When Surgery is Good News

Hey readers,

So we're going to be going with a relatively short post this day. I suppose it's a good thing, not having that much to report and update you on. Mostly it'll be focused on news with my ankle.

After getting an MRI and some x-rays, I finally managed to get in to see my new ankle specialist. I went through the whole routine of filling out paperwork and running out of room where it says "List all surgeries with approximate dates" and having various nurses and doctors saying "Wow, aren't you a bit young for all this?" and "I'm sorry you had to go through all that." It's funny to see trained medical professionals act with the same stunned uncertainty that I see when "normal" people find out about my medical past and can't figure out how to express their pity and/or sympathy properly. But I did like the doctor, he listened to my opinions (I can't work with doctors that assume I know nothing and won't factor in my suggestions or treat me like an ignorant child), showed me what he saw in the MRIs and x-rays, and freely admitted that this was an extreme case and, rather than go forward assuming he knew best, wanted to get the opinions of some other doctors to see what they thought. I always like that, because I've had more than my fair share of arrogant doctors who think they know best and then turn out to be totally wrong.

The bone spurs are visible just to
the left of the screws

There is some separation of the bones that
is usually associated with older people

Now let's get into the specifics about the ankle. The x-rays and MRIs showed that there are some bone spurs on the inside portion of my left ankle, no real news there. However, he also spotted a stress fracture on the medial malleolus (lower tip of the tibia), which is right above where most of the pain has been located. It might be possible that at least some of the pain comes from this stress fracture. These are all pretty sedate problems for me, things can will either heal on their own or require basic surgery (which I'll discuss shortly) to fix.

The black areas surrounded by white
are where the AVN is most noticeable
(A dove-shaped area above and a
bridge-shaped area directly below that)

However, the MRIs showed a much more serious potential problem in the future. Back in 2010 I had ankle allografts on both ankles (basically removing part of my ankle and replacing it with donor bone) that helped with the damaged portions of my bones caused by AVN (a degenerative bone disease I got as a result of my cancer treatment's treatment, my not so little souvenir I picked up when I had to survive the cure). These donor bones were healthy and over the last few years they've looked very good on x-ray, everyone's been impressed by them. But looking at the MRIs of the ankle, the specialist saw that the AVN was now starting to affect the fresh, healthy bone. The AVN is very pronounced in the lower "knob" of the tibia and also in part of the talus (the part that had been replaced five years ago). Although it probably isn't causing my pain now, since AVN usually only hurts when it reaches the surface of the bone, which it hasn't done yet in the aforementioned areas, it will require additional surgery at some point. It could be years or decades from now, or it could be months, it's hard to say. Basically it'll happen when the pain comes back because of the AVN or if the structure collapses like it did back in 2009, which is what prompted the surgery in the first place.


Fortunately, the AVN is not an immediate problem, but it is something to keep an eye on. The more immediately problem (bone spurs) are a lot easier to fix. My doctor would prefer to be on the cautious side and err toward a minimalistic approach to healing, which I can totally get behind. The plan is to do arthroscopic surgery, which uses a small camera and instruments to see and clean out the damaged areas of the ankle, and then see if that helps sideline the pain for a little bit. Compared to the huge joint replacement surgeries I'm so familiar with, this is far less intrusive and debilitating. After the surgery, the specialist wants to see me every 6-12 months to get images of my ankle so we can check on its progress and catch any further damage early on, before it has a chance to morph into something major. Until the surgery, I've been given orthotics and a brace to help take some of the weight off of my ankle and alleviate the pain as much as possible. And I'll be back to using my cane to take weight off of my ankle. (The doctor felt bad for me, since I would "stick" (terrible pun) out, but told me I could use it to whack people. I think that's the moment I realized how much I liked this guy. Beating people with canes always makes me think of the man who tried to assassinate Andrew Jackson and the 67-year-old president wailed on the guy with his cane). All in all, it feels like this is something that can be taken care of easily and I'll be able to move past it with relative ease. I don't have a date yet for the surgery, but I'm supposed to get a call from the doctor's surgery scheduler to get that sorted out.

Until then, I'm going to keep chugging along and staying productive.
Ciao

Coming soon:
Keep an eye out for the next blog post, which will throw some hard truths and harsh spotlights on an issue that underlies everything in my life, and in the lives of millions and millions of other cancer patients and survivors.

PS: I don't think this was nearly as short as I thought it would be. Sorry for accidentally lying to you.