Thursday, March 24, 2011
Cymbalta withdrawals
Today is day 16 without Cymbalta. The withdrawals are barely noticeable, save one. This is one I haven't mentioned before. Because Cymbalta causes drowsiness, when you take it away, your body doesn't have the chemical (medicinal) signal that it's time to go to sleep. It probably doesn't help that I spent the first few days after my surgery in bed, awake, watching TV, reading and playing games on the computer. For the last week, each night when I lay down to go to sleep, my mind races and I am just as awake as I am during the day. Last night, I finally fell asleep around 3:30am (after going to bed at 9pm). On school days, I usually have to get up between 4:30am and 5:00am, so not falling asleep until 3:30am is going to be a problem.
Ankle Recovery - started physical therapy
Yesterday, I had my first session of physical therapy. Today, I had my second. I went to John West Therapy Services in Friendswood. This is the same place I went to attempt therapy before my surgery.
During my first session, Tina, the therapist, measured my swelling as well as my range on motion. She commented that my range of motion was very small and I'm going to have to work hard to get it back. But, I should not necessarily work "hard", but rather be persistent with my stretching. Tina worked on the swelling in my ankle, trying to get it to go down. After Tina worked on my ankle for a bit, I had to start some stretches. Then it was time for a few exercises. I was glad that nothing was painful, although it was difficult.
Today it was time for round 2. Today, Tina was not here. I really feel bad that I don't remember the name of the therapist with whom I worked. She was really good. She again worked to reduce the swelling in my ankle and leg. Hopefully, once the swelling goes down, my mobility will increase. In addition to the stretches and exercises I did this morning (pulling on the balls of my foot (knee bent & straight)) I also moved my ankle up and down, with & without resistance, toe raises, heel raises, toe scrunches, toe pushes and going up and down with my foot centered on a bosu ball. None of it was really painful, but most of it was difficult.
I am still experiencing phantom pains in my ankle. The area that feels like there is a healing incision, is not where the incision is. I still have a toe that is numb and experiencing pins and needle pains in that same toe (the base of the toe is numb and the tip is pins & needles).
I will be doing my exercises twice a day, every day, until I return to physical therapy Monday morning.
On a not as nice note, twice today, I hit my boot on something and it hurt (one much worse than the other). After physical therapy, my husband and I went to the Black Eyed Pea for lunch. When we left, someone had parked too close to the car on my side. When I sat down and turned, my foot hit the car door (OUCH!). Then a couple of hours later, I was in a children's choir meeting at church and accidentally kicked the desk with my boot while I was trying to change positions (sitting in proper chairs, in an office is rather uncomfortable). This one didn't hurt as bad.
I have a goal of chaperoning my daughter's choir group to Schlitterbahn next month. Wish me luck!
During my first session, Tina, the therapist, measured my swelling as well as my range on motion. She commented that my range of motion was very small and I'm going to have to work hard to get it back. But, I should not necessarily work "hard", but rather be persistent with my stretching. Tina worked on the swelling in my ankle, trying to get it to go down. After Tina worked on my ankle for a bit, I had to start some stretches. Then it was time for a few exercises. I was glad that nothing was painful, although it was difficult.
Today it was time for round 2. Today, Tina was not here. I really feel bad that I don't remember the name of the therapist with whom I worked. She was really good. She again worked to reduce the swelling in my ankle and leg. Hopefully, once the swelling goes down, my mobility will increase. In addition to the stretches and exercises I did this morning (pulling on the balls of my foot (knee bent & straight)) I also moved my ankle up and down, with & without resistance, toe raises, heel raises, toe scrunches, toe pushes and going up and down with my foot centered on a bosu ball. None of it was really painful, but most of it was difficult.
I am still experiencing phantom pains in my ankle. The area that feels like there is a healing incision, is not where the incision is. I still have a toe that is numb and experiencing pins and needle pains in that same toe (the base of the toe is numb and the tip is pins & needles).
I will be doing my exercises twice a day, every day, until I return to physical therapy Monday morning.
On a not as nice note, twice today, I hit my boot on something and it hurt (one much worse than the other). After physical therapy, my husband and I went to the Black Eyed Pea for lunch. When we left, someone had parked too close to the car on my side. When I sat down and turned, my foot hit the car door (OUCH!). Then a couple of hours later, I was in a children's choir meeting at church and accidentally kicked the desk with my boot while I was trying to change positions (sitting in proper chairs, in an office is rather uncomfortable). This one didn't hurt as bad.
I have a goal of chaperoning my daughter's choir group to Schlitterbahn next month. Wish me luck!
