One Month Down

This past week marked one month since my surgery; on Thursday I visited my doctor for a regularly scheduled appointment to check my progress and change out another strut.

I was nervous this time as I know how painful a strut change can be now. In addition to that, we would have four kids with us so that immediately following my appointment we could be taking Matthew to practice. Nothing evokes sympathy from passersby like a frightened woman in a wheelchair surrounded by unruly children. As it happened, the kids were fantastic and, as far as I know, sat patiently in the waiting area throughout the entire appointment. Right now, most of the kids are at an age when my approval and love really means a lot to them, so they tend to try to at least maintain a facade of good behavior and argue over things like who gets to hold my hand as I’m wheeled around or who is going to bring me my pillow. The 13-year old is a different story; he knows everything, nothing impresses him, and nothing is more important than what he wants or needs. As much as I want to believe I could never have been this way at 13, I have to wonder.

They waved ferociously at me as I disappeared around the corner to the x-ray department. My doctor’s office has an odd system of communication which relies on cards with fruit symbols. I haven’t cracked the code yet, or even ascertained its usefulness, but I know that when you go to get an x-

*Awaiting my strut change at the Fracture Clinic.*

ray you are handed a yellow card with a banana on it and when you are done, the banana goes in a tray on the wall with a banana on it. I’m a little worried about the medical system in general if this is what they are using in lieu of email notifications, but I’m trying to stay optimistic.

X-rays are extremely annoying with a Taylor Spatial Frame; the tech is invariably confused, and has to ask what he’s looking at and which part the doctor cares about. He then proceeds to bend my leg in the most awkward positions. Usually this entails dislocating my knee cap and balancing the enormous rectangular metal frame around my foot on a single corner and holding perfectly still while my atrophied muscles scream from the abuse.

Back in the waiting area, I attracted the attention of a couple of nurses with my homemade frame cover. I’ve been walking around with different colored frame covers for a few weeks now, but this is the first real notice anyone has paid. It takes a very specific audience to appreciate the ingenuity and skill required to design and sew a cover for an external fixator and I enjoyed being lavished with praise. Even my doctor complimented me on it when she came in. Dr. Workman was supposed to be taking vacation for a couple of weeks, but as I am now her most favorite patient, she made a special trip in just to see me.

Dr. Workman, who I cannot possibly call Kimberly due to my absolute reverence for her as a mystical super human, is the only doctor I have completely trusted since the onset of my illness fourteen years ago. She is younger than me if crow’s feet and hair color can be believed, and has the kind of tan and naturally lovely appearance you would expect to see on a carefree hippie. She has three children who almost attended the appointment with her, but last minute decided they’d rather go for ice cream with their father. In addition to being this likable woman who says things like “F-bomb” and laughs at even my stupidest jokes, she also happens to be the foremost authority on lower limb deformities in the region. If you are toying with the idea of trying on an external fixator for a few months, I’m happy to offer an endorsement for her as you really won’t find more capable hands.

My x-rays showed the bone growth of a natural over-achiever; rather than worrying about a non-union from bone that won’t grow, we are now worried that the bone is condensing too quickly and will make my daily strut modifications more difficult and painful. All in all, she was extremely pleased with my progress. My swelling is minimal, the pin sites are in good shape, and my foot is noticeably flatter than when we started though I still have some ways to go. The main purpose of this appointment was to change out one of the rear struts- the same difficult one from my last appointment- to a slightly longer strut to continue the expansion. I got a picture of the Claw this time, but it doesn’t elicit the same level of fear anymore as the strut change was fairly simple and painless.

Once the strut change was done, we were free to go… unless… oh, did I want to do something about that top wire that was causing me so much pain every time I moved? She gave me the option of waiting until my next appointment to remove the wire, or do it now. I elected not to wait any longer as the pain was pretty

unbearable and all waiting would accomplish is provide me adequate time to elevate my stress level. It took a moment to round up the supplies, but in no time at all she was cleaning the pin sites on either side of my leg with alcohol and I sat back, gripped the sides of the table, and tried to keep my breathing steady.

