Ankle Fusion Surgery

I had my ankle fusion surgery the day after my previous post. I am now one month post op and I ventured out from my apartment for only the second time this past Tuesday. For the most part I am living a certain sort of “groundhog day” existence this summer in my roughly 800 square foot (75 sq meter) apartment. My days are filled with keeping my leg elevated. I spend time watching Netflix/HBO Max/Disney+, reading, communicating with family and friends, and working on a writing class I am enrolled in through Gotham Writers Workshop. Most days I have a visit from friend, neighbor, or colleague.

My surgery went as planned and my hospital experience was excellent! My friends Ebru and Meriç took me to the hospital at 8.30 AM on Tuesday, June 30th. After preliminary assessments–a blood draw and an EKG–we were escorted to the room that would be mine for the duration of my stay to await next steps. It was a spacious room–better than some hotel rooms I’ve rented–offering two hospital beds, two couches, two chairs, a mini-fridge, bathroom, clothing wardrobe, and a small TV. It was a corner room on the third floor offering views over the city in two directions.

An interesting aspect of Turkish culture is that an expected component of any hospital stay includes the patient having always a “companion” present and staying WITH them in the hospital. Thankfully Meriç prepared me for this. At work the Friday before surgery, she sat down at my desk and asked, “Do you prefer a male or female stay with you at the hospital?”

“What do you mean stay with me at the hospital?” I asked.

“At night, are you more comfortable with a man or woman staying overnight with you?” she asked.

In the conversation that followed I was educated that any person admitted for a hospital stay was expected to have a companion stay with them. The hospital would bring meals for this companion. The purpose of the companion is to ensure that the patient is never lonely and that all needs of the patient are looked after.

This is markedly different from what happens in American hospitals in my experience. In April of 2014 after emergency gallbladder removal, I spent a full week in the hospital. I never had a family member or friend spend the night. Friends and family were allowed to visit during the strict Visiting Hours (usually a 2-3 window in the evening) designated by the facility.

Prior to my surgery I had created an “A Team” of the three friends that I designated as my support team for all hospital/doctor/nurse interactions. Meriç, Ebru, and Erden are all fluent in English and in my innermost friend circle. I was comfortable to have any of them stay with me in the hospital–and so they did. All three were present when I was rolled into my room after the surgery. Erden stayed with me the first and third night; Ebru stayed over with me on my second night; Meriç stayed with me for the daytimes. I was only “alone” in my room for perhaps a total of 2 hours during my three day/three night stay. Additionally, Fatih and Neslihan visited me there as well. 

I have to say that it WAS comforting to have a companion present for my stay. Sometimes we had conversation, sometimes we slept or read our respective books. I watched a Netflix documentary with Meriç. When the pain level ramped up, my companion went to inform the nurse and I received my next dose of a pain killer. My water glass was always full, the room temperature always right. While the nurses did come to check my vitals and to empty my urine bag, they otherwise came when my companion asked them to. I never had to use the “nurse” button. My companions slept in the other bed. The cleaning lady changed both my bedding and the bedding for my companion. Two trays were delivered for every meal. At the start of the stay those varied–one specifically for the patient noting any limitations or exclusions, and another full tray for the companion.

My surgery experience was educational and unique. I was rolled into an operating room at 12.00 where the anethesia technician, Ahmet, introduced himself and narrated his preparations. An IV port was administered on my left hand. After some initial sedative, an epidural was applied to my lower spine. From the waist down I felt nothing for the duration of my 3.5 hours on the operating room. The greatest surprise was that the sedative administered through the IV port was not that strong. I dozed in and out a few times, but I would say I was lucid and cognizant for 80% of my surgery and watched what was transpiring on a monitor located to my right (If you would like to see: Clip 1, Clip 2). This was both fascinating AND disturbing.

I was in recovery for about 40 minutes while they warmed me up (I was shivering from the cold of the operating room) and inserted a catheter (a first for me).

I was rolled back into my hospital room at 16.10 and found my A-Team waiting for me: Ebru, Meriç, and Erden. I spent three nights in the hospital (I opted to add a third night–cost of 8,000 TL or 170 USD)–allowing me more time with the epidural for pain management.

