Quick fall on the ice Monday; BROKEN ANKLE...Advice Please

Type 1 and LADA
1

First (and /final) Facts: Ohio winters can begin early, and persist in length, variability and severity. Though it was 56 today, four days ago it was 25, gloomy icy. I took an unfortunate tumble on the front sidewalk of my home. I badly Twisted my ankle in the fall with resultant severe pain, some swelling.. I got a diagnosis of "right ankle bimalleolar fracture of the ankle" The orthopedist said that the fracture was small but complete and that ligaments are also stretched, swollen and bruised, making my ankle unstable.He recommends surgery "Operative reduction and stabilization(ORIF (?)ankle bimalleolar exam under anesthesia.. He does not want the ankle to grow back out of place and says that the surgery will reduce chances of a "malunion"; and several years ,down the line , of developing arthritis.
He recommends the surgery, even though it is very painful,; more actually, than I am experiencing now with the ibuprofen and the short hard cast that I am wearing . Dr. C said that I will have severe pain about 12 hours ager ward, so much that I will be zoned out for 3-4 days after it is done with. He says I will need to get someone to stay with me for those first few hours AND days afterwards..We Will plan rehab ( PT) after 4-6 weeks in a hard cast
Fearful Assumptions; I am not fond of pain. I know it will be for the short run to assure a healthy, healed ankle . Still I am concerned about how to manage the pain:, how to manage my diabetes while under anesthesia in the outpatient clinic, and how to round up people to stay with me for 48-72 hours while I sleep.The crutches were horrible for me and I was in tears from using them and felt so limited in my own home: I Had a pity party and cried because the most simple, routine household tasks had become so difficult and so painful.

Faithful solutions:I have close friends who are like family, church members who are retired, wonderful caring nurses !! I am holding on to my trust in Him to take care of all of my fears and all of my needs. All I have to do is ask and" expect the great>" I will be off work for at least 8 weeks, while I recuperate from my injuries, and renew and refresh my mind and my spirit.
It is a blessing that I did not crack my head on the cold concrete and received a concussion or worse, brain injury. Another blessing is that my next -door neighbor's little yappy poodle heard my cries and whimpering while I was on the ground on the snowy walkway, unable to get up. He alerted his owner, my neighbor, who was downstairs in his basement listening to music and hearing nothing from the outside. He followed his pet's lead to the top of the stirs, went to the window and saw me on the concrete, getting covered with snow, crying and unable to get up. He came right over to aid me and lift me up. Again a blessing: Today, 4 days later,I was able to get a knee walker delivered to me by a sweet former co-worker and friend, a PT. This walker is far easier and is far better for me to maneuver around than the crutches. So much more" moveability" and far less pain on my body.

I Just want to ask about the surgery and should I get a second opinion? I am 90% decided on it, but want to know other's experiences with orthopedic surgery. I talked to friends/family ( including my cousin who IS a doctor) who have had foot and ankle surgery, but their injuries were more severe than mine, and they were not given a choice for surgery or not.

Please pray for me and do offer some suggestions and encouragements, Tu friends. I will not be able to see my family in Ga; and after the past two years of family tragedies, it is disappointing to all of us that I will not be with them on Christmas Day. But we are grateful to have each other. There is always Skype!!

God Bless,
Brunetta

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I know nothing about orthopedic surgery, Brunetta, and I "know you" well enough to know you don't want pity. All I have to offer is to second your "Faithful solutions" paragraph. To lean on the support that is meaningful to you, to use the healing time for rest, renewal and growth (I have a love of "cozy" I fall back on happily where I can hunker down and do solitary/immobile mental/emotional projects, reading I've looked forward to, meals I enjoy and online pursuits. It's especially a winter pursuit.

I am sorry that you won't be able to spend Christmas with family as I know how much that means to you especially with the losses your family has sustained. Skype is a wonderful invention, isn't it? And I hope that some of those "like family friends" will be able to drop by with goodies and smiles. I certainly would be one of them if I weren't 2,000 miles away.