*Before photo of the top wire with inflamed and irritated tissue surrounding the pin site.*

The process for removing a wire is remarkably simple. The wires are culled on each end to hide the sharp points, so she unbent these on either side and unbolted the tiny vices holding them taut to the frame. With the wire now free and

protruding from both sides of my leg by about four inches or so, she snipped the end of the wire on the far side of my leg as close to the skin as she could get without nicking me. Gripping the remaining end of the wire with pliers, she gently wriggled the wire back and forth as she pulled until I could feel the end break free from the bone and it whipped out of the remaining tissues like a lawn mower cord. There was very little blood, the holes which had seemed enormous closed up almost instantly, and thanks to the pain medication I took before my appointment, there was relatively little pain beyond a sharp twinge at the end.

*After photo of the pin site immediately following wire removal.*

I asked Patrick to film the entire thing, and he did his very best, but he was more startled than I was when the wire flew out and his sudden jolting camera work shows it. I showed the video to the kids on the way home and for once I was able to impress that stubborn 13 year old. Maybe next time I’ll make him watch in person.

You too can watch the video below…

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Halfway There

I won’t lie- it’s getting harder now. In the beginning, only two or three of the struts would change in a day, but now that the ankle is fully separated, the upward rotation has begun and the strut changes are more difficult. Here comes the pain.

My “prescription” is a 29 day plan with daily modifications to each of the six struts on my Taylor Spatial Frame, trackable with an iPhone app that sends me reminders throughout the day and allows my surgeon to monitor my progress. Yesterday was day 15 of 29, which means I’m over halfway to a flat foot.

I won’t lie- it’s getting harder now. In the beginning, only two or three of the struts would change in a day, and in only 1 mm increments. Now that the ankle is fully separated, the upward rotation has begun and the strut changes are more difficult. Each of the struts move every day now, and most in 2 or 3 mm increments. The dials are more difficult to turn and the pain is reminiscent of a vice slowly crushing my bones.

This pain kicked in to high gear at my last appointment, just three days ago. Two of the struts on the backside of the frame, the side which is expanding, were too small to expand further and had to be changed out. As the entire frame is a complex engineered matrix of tension and compression members, one cannot be removed without imminent collapse of the remaining struts unless first placing some sort of support to hold the frame in place. In the past, the doctor would thread long bolts through the metal rings around my foot and leg to hold them stable, but my doctor brought out a new device invented by one of her colleagues during her fellowship. She called it “the Claw”. Small clamps bit down on the frame rings and she tightened the device to stabilize the frame. She started with strut number 5, and I leaned on my side and chatted with her as she worked, reading from a list of questions I’d been compiling for her. We addressed odd items such as whether or not such a thing as a bleach bath was advisable or if this was some crazy alternative treatment akin to putting a knife under one’s bed to cut the pain. (Knives under beds don’t work, just FYI. I highly recommend narcotics instead.) She was fine with a short bleach bath to disinfect the pins and we moved on to the efficacy of muscle massagers as she finished up strut 5 and began to work on strut 4.

I was facing the wall when I felt the frame begin to collapse, and with it my ankle. Patrick claims it was nearly imperceptible, but as strut 4 was pulled from the rings, I felt a crushing pain that stole my breath and forced a wash of tears through my tightly closed lids. I stared at the wall in silence. The doctor was becoming frustrated as the new strut was refusing to fit into place no matter how much movement in the frame she elicited. She left the room to find a different strut and I rolled to my stomach, buried my face in the pillow, and sobbed. Patrick hurriedly offered me more pain meds from the ready stash he had prepared before we left the house, but I couldn’t bring myself to move enough to reach out and take them. “I can’t

*The angle between foot and foreleg is gradually beginning to decrease with greater strut movement.*

move,” I gritted through clenched teeth, and the doctor rushed back in with the new strut. I was kicking myself for not having the presence of mind to take more pain medication before coming in, but I really wanted to have a sober conversation with her this time.

She struggled through another long period of tugging and yanking on a frame that took turns stretching and crushing my freshly healing ankle bone. “I hope I don’t offend you if I drop an F-bomb,” she finally said, and our laughter helped to ease both the tension in the room and the pain in my leg just enough to allow her to get the strut in place. A few minutes more and the horrible claw device was gone. I could sit up, but the throbbing and visible swelling in the tortured limb was just beginning.

Just prior to this exercise, I had discussed my desire to reduce my pain meds to something weaker and hopefully less addictive. I take Tramadol during the day which is an effective pain medication that doesn’t interfere with cognitive abilities and has a very low risk for addiction, but at night I need something stronger for sleep. She agreed to prescribe hydrocodone to replace the heavy dilaudid I had been taking, but as Patrick wheeled me toward the pharmacy after our appointment, I began to doubt my wisdom in the timing of this change. I was reducing my ability to battle pain at the same time I was increasing a number of activities which would increase it: larger daily strut movements, at least two more strut changes like this one to come in the next two weeks, and the next day- Wednesday- I would physically return to work which meant an hour or so of driving in traffic each way and a few hours on crutches.

