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StilettoDreams 03-31-2012 02:40 PM

Brostrom-Gould modified... What should I expect?
 
Hi! I am extremely new to this board, however it had been the most helpful to me in my search for information about the brostrom procedure. I found out this past Thursday that I will need to have the brostrom-gould procedure to repair my ankle (one too many sprains is the price you pay for 3/4 of a lifetime of competitive cheerleading). My Dr's are wonderful and really took the time to explain why I needed the surgery. To summarize, the best comparison I could give is my right ankle is to a stable ankle as Linda Blair's neck (during the exorcism scene in the exorcist) is to a normal neck... That flexible for lack of a better term. I will going back to the DR this Monday to have the "surgery" talk and schedule the actual surgery date. My question is what should I be asking my dr? What has been the most helpful advice you have received? What should I know and what should I expect? Truth be told I felt pretty secure in my knowledge of this procedure until I started reading this board and had the quick realization that I know aboslutely nothing!

Additional information- I am 30, do not live alone and do not have children. My home is not wheelchair compatible but will be able to accommodate a knee wheeler. I am easily bored and have a Hercules complex believing that I could be back at work, weight baring (being on my feet is 90% of my job) within 4-5 weeks.

Hollywood48 04-01-2012 12:22 AM

Re: Brostrom-Gould modified... What should I expect?
 
Ok first off...take a deep breath. You so remind me of me 11 years ago when I had my first modified Brostrom. I made some mistakes with that and believe if the 2nd surgery I just had (Brostrom-Gould, peroneal tendon repair and fibular groove deepening) had been my first, there wouldn't have been a 2nd! Just Ike you, had the Hercules complex and was back at work on week 5 in a boot. I was a critical care RN working 13 hour days....in a boot. Yeah, um....NO! My doctor ok'd it, but he was a general OS not a foot/ankle OS. Please tell me your doctor is a board certified foot/ankle orthopedic surgeon? Yes, there's a HUGE difference in a general and a foot/ankle. Believe me! And my doc trained under Dr Gould!! Glad you already know about the knee walker. You will be glad you have that.

Questions to ask doctor:
(1) How long non weight bearing (NWB)?
(2) cast or boot or combo?
(3) realistic expectations of returning to work
(4) what you will be on for pain management afterwards
(5) when (not can you) but WHEN will you be doing PT (I didn't do it the first time-BIG mistake)
(6) when does he expect you to back to complete normal doing whatever you want to do?
(7) ok if you drive if it's your left foot?
(8) go over exactly how day or surgery will be and if it's outpatient or overnight stay. Also ask to be first case!! It will be an early morning, but you'll get home faster and better yet, won't get too hungry or too anxious from anticipation!!

I will think of other questions, that's a start. Other people will chime in too.

As far as what you need:

(1) cast cover for shower. Check out Seal Tight online. Rec to me on this site and is PHENOMENAL. I've showered everyday for the 6 wks since surgery and now my doc wants me to bring it to my next appt b/c my cast has stayed dry. He changes so many b/c they get wet!
(2) cast coverz (yes with a "z") to sleep at night. Fleece to go over your cast at night is it won't hurt your sheets or scratch you! Also works as a great sock to keep your toes warm at night.
(3) cast cozy. Cover for your toes when you go out if it's cold or you just want them covered
(4) shower bench/chair to sit on to shower
(5) hand held shower head if possible
(6) "stations" set up at your bed and the couch or wherever you will be for both day and night. I have 2 set up. One at my bed and one at the couch with: trash can, chargers for phone, computer, iPhone/iPad/iPod, kindle, Chapstick, meds, remote controls
(7) get together reading material, DVDs or queue up Hulu, Netflix, etc or save DVR programs
(8) figure out meals ahead of time. Make stuff ahead of time and freeze in individual portions or make up sandwiches in baggies with fruit, chips, etc. you don't live alone so you will have help there. If people ask to bring you meals, say thank you and let them! That got me through big time! I had meals brought to me every other night for 5 weeks! I am married but my husband works days and into nights a lot.
(9) make arrangements for pets, plants, laundry, mail, etc
(10) stock up ahead of time on general household stuff: paper towels, paper plates, napkins, plastic silverware (cuts down on dishes), toilet paper, detergent, pet food/treats, etc)
(11) get ice packs (big gel pack that will slide inside cloth cover and Velcro around. Big enough for the cast.) or get an ice machine if your doctor doesn't send you home with one.
(12) get a handicap placard. This requires a signed permit from your doctor that you will fill out. Mine had them already signed and I picked it up and filled it out, but you might have to print it out online and take it to your doc. Then take to the DMV. Some states there's a cost, there wasn't in mine. They are good for 6 months, but most docs put 4 months. Do this within your surgery week. As close as possible, not too far out.


