Enjoying life

It's been 4 years and 3 months since my surgery. The update is that I'm just enjoying life. :) Once some time has past after your surgery you should be able to move on and not think about Brachy much anymore. (I realize that if you're reading this you're probably not at that stage yet... and that's ok. :)

Most of us seek out the surgery for the hopes of some level of normalcy. Well, normal, is not thinking about your feet so often. If you read back on my old posts you'll see I was consumed with Brachy and my surgery. I'm so happy that my journey has lead me 'through' it and I don't do that anymore.

I saw these 5-inchers and couldn't get past them :) I don't even like rhinestones! LOL.

My ex-brachy foot is on your right.

Have a great summer!

When Did You First Notice Your Brachy?

If you read my first post you know how Brachy runs in my family (when it shoes up), and how many of them share Brachy with me.

My sister is one of those people. Here is a picture showing how her toe began showing signs of Brachy before me because she is older. It also shows how I was born with normal toes. Flat and wide, but normal looking. ;o)

Click to enlarge

So when did you first notice your Brachy?

I thought you'd like to see this close up. The blue is how it was, the red is about 6mo post-op.

Did you know that webbed toed are very common? I remember as a child I had a neighbor, Daniel, who had his 2nd and 3rd toe that way. With all the toe issues in my family it seemed so normal to have a friend with something like that. ;o)

As I mentioned in this past post, there is always someone who has it worse than you:

Check out this FB page of very special feet

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Some more shoes. I got these last summer. Again, way too over zealous, coudn't wear them. The straps are way snug. But today I put them on and VOILA! They don't hurt. Walked the dog, cleaned the house and all is well.

In fact they are tight in all the right places. And as I mentioned in this past post, "pressure" is the best thing for, (and to avoid), hypertrophic scaring. 

I'll leave you with a flower I've never seen before in my life. It came from a very tall and huge tree in the park.

CIAO!

The Number of Brachy Blogs Are Growing

So the number of Brachy Blogs are growing! I keep researching to keep myself up-to-date. I'm noticing people going through the surgery, putting their experiences online. Even more so, these are people who have read my Blog and have modeled their blogs after mine, using it as a guide as to what to include in theirs.

Do I mind this? NO I DON'T!

It's great. That's one of the objectives for creating mine. I don't want to be the only one providing information. Brachy-ers need to be able to research different methods, outcomes, locations, perspectives, etc.

At this point there are more External Fixater blogs than One-Stage. I hope more people doing the one-stage method will consider capturing their experience online for other to benefit. Also, there are next to none of Men! This needs to change too.

I realize it may be probable that a woman's Blog would be more detailed, but I'm not inclined to make that conclusion for all men, or say that it matters at this point. The Brachy world needs to hear from men who opt to have corrective Brachy surgery. (So if that's you, get crackin' ;o)

As always, these stories are on my right column (Other Correction Stories). This list is often updated.

IMPORTANT

I'm very happy to see that others going through this surgery have discovered what I did, that a 6 week recovery period is a gross understatement and misrepresentation of recovery.

Remember this past post?

Well, Chris read my past post, and found it to be true for herself. 7-weeks in, and this is her post. (It takes a whole lot of time.)

BUT SO WORTH IT! I just love my feet now. I wear flip-flops all the time and have to stop myself from looking at them. I'm so grateful to have had this opportunity. What a blessing?!

Take care I'll talk to you soon! Thanks for following!

ONE YEAR ANNIVERSARY! - Post-Op

First, I want to thank God for being with me, cuz I sure did need to know he was around those first few months when I was shut in.

As I look back, I'm reminded of so many things! My melancholy, the pain, and the small hurdles I overcame along the way. =o) 

A FEW HAPPY THINGS

• I use to have a corn on my third toe and now it's gone. ;o) 

• I also use to have thick calluses in the bottom front of my feet. They are gone too. I hope it stays that way.

• Another little thing is that before the surgery I was a size 9 to 9 1/2 shoe size; and now I'm a size 8 1/2 to 9. This is due to my Bunionectomies. Yay. 

