Right ankle surgical consultation

4/28/2021  2:10 PM

NEW PATIENT VISIT

 CHIEF COMPLAINT  Pain of the Right Ankle

 HISTORY OF PRESENT ILLNESS

45-year-old female presents today for evaluation of right ankle injury.  Patient is at ultra endurance athlete, formally ran up to 100 miles at a time.  Has a history of significant trouble running and has had numerous prior ankle sprains.  She was running about a month ago when she plantar flexed her foot and felt something catch.  She had an acute onset of pain.  She did not roll her ankle.  She reports that this seemed to be locked for a few days and since that time when she is plantar flex or dorsiflex her ankle she has felt a catching sensation which is accompanied by pain.  When this happens her ankle does swell up.  Has not noticed any significant changes instability.  Has not trialed any bracing.  Got MRI and was referred here for further evaluation.

PAST MEDICAL HISTORY

She  has a past medical history of Coronary artery dissection (2018 (42-43y)), HLD (hyperlipidemia), Irritable bowel syndrome, Labral tear of left hip joint, Osteopenia, and Vitamin D deficiency.

PAST SURGICAL HISTORY

She  has a past surgical history that includes pr otoplasty protruding ear w/wo size rdctj; Hip surgery; Bone biopsy; and Coronary stent placement (2018).

 

INITIAL REVIEW OF MEDICATIONS

She has a current medication list which includes the following prescription(s): aspirin, atorvastatin, calcium carb/vit d3/minerals, cholecalciferol, magnesium citrate, mirena, multivitamin, nitrofurantoin monohydrate, nitroglycerin, 

SOCIAL HISTORY

She  reports that she has never smoked. She has never used smokeless tobacco. She reports that she does not drink alcohol and does not use drugs.

FAMILY HISTORY

Her family history includes Alzheimer's disease in her maternal grandfather; Diabetes type II in her paternal grandfather; Epilepsy in her father; Neuropathy in her mother; Other in her father; Thyroid disease in her mother and sister.

PHYSICAL EXAMINATION

Ht 167.6 cm (5' 6")  | Wt 64 kg (141 lb)  | BMI 22.76 kg/m² 

The patient is alert and oriented x3 and in no apparent distress. Hearing is intact to the spoken word.  There are no audible wheezes with breathing.    Standing examination demonstrates some swelling of the right ankle compared to the left.  Heals in appropriate valgus.  Can do a toe rise.  Has strong dorsalis pedis and posterior tibialis pulses.  Sensation intact to light touch throughout SP, DP, tib, saphenous sural distributions.  Ankle range of motion is 05/07/40.  Has crepitus with ankle range of motion and can feel something catching on the lateral side of her ankle.  Is markedly tender to palpation at the lateral talar dome.  Has increased translation with anterior drawer as well as talar tilt.  Tender to palpation along the ATFL.  None along the CFL.  Along the PT FL.

REVIEW OF X-RAYS/STUDIES

Reviewed x-rays and MRI today.  X-rays demonstrate an osteochondral fragment in the anterior lateral ankle that is visible in the syndesmosis.  This is confirmed on MRI which shows a small approximately 8 mm osteochondral fracture and the superior lateral talar dome.  There is some slight edema underneath this.  There is incongruity of the ATFL

IMPRESSION/DIAGNOSIS

45-year-old female with history of chronic ankle instability now with osteochondral fracture of the talar dome.  Discussed options for treatment with her today including non operative and operative.  Discussed that given her high level of activity would recommend operative treatment.  Discussed we would recommend modified Brostrom lateral ligament reconstruction as well as osteochondral fragment debridement.  Discussed pluses and minuses of microfracture with her today.  Discussed we would likely just do debridement at this time to get her back to activity.  She expressed understanding.  Will call us to schedule surgery.

TREATMENT/PLAN

1. Plan for right ankle arthroscopy with debridement of osteochondral lesion and Brostrom lateral ligament reconstruction. The patient understood the risks and benefits of surgery, including, but not limited to bleeding, infection, nerve or muscle injury, need for reoperation.  The expected post-operative course was discussed in detail.  We have discussed expectations after surgery to include expected physical therapy, anticipated shoewear and the expected duration of swelling.  All of the patient's questions were answered.  Informed consent for the surgery was obtained in clinic today.  