That's al I can come up with for now. Read the sticky thread at the top on tips for coping with non weight bearing. VERY good stuff on there! Others will chime in too! Let's us know how your surgery visit goes Monday! I remember that visit for me! I go to my doc on Mon too! To get my cast off and move into the boot and hopefully start to weight bear and start PT! Woohoo! Good luck!

StilettoDreams 04-02-2012 12:17 PM

Re: Brostrom-Gould modified... What should I expect?
 
Thank you SO much. That was really really helpful! How did your appointment go today? I bet it feels phenomenal to be cast free!

My surgery has been scheduled for next week 4/12. And I have an appointment on 4/10 specifically just to ask questions. I did find out today that I will be in a vented cast for 2 weeks followed by a boot cast, neither of which I have knowledge of. The surgeon I am using is actually a board certified podiatrist, certified in both foot surgery and foot/ankle reconstruction. I'm not as nervous as I feel should be... I'm sure that will come. My Dr. gave me the seal tight today which I was extremely happy about and now I'm working on ordering the other items you suggested. Unfortuneatly it is my right ankle that is undergoing surgery so I don't foresee driving in my near future, but the handicap placard is a great idea for the occasions when I need to be taken somewhere (I'm sure I will be going stir crazy).

Do you have any idea what a vented or boot cast is? I would rather be over prepared then under prepared at this point lol.

Also my Dr. Said something today that concerned me... He stated that based on his findings I have virtually no ligaments holding my ankle, I don't want to get ahead of myself (probably too late for that) but if there is nothing there wouldn't that be more of the chrisman-snook than the brostrom-Gould? Is it ok to ask my dr the what if scenarios? Or is that frowned upon in the surgical world?

Hope you are doing well cast free!

dmbnj 04-02-2012 03:16 PM

Re: Brostrom-Gould modified... What should I expect?
 
It may be that your ligaments are completely/mostly torn. My MRI showed that there was no normal ligament tissue. When the surgery was done he stated that the ligaments were in good condition and was able to get a good repair.
Of course the final decision will be made once they open you up.

Hollywood48 04-02-2012 08:31 PM

Re: Brostrom-Gould modified... What should I expect?
 
STILETTO--I agree with dmbnj. I had the same problem with my ankle. "Nothing there, completely torn". When he got in there, he more or less debrided the ligaments, "trimmed" and sewed them back together. He told me ahead of time that he might have to take a portion of my peroneus brevis tendon (I tore the longus so this could still be done) and anchor it to the fibula if things were just terrible in there and since it was a "re-do" from my first surgery. Thankfully, this didn't have to be done. Brostrom-Gould is usually the first line procedure for ankle reconstruction/stabilization surgery. It is an anatomical surgery, meaning you are still as you were when you "came out of the box" (born). With the tendon being anchored to the fibula this is an anatomically altering procedure and is often used in "re-dos", but it has other risks in that it messes with your subtalar joint which is another topic of conversation altogether. I promise you'd rather go through a Brostrom-Gould than a Chrisman-Snook any day!

