Thursday, August 16, 2012

Desperate times call for desperate measures

I had some really bad days in the first couple weeks of August. The sit in your bed and cry all day kind.  That's very unlike me, as I am generally a very positive and upbeat person (though I do my fair share of whining and complaining on here, no thanks to the pain). I am grateful and appreciative for what I have in my life, despite going through one of those top-stressful-life-events like I'm having to do now. I know that chronic pain and depression are strongly linked and I simply wasn't getting enough pain relief, which was creating a downward spiral in depression. I upped my motrin dose from 1000 mg a day to 1200 mg a day and added a daily vicodin back to the mix. That kept me out of bed and happy enough for a few hours a day, which makes a huge difference.

I absolutely hate being on so much medication, which led me to my general doctor to ask for suggestions on better ways of dealing with pain relief. I was thinking she could refer me out to a pain management center or physical therapy for some hands-on work (though I do soft tissue work for a few hours a day, so I'm not sure what else could be done), but instead she recommended a medication known to treat chronic pain and depression, Cymbalta (an SNRI, a type of drug I'm extremely hesitant to take because of side effects and the eventual withdrawal, based on my past experience with an SSRI I came off of four years ago). Unfortunately my insurance doesn't cover it as a first line of treatment, so she called in Effexor instead. Also an SNRI, it has very similar mechanisms to Cymbalta and is used off-label for chronic pain. She said she wanted to "break the cycle" of pain and depression. I thought back to when my podiatrist said that I shouldn't be in this much pain before the fifth surgery. He knows I'm not a complainer and that I hate pills, so if I say I'm in pain he believes me. After seeing what was left of my subtalar joint in the first surgery, he has a lot of respect for my pain tolerance. But where is this much chronic pain coming from?

That's when the lightbulb went off. I started researching pain receptor damage in surgery and found that sustained inflammation or surgery can damage pain receptors called nociceptors and a condition called allodynia can result, where a stimulus like light touch can cause extreme pain. I had significant inflammation in my ankle from the first day it was operated on until well after the fourth surgery when the screw came out, a span of over 12 weeks. I think five surgeries in a short amount of time constitutes a significant risk to receptor damage as well. Is this the real problem? Time will tell but I'm off to a really good start. I'm maintaining 1200 mg of motrin a day because I still get extremely stiff.

Day one of Effexor (14 August): I noticed within about an hour of my first dose that my pain was significantly diminished. When I stood up from sitting it still hurt, but not in the usual I-want-to-pull-my-hair-out-and-scream sort of way. I had trouble sleeping and only got about four hours that night. I was feeling hyper-alert, very thirsty, and had a bit of nausea before bed.

Day two: Woke up with some sensitivity to light and sound (my pupils were pretty dilated). My son had to get his blood drawn for routine testing and asked for donuts after so we went to a local bakery and picked out a dozen. I gave myself a high-five for not being able to eat more than half a donut. Finally the sugar addiction was kicked! The donut wasn't satisfying at all. I took the kids on a walk around a local lake for the first time after living here for nearly a year. The walk was approximately two miles, and I was fine. Started feeling a little stiff towards the end but nothing horrible. It was around dinnertime that I realized not only was my appetite for sugar gone, but my appetite for everything was gone. This is new territory for me, as food brings me so much enjoyment: from shopping for it, preparing it, and especially eating it. Forcing myself to eat is dreadful. I got about five hours of sleep, again feeling hyper-alert upon waking.

Day three: Bouts of nausea come and go. I have to remember to eat, which is crazy. When I get out of bed there is still pain, but minor compared to what I'd been dealing with. I can hear and feel "crunchy" sensations of scar tissue breaking up with the first few steps. I managed a 30-minute nap and woke for my third dose. I want to try a workout and am waiting for it to get a little cooler outside. My head feels very trippy overall, but wow how my mood has improved!

Now the fun stuff.

7 August

Spent the day at the Disney parks, over 12 hours on my feet. Every couple of hours I'd have to stop and massage the tissue in my feet and lower legs, but I made it!

8 August 

Joint mobility

10 swings
5+5 snatches

20 swings
10+10 snatches

30 swings
15+15 snatches

20 swings
10+10 snatches

10 swings
5+5 snatches

I used a 12 kg bell for the swings and 8 kg for the snatches. My hands started feeling a little hot towards the end so I had to put band-aids on both ring fingers where they were starting to blister. It was a challenge to get through but felt great.