All of the patient's questions were answered, and the patient was agreeable with the plan.

FOLLOW UP

Time of surgery

1406: "Whatever you are not changing, you are choosing"

 Ouch. But it's true. I'm choosing this. I'm choosing the old habits and old ways and old mechanisms.

I'm listening to Tom again, now and then. A recent pod was called "Deem yourself worthy", one of his phrases. I started listening to him in 2015, since he started and since my new life started. I've wanted to change since then. I'm still wanting to change, all the same things I wanted to change then I still need to change now.

OK, not ALL things. But the Main Things I wanted to change, I still want and need to change.

Post after post after post here, I keep saying the same things. Yet, still again I need to say it. 

So I can conclude from this, that I'm choosing these things instead of changing them.

I used to have a file in my Drive called Danaus or Chrysalis or something in which I tracked my habits. It started off small then over time built into a 30-something habit tracker over time. Some of the habits stayed for the duration of the tracking: M, STFD, Blerch, etc. I can't find the file, so I guess I've deleted it. You can delete the file, but you can't delete the bad habits so easily!

I did delete the Balog - 693 days ago! 

I have four main bad habits right now, and since Jan 1st I've been tracking them Today is 112 days into the year, how's it going?

M as recent at April 20th. 41 days or a 37% fail rate.
Az as recent at April 10th, 11 days or a 12% fail rate. Really Feb 10th with AzucBowl. 
CO as recent as last night, 30 days or a 27% fail rate
8pm again last night, 24 days or a 21% fail rate. 

I should also do the success rates, but in light of the LACK of progress and change - it's not really a success, is it?

Damn. 37% fail with M. I "quit" again on the 20th, after rice cereal. So I'm barely 1.73 days into this new Never Ever Again start. 

It's like quitting smoking. You have to quit over and over before succeeding? 

This blog is supposed to be a training log, but since once again I'm injured there's no training to log. I try to not post things like this here, but maybe this can be my way to track a different type of training. The re-training of habits? Is it worth it? Do I want to have MORE tracking of all this?

For now, the focus is on Death of M, the need to Lose St Louis. On IF and gut issues. 

CHOOSE CHANGE!

W&P, Freemason to Pierre

 "You are young, you are rich, you are educated, my dear sir. What have you done with all these good things that have been given you? Are you content with yourself and your life?"

DrB00108 reaches one year

Will I be able to remember what that means? Sadly, likely, yes.

This reaches one year TOMORROW. The 21st. 

150 start - Oct plateau

ONE YEAR ALREADY? Waste some more time, and read back to then....

I wasn't posting much, and my April 14th post was about being sick in March, COVID, and U Mich.

I actually used the term "M the fuck out". I lamented the upcoming changes. Acknowledge my denial. And wrote this: 

But I'm stuck. I've been stuck since the heart attack in Sept 2018. I realized soon enough that I need to leave STL, I can't keep driving my that great hill I used to run, pass the park I used to run, the trails I used to run, the pool I used to swim, the route I used to ride, the paths I used to ride. The mental strain of this is manifesting in M, the mental monster that lives in my head, that sabotages any positive forward progress I make.

Is this what I need to get unstuck? Initially my plans were to leave STL in a few years, but I had no where to go. I entertained just moving back home, but my job with mean quitting science. So since I felt I had no where to go, I stayed. Driving by and reliving old memories, day after day. Memories of what used to be.

A year ago I committed to changes. I'm still here. And I'm still stuck...

Never Never Ever

 NOTHING. 

This sucks. Yesterday I went without the boot all day, a sort of protest. Now my foot hurts. I have a surgical consult on Weds 28th - the day the movers pack the house. The ortho clinic called yesterday and said to see surgeon ASAP and also wear boot for 6 weeks. It's as if they WANT me to atrophy.

It also sucks that to decompress yesterday it was Aveen and RC and PB time. M. But saw what was happening and stopped. Took two times, but now all basura. 

