Q & A with Dr. West

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I have a lot on my plate lately, sorry for the delay on this. This is what came out of my consultation with Dr. West. (If you want to refresh your memory of my visit with Dr. East, see the entry Q & A with Dr. East in July)

Dr. West took a look at my feet. Did a little fiddling around and then grabbed his electronic tablet and began to write on it. It seemed to me, I was now "on file". ;-)

"So tell me about your toe. How does it feel? Does it hurt? In what way?"

As I answered I found that one-word answers were not going to do. I felt a bit of pressure as he asked the same questions, but rephrased. As if I was expected to give my woes and be as explicit as possible. Of course this is necessary, he wanted to get accuracy and make sure my profile was complete. And being from out-of-state I'm sure it was all the more important to have correct notation. I think I was just nervous. Too much build up to the event, you know. ;-).

Am I a candidate for the one-stage or the fixator?

"The one-stage, undoubtedly. I've done that surgery on patients who have a larger length defecate that you with success."

Would the foot/leg be numbed or would I be under anesthesia?

"You must be under anesthesia."

Do you use a cadaver bone?

"No! Out of all my cases, I have several hundred under my belt, I have used a cadaver bone twice, it hasn't favored well. I use bone taken directly from my patients. The heel. That area will fill in again with time— totally within 2 years. You will see a small dimple there." (10 month post-op I can tell you there is no dimple.. there is a 3" scar.)

What kind of bunionectomy would you recommend for me? Lapidus or Austin?

"Neither. I prefer a chevron osteotomy. Why? What has your other doctor recommended?"

Well I prefer to hear what a doctor has to say on his own. Not in contrast or comparison to another. I've researched both the Austin and the Lapidus.

"That is too severe for you. In my opinion that procedure is a little dated and overused in the East."

I was told that if I've been dreaming of a straight line that an Austin is the way to achieve that. The Lapidus will provide correction, but there would still be a bit of a bone-bump. I'm also concerned about the re-occurrence of the bunion itself.

"Why would you want your foot to look like this?"

He took by big toe and straightened it to a straight line.

I asked, "What's wrong with that?"

"You want this?" He pointed to the now huge space between my big toe and second toe.

I said, "Well not the space, but wouldn't my other toes be in proper position within some time?"

"No. Surely your 1st metatarsal is shoving them over a bit, but not this whole space. That is not natural. Square shaped feet are not natural. There should be a bit of an angle. You want it to look like this:..." He placed his fingers over my bunion so I could no longer see it. Then straightened my big toe a bit.

I realized he was speaking about bone structure and I was speaking about look. His demonstration is one I've done to myself many times. It's dreamy even. So I understood what he was trying to convey. Most of his answers during the entire consultation where not prideful, but confident. His statement about square feet, well, not sure I agree. I've looked at thousands of feet all my life. I've seen a whole lot of square feet! Even Anita's, the girl from Spain, are square to me. And I mean that as a compliment! But surely God did not create mine that way, even without bunions. So it's all good.

Have you ever done Brachy and bunion surgery on the same person, same foot?

"Yes, quite a bit of them. Pretty natural thing really, because the forth toe being shorter actually causes the other three toes preceding it to shift over."

Is the surgery done strictly by you? Do you have other doctors or assistants that work with you?

His eyebrows shrugged closely together in the center, taken aback a bit, but smiling, he pointed at himself.

"By me. I may have a tech working with me but it's all done by me."

Would I be in a hard or soft cast?

"Hard cast. 12 - 14 weeks. Removed every 3 weeks to make sure all is healing well, then a new one put  back on."

What medication will you be prescribing after surgery?

"Percocet (Oxycodone) and a pain infused pump."

(If this is surgically implanted (pump), I will flat out refuse. NOT DOING THAT.)

Any mandatory medications or nutritional supplements you recommend before surgery.

"No."

I've been taking Echinacea, Calcium, Vitamin D and Glucosamine for two months now. I really want to heal as well and as quickly as possible.

"There is really no evidence on that helping in these circumstances." Of course I do not care and will continue this. I believe they will help. My aim is to be the fastest and best healing person he's ever seen!