Patrick assured me it would be fine and we would just call the office if it wasn’t. Patrick is very different from me in the way he handles problems. I worry about every potential situation before it can happen so that I have the answer to each problem already solved and at the ready. He does not worry and instead points out the futility in such an endeavor to actually change what’s going to happen, promising to cross each bridge when he gets there. There are merits to both methods, but I am noticing that Patrick has far fewer wrinkles and gray hair than I do.

*Swelling in foot increasing the likelihood I will be mistaken for Miss Piggy on the street.*

I took a hydrocodone on the drive home from the doctor’s office. An hour later I demanded something else as my head was fuzzy, but the pain was just as sharp and bone-jarring as if I’d taken nothing. That night was the hardest one since I’d left the hospital and Patrick jumped up multiple times to fetch me more pain meds when the schedule would allow. My Achilles tendon was on fire, my foot looked like a muppet appendage, and every muscle in my foot and leg took turns spasming and jerking on the offended ankle.

By morning, the pain and swelling had calmed down enough that I felt confident I would be able to drive to work for my first day back without passing out from the pain. I am obviously not allowed to drive while taking pain medication (laws and what-not), so I spent the morning working from home and elevating my foot until the very last possible moment. To be to work by noon, I have to leave the house at 10:30, which meant I had to call in to two of my meetings on the road to attend over the phone while driving with a swollen leg using my left foot. Patrick was terrified I was going to kill myself or someone else, so I just told him not to worry and we’d cross that bridge when we got there. He tucked me into the driver’s seat and gave me a very serious lecture in his most serious voice and then kissed me like we’d never see each other again.

The left foot accelerator pedal we had installed took some getting used to. I did mistake it for the brake more than once on the drive, but I drove slowly, put both hands on the wheel like a student driver, and forced myself not to let my mind wander. I survived. I pissed off a motorcyclist as I very slowly weaved my way up Germantown Road, clenching my teeth around every sharp turn, but aside from an angry shaken fist as he finally passed me at the top of the hill, I arrived at work unscathed and having caused no bodily harm or property damage along my trek.

It was a relief to be back at work and into the swing of things again. I was coaxed into showing my foot to the attendees in my first meeting of the day, but after that everyone else just commented on my lovely foot covering and said it was nice to see my face again. Hard to believe since my face hasn’t seen the sun in weeks, but nice to hear anyway. Shortly after my second meeting of the day, I was gifted with a key to my very own golf cart, mine for as long as I am on crutches and unable to board the shuttle that runs between campus buildings. I took my work buddy, Jarrod, for a spin around campus as he showed me the ropes of how to get around behind the buildings, where to park, and for God’s sake to follow actual traffic laws and not roll through the stop signs Marie!

By the end of the day, I was exhausted from all the crutching and my leg was begging me to lay down. I informed my leg we still had an hour and a half commute home and it began to shout in the form of angry muscle spasms that jerked on the frame and squeezed my ankle. This poor ankle. It’s been through so much. When this is all over, I’m going to treat it to a few days lounging in the sun on a beach. No walking, no frame, nobody trying to make it change when it doesn’t want to. Just some margaritas and the sound of mother’s screaming at their children in the distance. Heaven.

I called my doctor the next day. I informed the office I would be at work until 5 and would then swing by to pick up a prescription for something better than what I had just received if they would be so kind as to write a different prescription. The nurse was sympathetic and assured me she would see what she could do. At 4:59, they called me back to say they had made it happen and my new prescription would be waiting for me at the nearest pharmacy. After another day of driving and crutching after another night of agony and limited sleep, it took all my mental coaching abilities to convince myself to extend my commute with a detour to the pharmacy. I knew, however, that if I didn’t do it now, I would run out of what remained of the dilaudid in a day and I would spend the weekend in abject misery.