As far as vented cast and cast-boot.....a vented cast is more than likely your doctor's terminology for post surgical splint in which you will have an anterior/posterior (front/back or when you are lying down bottom/top) fiberglass cast that is cut on both sides and held together by heavy ACE wraps and heavily padded inside. They are comfortable. Its job is to immobilize your ankle while allowing for swelling so you don't become uncomfortable. The cast boot is probably what I was just placed into today-a CAM walker, the black boot you've probably seen a thousand times on people. It's a Controlled Ankle Movement walker. Makes it so you can walk, but you still don't use the normal gait as you walk. Keeps you from pushing off your toes which strains a lot of the ligaments/tendons in the ankle. You will likely be in this a while. I was in the vented cast or post surgical splint for 6 days, then a full fiberglass cast for 6 wks which I got off today and now in the boot for 3-6 wks. I can't remember which one he said! Terrible huh? I blame it on the pain meds! ;)

Thanks! I do feel great getting it off! I can bathe, shave, exfoliate, and moisturize my leg now! LOL! I think I can sleep with it off too although not sure if I love that idea or not, but I don't want the nasty boot in the bed with me either!

Let me know if you have any further questions! Having JUST been through it, I have a lot to say on it and there are a few others who do too! I'm glad you have an appt just to ask questions! That's great! How long will you be NWB?

StilettoDreams 04-11-2012 10:46 AM

Re: Brostrom-Gould modified... What should I expect?
 
Hi there!

So I had my "question asking appointment" and literally spaced out and barely asked anything. Luckily my doctor is pretty great so he gave me lots of information and I walked out not feeling completely in the dark.

My biggest question for you would be around pain management. My dr had me fill my scripts today so I had them ready, I really didn't look or ask too much about them but when I picked them up I was a little taken back at what I had... 20 5-500 Vicodin and 30 800 Motrin... Based on the instructions I will be taking 8-12 of the Vicodin in the first 24hours. Is this right? Is the expectation (and reality) that I will be in pain manageable by Motrin after 48 hours? I know I dropped the ball not asking about it and thinking back to my wrist reconstruction I certainly don't recall being in Motrin manageable pain in the first few days... But I also know this is a completely different type of surgery. What has your experience been? I do have my post op oppointment scheduled for Monday (surgery is tomorrow) and clearly if I'm in pain I can address it Monday but is 48-72 hours the reality/norm for this surgery? I don't want to get my hopes up but if that is what the general consensus is, it would be awesome!

dmbnj 04-11-2012 04:33 PM

Re: Brostrom-Gould modified... What should I expect?
 
My doctor said that the first 48hrs are the worst and I could take 2-3 vicodin at a time. After that he said it would be better, and for the most part it was. I wound up taking aleve during the day and a vicodin at night if I was in pain. I still have some left from the 20 he gave me. I was given clearance to WB 9 days post op and there was some pain initially, and again after my cast change.

Hollywood48 04-11-2012 08:58 PM

Re: Brostrom-Gould modified... What should I expect?
 
This is my 2nd Brostrom and as DMBNJ said, the first 48-72 hours are the worst and you do need to take the Vicodin around the clock those days. It does slack off after then, but I was NOWHERE near Motrin manageable pain (either time). Granted I had a lot more done this time than just the Brostrom (I had both the ATFL and CFL ligaments repaired, the retinaculum repaired, the peroneus longus tendon repaired and my bone drilled and broken to deepen the groove) so that could be why I couldn't get by with Motrin. Well that and I couldn't take NSAIDs then and still haven't been told that I can. I had percocet for pain and got it down to 2-3 total/day after the first 3 days of taking 2 every 4 hours around the clock. However, even with my first Brostrom (only a Brostrom), I was given percocet and took 2 every 4 hours for the first couple of days and then I was taking Lorcet Plus (basically high dose Vicodin, same active ingredient) 2-3 times a day after that. Both times my pain was well managed and I was given drugs appropriate for the 2 different procedures. However, I know others on here that had Brostroms that couldn't go to just Motrin after 2-3 days. I don't know what your pain tolerance is, but with the description of your wrist reconstruction, you might need more pain meds than just 20. Good thing is they can call in Vicodin unlike Percocet where you have to have a written Rx for every refill. You can always ask him before you go under for surgery or after you are good and awake or have the person taking you to and from surgery ask? Good luck and let us know as soon as you can how it went and how you are doing!

StilettoDreams 04-14-2012 04:11 AM

Re: Brostrom-Gould modified... What should I expect?
 
Good morning!