Tuesday, March 22, 2011
Cymbalta Withdrawal update
Today, I am 14 days since my last dose of Cymbalta. The withdrawals are much better, but not totally gone. The headaches are gone. The stomach ache is mostly gone, and would probably be better if I were eating better (staying home alone on crutches means you only get to eat what you can carry while using crutches). My lips still tingle occasionally, but not as bad. The brain zaps are actually happening more often, but are not as intense (no where near as intense). And when I turn my head, my vision moves at the same speed as my head. Day 10 or 11 was probably the turning point. Once I got to day 11, I knew I had made it over the hill and was on my way down. I still say, if you're taking Cymbalta, call you doctor, set an appointment, and tell him/her you want off. Reading all the experiences people have had should be enough to scare anyone into picking up the phone. I fully expect to begin seeing commercials from lawayers on the TV looking for people to sign to a class action lawsuit against Eli Lilly because of this drug.
Wednesday, March 16, 2011
Ankle injury & recovery - Cymbalta Withdrawls
On Saturday, January 15, 2011, I was at the Friendswood High School Wranglerette's January Jubilee. This is an annual dance competition held at Friendswood High School and my oldest daughter was competing. Around noon, I was in the cafeteria looking at pictures that were taken of my daughter during her dance. When I got up & turned around, my left ankle got caught between 2 chairs. I put my right foot out to catch myself & two people tried to catch me. But I still hit the floor. As I was going down, I felt something in my right ankle pop. I wiggled all my toes & ankle. It hurt, but since everything moved, I figured I would just have to walk it off.
It hurt a little, but the more I walked, the better it felt. Until . . . . . I sat for a while, watching several people we know dance. When I went to get up, I was immediately aware of the pain in my ankle. When I looked down, my ankle looked like I had a softball under the skin. I continued limping on it for the rest of the afternoon/evening. Anyone who knows me well would not be surprised by this. About 3pm, some of the dads who were volunteering at the event saw me limping and sent for the athletic trainer (who was on the the soccer field). He came in with a big bag of ice, looked it over and said I should go to Urgent Care that day or the next. I chose the next day option, turning down the offer to call an ambulance or for one of the dads to carry me around for the rest of the day. The longer I walked (hobbled) around, the bigger my ankle got and the more painful it became. But that didn't stop me from staying until 10 or 11pm.
And it didn't stop me from driving myself to church the next morning. Normally, I wouldn't have gone to church that morning, but I had already agreed to work in Childrens' Church, and the two people who regularly "ran" Childrens' Church (our childrens' minister and her side kick) were out of town and I had no way of finding someone to take my place. Driving to church was no problem. Driving home was a little different (read painful). When I got home, my ankle still looked like there was a softball under the skin. So, I finally let my husband talk me into going to Urgent Care (about 25 hours after the fall).
We went to the closest, open, Urgent Care that was on our insurance. We ended up at a nice Urgent Care Center that was newly opened (Bay Area Urgent Care). We were the only patients there, and the doctor and her assistant were very helpful. They insisted on taking me the 50 feet to the x-ray machine in a wheelchair. They took 3 x-rays of my ankle, and brought my husband into the x-ray room and had him behind the half-wall, looking at the computer screen. All three images were available for us to look at in less than a minute. Verdict - no broken bones. The doctor made a splint for me & her assistant handed me a pair of crutches. They told me it was a grade 3 sprain. I should stay off of it for 2 weeks, and if it still hurt at the end of those two weeks, I should see a specialist.
So, I cancelled everything for the next two weeks, and had my mom stay with us when my husband was working. They drove the girls everywhere they needed to go and I stayed on the couch with my foot propped up.
At the end of the two weeks, I still could not put any weight on my foot, so I called the orthopedist who took care of me back in 2000 when I lost a disagreement with a horse, Dr. Schauder. I started calling his office at 8am Monday morning. I found that they open at 9am, and the earliest I could get an appointment was 3pm that Wednesday. When I made the appointment, I explained to the office person that I HAD to be out of their office by 5pm because my husband was working the night shift and he had to go to work (remember, this is my right ankle, so I can't drive). I was assured that it would not be a problem for us to be out of the office by 5pm. We arrived at the office in Houston at 2:45 in order to update my paperwork before my appointment,. When we arrived, we were told (after we asked) that the doctor was running behind, but it would not be a problem for us to be out of the office by 5pm. At 3:40pm, we were called to the front window and told that there were still several people to be called back before us, and they would not be able to get us out by 5pm. She told us to call his Alvin office to reschedule. So, I called on the way home and was able to get into the Alvin office the next day.
Dr. Schauder's office took 3 more x-rays (same angles and equipment as urgent care). Dr. Shauder said nothing was broken, I merely had a grade 2 sprain. He told me to start physical therapy, wear the boot they were going to give (sell) me, and come back in 2 weeks. This boot had a beveled bottom and went 3/4 up to my knee. I made the follow-up appointment before I left. They scheduled me for the first appointment after lunch. We explained that we would have to be out of the office by 2:30pm in order to be home before our daughter got off the school bus. Again we were told that it wouldn't be a problem.