I parked as close to the pharmacy as I could, but once I made it up the pharmacist’s window, I was informed they were out of the medication. Not to worry though! All I had to do was take this hard copy signed prescription down the block to the neighboring building where there was a smaller pharmacy that had it in stock. I crutched a block in the heat, clinging to the prescription with two fingers and begging my arms to go faster. I waited nearly an hour for this next pharmacy to fill the prescription, and then crutched back holding the bag of medication with my curled fingertips. I stopped twice to catch my breath and willed the car to roll closer to no avail. By now every muscle in my lower leg and thigh were cramping up, but I made it to the car, threw my crutches in the backseat while I balanced on one leg, and collapsed on the driver’s seat.

I texted Patrick to let me him know I was on my way so he could start worrying and I relayed my little sob story to him. He responded with adequate sympathy and I felt foolish. “No, I”m okay, nobody tried to shoot at me or eat me. I’ve got to stop complaining so much.”

His instant reply? “Nah, it’s you.”

Find somebody who gets you; it’s so much better than trying to change.

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Of Pins and Pain and Love

Love makes hard things easy, makes weak people strong, and makes the most difficult parts of our lives the happiest.

I couldn’t have done this without Patrick.

He scoffs at this when I tell him, but I remind him that I simply WOULDN’T have done this without him. I had no intention of even trying to change this foot before I met him, and it was only upon his eager insistence, his unwavering optimism, and his highly convincing confidence that I was persuaded it was possible.

Early on in my married life, I came to realize the myth that all a woman has to do is sit around waiting for a prince to show up and take care of her was just that- a myth. With two children in diapers, I made the decision to take my family’s financial future into my own hands and started my degree program in Engineering. I was allowed to do this on the strict caveat that it was not allowed to cost my husband a dime. I took out loans, both subsidized and unsubsidized, finagled the department to give me a few scholarships, and gratefully relied on my little sister’s generosity as she babysat for me. My husband at the time was not the sort to get up at night with a baby, so I was still a full time mother and housewife the entire time. By the time I graduated and got a job, I was accustomed to doing everything without help- planning for my family’s future, taking care of the kids, buying and selling homes and stock investments and running the household- everything. After I left my husband, my load didn’t really get heavier, but my confidence fell and I had to learn how to do everything alone without even a cheerleader to believe in me. And so I did.

But over the past year, Patrick has taught me to let go of the reins a bit and learn to accept a little help. I still struggle with it, but there isn’t much I can do about it these days with a cage on my foot. In the hospital, he slept sideways in a recliner, his head lolling over one arm of the chair and a leg haphazardly drooped over the other. He woke instantly at the slightest sound to ask how I was doing and ran out to chase down a nurse every once in a while. He stayed right at my elbow as the physical therapist forced me to walk up and down stairs and back and forth along the hallway on my crutches before signing off on my release.

When we arrived home from the hospital, he was too worried I would fall and instead carried me up two flights of stairs like a baby in his arms. He has managed all of the instructions from the doctors as I’ve been too drugged at most of our appointments to comprehend their conversations, and he has completely commandeered control of my medications. (The two times I have taken this into my own hands so far I took the wrong dose and

didn’t write down the time.) He cooks for me, makes me coffee every morning, does all the housekeeping and laundry, and watches all five of the children.

Of all of these chores, however, by far the kindest and most difficult is my pin care. Pin care is vital to prevent infection and will occur every day until my frame is removed. If performed improperly, the skin around the pins may heal wrong and cause tenting, a situation where the skin grows up around the wire in a cone and leads to skin tearing and irritation with any movement. If all of the drainage and scabbing is not removed each day, infection can brew and in no time this can lead to a deeper infection which may tract to the bone. Nearly every complication with a Taylor Spatial Frame results from problems with the pin sites and most of these can be prevented with adequate pin care.

Each evening after the kids have been put to bed, I take a shower and soak my leg with the frame in water. I am only allowed to use Dial antibacterial soap and I lather up my knee as I sit on my shower bench and rinse the soap down my leg over the pins. When I’m done, I towel-dry the frame and use a fan or blow dryer to dry the rest of the droplets. I lay down in bed with my leg elevated on a one foot-high foam wedge pillow and Patrick takes over. Using a sterile cotton-tipped applicator and sterile saline, he must diligently scrub each pin and gently push the skin back from the wire all the way around. Each pin requires a fresh applicator which must be opened from sterile packaging. After the first few cleanings, the pin sites were inflamed and irritated; even gentle pressure hurt immensely and with each of my gasps he would stop

and catch his own breath, visibly upset at the pain he was causing me. He must watch for infection and monitor each bruise and blister closely to report it the doctor, and sometimes this involves tracing a line around a reddened area to see if it spreads or snapping a photo to email to my doctor. Once each pin has been cleaned, he places dry gauze carefully around

*An irritated pin site- excruciatingly painful with each movement.*

each of the pins which are still draining and tightens the plastic clip on the wire to put pressure on the dressing. When this is finished, he turns the struts. There are six of them and the changes have gotten larger as the ankle has now been separated and we are beginning the movements to raise my toes and lower my heel. He turns the dials slowly on each strut for fear of hurting me, but I groan and gasp anyway.