Have you ever had surgery on your feet?

"No. I'm too scared.;-)" He was pleasant during our entire time together. Confident, not egotistical. He had a good sense of humor and this came across here in his answer. He laughed a little. But it was delivered with a bit of admiration for those that do undergo surgery.

What about my bunionettes? They are extremely painful for such small things! I have stopped wearing really high heels so I keep my bunion pain under control, but these two little things are so painful, especially when I wear flat closed shoes!

"We can address those." He explained the procedure and options depending what he finds once he is in there. 

"I want to let you know that I have 4 hours in which to work. Actually, less than that. The anesthesia is for 4 hours. That is really the most for this type of foot surgery. The safest. My priorities will be as follows, 1. your fourth metatarsal (brachy), 2. Your bunion, and 3rd, if there is time, the bunionette." (God I am so praying he has time! They are so painful and I don't live around the corner!)

Doing the one-stage for my Brachy, can I expect the fourth metatarsal to be identical in length as on my normal right foot?

"Ye-es." The he looked at both feet again.

"Um, it would be amazingly close. It is possible that it might be 1 to 2 millimeters shorter. But that wouldn't be because of the bone we are extending, it would be because the toe itself is actually shorter than the normal one on your right foot. Most Brachy patients don't realize that this condition is sometimes caused by both, the shortening of the bone within the foot and within the toe itself. 

I have gone back in with some patients and done a tiny implant to extend the toe itself. It's no big deal really."

But that is considered a whole separate surgery is it not? With insurance.

"Yes."

Cost. What is the cost of these surgeries?

"I don't know. You'll have to speak with so-n-so (financial person in his office) about that. Call him up, he will be happy to work with you on all that."

The incision for the chevron osteotomy, where is it?

"I do the incision on the side of the bunion, a bit more towards the bottom."

Functionality. When I grip all of my toes on my left foot, even my short 4th toe grips very well. I demonstrated. What will this be like afterwards? Will I lose this?

"I'm afraid you will lose most of that."

What are the top three complications with Brachy surgery?

"Patient compliance". ;o) He gave a really big grin. 

He skid right past this one. Not sure if it was intentional on his part, but he did. I was speaking about the procedure on his end, not post-op really.

He explained that patients get really restless and want things to go quicker than they do. He is constantly dealing with morale and trying to keep his patients on a positive thread. He said being in a cast that long is difficult for people. This causes them to not follow direction, etc.

This was said in honesty and wrapped in humor. And because he had asked my three times already, "Anymore questions?" and I said "Yes" and continued to plow through, I decided to not restate this question.

Other things that came up during the consultation...

I don't really plan on wearing high heals after my complete healing.

"You should! It actually helps give the proper range of mobility. Actually I'll tell you, when I do the second foot on most patients... when they are under anesthesia I actually take the big toe from the first surgery and crank it all the way forward! To give it a complete range of motion I know it's not getting. ;-)"

It was nice to hear the honesty. And great to know because I will now be trying to not keep my foot perfectly flat all the time post surgery. I now intend on doing my own bit of therapy even while sutchers are in if I can. I still don't plan on wearing rigidly stiff shoes that will rub against my bunion

Ironically, I bought an amazingly high shoe while out west. BUT it's a wedge heal (better support) AND the shoe is actually soft fabric! It's fleece material and conforms to any shape! So there is NO pressure on my bunions! YAY! This sort of shoe I think would help greatly in my recovery. It would provide the 'bend' Dr. West spoke about while applying no pressure.

I noticed that Dr. West was more surprised by the calluses under my left foot than I thought he would be. I just assumed he'd  seen worse cases, but his reaction was one of surprise. He used the word "wow" along with his reaction. ;-) I did not mind because he immediately went into notation on his electronic pad.

Lastly, I forget how it came up, but Dr. West spoke about a study that is soon to be released. It's based on his cases. About 200 of them. This would be the largest study thus far of it's kind.

I am very interested to see what it reveals!

Tootles! ;-) 


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UPDATE, about 2 weeks after this post I found a local post-op doctor. Solidifying my choice of Dr. West for my surgery.