• In case you're wondering, I do not feel the hardware in my foot.

OUTSTANDING PAIN ISSUES

(the red areas are further past muscle, closer to the bone if you will.) This Sciatic Pain pain keeps me from taking long walks or doing anything on my feet for hours. It's an annoying and sometimes miserable kind of pain. It's daily, and if I keep going I end up limping. I'm hoping it will diminish completely with time.

UPDATE The issue in this box WAS part of my outline when I started putting this entry together 4 few weeks ago. BUT something amazing happened. I won't go into the details, but I received complete healing in this area. This pain lasted 11 months and 2 weeks. I've been completely pain free for the past 2 weeks! So there are no outstanding pain issues!

TENDONS

Remember I spoke about this back in the "Didn't know" page? Back in the 11th post-op week? Anyway, when I wake up in the morning it feels as though my tendons have been in a ballerina position (pointed foot) for an ice age. 

So every morning I have to recline myself forward to make the tendons feel "released". It's weird.

NUMBNESS

RED are numb areas. YELLOW are areas of a tingling sensation when touched.

PINKIE TOE
As I mentioned in a previous post, I suspected my 5th toe might develop a bump or callus because it's now rubbing up against the inside of my shoes.

It never did that before because it lived under my 4th toe. (I placed it out from underneath my 4th toe for the B/W photo.)

PHYSICAL ACTIVITY
Well, the past year has been a sedentary one. If you remember, I tried walking at the track back at the 6.5 post-op-month mark. It didn't go well. This post explains the complication with the fourth toe.

At the 8th month mark I tried the treadmill for 2 weeks, but my whole leg was in pain. I had to stop.  

So now the question remains, "Will I forever have to wear a band-aid on my toe when doing intense physical activity to avoid a blister?"  I think I've avoided the gym because I don't want to test this. I don't want a painful blister under my toe! But at this annual point, I really have to. I'll be sure to post the results.



SCARS

The two in the center are from the Brachy surgery.

VIDEO

As promised, I made a video to summarize this past year's journey in case you've just joined the Blog. ;o)

INSOLES

In the past few months I've had to invest in this stuff.

It helped with the pain, but moving forward I will make this part of my shoe-drobe because I want better foot health.

I wore this lovely little number a few days ago for a 40th BD party.

Again, the higher the heel, the shorter my new fourth toe looks. ;o)








The "High Heel" insole is just a must for me now. They feel so good. I think this will help keep those calluses under the front part of my foot at bay. 

And these things even have arch support! Awesome.

FLEXING

This is how things look when I flex my toes upward.

RESULTS

My right foot looks gigantic! LOL

Obviously my left 4th toe isn't as long as my normal right one. 

This is more likely with the one-stage method vs the external fixator. I knew that going in. 

With all I've been through— I'm ok with it.

I'm more bothered by the results of my bunionectomies. Specifically, the first-metatarsal on my left foot. Seriously, I thought it would be better than that. But it's been a year of recovery and it's time to just move on.

HELP

As I had shared in this post, I'm looking for flip-flops that say "Puerto Rico" on the straps. Preferably in leather. If anyone knows where I can find them, please leave me a comment. ;o) Thanks.

QUESTIONS

Is there anything you'd like to know that I haven't covered?



Thanks for following!

8 Month Mark

          (34 weeks) 
Hello all. Autumn is here! Isn't it lovely?! ;o)


At this point I am pretty sure that the Sciatic nerve issue I've experienced is not usual. I really haven't heard anyone else who's had this surgery mention it. 

I also no longer think it was ONLY due to how I was sitting post-op. I think it's more than that. When you look at how this nerve runs all the way down your leg, and to your heel, I now believe that the heel surgery itself had something to do with this. I think it was aggravated somehow during surgery.

I had Brachy and Bunion surgery on my left, and only Bunion surgery on my right. The sciatic issues are only on my left. I really feel the "heel" surgery aggravated my nerve because if it were the sitting position I did months ago, it should really be gone now, and it's not.

I believe I will be well again and it will be gone at some point, but for now, after 8 and a half months it comes and goes.