Due to the weather here and where our insurance office is located (ice storms that closed schools. very unusual in Southeast Texas), I wasn't able to begin physical therapy until almost 2 weeks later. The physical therapy place was wonderful (John West Therapy Services in Friendswood). The lead therapist gave me some homework to do twice a day. I followed her instructions, enduring pain each time.
I went back to Dr. Schauder for my follow-up appointment. I was quite surprised to see a full waiting room. Especially since I was supposed to be the first appointment after lunch. When I checked in, I asked the person at the front desk (who appeared to be the office manager) how far behind the doctor was running. I was told, in an uncaring tone, "I don't know. I just got back from lunch." Again, I reminded them of my need to leave by 2:30 (it's 1:30pm). A tech who happened to hear this conversation said that he couldn't even put a time on how far behind the doctor was running. Every treatment room was occupied and the tray of people to call back was full. The lady at the front desk just looked at me as if to say, "so." I said that we would wait as long as we could, but we HAD to leave by 2:30pm.
At 2pm, I again asked how far behind the doctor was running and explained my issue. She said I could reschedule if I wanted to. So I said great, when is the first available appointment. She said, "Thursday." I asked "Tomorrow?" She said, "No, next Thursday." I said I would just have to find a new doctor. She looked at me, shrugged, and said "All right."
I know that it's possible for doctors to be on time. Our pediatrician is always on time. I also understand that doctors who also perform surgeries can run behind due to complications in surgery that morning. But for them to be 2+ hours behind 2 of the 3 times I tried to see the doctor is unacceptable.
I came home, did a little research, talked to some people of facebook, and then called a local podiatrist (Dr. Sands). They were able to see me the next morning (I called about 4pm)
When I got there, Dr. Sands was running about 30 minutes behind. I was told this as soon as I checked in, and the receptionist apologized in advance. Then, both nurses apologized for them running behind. Of course, I had to have more x-rays. I was surprised to find that I could walk unassisted to the x-ray machine. Dr. Sands took a quick look at the x-ray then began a physical exam of my ankle. He gave my ankle a stress test, which I failed, in a big way. He was also concerned about the amount of swelling in my ankle. His nurse applied a soft cast to wear under my boot to help with the swelling. Dr. Sands drew a diagram to show us what he believed to be going on in my ankle, then asked if I could have an MRI done the next day. He didn't want to wait.
I called the MRI office while we were still at Dr. Sands office. They said they had to verify my insurance, and would call back within 30 minutes. Well, it wasn't 30 minutes later, it was 45 minutes. They scheduled me an appointment for the next morning.
Unfortunately, when I arrived at the MRI office the next morning, I was told that they had just tried to call my cell phone, because there was an emergency work in who had just arrived. The receptionist said that it would take about 90 minutes and encouraged us to go eat or run errands. When we came back, they were still with that emergency work in. We went next door and got sandwiches from Subway, and came back to eat. The manager of the facility came out more than once to apologize and they gave us gift cards to Subway and Starbucks in apology. 2.5 hours after my original appointment time, I was finally on the MRI table.
1.5 hours after I got off the MRI table, I was at church getting ready to head to the pre-teen camp leadership retreat. We had a great time at Camp Pineywoods and worked to make this year's camp even better than last year's.
Monday, I got a call from Dr. Sands office. My MRI results were in, and when could I come in to get the results. Unfortunately, I wasn't able to get back in until Thursday. As expected, Dr. Sands presented me with 2 options. Option 1, I could spend the rest of my life in an ankle brace, knowing that walking over a crack in the sidewalk could/would cause my ankle to buckle. Option 2, surgery. The MRI showed 2 ruptured ligaments, the ATFL and the CFL. Again, Dr. Sands drew diagrams on his white board to explain what was going on inside my ankle and demonstrated the stress test for us. I chose not to watch and concentrate on relaxing. My husband was very curious and described it for me later. Surgery was scheduled for the following Friday (March 4).
So, I told everyone that I would be stuck at home for quite a while, tried to load up on groceries and got everything ready for my surgery.
