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Monday, January 9, 2012

2012-Whats ahead???

Well, I can say with all my heart, I am glad 2012 is here and 2011 is gone.
In the past year myself and my family really took a beating (major surgery, lost jobs, wife with health issues).  I could have been worse, but more importantly, we came out the other side with so many new opportunities!

(my ankle joint, the focus of this post)
Being this is a "running" blog, I will focus on that aspect.  In may of 2011, I had major surgery on my left Talus.  I will back up a bit and explain why:
When I was 13, I was a competitive skiier.  I skied slalom, GS, and bumps.  While preparing for the Junior Olympics on a weekend at White Pass in WA, I was tree skiing in an out of bounds area in a blizzard. I went over a small lip and next thing I knew, I was looking at the tops of trees.  I crashed down through several branches and hit with considerable force on my left leg.  The impact snapped my Fibula and Tibia.  I was alone, in quite a bit of pain, and a bit unsure of what to do next.  I was able to traverse the fall line on my right leg and eventually got under a chair lift where I could yell to other skiiers for help.  Fast forward 5 years to 18...I developed hyper uricemia which caused some renal issues and also caused "gout" in my left ankle.  As the swelling and pain increased, I finally got and x-ray done of my ankle, which showed a nickel sized fragment of bone that separated from my Talus.  The suggestion was to remove this to prevent further damage to the cartilage in the joint.  Note:  I was not a runner at this time, rathe pursuing my career as a concert violinist.  My father (who is a doctor) recomended I do nothing, take NSAIDS and deal with the issue that was causing kidney stones.  I took the advice, spent the summer in Germany studying at a music conservatory, and returned with little to no pain.  I had another scan and the fragment had somehow found its way back to its hole.  I figured cool.....done. forward to 4 years ago (+15 years).

I found my birth mother, learned she was a marathon runner, quit smoking, started running.
All was grand for a while.  I began running 60-70 mile weeks, runs often hit 20+ miles.  I felt amazing.  One day at about 18 miles into a weekend run, I hit a curb wrong.  This caused considerable pain and a pain I recognized as one from the past.
I was training for a race in Seattle that summer.  One that I would run with my birth mother.  I began to take near over doses of NSAID's and eventually went to my primary care doctor to have this delt with.  Her initial recomendation was to have PT.  So, I went to PT.  That actually made it worse....then she sent me to an orthopeadic surgeon.  I liked the guy, he was young and well trained!  He did an MRI and CT of my ankle.  I went to the consult with my wife, expecting to hear the need for an athroscopic procedure and 2-3 week downtime.  My wife was dreading a 2-3 week period of me being a baby!
We went to a PAX view and he opened the files (he had not looked at them), his face looked funny.  He excused him self and left the room.  He came back with an older partner in his practice.  They both left the room.  A short time later he returned with an odd smile on his face.  He proceeded to tell us that I had a large piece of bone that had seperated from my Talus.  In addition to this, there was a large area of necrosis in the bone marrow beneath the area of bone seperation, and I also had two large opposing bone beaks on the front  medial side of the Talus and Fibula that greatly reduced the mobility of the joint and would hit and bruise (I can vouch for that, it really hurt to run really steep hills where I would cause the two beaks to hit each other.  In his words, this is a disaster of an ankle joint.  My wife asked what needed to be done....oh the silence that ensued after that question was asked.  He said we had 3 options
1.  Do nothing
2.  Remove the beaks, remove the fragment, and see what happens
3.  Have a procedure that would incorporate option 2, but would also involve transplanting a portion of healthy bone from a "fresh" Talus into mine-Bone marrow and all.

Our jaws hit the floor....he said it would be a 12 week recover, likely all non weight bearing!!!!

He said this was the only option available that would really allow me to run again.  I asked him how many times he had done this.  He said "well, I saw it done once".  Not a boost of confidence, but at least there was an option.
At this same time, I was working deeply with Rush University Medical Center.  In a meeting with several of the executives, I mentioned what was going on (they saw my limp) and immediately they insisted on getting me into Dr. Lee @ Midwest Orthopeadics at Rush.  I said "ok".  Next thing I know, I have to change my primary care doc over to Rush so I can be seen at Rush.  I brought my scans, and they took another CT of my ankle. Once I sat down with Dr. Lee, I knew things were perhaps even worse than I had thought.  Indeed they were.  I also had what is called and Os Trigonum.  Which, is an extra bone that sits behind the Talus above the Calcaneus (heel bone), this had exploded due to being impinged while running downhills (I do love hill repeats).  He confirmed that I would need a transplant, but I would need the entire bone, not just a piece of bone, due to the very large size of the hole that had developed.  So, I was put on a donor list, based on my blood type and the size and shape of my left Talus.  With this diagnosis, I also had to ensure my insurance would pay for this....which they wouldnt.  I then had to through a process of justification with the insurance company and my surgeon.  After 1 YEAR, it was approved.  We still did not have a donor though-how often I wished a 19 year old, olympic swimmer would expire peacefully in Chicago so I could have his Talus.  How strange it is to look at others are potential donors.  How strange to think I would have someone elses bone in me.  But, hey, I wanted to run again!
come Dec. 29th of 2009, while in IA for a wedding, I learned that BCBS of IL dropped Rush as a provider and I could no longer go to Rush.  I then had to call my employer (who's insurance I had never used) and get on their PPO plan ASAP.
All was good.....NOT
so I continued to sort of run, knowing that I was going to get a new bone...why not right?
the pain got worse, nothing really made it go away.  My ability to run farther than a few miles was lost.
By the spring, I was in dispair.  A nurse friend of mine suggested I just have the thing cleaned up, remove all the mess and perhaps buy some time where I could run and be waiting for a donor at the same time.
I brought the idea to Dr. Lee.  He agreed that would be a good option.
This was the end of April.
I scheduled the surgery for May 6th. Yippee!
So we head down early, 5 am, to prepare for the procedure.
We were slated for 2 hour athroscopic procedure, done with sedation and 2 nerve blocks.