The entire process takes about an hour and we have a pretty good system now. He puts Bob’s Burgers on to distract me and we laugh and make fun of each other the whole time. If you don’t know Patrick, you don’t know that he is not good with these things. He cannot stand gore and his idea of what constitutes gore is pretty pathetic on my scale. While I knew I could count on him to get the door for me and help out with cooking, I honestly thought I’d be on my own with most of the raw and dirty medical procedures.

*Turning the struts- that one in the back needs a little help sometimes.*

But love is odd.

Love makes hard things easy, makes weak people strong, and makes the most difficult parts of our lives the happiest. It makes a man who hates the site of blood buck up and take over without comment or complaint because he doesn’t want me to struggle on my own. It makes a woman who likes to complain bite her tongue when it hurts because I don’t want him to worry that he’s hurting me.

I can’t walk, I have a monstrosity on my foot that rivals some of the best horror movie props, and I have never been happier in my life. Thanks to love.

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The surgery

Monday, June 15, came EARLY. We had to get up at 3:30 to make the hour drive for check-in at 5:30. Naturally, I hit snooze until 4:15. I packed almost nothing, responding to Patrick’s concerns over this with my certainty that I would be issued a lovely hospital gown and all necessary toiletries would be provided. Besides, I had no one to impress. For a fleeting moment I considered the likelihood that my mother would snap a groggy-eyed photo of me in recovery to post on facebook. As this couldn’t possibly be any worse than the Christmas morning photos in my pajamas with geyser type hair on half my head and my lips so dry they apparently stayed tucked up onto my gums showcasing my chipmunk teeth, I shrugged it off.

I tip-toed into the kids rooms and gave them fierce hugs and kisses that half-woke them from their dreams and said goodbye. In the back of my mind were all the random stories you hear of people going in for a routine surgery and dying on the operating room table because their anesthesiologist was a closet coke addict and forgot to turn on the oxygen. Or similar scenarios. This surgery was not routine or short and was scheduled to last half the day.

On the drive there, Patrick got coffee. For himself. I was not allowed to eat or drink, presumably because if you do die on the operating room table, they want you looking as slender and beautiful as possible. I was silent for most of the drive, but I can never stay introspective for long and soon Patrick had me laughing. Somewhere along that drive it occurred to me that although it would be long and torturous for Patrick and my mother to sit and wait for word of how I fared, I would be asleep that whole time. For me the surgery would be “Oh, I’m feeling groggy,” and then I’d wake up. That lightened my mood quite a bit.

Check-in was fast and as expected I was issued an amazing Vera Wang-esque hospital gown upon admittance. I stubbornly demanded underwear and the nurse gave me a pair of white mesh panties new mothers get after delivery. I secretly loved them. Before Patrick could join me to wait for the surgeon, I went through the necessary scrubbing of the leg, iv inserted, monitors stuck haphazardly across my chest, and – this is the best – a hose blowing warm air was attached to an opening in my gown. My hospital gown filled up with air and they covered me with a blanket pulled directly out of a warming oven. As I crossed my arms and waited for Patrick to be ushered in, I noticed the warm air was filling out my normally frail bosom quite nicely. Patrick noticed too and complimented me on my rack as he entered. Maybe it was the Oxycodon and Valium they had just given me, but it all seemed not so terrifying at that moment. We talked about how much food I intended to eat when I woke up and as each new specialist came in to introduce themselves, I would slide in a comment about preferring to wake up with all my limbs still attached. When my surgeon arrived, I asked her if she’d gotten enough sleep and had all her coffee that morning. She laughed slightly, but I could tell she was already in the zone and focused on getting this shit done right. Her demeanor set me at ease.