Of course, I didn't mention that, the Monday before my fall, I had gone to my regular doctor, Dr. Lyons, for my regular check up. Due to some of the side effects, we decided that I should come off the cymbalta and start Wellbutrin. Unfortunately, this is easier said than done. I had quit taking cymbalta on my own before (between doctors). I was off of cymbalta for approx 6 months. When Dr. Lyons first suggested I take cymbalta, I voiced my reservations. My problems were not with the time I was on or off cymbalta, but rather the withdrawals I went through when I quit taking it. For the first couple of weeks, it took all I had to get out of bed. I had trouble with head aches, stomach aches, dizziness, tingling lips, brain zaps (which you have to experience to fully understand, but the best analogy I can give is being drunk. when you turn your head, your body moves at a different speed than your vision.) I also had emotional side effects. My anxiety was worse than at any other time in my life. My husband actually had to come rescue me at Walmart when I was trying to buy school supplies. I called him when I was on my way to Walmart because I was already feeling anxious (read down right scared). Dr. Lyons told me that rather than stopping cold turkey next time, he would bring me off of it gradually. I reluctantly agreed to take it again. So, in January, Dr. Lyons had me start the Wellbutrin and cut my cymbalta dosage in half for 4 weeks. After the 4 weeks, I was to completely stop the cymbalta and keep the Wellbutrin the same. I followed his instructions to the letter. However, three days after stopping the Cymbalta, the withdrawals symptoms became too much. Thankfully, this time it was only the physical symptoms, no emotional symptoms. In addition to the previous physical symptoms, this time I also had hot and cold flashes and well as dificulty talking. I made an appointment to see Dr. Lyons the next morning. Dr. Lyons advised me to take the lowest dosage of Cymbalta every other day for another 4 weeks, then I should be able to discontinue to Cymbalta with no withdrawal symptoms.
So, back to my surgery & my ankle. At 6am, the day before surgery I contacted the surgical center to confirm my arrival time the next day. A couple of hours later, the surgical center called to move my time up 30 minutes. Then, 5 minutes later, they called again, pushing my surgery up to first thing in the morning. I arrived at Foundation Surgical Center in Dickinson at 5am that morning for pre-op. I was taken into pre-op at approx 5:20am and into surgery at approx. 6:20am Although I was told I wouldn't, I remember everything that happened up until I was lying on the operating table and I had been on the inhaled anesthesia for a couple of minutes. I remember my IV being started. I remember 2 anesthesia doctors explaining things to me, I remember the pre-op nurse and the operating room nurse. I remember Dr. Sands & Ms. Beverly coming in to say good morning and Dr. Sands again performing the stress test (just to make sure my ankle hadn't healed itself). I remember having anesthesia administered through my IV, and the OR nurse coming to talk to me shortly after. The anesthesiologist and I both told her to be quick, because I felt like I was fading. I was having to concentrate on every thing she said. I remember the block being administered in the back of my leg (thigh). I remember being wheeled down the hall & into the OR. I remember moving from the pre-op bed to the operating table (which seemed incredible skinny & I had to remind myself that I wouldn't fall off). I remember being able to see a little of what was going on in the OR next to mine. I remember watching what was going on while I breathed in the anesthesia.
The next thing I remember, I was in the recovery room. My husband came in and told me that the surgery took longer than expected. Dr. Sands had told him that the damage inside my ankle was much worse than the MRI had led them to believe. The CLF was separated from the bone, but it was a textbook tear. The ATFL was a different story. My ATFL was not torn, it was shredded. Necrosis had set in, and every time they tried to put a needle through the ligament to pull it back to the fibula, it just shredded even worse. The name for the surgery I had is the Brostrom Procedure, but they had to do a little more than normal to get my ligaments where they needed to be. I was told this would add a week to my recovery time (6-10 weeks).
I went home, got into bed, and enjoyed the comfort of the cold rush ice therapy machine and the pain meds for the rest of the day. I had been told that, due to the extent of the damage in my ankle, I should expect more pain than I would have otherwise. While this was good information for my husband, to know that I would be in alot of pain; since I had no idea what to expect before hand, all I knew what that I was in pain, and the meds worked.
Now, Tuesday, 4 days after my surgery, I took my last Cymbalta. I felt fine for the first 4 days. But after that, the withdrawal symptoms began to set it. I decided to tough it out rather than go back to an even lower dosage (every 3 days or so).
A week after my surgery, I went to Dr. Sands off & had my bandages changed. Dr. Sands said everything looked good, and to come back in a week. Rather than continuing in the splint that was putting pressure on my calf & mimicking the pain of a blood clot in my leg, he had Beverly wrap my leg and told me to put my leg back in my boot when I got home. As soon as we got home, my husband tried to help me put my boot on. We realized very quickly that my ankle was way too tight to bend to a 90 degree angle in order to wear my boot. I called Ms. Beverly and she suggested we head back to Dr. Sands office and bring my boot with us. When we got there, Ms. Beverly tried, but immediately told us that she didn't like my boot. She got me one of their boots. These also have a beveled bottom, but only go up a little ways past the ankle. I had to leave my ankle in this boot 24 hours a day until I saw Dr. Sands again. During the day, it wasn't that big of a deal, but I hated trying to sleep with it on. It wasn't anything to do with comfort. The rubber sole of the boot stuck to my blankets and sheets. I had to sleep with my leg out of the sheets and every time I moved, that boot would stick on the sheets or something and wake me.