The first 48 hours were BRUTAL pain-wise, but I also can say that the pain dropped significantly after that. I still needed a pain killer, but the epidural cocktail was no longer necessary. My surgery happened on a day of the full moon and I was delighted to observe, from my hospital bed, the full moon rising over the city lights of İzmir (picture below); the following morning we witnessed a pretty nice sunrise as well. 

My doctor visited daily to change my dressings and check on my progress. On Friday morning he applied a back cast before I was discharged. The nurses removed my catheter–surprisingly this was not painful. It felt odd, but was over quickly and I was then able to navigate to the bathroom with a walker and get dressed for my transport home.

Transport home required the hiring of a medical transport team because my apartment is on the 5th floor and there is no elevator. For 4,000 TL (85 USD) a team of young men took me from my hotel room to my apartment, carrying me up the five flights. This was money well spent!

While my hospital stay was comfortable, it was GREAT to be home! Fatih and the cats were here to greet me. I had asked him to stay at my apartment with the cats while I was in the hospital because they know and love him.

This week marked four weeks and I left my apartment for a second time to have X-rays taken prior to a checkup with my doctor. He is satisfied with the progress. I will continue another two weeks of no weight bearing, though he has encouraged me to put my foot on the floor and using a scale to check, putting 10-20 kilos of pressure on the foot while in a seated position. It does feel nice to feel the ground under my foot. My poor left calf and shin have gotten so skinny and wimpy these weeks of no use. I get sad looking at them to be honest. But I work to keep my eye on the prize and continue to trust the process.

So what have I been doing all these weeks at home?

I usually awake between 7 and 8 am. I get up and enjoy coffee (with collagen peptides) and writing time (my journal, a blog post, or the writing class I am enrolled in). Once coffee time is finished, I usually put together my first meal and watch a little Netflix or the news. The rest of the day is a mix of reading, communicating with friends/family, and completing various household tasks (laundry, cleaning cat litter, washing my hair, cooking or doing the dishes).

Because I need to keep my foot elevated as much as possible, I break those tasks up across the day. I complete one, then I am seated with foot elevated for an hour or two. Then I complete another task. You will find it strange to learn that even one-legged I am getting 3-5K “steps” per day according to my Apple Watch. I guess that makes sense knowing that when I spent a day in my apartment pre-surgery (two-footed) I could easily get 8-9K steps.

My knee scooter is by far THE best investment I made. I still use a walker to move around in the bathroom, and when I navigate out to the terrace, and of course for the two excursions to the doctor thus far. But rolling back and forth across my apartment on the scooter has been wonderful. It’s also a very sturdy base for when I wash dishes, cook, or wash my hair in the kitchen sink. Jinx also likes the scooter!

Now I want to transition and talk about how this event and process has impacted me emotionally and psychologically.

I was scared the day I was rolled into the operating room. I was afraid to feel pain, I was scared while I wondered it everything would go as it should, and did I have the best doctor for this job? Would there be complications? Unforeseen issues?

There WAS pain–significant pain–those first 48 hours post surgery. It was unlike any pain I have felt before. It felt like the world was pushing INTO my ankle joint from all directions. Incredible pressure–and it made it hard to think and speak. My friend Erden can attest to how my demeanor would change, almost like a switch, within 20 minutes after receiving a dose of pain killer through the epidural port. Suddenly I was able to make sentences and engage in conversation. But, if you can bring yourself to watch the two video clips (links above) of what my doctor was doing–shaving and scraping out the damanged cartilage to get to the healthy bone–you can understand it is a traumatic event for the ankle–bones, joint, and all the surrounding soft tissues. Here is a layman’s translation of my Doctor’s operation report made by Gemini.

After arriving home, the pain experiences have been interesting. The Doctor told me to take the Naproxen 750 mg slow release NO MATTER WHAT until I saw him at the 2 week post-op check up. I had two additional pain medications–paracetamol 500 mg and Arveles 25 mg. To be honest, I never felt any difference taking either of them, so I discontinued use. I had an antibiotic for five days as well.

At the two week checkup the doctor said I could discontinue all medications. If I experienced pain, I should use the Naproxen. I was to continue my supplement intake–Calcium, D3, Vitamin C, Zinc, and now vitamin B.

In the weeks at home I was surprised to experience very little or no pain during the daytime hours. Sometimes when I was upright too long, there would be an ache or throbbing, but it was quickly discontinued upon sitting down and elevating my foot.

