Cymbalta and the second subtalar fusion

It's been awhile since I've written anything on here, and that's because it's been awhile since I've been up to writing anything. Taking cymbalta really changed me, and not in a good way. Did it do what it was supposed to with taking care of the pain and pain-related depression? Yes. At what cost? Well, my mind. I felt very drunk every minute I was awake, completely disconnected from my body, had no motivation to do anything productive, got very obsessive about things I normally don't care that much about, had no appetite, and couldn't sleep. The only thing positive was becoming aware of the tension I carry in my left shoulder and jaw. I've had trouble with my left shoulder for a few years with strength training which I attributed to my right foot being damaged, but I'm beginning to think a bigger contributor was playing clarinet with high anxiety for 10 years and always holding my left arm and shoulder a little higher while practicing for hours as a time, which carried over into everyday life. The tension in my jaw is just from high anxiety. Now that I'm aware of it and consciously relaxing the tension in my shoulder and jaw, my overall anxiety level has gone down dramatically. I'm also internalizing a reminder when I'm out in public to keep my body relaxed when I start to feel anxiety taking over. That's the only positive thing I can take away from my experience with cymbalta.

The withdrawal was pure hell. I had severe headaches, horrific mood swings, nausea, vertigo, brain zaps when moving my eyes (neurons misfiring), sensitivity to light and sound, and basically felt like I'd lost my mind. It persisted for close to two months at varying degrees, the worst being in the first 3 weeks. I've never been happier to be off of a medication. I recently had coffee with a friend who hadn't seen me since I was on cymbalta, and the first thing she asked was what exactly I was on last time because I was flying high. I'm very glad to be in control of my body and thoughts again, even if some of the pain came back with it. Friends close to me have said that I just wasn't myself for those few months, and I can see it in pictures. My eyes were different and my expressions were vacant. I'm finally feeling like myself again. I'd forgotten how happy I usually am!

I had a subtalar joint fusion on January 16th on my left foot. My anxiety leading up to it was extremely high because of what had happened last time and not really knowing what had caused it. When I woke up from surgery, my doctor said that this fusion was even more complicated than the first (not reassuring!!) because the birth defect was more severe. Instead of the defect being a bar of bone connecting the calcaneus (heel bone) and talus (the bone above it), it was a much bigger block of bone that took an extra 30 minutes to remove from what he was anticipating. No artificial bone matrix was used in the joint this time, but he had plenty of my own bone to use and took a graft from the back of my calcaneus (heel) as well. After packing and aligning the joint, he drilled a large titanium screw through my heel that extends to the very top of my ankle. The hazy white part around the joint is where he removed the extra defective bone that was holding the joint together, essentially bone rubbing on bone with every step I took, a very painful arthritic condition. Before it would rain, the joint would throb as well. I've been living with a lot of pain for a long time and am glad the arthritis pain is gone.

Overall my experience has been extremely positive so far this time, while my whole body reacted badly to the fusion on the right foot. I was able to get myself out of the car, up the steps into the house and into my bed by myself immediately after the surgery. After the first one, I had to be half-carried for the first three days because I couldn't even get to the bathroom by myself. I was off of pain meds by the end of the first week this time, and I know I was on them for a few weeks last time. The best news is that while being casted, I could get my heel down to the casting stand both times while I was never able to the first time around from severe inflammation. The stitches came out a few days ago and everything is healing beautifully, while last time I had a large blister from the splint over the incision site that possibly contributed to the site opening later on. My body seems quite happy with the titanium and I'm feeling amazing overall. It's just an inconvenience that I can't put weight down for a few months. I'm using a bone growth stimulator every day for 30 minutes to help the bone fuse faster.

My first workout was one week post-op, a huge victory for me. Last time I couldn't move well enough to even think about it for several months from the complications. My right ankle hasn't been particularly happy with me because it's still full of scar tissue and I'm relying completely on it to get me around. I've refused using a wheelchair or electric carts in the stores this time, though I have a wheelchair in my garage just in case. I'm still taking anti-inflammatory supplements so the joint doesn't lock up too badly. I had stopped my supplements two weeks prior to surgery so my blood wouldn't be too thin and I felt like the tin man before he used the oil can. Very painful to walk.

Right now I'm eager to get back into the swing of things now that I'm feeling like a person again. I'm having a lot of fun modifying workouts so I can keep progressing as much as possible to be prepared for walking and full movement again. I never imagined I'd ever have to spend so much time being broken and finding ways to overcome it in my training sessions, but I hope to help others in a similar situation with my experience. Now that the worst has passed, I'm feeling up to the challenge.

After the post-surgical euphoria wears off...

I felt great after surgery. Better than I had any right to feel, actually. I only took pain meds for the first 48 hours post-op. I started a very slight amount of crutch-assisted walking 4 days post-op. I'd taken my son to Downtown Disney for a new Lego set as a reward for helping me so much on bed rest, which probably wasn't the best excursion for the first day out of bed. We also went to Ra Sushi and Whole Foods beforehand and Bruxie after. The day out reminded me of how much I don't like being on crutches.