A week later, I went back to Dr. Sands for another check up. His nurse, Beverly, cleaned my leg & cut the stitches. Dr. Sands took a look and said that everything looked great. I was again told that I my ankle was that of someone much older than I am. I was also told how bad things were inside my ankle and that it was obvious there were previous injury(ies) to that ankle. They believed that my fall that day in January was just the straw that broke the camel's back. The thing is, I don't remember injuring my ankle since I was 7 or 8 years old. When I was taking ballet as an adult, I did fold my ankle under me several times (falling off toe shoes), but never anything that hurt. Apparently, all those folds had caused damage and I just didn't realize it. Dr. Sands told me to continue to wear the boot during the day, but I could take it off to sleep and bathe. No soaking my ankle yet, because of the new steri-strips, but I could at least wash my ankle and foot again. He also told me to start partial weight bearing and did a good demonstration of exactly what he meant. He told me that if I did not follow his directions in this, he would put me in a fiberglass cast so I couldn't walk on it. He instructed me to start physical therapy a week later (I have to wait at least 8 days before I start PT). and I have to continue the partial weight bearing until I see him again in 4 weeks. I am going back to the same PT center (John West Therapy Services in Friendswood), and will go 3 times per week for 4 weeks. As soon as I got out of the exam chair, I tried to put some weight on that leg. I nearly screamed and was fighting tears (I have never cried in pain before, although I was close when I broke my arms and during PT earlier with my ankle. but these were also tears of fear due to the pain). The nurses explained to me that it was normal for this to be very painful. I haven't put any weight on that ankle in 11 days and my Achilles tendon is very tight from non-use. I should take everything very slowly. I made an appointment for 4 weeks and have put a very small amount of weight on that ankle since.
That was yesterday. Today, as my husband took our daughters to the Museum of Natural Science (it's Spring Break) and I sat at home, I began to realize that I still have 4 more weeks on these crutches. I can not sit home for another 4 weeks. I'm going to have to go somewhere, even if I'm on my crutches the whole time. Several people have suggested I rent a knee scooter, but I just can't justify the expense for the amount of time I would be using it ($45/week, $250/month). And since this is my right leg, I haven't driven in 2 months, and still have another 4 weeks before I'll be able to drive again. I've been relying on my husband and mom to get me and the girls everywhere we need to be.
While I was going yesterday, I noticed that the withdrawals were not as bad. I'm not sure if it's because my mind was on other things, because I was active, or both. Today, the withdrawals are worse than yesterday, but not as bad as the day before. I have thought of taking a cymbalta, because I know that if I take one when I go to bed, I'll feel better when I wake up. But, . . . when I saw Dr. Lyons about the withdrawals last month, he said that he expected them to last no more than 2 weeks if I had toughed it out the first time. I'm already 8 days without the cymbalta, so I don't want to have to start over. I just keep telling myself that this should be over soon. I've visited websites & discussion boards for people who have also had these cymbalta withdrawals. My experiences seem to be typical of others, but I haven't found anyone who has seen the other side; so I'm not sure if I'm past the half way point or not, but I do know that I don't want to start this over again.
Hopefully, I'll remember to update this again to let anyone/everyone know how my revocery is going as well as how the withdrawals go.
It hurt a little, but the more I walked, the better it felt. Until . . . . . I sat for a while, watching several people we know dance. When I went to get up, I was immediately aware of the pain in my ankle. When I looked down, my ankle looked like I had a softball under the skin. I continued limping on it for the rest of the afternoon/evening. Anyone who knows me well would not be surprised by this. About 3pm, some of the dads who were volunteering at the event saw me limping and sent for the athletic trainer (who was on the the soccer field). He came in with a big bag of ice, looked it over and said I should go to Urgent Care that day or the next. I chose the next day option, turning down the offer to call an ambulance or for one of the dads to carry me around for the rest of the day. The longer I walked (hobbled) around, the bigger my ankle got and the more painful it became. But that didn't stop me from staying until 10 or 11pm.
And it didn't stop me from driving myself to church the next morning. Normally, I wouldn't have gone to church that morning, but I had already agreed to work in Childrens' Church, and the two people who regularly "ran" Childrens' Church (our childrens' minister and her side kick) were out of town and I had no way of finding someone to take my place. Driving to church was no problem. Driving home was a little different (read painful). When I got home, my ankle still looked like there was a softball under the skin. So, I finally let my husband talk me into going to Urgent Care (about 25 hours after the fall).
We went to the closest, open, Urgent Care that was on our insurance. We ended up at a nice Urgent Care Center that was newly opened (Bay Area Urgent Care). We were the only patients there, and the doctor and her assistant were very helpful. They insisted on taking me the 50 feet to the x-ray machine in a wheelchair. They took 3 x-rays of my ankle, and brought my husband into the x-ray room and had him behind the half-wall, looking at the computer screen. All three images were available for us to look at in less than a minute. Verdict - no broken bones. The doctor made a splint for me & her assistant handed me a pair of crutches. They told me it was a grade 3 sprain. I should stay off of it for 2 weeks, and if it still hurt at the end of those two weeks, I should see a specialist.