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Thanks, Zoe. Would so much welcome you with open arms and a big Hug!!
God bless,
Brunetta

4

Oh Brunetta! What a crazy thing to have happened. Please get a second opinion. The pain is secondary to whether it will heal or not. The bone will heal but it is the surgical wound that I would be concerned about. Ask your doctor if it would be okay to let it heal in a cast first. If that doesn't work, then opt for the surgery. It is all about blood flow and how much oxygen gets to the wound. You may want to get in touch with a vascular surgeon and have what is called an ankle brachial index performed. This will tell you if you have limited blood flow to your feet. No one will be able to tell you how the wound will heal. This is a very serious problem and I am very sorry. I shudder when I think of what I went through with a "Jones Fracture" in my right foot. I have known you for a while and want you to know I love ya and I wish for the best.

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Your are slim ...petite another good word ?? Have you been checked for osteoporosis ?? PWD ...type 1 as well as type 2 , both women and men are at risk I was told , when I did similar 8-9 yrs ago and broke my left wrist in 3 places at this time of year too ...my GP was hesitant to have me tested for a bone densitity scan , while my Specialist suggested this and I insisted . He was surprised as he knew me as regular walker ...in the end surgery , Calcium , Vit D 3 1000 iu daily and weekly prescribed Risedronate Sodium 35mg ; ....I am praying for you ...as I know your original planned time will sadly not be the same !!

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No I am not petite(5'10") nor slim ( 162 pounds); but I am concernedd about my bone density. Never been checked for osteoporosis. thanks for the info Nel.
God Bless,
Brunetta

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And I do so appreciate the prayers, too, dearest nel.

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Mark, I will try on Monday, to get my long-term internist , who is to do my pre-op testing, to set up an ankle brachial index, because the surgical wound is more of a concern to me, too. The surgery is scheduled for December 30. The orthopedic surgeon, Dr.C says he is not comfortable doing the surgery past 14 days post -trauma, which is exactly the date of the surgery, but I still have questions. Maybe my internist, who has treated me for me for over 30 years, will have some suggestions. He will squeeze me in for a consult a long with the pre-op tests, if I go that way. I will research "jones fracture".
God bless,
Brunetta

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Brunetta my friend, if you're asking if you should get a second opinion the answer is yes - trust your wonderful instincts. If the second opinion doc confirms what the first said, wonderful; if not then you will have a choice to make.

It sounds as if you're already surrounded by wonderful people (and dogs!). I have no doubt that you'll be able to round up the support you need for whatever path you decide to follow. I was really uplifted by how supportive my daughter and son-in-law were, as well as other people who seemed to offer just what was needed at just the right time.

When I broke my shoulder 9/2, my orthopedist x-rayed it regularly to be sure it was healing properly; no surgery unless it wasn't. Thank goodness it is. I know an ankle is not a shoulder. The most difficult thing for me, STILL, is asking for help and accepting it gracefully. I couldn't drive for 3 months, and there are still things I can't do, so I'm still practicing letting it be ok that I can't do it all myself.

The other lesson (also repeated) was to take the pain meds! They're given for a reason. I believe that pain impedes healing. Crying is healing as well, and feeling sorry for yourself for short periods of time is ok.

You asked about D management. I had the same experience with the broken shoulder that I did with a dental bone graft - high blood sugars 7 days - 2 weeks (approximately) from the injury. I talked with my endo who said 'they' are just starting to do some studies on osteogenesis and elevated blood glucose. Don't be surprised if this happens. Other than that, my D management was no different.

I hope you have a wonderful Christmas despite the change in plans my friend. I hope you're looking forward to going home in the Spring/Summer. Please stop into chat. It was the most supportive place I had in the midst of pain and frustration.

Big, big hugs Brunetta. I'm so sorry this happened. Be kind to yourself :)

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I read orthopedic surgeons' reports at work pretty regularly. If the doc thinks that it will heal better, I would probably go for the surgery. A second opinion isn't a bad thing but there's cost and time issues at risk, given the poor timing of the holidays.

I know you are pretty active and it would be more unfortunate if you decided to skip the surgery for now but found that there was some kind of issue w/ healing. I think that anything that goes wrong in an ankle, particularly malunion type of issues, would be a much bigger problem that would bother you in the long run.

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I worried throughout the night for you. I hope I overreacted and you will do well. I just want you to be cautious in whatever you choose to do. I hope I am an alarmist. A Jones Fracture is of the fifth metatarsal, the long bone in the foot that goes to the fifth toe. It is poorly supplied with blood and is difficult to heal, even in non-diabetics. I hope you will let me know what is goin' on.