I did experience disconcerting pains at night when I laid down to sleep. Despite my ankle being elevated on a special pillow, the pains and aches sometimes took my breath away and made me scared that something was wrong. BUT, I messaged with my doctor and he assured me this was normal. That the process of “growing bone” is a painful thing, biologically speaking. He also explained that most people normally experience more pain at night because that is when our endorphin reservoir has been depleted to the lowest level (it is highest in the morning when we wake and begin the day).

I have tried using the naproxen at night with my dinner to try and address the night aches and pains, but it doesn’t do much. So I wrestle through the nights–struggling to find a comfortable position for my ankle. I have one real point of concern which is where the heads of the two screws sit on the inside of my ankle (picture here shows you where I am talking about).

The doctor predicts that they will not cause me pain, that he “put a muscle over them” and that they will be fine once I am healed. I am skeptical. I think they will be a problem. For now I will have to wait and see. He did say that if they do bother me we can remove them one year post op (I feel confident I will want to do that).

I know that I still have four incisions that are healing. I want to HOPE that the pain in that area will disappear, but I have a real fear that I will have regular pain in the region. This has made me wonder if I traded pains. I can get weepy thinking about trying to live with daily pain. It was frustrating and hard before the surgery living with only 10% of my ankle cartilage. But did I trade one pain for another? Only time will answer that question.

This summer has been a difficult time for the three of us that work together in the Naomi Foster Library. Meriç and Ebru have been dealing with various familial challenges. While we are supporting one another in any and all ways we can, it has caused me to come to recognise what I believe to be a universal human truth. What follows is an excerpt of a message I sent to these dear women who have spent their time and energy taking care of me, in the midst of also dealing with their own stresses:

It has come to my understanding that even IF we have others with us–in our minds and
in our hearts we still have moments when we feel SO ALONE. I have felt it myself in
these days. EVEN THOUGH I know I have you two, and Fatih and Erden–in the dark of
night when I am suffering with my ankle pains–it is ME, alone in my skin and with my
thoughts. There is nothing another person can do to ease that feeling or that dark time.

I think perhaps this is an aspect of being human that we each must face in our days on
this earth. Some people cannot stand in it. I don’t like it. But I will keep going forward
one hour, one day at a time. And I know you do the same. May God bless and keep us!
(and that’s on the days when I believe in a God….other days, I don’t know.)

The hours move slow for me, while the days seem to pass fast when I look backwards.
It feels like yesterday I was being rolled into the operating room, but here we are one
month post surgery. Psychologically it is difficult to look at my left shin and calf and see
how atrophied and small they are getting. Of course there is nothing to do–I just have
to wait until I can begin PT. But I also know that some of those muscles will no longer
have a purpose and they will “die”–I have been grieving that loss.

And the aches and pains at night (they are not constant, but they come and can be strong
when they do—and they are bone deep, inside) make me scared that I will end up living with
a new pain to replace the one I had surgery to cure. I am *hoping* that is just my imagination
playing a sick game with me–but the way it aches scares me some days. I don’t want to have
constant pain anymore. I am doing my best to keep faith that Dr Burak did everything perfect,
and that this is just a passing feeling while my bone is fusing. But have dark moments in
the middle of the night when I sit alone with my fear and worry.

I could message anyone to talk or chat–but these are my thoughts and fears. It is my body–
which I live in every day. So in the end, it is me–alone with myself.

That noted, I DO want to say that I have been overwhelmed by all the messages of concern and support. The day I arrived home from the hospital I received the delivery of a beautiful peace lily and a handwritten note from my Turkish Principal. My Head of School, who is home in the U.S. currently, has checked in on my progress. Many friends and colleagues have visited me at home, have offered to bring me anything I might need or want. I have received messages of support on WhatsApp, Instagram, and Facebook Messenger. So while I am “alone” in the dark of night with my concerns and fears, I also know that I am surrounded by a sea of amazing people that support and care for me. 

I will end with a collage of pictures with my two constant companions–Zigzag and Jinx. They have been very good little nurses (for the most part). I know they miss being outside in the Catio as much as they used to be–but thankfully Fatih visits a few times each week and spends time with them there. I also enjoy getting out into the fresh air and sunshine. Morning is best when the air is coolest in these summer months.