So, I cancelled everything for the next two weeks, and had my mom stay with us when my husband was working. They drove the girls everywhere they needed to go and I stayed on the couch with my foot propped up.
At the end of the two weeks, I still could not put any weight on my foot, so I called the orthopedist who took care of me back in 2000 when I lost a disagreement with a horse, Dr. Schauder. I started calling his office at 8am Monday morning. I found that they open at 9am, and the earliest I could get an appointment was 3pm that Wednesday. When I made the appointment, I explained to the office person that I HAD to be out of their office by 5pm because my husband was working the night shift and he had to go to work (remember, this is my right ankle, so I can't drive). I was assured that it would not be a problem for us to be out of the office by 5pm. We arrived at the office in Houston at 2:45 in order to update my paperwork before my appointment,. When we arrived, we were told (after we asked) that the doctor was running behind, but it would not be a problem for us to be out of the office by 5pm. At 3:40pm, we were called to the front window and told that there were still several people to be called back before us, and they would not be able to get us out by 5pm. She told us to call his Alvin office to reschedule. So, I called on the way home and was able to get into the Alvin office the next day.
Dr. Schauder's office took 3 more x-rays (same angles and equipment as urgent care). Dr. Shauder said nothing was broken, I merely had a grade 2 sprain. He told me to start physical therapy, wear the boot they were going to give (sell) me, and come back in 2 weeks. This boot had a beveled bottom and went 3/4 up to my knee. I made the follow-up appointment before I left. They scheduled me for the first appointment after lunch. We explained that we would have to be out of the office by 2:30pm in order to be home before our daughter got off the school bus. Again we were told that it wouldn't be a problem.
Due to the weather here and where our insurance office is located (ice storms that closed schools. very unusual in Southeast Texas), I wasn't able to begin physical therapy until almost 2 weeks later. The physical therapy place was wonderful (John West Therapy Services in Friendswood). The lead therapist gave me some homework to do twice a day. I followed her instructions, enduring pain each time.
I went back to Dr. Schauder for my follow-up appointment. I was quite surprised to see a full waiting room. Especially since I was supposed to be the first appointment after lunch. When I checked in, I asked the person at the front desk (who appeared to be the office manager) how far behind the doctor was running. I was told, in an uncaring tone, "I don't know. I just got back from lunch." Again, I reminded them of my need to leave by 2:30 (it's 1:30pm). A tech who happened to hear this conversation said that he couldn't even put a time on how far behind the doctor was running. Every treatment room was occupied and the tray of people to call back was full. The lady at the front desk just looked at me as if to say, "so." I said that we would wait as long as we could, but we HAD to leave by 2:30pm.
At 2pm, I again asked how far behind the doctor was running and explained my issue. She said I could reschedule if I wanted to. So I said great, when is the first available appointment. She said, "Thursday." I asked "Tomorrow?" She said, "No, next Thursday." I said I would just have to find a new doctor. She looked at me, shrugged, and said "All right."
I know that it's possible for doctors to be on time. Our pediatrician is always on time. I also understand that doctors who also perform surgeries can run behind due to complications in surgery that morning. But for them to be 2+ hours behind 2 of the 3 times I tried to see the doctor is unacceptable.
I came home, did a little research, talked to some people of facebook, and then called a local podiatrist (Dr. Sands). They were able to see me the next morning (I called about 4pm)
When I got there, Dr. Sands was running about 30 minutes behind. I was told this as soon as I checked in, and the receptionist apologized in advance. Then, both nurses apologized for them running behind. Of course, I had to have more x-rays. I was surprised to find that I could walk unassisted to the x-ray machine. Dr. Sands took a quick look at the x-ray then began a physical exam of my ankle. He gave my ankle a stress test, which I failed, in a big way. He was also concerned about the amount of swelling in my ankle. His nurse applied a soft cast to wear under my boot to help with the swelling. Dr. Sands drew a diagram to show us what he believed to be going on in my ankle, then asked if I could have an MRI done the next day. He didn't want to wait.
I called the MRI office while we were still at Dr. Sands office. They said they had to verify my insurance, and would call back within 30 minutes. Well, it wasn't 30 minutes later, it was 45 minutes. They scheduled me an appointment for the next morning.
Unfortunately, when I arrived at the MRI office the next morning, I was told that they had just tried to call my cell phone, because there was an emergency work in who had just arrived. The receptionist said that it would take about 90 minutes and encouraged us to go eat or run errands. When we came back, they were still with that emergency work in. We went next door and got sandwiches from Subway, and came back to eat. The manager of the facility came out more than once to apologize and they gave us gift cards to Subway and Starbucks in apology. 2.5 hours after my original appointment time, I was finally on the MRI table.