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Hi Brunetta. I'm sorry you're dealing with a broken ankle now during the Holidays, right before Christmas. I'm familiar with Ohio ice! Falls are awful. Mine was on 10/17, falling over a garden fence and dislocating my right shoulder. There were stretched ligaments and edema, but no break. My timing was bad, too--our van and trailer were packed and hitched, a trip to begin the next morning. Well, with the help of physical therapy, I'm steadily improving. I know you'll be OK in time also, but right now has to be difficult. I can't improve on the advice you've already received; I do like Acidrock's advice.

When I was on a pump and had surgery, some time ago, my doctor left instructions with the hospital to allow me to treat my diabetes myself. If you're out of it for a while, I guess you'll need help during that time. Maybe your doctor could leave instructions saying that whenever you are able, you should treat the diabetes yourself.

Yay for yappy poodles! I'm wishing you the best luck possible!

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Thanks,Mark. Your advice was great. I am definitely trying not to worry, so You do it , too.!!:+)

God Bless,
Brunetta

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Dear Brunetta,

So sorry about your fall! Thanks for sharing both your fears and your faithful solutions! it's wonderful that you have good friends and I'm sure that you will get the support you need. And thank goodness for your next-door poodle and his owner!!

Many good wishes and prayers will be with you as your sort through your options in the next ten days.

Best, best wishes,

marty1492

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Pup, I have a gut feeling that I want to hear from another doc.. I will see if my internist for 30 years can get me a squeeze in appt. next week with an orthopedic surgeon he knows. He has "connections" and has been able to do that "appt. thing" for me in the past. We have "matured" together, as he is but two years older than me: I started with him when he was just past his residency and was starting up a new practice. Nice man.

Thank you so much, Pup.

God Bless, . see you in chat
Brunetta

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Acid, additional info, D.C, Orthopedic doc, says he can't guarantee about the healing of the wound from surgery, just that the surgery to stabilize the bone fracture ( insert a pin or a screw or whatever they call it, it sticks out of your ankle) will allow me to weight bear quicker. That assured stable weight bearing may speed up my recovery time to normal activities, but onlyIF the surgery wound heals well, too. He said my surgery would be considered elective by insurance. His office staff says that are trained and experienced in convincing them convincing them other wise. What do you think?
Thanks for your input, dear friend.

God Bless

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So glad to have you as a tu friend, Trudy.. and this will be out-patient surgery, so I will set the basals just bit lower before I go in. I will ask my internist directly ) for some advice. He will be willing to cosign on a written pad ,our mutual decisions.

God Bless,
Brunetta

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Mark

I meant for you to NOT WORRY.

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Have you had surgery before? I've had two, but nothing orthopedic. I didn't have trouble recovering either time and feel pretty confident I'd go with it. How familiar is the doc with diabetes? Sometimes, I get the impression that every orthopedic doctor will always figure whatever they do is correct and will result in a great recovery although they aren't the ones with plates in their ankles. My boss was mentioning some hardware in hers during our yoga class the other day which made me think maybe it wasn't so bad? Has your BG been ok during all of this? I think that's the big thing with people with diabetes and I know you usually do a pretty good job but I also know you've had a rough year. When I have hard times, I am always drifting back to potato chips...

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Honestly, I always get a second opinion. But anything that deals with preventative type maintenance, Like repairing an ankle when it has been broken and severely "Stretched out" i usually do.
My story, At age 13 I was rough housing with some friends, I ended up falling down a flight of stairs and twisted my ankle. The pain was horrid and I ended up crawling back to my house, which was 3 blocks away. This happened on a friday afternoon, by monday the pain had not improved so my mom took me to the doctor. He told me i just had a bad sprain and to take it easy. Well after 3 years of football and just being a very active teenage boy, my foot still hurt all the time. So I got an appointment with a foot doc. He took one look at the bottom of my shoe and said "When can we schedule a surgery?". What had happened that my PCP didnt notice for some reason is I broke a bone which is the anchor for a tendon. Which gave me a chunk of bone attached to a tendon. Kinda like those balloons tied to a rubber band. It ended up further breaking the bone into small shards which tore and shredded multiple tendons and ligaments in my foot. Has the PCP noticed the broken bone instead of claiming it was a "growth plate" I would not have had to endure the pain i did for 5 years. The end result was surgery to repair the bone, and replace 4 tendons and 3 ligaments in my foot. I ended up on bed rest for 2 weeks, cast for 3 months and physical therapy for 4 months after that. Needless to say, now I always get a second opinion.