11 August

Joint mobility

bottoms-up clean and press with band-assisted pull-up 1-2-3, two rounds (8 kg)

Turkish get-up, 6 alternating (3 each side), continuous (8 kg)

5+5 snatches, 10 swings - 5 rounds (12 kg) Total of 50 snatches and 50 swings

I wanted to try the bottoms-up press to see the differences between the right and left side and was very surprised at how much weaker my left hand is grip-wise is than the right. The grip would fail right at the top of the groove and the kettlebell would sometimes come down on my forearm. I still attribute this to my right foot.

13 August

Joint mobility

5:00 pull-up practice (unassisted), I-go-you-go format with my 11-year-old son, alternating between neutral and underhand grip

TGU I-go-you-go, 1+1, three rounds (8 kg)

Two rounds:
Goblet squat - 3 (8 kg)
OH squat - 3+3 (8 kg)
1-leg deadlift - 3+3 (12 kg)
Reverse lunge - 3+3 (8 kg, slight assistance from my bed when the right leg was back from limited range of motion)

1-arm swings, 12 kg, 10+10 continuous for 40, two rounds (80 total)
2-arm swings, 12 kg, 40

This was the most fun I'd had in awhile because my son was interested in doing the workout with me. He would use the step stool for pull-ups and did TGUs like a champ with the 7-lb kettlebell. He even kept up with most of the circuit and wanted me to teach him how to do the exercises. There was a significant amount of scar tissue breaking up during the workout, and I was really excited by that. The next morning, however, I was just as stiff as any other day getting out of bed. Very disappointing.

These were taken using my phone and a mirror, so this is my right foot. The surgery scars can be seen under my ankle. This is the range of motion I had at the end of my workout, which was significantly more than at the beginning.

 This is the range of motion I have with my left foot that has not yet been operated on. Quite a difference.

I hit a new record with how deep my goblet squat can go. I had gotten below parallel a few weeks earlier, but this was several inches lower. Slow and steady progress, emphasis on slow.
(please excuse the messy pile of music books on my nightstand. I'm in the midst of giving my kids music lessons on several different instruments)

I'm interested to see how my body will respond to working out on this medicine. I should be accustomed to the drug in a few weeks, so hopefully my appetite will return and my eyes will go back to normal. I feel like I've had too much coffee! Fingers crossed this does the trick and my recovery can continue on a better and faster track.

And yes, my hair is now red. When I walked in to see my stylist last week for a touch-up, she took one look at me and said "No. We will make your hair flaming red like fire, yes?" in her sweet Ukrainian accent. She knows I'm up for anything so I let her do her thing. I was a little hesitant at first but it's really growing on me :)

(also please excuse the cracked-out look. It's that hyper-alert thing with the dilated eyes)

Monday, August 6, 2012

After the post-surgical euphoria wears off...

I felt great after surgery. Better than I had any right to feel, actually. I only took pain meds for the first 48 hours post-op. I started a very slight amount of crutch-assisted walking 4 days post-op. I'd taken my son to Downtown Disney for a new Lego set as a reward for helping me so much on bed rest, which probably wasn't the best excursion for the first day out of bed. We also went to Ra Sushi and Whole Foods beforehand and Bruxie after. The day out reminded me of how much I don't like being on crutches.
Bruxie's Liege waffle sundae with Belgian chocolate and caramel- SO good

I walked into my doctor's appointment without crutches 5 days after surgery. He was very happy to see that, and gave me the green light to do as much as I comfortably could. He removed the stitches to save me a trip from coming back the next week, so I took it a little easy and kept a butterfly bandage on the incision site to keep it together. I noticed there was some nerve damage, because every time I touched the site to put ointment or a bandage on, I would feel shock waves down to my toes. It's difficult for me to touch it (or let water in the shower hit it) because of the discomfort. It's getting a little better, and I know these things take time to heal. 

One week post-op, I went to Disney to celebrate my son's 11th birthday. We park-hopped for about six hours and I didn't use any narcotics, just an 800 mg motrin. By the end of the night, I knew I couldn't stand in the very long line to get back to the parking lot, so we hopped on the handicapped shuttle. I was hurting but still refused to medicate with anything strong. 

I did my first workout the next day, on July 19th.

Joint mobility

press/ pull-up ladder 1-2-3 with the 10 kg, 2 rounds

naked get-up, 1+1, successful! 
8 kg get-up, 1+1, 3 rounds

Swings- 16 kg, 5 rounds of 10

It was a nice, easy workout to transition back in, and I was still feeling great.

Next workout was July 21st.