1.5 hours after I got off the MRI table, I was at church getting ready to head to the pre-teen camp leadership retreat. We had a great time at Camp Pineywoods and worked to make this year's camp even better than last year's.
Monday, I got a call from Dr. Sands office. My MRI results were in, and when could I come in to get the results. Unfortunately, I wasn't able to get back in until Thursday. As expected, Dr. Sands presented me with 2 options. Option 1, I could spend the rest of my life in an ankle brace, knowing that walking over a crack in the sidewalk could/would cause my ankle to buckle. Option 2, surgery. The MRI showed 2 ruptured ligaments, the ATFL and the CFL. Again, Dr. Sands drew diagrams on his white board to explain what was going on inside my ankle and demonstrated the stress test for us. I chose not to watch and concentrate on relaxing. My husband was very curious and described it for me later. Surgery was scheduled for the following Friday (March 4).
So, I told everyone that I would be stuck at home for quite a while, tried to load up on groceries and got everything ready for my surgery.
Of course, I didn't mention that, the Monday before my fall, I had gone to my regular doctor, Dr. Lyons, for my regular check up. Due to some of the side effects, we decided that I should come off the cymbalta and start Wellbutrin. Unfortunately, this is easier said than done. I had quit taking cymbalta on my own before (between doctors). I was off of cymbalta for approx 6 months. When Dr. Lyons first suggested I take cymbalta, I voiced my reservations. My problems were not with the time I was on or off cymbalta, but rather the withdrawals I went through when I quit taking it. For the first couple of weeks, it took all I had to get out of bed. I had trouble with head aches, stomach aches, dizziness, tingling lips, brain zaps (which you have to experience to fully understand, but the best analogy I can give is being drunk. when you turn your head, your body moves at a different speed than your vision.) I also had emotional side effects. My anxiety was worse than at any other time in my life. My husband actually had to come rescue me at Walmart when I was trying to buy school supplies. I called him when I was on my way to Walmart because I was already feeling anxious (read down right scared). Dr. Lyons told me that rather than stopping cold turkey next time, he would bring me off of it gradually. I reluctantly agreed to take it again. So, in January, Dr. Lyons had me start the Wellbutrin and cut my cymbalta dosage in half for 4 weeks. After the 4 weeks, I was to completely stop the cymbalta and keep the Wellbutrin the same. I followed his instructions to the letter. However, three days after stopping the Cymbalta, the withdrawals symptoms became too much. Thankfully, this time it was only the physical symptoms, no emotional symptoms. In addition to the previous physical symptoms, this time I also had hot and cold flashes and well as dificulty talking. I made an appointment to see Dr. Lyons the next morning. Dr. Lyons advised me to take the lowest dosage of Cymbalta every other day for another 4 weeks, then I should be able to discontinue to Cymbalta with no withdrawal symptoms.
So, back to my surgery & my ankle. At 6am, the day before surgery I contacted the surgical center to confirm my arrival time the next day. A couple of hours later, the surgical center called to move my time up 30 minutes. Then, 5 minutes later, they called again, pushing my surgery up to first thing in the morning. I arrived at Foundation Surgical Center in Dickinson at 5am that morning for pre-op. I was taken into pre-op at approx 5:20am and into surgery at approx. 6:20am Although I was told I wouldn't, I remember everything that happened up until I was lying on the operating table and I had been on the inhaled anesthesia for a couple of minutes. I remember my IV being started. I remember 2 anesthesia doctors explaining things to me, I remember the pre-op nurse and the operating room nurse. I remember Dr. Sands & Ms. Beverly coming in to say good morning and Dr. Sands again performing the stress test (just to make sure my ankle hadn't healed itself). I remember having anesthesia administered through my IV, and the OR nurse coming to talk to me shortly after. The anesthesiologist and I both told her to be quick, because I felt like I was fading. I was having to concentrate on every thing she said. I remember the block being administered in the back of my leg (thigh). I remember being wheeled down the hall & into the OR. I remember moving from the pre-op bed to the operating table (which seemed incredible skinny & I had to remind myself that I wouldn't fall off). I remember being able to see a little of what was going on in the OR next to mine. I remember watching what was going on while I breathed in the anesthesia.
The next thing I remember, I was in the recovery room. My husband came in and told me that the surgery took longer than expected. Dr. Sands had told him that the damage inside my ankle was much worse than the MRI had led them to believe. The CLF was separated from the bone, but it was a textbook tear. The ATFL was a different story. My ATFL was not torn, it was shredded. Necrosis had set in, and every time they tried to put a needle through the ligament to pull it back to the fibula, it just shredded even worse. The name for the surgery I had is the Brostrom Procedure, but they had to do a little more than normal to get my ligaments where they needed to be. I was told this would add a week to my recovery time (6-10 weeks).