We checked in, got changed, went up stairs to get the nerve blocks.  At that point, my wife was asked to leave.  They gave me several meds in my IV, and used a doplar ultrasound machine to pinpoint the Siatic and Femoral nerves, injected them and my entire leg felt nothing.  I was then rolled through a long hallway, that had windows giving me an expansive view of the Chicago skyline.  Once in the OR, there were alot of people there....odd.  Dr. Lee said hello, made a joke, then they asked me to butt shuffle off the bed to the OR table.  Well, I couldnt lift my they had to pick me up and put me on the table.  Then the mask...I looked at the clock, it was 9:30 am...1,2,3.....

Next thing I knew, I opened my eyes, there was a clock in front of me, it said 5:42 pm.  WTF????  I was asleep for 8 hours????  Next thing I noticed was my throat really hurt, bad, like something had been shoved in there.  What was up with that?
A few minutes later a nurse came to the bed.  I asked her what happened, she ignored me and handed me the button to my pain meds.  I asked her again, she replied with "please hit the button, you are going to need it".  I  asked her one last time...she said "well, things didnt go according to plan, you will have to have Dr. Lee tell you".  I panicked.  I looked at my left leg, there was a massive system of bandages, something that kind of looked like a cast, but it looked like there was a foot....
Oh, the nurse hit the pain button for me.  I went out.  Next thing I know, I wake in a room in the hospital.  My wife is there and Dr. Lee is there.  He explains:
We went in the medial side of your ankle with a scope.  We removed your beaks.  We then went to remove the fragment, and discovered there was a blood supply that grew through the bone to the fragment and as a result we had live bone and cartilage to work with.  So, we opened up the lateral side of the ankle, popped your foot off.  We then took some blood, harvested cells to transplant into the area where the marrow died.  We fractured the interior of your talus, packed the hole with a scaffold material to hold the stem cells in place.  We then bolted the fragment back to where it came from using glass/biopolymer screws.  Oh, we didnt remove the Os Trigonum, as that has healed.  WHAT?  Thats Awesome!  Thank you GOD!!!!

(my first day back at home, the pain had not yet begun)

For the next 10 weeks I could not bear weight at all.  At 10 weeks I got my cast off...eeeek.  They removed a ton of stitches and I was given a walking boot.

 I still had another 4 weeks of crutches and began to ramp up the PT to get some mobility and strength back.

Exactly 1 month post surgery, my company decided to let every one at my level go (I was a regional VP for a medical robotics company).  This made everything more difficult. Including job interviews.
It also meant that my insurance that would allow me to go to Rush would be scary.  What if I had more issues?  What if I re-injure it?  Fortunately that didnt happen.

In late Sept. I had everything rescanned, I had radiologist from Northshore University Health System read it, and I also sent a copy of the scans to Dr. Lee.
It was very interesting to see the difference in opinions.  Northsore basically said...huh?  WHAT?  Dr. Lee came back with...........YOU ARE HEALED!!!!!  You can run as much and as far as the rest of you will allow.  Sept. 28th, I went on my first trip downstairs to the treadmill to run 1 mile.
Here is the same pic as the begining....if you know where the talus is, you can see a series of small holes.  Those are the glass screws holding the bone fragment inplace.  Right under the top vertical bone, the horizontal bone is the Talus. You can see in the middle a depression on the top, that is where they bolted everything back in place.
You can also see the nicely squared off portion of my Fibula where they removed the bone beak.

Right now here are the races I am going to focus on:
Shamrock Shuffle 8K-not a serious race, but fun.  I plan on a sub 40 minute time
Ice Age 1/2 marathon-a trail race and a prelim for me to scout the TNF 50 later in the year.  Would like a 1:45 or better, its fairly flat and smooth.
Chicago Marathon-Sub 4 pacing for a friend.  He tried to sub 4 last year came close, but no cigar.
TNF 50, looking to run the 50K, not 50 miler in Sept
Des Plaines River Trail 50K

I will likely do more, but these are the focus races for the year.

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