In looking for injury posts (the run to LP in which my ankle hurt, couldn't remember when it was or which ankle - the right one!) I found "I need to quit Aveen" notes to myself. 

CHANGE DAMMIT. 

Getting to the real issues I don't want to talk about

ISSUE #1. The neurological shit. The appointment last Friday got buried in the foot MRI and the dog's pneumonia. And I have to credit LA for keeping my calm or distracted and for just rolling through the day. I don't know how to interpret that. Is he not worried at all? Is he worried? Is he just going to wait like I am, for the results before worrying? 

Left to my own devices, I wouldn't have attended this appointment. But then I wouldn't know about any of this. To me, this is good. But then I wouldn't know if there was a problem. Ah, that's still good.

The Dr said I was "slow" in the "open and close your hand fast as possible" test. Subjective. He said I should have felt the tuning fork think for 25 seconds but I only felt it 10 or 16 seconds. Well now that I know the answer, let me try again. Then the facial changes - to me I ignore it all - but they're there. They are much better than even a few weeks ago - that's an honest assessment. 

I've been feeling tired, weak, uncoordinated. I'm less willing to bike and run. It's like I want to run, but I don't want to for some reason. The Dr noted this as a "soft symptom" too. So the plan: I get an MRI on Monday the 10th, a detailed one to look for changes or lesions. After that, and depending on what that shows, then we go forward with more testing. He's wondering if it's something genetic, something slow to appear, something maybe related to what mom shows sometimes.

In the meantime, now I doubt fucking everything. I don't think clearly, is that a symptom? I feel wobbly, is that the ankle or something else? I'm tired and I don't feel strong, and things that used to be easy for me are suddenly too much to do. I've been blaming stress (the move, the new job, the disrupted schedule) for how I've been feeling. Denial. 

ISSUE #2. The M shit. M is not moving to Michigan. I need to lose St Louis, I need to lose the damage and the gains and the habit and the thinking and the tendency and the coping. M is not moving to Soulard either. I feel the pinch of time getting small. 

ISSUE 3#. The lack of change shit. I set a bunch of goals for this year and this spring, purple and yellow, simple goals. But I'm falling short. (Is that another symptom?). I make some gains then lose the gains. I feel like I'm living the same days over and over yet time is so short. These are coping skills, and I'm not coping. It's so much yellow.

On the plus side, I've quit dairy again (I was exposed to dairy in the kids visit over Easter. I say that passively, I mean that I ate dairy and sugar and junk food!) and I'm feeling better. The vague symptoms I get (swelling, itchy skin, gut upset) that I attribute to dairy are gone. So that's good. 

I'm doing IF again, and it helps my gut. Lately I feel worse after eating, it's less likely what I'm eating more likely how I'm eating. Random. Standing at a counter. Hurried. Whatever I grab. Whatever is easy. Bad habits I want to get rid of. 

I'm having trouble typing lately. Is it a lack of focus? A symptom? Ugh. 

So much to say, so much is going on!

 How to sum up the past few weeks?! As I think of it, I guess. 

My right ankle is getting better, now I'm left with an ankle that clicks a lot more, and it's more painful clicks unlike before. And I still have limited ROM. But I can carefully and slowly walk.

I have a job! I'm emailing back and forth with the new lab, I was gonna start in Sept but not it looks like mid August. 

We have the kids mid June, and late July into early August. Things are improving for them with Lev! They visit this weekend and we're going to my parents. 

My house is ready to sell. LA worked continuously for the past 7-10 days on windowsills, the new post for the basement, the plumbing issue. I helped as I could with my ankle and limited woodworking ability. The last things to do  - dishwasher and the vestibule stone. Oh and find a few more curtains for the living room. 

The house is not packed. I want to pack, but LA and the movers say not to do that. I'm going to pack my stained glass bench at least. And I'm still hoping to get another project done before mom's birthday. 

Work at STL is off balance and SLOW. I suffer guilts from it. I just don't get anything done here. 

I started reading War and Peace, and might make a summary book for Aurora and Kaitlynn. Slava wants to do a drawing challenge. And Arlette talks about writing more, how can we help her?

I'm dancing around the real issues and ignoring them. Another post maybe.