I am now on the treadmill several days a week. I do a max on 4.0 speed and 7.0 incline. Only walking for an hour. Because the pain comes and goes so sporadically I still don't know if exercise helps or hurts it. I just started on the treadmill so time will tell. (update: I had to stop the gym, it got to be too painfull.)

It's still not freezing out so I'm mostly in flip-flops. And I work from home so the only closed shoes I am really wearing are sneakers. Because of my bunionectomies, wearing closed shoes will take a while. If it was only Brachy I'm sure I'd be wearing them already.

GOOD NEWS! Remember that trip I booked?! Well it's in 3 weeks!!!!! Wow it's been a long haul. Remember this? 

Well things do get better. I look back at my struggles and I'm very grateful to be past them. All I have now is the sciatic pain that comes and goes (it flows into my buttock and makes me limp), and my feet still swell a bit.

But now it's time to look forward to my trip! YAY! I'm planning to have my first ever professional pedicure on the Cruise, ON MY BIRTHDAY!

I will try to take snapshots of the event to post. lol. Next post will have foot pics for sure, I promise! ;o)

Tootles!

Brachy Toe FUNCTIONALITY

I'd like to talk about the actual function and alignment of my fourth toe with this corrective surgery. I think it's important and seems like no one is talking about it. As I stated in my very early posts, I wasn't just interested in an esthetically pleasant looking toe. I wanted to know about functionality, but no doctor really had abundant specifics on that. They are just sure not to promise anything. And if you don't ask about certain topics, they won't bring it up either.

So let's get to it. My take on it at this point is that Dr. West went a little overboard with "over-correcting" my toe. My best guess is that from his medical perspective of how the foot functions, toes are your grippers and offer a great deal of balance for the body. If he had to choose between a floating toe or a toe that grips the floor too much, he would choose the later. BUT, that's giving him the benefit of the doubt.

There is no doubt that I've done my exercises, etc. I even took Dr. West's advice about wearing heels after surgery to help gain range-of-motion (mostly for the Bunionectomy he did.) (See that post here. Once there, scroll down to the bottom  and read the short blurb starting at: "Other things...")

Bottom is BEFORE wearing the heels,
Top is AFTER wearing the heels.
(I'm reclined forward in both shots.)

This image shows my fourth toe after wearing that heel for about 3 hours. In the top image, my fourth toe isn't pressing against the floor more than the other toes as in the bottom shot. But then my 4th toe settles back down and is like in the before image, which is set too low. imo.

You can see here, when I lean my body forward, the fourth toe shows a great deal more pressure onto the floor than the other toes. (See the yellow tip of the toe?)

This photo shows you how it is set too low. As you know, it was even lower 10 weeks ago. The exercises have placed it up this high. But now at my 20th week, it seems this is as good as it will get? Thus, Dr. West went too crazy with the over-correction. (Remember, this is my opinion.)

The imprint of my foot on my flip-flop demonstrates what I'm talking about. My fourth toe is pressing against the floor much more than my other toes.

So why does this matter?

I'm glad you asked.;o)

It causes several difficulties. 

1. I'm not so sure it is healthy for the bones in that toe to be under this constant 'resistance' pressure.

2. Being set so low forces the entire 4th toe to touch the floor. That's not normal.

The stem of your toes do not usually touch the floor consistently. There isn't enough meat (cushion) in that area like the tip of your toes. The tips of your toes were designed to touch the floor consistently, not the stems. If they were, you'd have more meat there to deal with the pressure of your bones against the floor.

So that is what is happening to me. The stem of my fourth toe is being forced against the floor by the way the bones are set. This causes discomfort. I can't walk barefoot without discomfort so I have to keep foam flip flops near by.


Before my surgery the 3 bones to my fourth toe were in a curved high position (see "B" below). Also, the 4th metatarsal bone that was elongated, seemed to have a portion of the bone, that by nature, protruded downward. (See "A" below. Orange.)