In my surgeon’s own words, the actual ankle surgery, or osteotomy, is a fairly minimally invasive, straightforward procedure. With a small number of short incisions in the front and sides of my ankle, she would be able to fit a wire around the existing bone and essentially saw her way through where there used to be a joint, separating my tibia and fibula from the talus bone. These incisions would then be stitched up and the frame would be affixed using wire that would drill through one side of my limb, through the bone, and come out the other side. These wires would be inserted in my foot at the top just below my toes, in my heel, and in my leg at counter angles to prevent lateral movement of my limb along the length of the wires. The ends of the wires would be wound around bolts along the frame and tightened to create a tension-bearing member capable of withstanding the force required to shift my bones without stretching or bending. External fixation has been around a while, but the Taylor Spatial Frame is a relatively recent invention which utilizes fixation and gradual correction to modify bone. While my surgery is fairly basic and unexciting for a surgeon who specializes in limb deformities, some of the miracles these contraptions can achieve are nothing short of life-altering and awe-inspiring.

My last memory was in the operating room performing a flawless butt-scoot from the gurney to the operating room table. I vaguely remember seeing my surgeon’s face, and then I awoke in recovery. I guess it hurt, I don’t remember it that well as the recovery nurse was quick with the good drugs whenever I started to grimace. I looked at my leg right away, but there wasn’t much to see as the frame was wrapped in ace bandages top to bottom, completely shielding the carnage beneath. I asked for a pillow to elevate it and the nurse seemed surprised I could lift my leg without assistance as he tucked a pillow under my ankle. I’ve read many stories from others who’ve had this surgery and they are unable even to bend their knees or move their leg without manually lifting the frame with it, so I immediately felt lucky for my level of mobility.

It took three hours for a room to open up on the med-surg floor. Once it did, my experience went downhill. My surgeon had prescribed Oxycodon, morphine, and Tylenol. Sadly, this was not helpful and I writhed in agony sobbing until my nurse’s shift ended and she gave bedside passdown to the night nurse. I interrupted them to demand that someone call my doctor, at which point the nurse said they really didn’t like nurses to do that. My new night nurse acquiesced and my doctor not only prescribed much heavier pain medication, but also expressed annoyance that she hadn’t been called sooner. I might have taken the time to look smug if I hadn’t been in so much pain. Eventually the pain abated, but I hardly recall the rest as I was heavily stoned for the remainder of my stay. I vaguely recall pushing a button marked pain whenever I would start to feel anything, and in short order soemone would come in and shoot something into my iv, bringing relief in as little as five minutes. I had to pass a physical therapy test on crutches before they would allow me to leave, and Patrick staying right next to me the whole time for fear I would collapse. I was so stoned you guys.

I was released Wednesday, just as a migraine hit me and forced me to vomit up all of my meds. They gave me this Zofran for nausea which sits under your tongue and claims to dissolve like magic. The reality is that it sits under your tongue and makes you more nauseous as it mixes with your saliva and tastes like glue. It might be the worst invention ever.

All I remember about going home was laying across the back seat as Patrick swung by to pick up his five-year old daughter and explain that for just this once she would need to ride in the front. Her eyes got huge and she immediately rallied at the sacrifice. The next few days are sketchy. I laughed a lot. Patrick worried I was too stoned and starting cutting back my medication. At night he set his alarm for every hour and a half so he could get up and give me more medication, and he tracked every pill and dosage and time in a notebook with a diligence I wish I’d put into my kid’s baby books.

On Friday, I got to see my foot. Seven metal wires ran through my foot and leg holding one side of the frame to the other. Additionally, four metal rods about a half-inch (Patrick says a centimeter, whatever) in diameter were drilled into the front of my tibia. In all, I have 18 holes with metal protruding out of them, or 18 pin sites as they are called in the biz. Another way to look at is 18 entry points for germs to travel straight to my bones. Infection right now is my primary enemy and my first concern is keeping those pin sites clean.

You can see in the side view photo the adjustable struts connecting the frame along the bottom of my foot to the frame just above my ankle. There are six of these and starting about ten days out of surgery, I will turn each one to a prescribed number to stretch the soft tissues and Achilles tendon at the back of my ankle, widen my joint space to enable movement, and subsequently rotate my entire foot up to a flat position. In the office during this visit, the surgeon noted that one of my struts had gone slack and the number was 3mm longer than it should have been. She tightened it minimally in the office and directed us to reset it the rest of the way when we got home. That night, Patrick turned the strut, talking to me the whole time so that I didn’t even realize he was doing it. No pain.

This should be a breeze.

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