Surgery went great and im a little less than 48 hours out...To quote my dr "the surgery was meticulous". It's what happened after that I wasn't quite prepared for. Apparently my long acting nerve block didn't take and I woke up out of anesthesia screaming. It's been highs and lows since then. I'm really lucky my dr is quick to take action and really diligent on checking in on me because this could have been way worse then it has been. In the hospital they gave me 2 doses on dilaudid by IV and a Percocet before sending me home. At home my dr called me in an emergency script for dilaudid which I have been taking every 4 hours sometimes 2 pills at my drs orders in an attempt to get ahead of the pain which I haven't been able to do... I'm getting about 2-3 hours of relief then the last hour or two before I can take my next dose I'm writhing in pain (literally there has been screaming, tears, cursing... I referenced Linda Blair in the exorcist in an early post... She's back). I believe I am pretty tough and am able to deal with substantial pain so Im really not sure why I am in SO much pain, which my dr seems to think is unusual as well. I'm elevating, icing, taking motrin with the dilaudid and it's just not enough. I'm only able to get an hour or two (rare) of sleep at a time before the pain is waking me up. I'm always in pain which I'm sure is common to some degree.... Is this normal or more common than my dr seems to think it is? Does anyone have any other suggestions to try to subside the pain. I would be so grateful just to get 4 hours of consecutive sleep. Any help would really be appreciated.

Hollywood48 04-14-2012 10:37 PM

Re: Brostrom-Gould modified... What should I expect?
 
Wow! I'm SO sorry you are in so much pain! One reason you can't get ahead of it just yet is because you weren't ahead of it to begin with, but that isn't your fault. I honestly can't say for sure the commonality of it. I know for both of mine, I never had a nerve block, woke up with anesthesia on board, took 2 percocet and left the hospital and took 2 percocet every 4 hours for the first 3-4 days and then decreased to 2-3 total a day and I was fine with this unless I had my leg down. I didn't sleep well, but it was because of positioning and I had a cast on, not really because of pain. So unfortunately, I can't identify or answer your question. Hopefully there are others on here that can. I mean, I know of some others who had to take dilaudid or had a hard time in the hospital and I know of a lot of people like me who didn't have a terrible time. What I do know is that I hope this goes away quick for you and you can get ahead of the pain soon! I know you are miserable and I'm SO sorry! Hang in there though because either way, you can't stop the clock and it WILL (and does) get better!!!

StilettoDreams 04-15-2012 01:04 AM

Re: Brostrom-Gould modified... What should I expect?
 
Hollywood, thank you so much for your encouragement! I agree that time is on my side... And on the up side of things pain is not largely committed to memory so while I might remember the thought that I was in pain once the feeling is over, its over lol!

I have to say while I thought I would be far more self sufficient than I actually have been I'm truly lucky to have my husband home/ off from work these past few days, he really stepped up even though I know sometimes I scare him half to death with the pain (yay husband!)

I started keeping a rough journal of my pain, when I'm feeling it, when it's the worst, when I'm taking medicine, how much I'm taking etc... My plan is to share this with my dr Monday, could do absolutely nothing for me or maybe I'm doing something wrong which he might identify through a pattern in my notes... I figured it can't hurt at this point. Plus it makes me feel slightly more in control, like I'm doing a little something extra to help myself.

... Even with the pain, if I can eventually get back into heels it would all have been worth it!

Hollywood48 04-15-2012 10:33 PM

Re: Brostrom-Gould modified... What should I expect?
 
That's a good idea actually! He very well might be able to identify something in the pattern of your notes! Great thinking!! And yes, yay husband!! So glad you have great support! Hopefully you'll be back into heels soon although not sure how you do it! I love the way heels look and how I feel in them, but they hurt my feet too much to wear them any length of time!!

joyful123 04-16-2012 04:47 PM

Re: Brostrom-Gould modified... What should I expect?
 
[QUOTE=StilettoDreams;4961747]Hollywood, thank you so much for your encouragement! I agree that time is on my side... And on the up side of things pain is not largely committed to memory so while I might remember the thought that I was in pain once the feeling is over, its over lol!