Bruxie's Liege waffle sundae with Belgian chocolate and caramel- SO good

I walked into my doctor's appointment without crutches 5 days after surgery. He was very happy to see that, and gave me the green light to do as much as I comfortably could. He removed the stitches to save me a trip from coming back the next week, so I took it a little easy and kept a butterfly bandage on the incision site to keep it together. I noticed there was some nerve damage, because every time I touched the site to put ointment or a bandage on, I would feel shock waves down to my toes. It's difficult for me to touch it (or let water in the shower hit it) because of the discomfort. It's getting a little better, and I know these things take time to heal. 

One week post-op, I went to Disney to celebrate my son's 11th birthday. We park-hopped for about six hours and I didn't use any narcotics, just an 800 mg motrin. By the end of the night, I knew I couldn't stand in the very long line to get back to the parking lot, so we hopped on the handicapped shuttle. I was hurting but still refused to medicate with anything strong. 

I did my first workout the next day, on July 19th.

Joint mobility

press/ pull-up ladder 1-2-3 with the 10 kg, 2 rounds

naked get-up, 1+1, successful! 

8 kg get-up, 1+1, 3 rounds

Swings- 16 kg, 5 rounds of 10

It was a nice, easy workout to transition back in, and I was still feeling great.

Next workout was July 21st.

Joint mobility

press/ pull-up ladder 1-2-3 with the 10 kg, 3 rounds

TGU- 1+1, then 2+2, both with overhead squats at the top

TRX circuit, two rounds:

Body saw (5)

Crunch (5)

Pendulum (5)

Pike (5)

All were low plank except I did the last round of pikes in high plank

1-arm alternating swings with the 12 kg, three rounds of 25

I felt great after that one. I was happy to be able to use the TRX at home, as my patio cover was just replaced. The wood had rotted to the point where I was afraid to try to hang anything from it, but it's perfect now. I have plans to hang a pull-up bar from it as well.

This is about the time I started having some real trouble with my recovery. The scar tissue is building back up in the joint after just having been freed from it, so walking is still difficult and painful. When I've been sitting for awhile, I get extremely stiff and the joint screams at me for putting weight on it. It takes a few minutes to be able to walk comfortably, though sometimes it's still with a limp. I have good days and bad days. On the bad days, it's hard to get out of bed at all. On the good days, I feel ok.

I didn't do another workout until July 26th.

Joint mobility

press/pull-up ladder 1-2-3-4 with the 10 kg, 3 rounds

Kettlebell circuit, two rounds:

goblet squat, 10 kg, 5+5

double windmills, 10 kg (top) and 12 kg (bottom), 5+5

1-leg deadlift, 12 kg, 5+5 (very difficult when standing on my right foot)

get-up sit-up, double 8 kgs, 5

Swings alternating with the 16kg and 24kg, 6 sets of 10 (30 total with each weight)

I think the issue with my left shoulder being weak in presses has more to do with my right foot being jacked up than doing anything wrong with the left shoulder. I'm going to stop focusing so much on presses until my right foot gets a little more mobile. 

I started having more bad days than good. I limit my vicodin intake to once a week, when I simply can't deal with the pain. I had a week where I overcompensated with sugar and pasta, and gained two pounds in the process. Sometimes I think it would be better to take the pain meds than medicating with sugar. I've had to go back on a steady diet of motrin to cope. I try to take 400 mg in the morning, 400 mg midday, and 200 mg in the evening. Some days I go without, and those are really, really bad days. I just can't win.

I did a TRX/ kettlebell circuit workout on July 28th.

Joint mobility

Three rounds:

Squat/ press, double 8 kg, 6

TRX side plank with hip drop, 6+6

Overhead squat, 10 kg, 6+6

TRX chest press, 6

Assisted pull-up, 6

TRX pike, 6

I am trying to include as much ankle mobility in my workouts as possible. I put my tennis shoes on for the TRX side plank and pike, knowing that it would put some different angles of pressure on the joint, without putting too much pressure on any particular part of my foot. It felt great.

Last week was a really bad week. I'm constantly craving vicodin just to get a break from the incessant pain, but am stubbornly refusing to give in (for now). Backing off the sugar isn't easy but I'm making it a priority. I know it makes me feel worse, past the initial instant gratification of whatever happens in my brain when I bite into some mint slice or tim tams. 

My most recent workout was another kettlebell/ TRX combination on August 4th.

Joint mobility

TGU 2+2, 8 kg (feeling super weak)

side press, 8 kg, 5+5

TRX cossack lunge, 5+5

bottoms-up clean, 10 kg, 5+5 (no chalk)

TRX suspended lunge, 5+5  (my son was holding my hands so I wouldn't fall, just to be safe)

double windmill, 8 kg on top and 10 kg on bottom, 5+5

TRX low row, 10

I had intended to do a swing/ snatch combination at the end but ran out of time and motivation. 