Joint mobility

press/ pull-up ladder 1-2-3 with the 10 kg, 3 rounds

TGU- 1+1, then 2+2, both with overhead squats at the top

TRX circuit, two rounds:
Body saw (5)
Crunch (5)
Pendulum (5)
Pike (5)

All were low plank except I did the last round of pikes in high plank

1-arm alternating swings with the 12 kg, three rounds of 25

I felt great after that one. I was happy to be able to use the TRX at home, as my patio cover was just replaced. The wood had rotted to the point where I was afraid to try to hang anything from it, but it's perfect now. I have plans to hang a pull-up bar from it as well.

This is about the time I started having some real trouble with my recovery. The scar tissue is building back up in the joint after just having been freed from it, so walking is still difficult and painful. When I've been sitting for awhile, I get extremely stiff and the joint screams at me for putting weight on it. It takes a few minutes to be able to walk comfortably, though sometimes it's still with a limp. I have good days and bad days. On the bad days, it's hard to get out of bed at all. On the good days, I feel ok.

I didn't do another workout until July 26th.

Joint mobility

press/pull-up ladder 1-2-3-4 with the 10 kg, 3 rounds

Kettlebell circuit, two rounds:
goblet squat, 10 kg, 5+5
double windmills, 10 kg (top) and 12 kg (bottom), 5+5
1-leg deadlift, 12 kg, 5+5 (very difficult when standing on my right foot)
get-up sit-up, double 8 kgs, 5

Swings alternating with the 16kg and 24kg, 6 sets of 10 (30 total with each weight)

I think the issue with my left shoulder being weak in presses has more to do with my right foot being jacked up than doing anything wrong with the left shoulder. I'm going to stop focusing so much on presses until my right foot gets a little more mobile. 

I started having more bad days than good. I limit my vicodin intake to once a week, when I simply can't deal with the pain. I had a week where I overcompensated with sugar and pasta, and gained two pounds in the process. Sometimes I think it would be better to take the pain meds than medicating with sugar. I've had to go back on a steady diet of motrin to cope. I try to take 400 mg in the morning, 400 mg midday, and 200 mg in the evening. Some days I go without, and those are really, really bad days. I just can't win.

I did a TRX/ kettlebell circuit workout on July 28th.

Joint mobility

Three rounds:
Squat/ press, double 8 kg, 6
TRX side plank with hip drop, 6+6
Overhead squat, 10 kg, 6+6
TRX chest press, 6
Assisted pull-up, 6
TRX pike, 6

I am trying to include as much ankle mobility in my workouts as possible. I put my tennis shoes on for the TRX side plank and pike, knowing that it would put some different angles of pressure on the joint, without putting too much pressure on any particular part of my foot. It felt great.

Last week was a really bad week. I'm constantly craving vicodin just to get a break from the incessant pain, but am stubbornly refusing to give in (for now). Backing off the sugar isn't easy but I'm making it a priority. I know it makes me feel worse, past the initial instant gratification of whatever happens in my brain when I bite into some mint slice or tim tams

My most recent workout was another kettlebell/ TRX combination on August 4th.

Joint mobility

TGU 2+2, 8 kg (feeling super weak)

side press, 8 kg, 5+5
TRX cossack lunge, 5+5
bottoms-up clean, 10 kg, 5+5 (no chalk)
TRX suspended lunge, 5+5  (my son was holding my hands so I wouldn't fall, just to be safe)
double windmill, 8 kg on top and 10 kg on bottom, 5+5
TRX low row, 10

I had intended to do a swing/ snatch combination at the end but ran out of time and motivation. 

I know all the sugar I had really affected my strength. I'm also not sleeping well. It's very frustrating to be where I am right now. I started getting ultrasound treatments on my foot and ankle 15 minutes a day, 4-5 days a week. I've noticed a big improvement, and my ankle makes some interesting noises immediately following treatment. I'm also spending a few hours a day working on the soft tissue in my foot and lower leg. The tightness is progressively moving up my leg, which I think is a good thing. My ankle can barely get to 90 degrees, so going down stairs or slanted ground is still very challenging (especially when a shopping cart is pulling me down towards moving vehicles). It's easy to let the negative emotions overpower the positive ones, so that's my biggest battle at the moment. 

It's been 10 months since I sprained my ankle prior to the first surgery. Five surgeries later, waiting for my body to recover so I can get the left subtalar joint fused and get on with my life, and I'm having a lot of trouble staying positive. I found some interesting articles on chronic pain and its effect on mental health, and I'm not too surprised by what they say. Chronic pain really is a mindfuck.