I have to say while I thought I would be far more self sufficient than I actually have been I'm truly lucky to have my husband home/ off from work these past few days, he really stepped up even though I know sometimes I scare him half to death with the pain (yay husband!)

I started keeping a rough journal of my pain, when I'm feeling it, when it's the worst, when I'm taking medicine, how much I'm taking etc... My plan is to share this with my dr Monday, could do absolutely nothing for me or maybe I'm doing something wrong which he might identify through a pattern in my notes... I figured it can't hurt at this point. Plus it makes me feel slightly more in control, like I'm doing a little something extra to help myself.

... Even with the pain, if I can eventually get back into heels it would all have been worth it![/QUOTE]

Hi, just checking in on some people. I had the modified Brostrom on 2/22/12 as well as some another tendon repaired, muscle cut out that I had shredded and some other things! I'm so sorry you are in so much pain. I was on vicodan, vistoral and a combo of 600 mg of motrin in between everything. I hope the pain is diminishing and you can rest soon! Good luck with the doctor and hang in there!

StilettoDreams 04-20-2012 08:27 AM

Re: Brostrom-Gould modified... What should I expect?
 
Thank you for checking in joyful :)

My dr was able to re-numb me at my last visit.. I didn't really take to it again, he seems to think I'm like the 1 in 1,000 that numbing agents don't work on lol lucky me! However the pain has subsided drastically and I'm actually getting some good relief in between medication dosages. The biggest time I have pain is right before bed, as soon as I wake up and randomly when my leg spasms which tends to be sporadic and unpredictable but when it does it amps the pain way up, pain killers or not.

I still have my staples in right now, which I was able to see this past Monday Att visit... I was not prepared for the sight of staples lol. I'm sure they are adding a little bit to my discomfort. I get the staples out this coming Monday and I believe my dr said I will go into a boot, still non weight baring but I think it's one of those black walking boots instead of a cast? I could be wrong and misunderstood but the cast I've been in since the day of surgery has been a regular cast that was cut in the hospital on both sides they wrapped in bandages.

I have to say I'm a little disappointed that I won't be getting a hot pink or bright yellow cast!

Hollywood how are you feeling in your boot? Are you keeping it on at night?

Joyful where are you at in your recovery?

joyful123 04-20-2012 08:32 AM

Re: Brostrom-Gould modified... What should I expect?
 
[QUOTE=StilettoDreams;4964915]Thank you for checking in joyful :)

My dr was able to re-numb me at my last visit.. I didn't really take to it again, he seems to think I'm like the 1 in 1,000 that numbing agents don't work on lol lucky me! However the pain has subsided drastically and I'm actually getting some good relief in between medication dosages. The biggest time I have pain is right before bed, as soon as I wake up and randomly when my leg spasms which tends to be sporadic and unpredictable but when it does it amps the pain way up, pain killers or not.

I still have my staples in right now, which I was able to see this past Monday Att visit... I was not prepared for the sight of staples lol. I'm sure they are adding a little bit to my discomfort. I get the staples out this coming Monday and I believe my dr said I will go into a boot, still non weight baring but I think it's one of those black walking boots instead of a cast? I could be wrong and misunderstood but the cast I've been in since the day of surgery has been a regular cast that was cut in the hospital on both sides they wrapped in bandages.

I have to say I'm a little disappointed that I won't be getting a hot pink or bright yellow cast!

Hollywood how are you feeling in your boot? Are you keeping it on at night?

Joyful where are you at in your recovery?[/QUOTE]


Hi! I vote for the boot instead of a cast. I didn't have a cast, I came out with the boot on, it was so nice because they gave me permission to open it during the day when all the swelling was going on and then to reclose it when I got ready for bed.

I am 8 weeks out, haven't started rehab yet. I had my first day back to work - driving. I live an hour from where I work, so I have been working at home. I was in so much pain I left early and called the doctor's office. They put me back on 800 mg of motrin every 8 hours and Tramadol every 4 hours to try to get the pain under control. I'm so glad it's Friday.

Sorry about the staples - I"m sure that is really adding to your pain, but am glad you are finally getting relief!!! I'm sure you are too :)


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