This is verified in "C" below when you look at the shape of those bones. (Orange) 

And now all of that has been set downward. Too downward. Look at the bones for the 1st and 2nd toes in "C" (black and pink). The bones for the 4th are way too close to the floor now inside my foot. Perhaps this is the only way to get a Brachy toe to stop levitating?

*Double-click for larger view.*

3. Another thing it causes is the stem of the 4th toe to press against the skin of my foot, trapping moisture.

I learned in my 20s, when I had my Brachy toe, that I had to be sure to keep the skin under that toe very dry. Otherwise I'd get athletes foot in that one little area beneath the toe. The moisture would sort of eat away at the skin and cause a wound. 


Well I guess I'll have to watch out for that now too with the stem of that toe trapping moisture because of the way it's pinching the skin. ;o/

"Trade-off" is a topic more of us need to address with this surgery. You gain some things you wanted, but you also have chances of gaining some things you don't want too.

I'm seeing Dr. West in a week for my right foot. I need to gather myself and see what is worth mentioning to him and what is not. I think he is a good doctor. But this condition, being addressed by doctors, is a new thing. 

My job is linked to the medical community. I know all too well the mind-set of doctors. It's a whole different world. Even good doctors practice keeping silent about things they feel are 'touchy' areas.

There is something I do want to mention to him and need to find a constructive way to do it. The Bunionectomy he did for my bunionette is disappointing. He missed the mark completely to what I had complained about in my consultation with him. The bone I needed him to shave down, due to pain in shoes, wasn't touched. Instead he worked on the "profile" of the bunionette. He did what he called a sort of "tuck" with the skin. Which looks real nice. ;-) It makes my foot look narrower. I really like that— I want him to do that to my right foot. BUT I think it's unacceptable to go through all this and still have the bone I initially complained about still be a pain issue. (turns out he did miss the mark and unless I go under the knife again, I'll have to live with it.)


I do have a small suspicion that perhaps it was not done because it can't be done. You know, like it's part of the joint kinda. But I have to talk to him about this cuz there needs to be understanding between us before doing my right foot.

I think it's important to extend grace to people who are trying to help you. I don't want him to think I don't trust him, cuz I do. I wouldn't travel so far if I didn't.

I have no idea if Dr. West will volunteer to fix what he missed last time on my left foot. It would have to be very un-invasive  because I need my left foot to bare all the weight while my right foot is healing.

Anyway, I'll see how it goes. It's important to be gracious and demonstrate understanding. He may not volunteer to fix what he missed. I need to be prepared for that.

On a good note, in a week all my surgeries will be over. Thank God. ;o)

Tootles.

Cost of Pre-Surgery Tests

One of the aspect about my Brachymetatarsia research is that I found no personal blogs stating the cost of anything. Not the cost of their prescription medications and certainly not their medical bills for the surgery. I had one post-Brachy person tell me they would and never did. *shrug*

Anyway, remember those unexpected surgery clearance tests I had to get before surgery? Well here are the costs of those.

(FYI, two doctors here at home found it odd that things like an EKG were being asked for. They felt because of my health and age it was unnecessary. Overkill. I can't speak for Dr. West, but my feeling is that he probably realizes this BUT because I am traveling for this, he may want to make sure nothing stands in the way? From my end there is a lot riding on this.  I'd like to think that's the reason why.)

Keep in mind doctors charge more in the east than in the west.

Office Visit: $365.00
Venipuncture: $30.00
Urinalysis: $30.00
Pregnancy Urine: $40.00
EKG: $100.00
Laboratory Fees: $155.75

TOTAL: $720.75
Portion paid by my insurance: $680.75
Portion I pay: $40.00 (co-pay)

Pre-Surgery Tests Are Done

© www.noao.edu

(MERRY CHRISTMAS!)

My pre-tests are done. Before doing so however, I did contact my surgeon's office and ask if getting these tests done 8 wks before was ok. (Some hospitals have stipulations about the timing of surgery-clearance results). Eddie told me there would be no problem (I have that in writing), so I went ahead and had it done at an internist's office. (I didn't know any internists, so my OBGYN recommended someone.)