I went home, got into bed, and enjoyed the comfort of the cold rush ice therapy machine and the pain meds for the rest of the day. I had been told that, due to the extent of the damage in my ankle, I should expect more pain than I would have otherwise. While this was good information for my husband, to know that I would be in alot of pain; since I had no idea what to expect before hand, all I knew what that I was in pain, and the meds worked.
Now, Tuesday, 4 days after my surgery, I took my last Cymbalta. I felt fine for the first 4 days. But after that, the withdrawal symptoms began to set it. I decided to tough it out rather than go back to an even lower dosage (every 3 days or so).
A week after my surgery, I went to Dr. Sands off & had my bandages changed. Dr. Sands said everything looked good, and to come back in a week. Rather than continuing in the splint that was putting pressure on my calf & mimicking the pain of a blood clot in my leg, he had Beverly wrap my leg and told me to put my leg back in my boot when I got home. As soon as we got home, my husband tried to help me put my boot on. We realized very quickly that my ankle was way too tight to bend to a 90 degree angle in order to wear my boot. I called Ms. Beverly and she suggested we head back to Dr. Sands office and bring my boot with us. When we got there, Ms. Beverly tried, but immediately told us that she didn't like my boot. She got me one of their boots. These also have a beveled bottom, but only go up a little ways past the ankle. I had to leave my ankle in this boot 24 hours a day until I saw Dr. Sands again. During the day, it wasn't that big of a deal, but I hated trying to sleep with it on. It wasn't anything to do with comfort. The rubber sole of the boot stuck to my blankets and sheets. I had to sleep with my leg out of the sheets and every time I moved, that boot would stick on the sheets or something and wake me.
A week later, I went back to Dr. Sands for another check up. His nurse, Beverly, cleaned my leg & cut the stitches. Dr. Sands took a look and said that everything looked great. I was again told that I my ankle was that of someone much older than I am. I was also told how bad things were inside my ankle and that it was obvious there were previous injury(ies) to that ankle. They believed that my fall that day in January was just the straw that broke the camel's back. The thing is, I don't remember injuring my ankle since I was 7 or 8 years old. When I was taking ballet as an adult, I did fold my ankle under me several times (falling off toe shoes), but never anything that hurt. Apparently, all those folds had caused damage and I just didn't realize it. Dr. Sands told me to continue to wear the boot during the day, but I could take it off to sleep and bathe. No soaking my ankle yet, because of the new steri-strips, but I could at least wash my ankle and foot again. He also told me to start partial weight bearing and did a good demonstration of exactly what he meant. He told me that if I did not follow his directions in this, he would put me in a fiberglass cast so I couldn't walk on it. He instructed me to start physical therapy a week later (I have to wait at least 8 days before I start PT). and I have to continue the partial weight bearing until I see him again in 4 weeks. I am going back to the same PT center (John West Therapy Services in Friendswood), and will go 3 times per week for 4 weeks. As soon as I got out of the exam chair, I tried to put some weight on that leg. I nearly screamed and was fighting tears (I have never cried in pain before, although I was close when I broke my arms and during PT earlier with my ankle. but these were also tears of fear due to the pain). The nurses explained to me that it was normal for this to be very painful. I haven't put any weight on that ankle in 11 days and my Achilles tendon is very tight from non-use. I should take everything very slowly. I made an appointment for 4 weeks and have put a very small amount of weight on that ankle since.
That was yesterday. Today, as my husband took our daughters to the Museum of Natural Science (it's Spring Break) and I sat at home, I began to realize that I still have 4 more weeks on these crutches. I can not sit home for another 4 weeks. I'm going to have to go somewhere, even if I'm on my crutches the whole time. Several people have suggested I rent a knee scooter, but I just can't justify the expense for the amount of time I would be using it ($45/week, $250/month). And since this is my right leg, I haven't driven in 2 months, and still have another 4 weeks before I'll be able to drive again. I've been relying on my husband and mom to get me and the girls everywhere we need to be.
While I was going yesterday, I noticed that the withdrawals were not as bad. I'm not sure if it's because my mind was on other things, because I was active, or both. Today, the withdrawals are worse than yesterday, but not as bad as the day before. I have thought of taking a cymbalta, because I know that if I take one when I go to bed, I'll feel better when I wake up. But, . . . when I saw Dr. Lyons about the withdrawals last month, he said that he expected them to last no more than 2 weeks if I had toughed it out the first time. I'm already 8 days without the cymbalta, so I don't want to have to start over. I just keep telling myself that this should be over soon. I've visited websites & discussion boards for people who have also had these cymbalta withdrawals. My experiences seem to be typical of others, but I haven't found anyone who has seen the other side; so I'm not sure if I'm past the half way point or not, but I do know that I don't want to start this over again.
Hopefully, I'll remember to update this again to let anyone/everyone know how my revocery is going as well as how the withdrawals go.
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