I know all the sugar I had really affected my strength. I'm also not sleeping well. It's very frustrating to be where I am right now. I started getting ultrasound treatments on my foot and ankle 15 minutes a day, 4-5 days a week. I've noticed a big improvement, and my ankle makes some interesting noises immediately following treatment. I'm also spending a few hours a day working on the soft tissue in my foot and lower leg. The tightness is progressively moving up my leg, which I think is a good thing. My ankle can barely get to 90 degrees, so going down stairs or slanted ground is still very challenging (especially when a shopping cart is pulling me down towards moving vehicles). It's easy to let the negative emotions overpower the positive ones, so that's my biggest battle at the moment. 

It's been 10 months since I sprained my ankle prior to the first surgery. Five surgeries later, waiting for my body to recover so I can get the left subtalar joint fused and get on with my life, and I'm having a lot of trouble staying positive. I found some interesting articles on chronic pain and its effect on mental health, and I'm not too surprised by what they say. Chronic pain really is a mindfuck.

ABC news article

Harvard news article

Return from the Living Dead

On November 16, I had a subtalar joint fusion that led to nearly 4 months of bed rest due to severe complications and multiple subsequent surgeries. But that story is for me to tell another day. Today I want to share my first workout since the final surgery.

This morning (March 5th), I was cleared to do partial weight-bearing by my doctor. I had been standing on both feet for about a week for stability while in the kitchen cooking, doing dishes, etc. Whenever I try to walk without crutches, it is painful and I can't do it, so I'm just starting partial weight-bearing while using crutches. I hope to be off the crutches completely in another couple of weeks. I get way too many compliments from random people about my skill with using them. Time to put them into retirement.

Since my last surgery almost 3 weeks ago, I've been in tremendous pain. Both feet hurt for similar but different reasons. My right foot for healing from the surgical trauma and bones fusing, and my left foot for bearing all of my weight on top of the arthritis. I had a cortisone shot a week ago today in the left foot, and I was in a lot of pain from it all week. I still feel twinges but it's not overwhelming. My immune system is completely shot, so I can't even have a glass of wine with dinner to help take the edge off of the pain at the end of the day. I still take a vicodin almost every day, but it doesn't do much for the pain except take the edge off of my grumpiness from being in pain for so long. Pain is worst at night, so my sleep schedule has been altered badly. It doesn't help that I live with someone that works 7pm-7am night shifts, so the house has to stay pretty quiet during the day for sleeping. While the kids are in school and nobody is around to help me get food and my pain is low, I've gotten on a daily sleeping schedule. That works very well until I have a lot of things to do during the day! But I digress...

On top of the pain and getting 2 or 3 hours of sleep last night, I was dealing with some personal issues today. I knew it was a perfect time to get my frustrations out in the form of a workout. I've been going a bit crazy with the bed rest, because I've always relied on workouts to get me through the stress of whatever I'm dealing with at the time. Take that away, add surgery stress and pain, and I'm a mess. I headed to the school playground wearing workout clothes and my Chuck Taylors, knowing that if I went wearing the air cast boot, I'd end up taking it off anyway and continue in my socks. Due to the surgical incision in my heel, I won't be going barefoot for awhile. It felt great to wear two matching shoes. The last time I wore both shoes was the day I was taken off of a wound vacuum I'd been on for a month. My right foot was so swollen the shoe would hardly tie. My feet and ankles are close to the same size now so that wasn't a problem this time.

I took an 8 kg kettlebell with me. It was challenging crutching to the playground with the kettlebell in one hand and my water bottle in the other, but I managed. After a wonderful joint mobility warm-up, I did a little circuit. I wasn't sure what I could do, so I developed my workout in the moment. It went something like this:

1-2-3 OH press ladder
2-arm swings (5)
Bottoms-up clean (5+5)
Snatches (5+5)
Squat (5)
1-arm swing plus snatch, alternating (5 each side)

I repeated this circuit three times.

Because of my state of mind, I wanted to focus more on cardio than strength. I felt myself coming alive again for the first time in months. It was a perfect day, in the upper 70s, with Adele singing loudly in my ears, urging me to keep going. One challenge I found was not being able to walk to lower my heart rate after snatches. I did the best stationary fast and loose that I could manage. At the end of the workout, I did the kneeling hip flexor stretch, crutched over to the monkey bars to hang on them to stretch a bit more, and finished swinging with my daughter on the swings for the first time since I sprained my ankle in mid-October. Without the boot, I could clear the ground. It was fantastic to feel so weightless and carefree. I think more adults should play on play grounds. It really is quite fun!

Looking forward to what's to come, and hoping I'm not too sore to use my crutches tomorrow!