Talonavicular Joint Fusion

As predicted, yesterday was busy with work and two different appointments. It was a great day to have company, so I’m glad Ben used his company time accrued on Sunday.

My appointment with the psychiatrist in the morning went better than I expected, probably because I was dreading it so much that it felt comparatively low stress. We continued our conversation about medication options. It’s just not a simple decision for me–to medicate or not–there are many factors to consider.

The ankle surgeon delivered the news I predicted: the talonavicular joint fusion surgery is really the only option now. We discussed the higher-quality images that were obtained from the CT scan I had in March and talked at length about the surgical procedure, the risks, the recovery period, and the implications for future running and athleticism. He has a wonderfully calm, informative, and compassionate demeanor. He conveys clearly his understanding of my pain, concerns, and hopes. Another thing that’s reassuring about him is, as Ben says, he definitely doesn’t “need the business,” which is to say it’s not only busy there with many patients of all ages and fitness levels, but he also isn’t at all pushy about scheduling the surgery and jumping right in. He lets patients absorb the information and come back to him or call at any point should questions arise or the decision to operate is made by the patient. We did end up meeting with his surgical coordinator, one of my once-held jobs (though not there), and booking a day in November. It’s so far off that the likelihood I’ll actually undergo the fusion on that day is far from definitive, but I am leaning that way. Right now, the biggest deterrents are the extensive recovery period and the concern that I am at somewhat of an elevated risk for a “non-union,” which occurs when the body fails to unite the bones joined by implanted hardware. In order for the fusion to truly “take,” new physiologic bony matrix must be laid down along the seam created by the plate and screws. Patients at risk for a non-union are those whose bodies struggle to make new osteocytes (bone cells) and heal bone injuries. I straddle the membership category to that challenged group given my nutrition, bone density, and autoimmune issues. I’d like to get another bone density test and vitamin D level before committing to the procedure. It would be awful to put my fragile body through the aggressive surgery and lengthy rehab process and not be able to actually heal; that would be a disappointment I don’t think I can bear.

Understandably, it was hard to fall asleep last night because my brain was running with thoughts from the day. This is all “big stuff” for me–the antidepressants and surgical decision–because my mind and body are so sensitive and significant to my life. I couldn’t turn my mind off, so I tried my best to stay calm and focus on more relaxing thoughts. I’m glad I have plenty of time to decide on both of these issues, although time itself won’t make the decisions easier. It’s rather impossible to really “know” what’s going to be right for me. The best I can do is gather as much information as I can about all options and then critically evaluate which choice is the one most likely to be optimal for me.

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