal osteotomy and that really freaked me out.  Unfortunately, at this point I figured I would just go through with it.  I went to surgery, anesthesiologist gave me some more meds to calm me down, then knocked me out.  Woke up a few hours later, leg completely numb and with a head ache.  At that point, I could move none of my toes.

Post Surgery:
Left surgical center at 2 pm, stopped at pharmacy to fill prescriptions.  Doctor forgot to write dosage on script for percocet (oxycodone and acetaminophen) so the pharmacist could not fill.  As it's a class II drug, they can not fax or call it in.  Fortunately, the doc had written a proper script for Norco (10/325) so I was able to fill that.  I requested the new script to be oxycodone only as a way to avoid too much acetaminophen.  This may be the smartest thing I did.

Medication plan:
Either take 2 norco (10/325) and 1 oxycodone (5 mg) for breakthrough pain or 2 oxycodone and 1 norco for breakthrough pain.  Every 4 - 6 hours.  The biggest variable is the nerve block and when it will wear off.  Everyone metabolizes differently.  For some it lasts 8 hours and others 36.  They recommend starting pain medicine the evening after surgery in case the nerve block wears off in middle of the night.  They also want to make sure the pain does not get ahead of you because it can be difficult to gain control.

Home:
Home around 3 pm.  No pain all day.  Began to feel a few tingles in foot in the evening.  Once again, no idea if nerve block is wearing off or not.  I took 1.5 norco at 9:30 pm.

Biggest recommendation I can make is to keep a log of when you take your medications.  It is the smartest thing to do to avoid taking too much or too little.