It's the holidays so hopefully by Jan 3rd, the results will be faxed to my surgeon. My flight is booked and the only thing I am concentrating on now is me— my health. I'm making very specific efforts to detoxify myself in a balanced way. Physically, mentally, emotionally, etc. To prepare myself mentally and spiritually for the surgery itself and post-op.

There may be traveling stresses, physical pain, and emotional events in store. I'd like to be as prepared as I can to handle them all intelligently, patiently, and happily. I just feel I need to do this.

So that's it for now. Stay well my friends!

"Shoot for the moon and if you miss you will still be among the stars."

                 ~ Les Brown

Post-Op Care

This is Pia, she traveled from Denmark
to the US for this surgery!
© Pia Christensen

If you've read all the ups and downs with Dr. East you'll know that he said things like, "No one will be able to tell you they've done hundreds of these." Of course he didn't know that I already knew that wasn't true. That's a shame I think. (while there isn't many podiatrist who can say that I did know of one.)

In any event, I really wish Dr. East had handled things a little better with the whole DICOM thing. (It's not a crime to not be familiar with something, but I didn't appreciate being treated as though I was asking for something that didn't exist. And being made to go through so much to get something so standard.) I would have liked to be able to go to him for post-op care.

Call me stupid, but I thought it a great thing for Dr. East to be very amiable. This way he could be the post-op provider and be in contact with Dr. West. Perhaps begin a report with him and maybe, just maybe, end up partnering a bit with him for future patients who live in the east? Who knows where it could have lead. Dr. West could then perhaps offer more personalized post-op care for his patients from the east through Dr. West. Oh well, water under the bridge. And maybe things don't really work that seamless among practitioners anyway. Upward and onward. ;-)

Last night I found someone online who had the one-stage done! This person is identical to me. She has Brachy only on her left and also needed a Bunionectomy. I got to see photos online!

Dr. West has the experience where I don't need to ask him to provide patient referrals I can speak to. They're online blogging their results/progress.

Reading up on this person's experience, I found out the pump was surgically placed. The dose released is automatic, BUT it is set to end (run-out), etc. She didn't seem to have a problem and from her description— she needed it! So perhaps I need to reconsider. **grin**

I was able to see her bunion incision too. And it was exactly as Dr. West had described to me. On the side, towards the bottom! Awesome. Dr. East was going to do this on the top of my foot! I was also able to see the bruising that occurs. Even in the heel area where the donor bone is taken from.

In any case, I am thrilled having found a patient just like me. This week I am going to try and see if I can network to find a doctor here who would be willing to do the post-op care. I'm not willing to give up on that just yet. ;-)

Looking at her results I feel very confident about having both my issues addressed. Her xrays reveal her bunion seems to be about as serious as mine— and her results are beautiful. 

Mine is the third image from the left. (© Pia Christensen - © DNC)

I will say this, I read through her chronological progress. Just reading it made me very restless! As if I could feel all the discomfort/pain she described while having her cast on for 12 weeks. (and might I add she was very high spirited and positive) Reading it line per line, entry after entry.... I wanted it to be over (as she did and many others). I think the realities are that it is difficult to not walk for 12 weeks. Difficult to remain happy as itching & discomfort develops, and tendons wake up several weeks post-op... in a cast! (FYI, her progress photos and detailed progress has been removed online. She had shared it on a site that was not her own. When that site went down her story went with it.)

Skin gets dry and cracks... in the cast. It can cause wounds. Rashes form. Ankle gets weak. One becomes restless. Heel pain forms. The toe in question isn't moved for so long that its painful once you do. It can stay numb too. It also can 'stick' to the toe beside it and cause discomfort and confusion for a patient. Also, within the 12 weeks one will have several casts and it seems sometimes it hardens just right while other times you feel it's 'off' somehow. It can cause a 3-week-discomfort. But as described with having children... all that seems to fade when full healing arrives. They'd all do it over again if they had to... I guess.

I think I need to come up with a game plan to try and make post-op a little less burdensome for me. I will be working with my foot up, but I will be unable to drive. Going up and down a flight of stairs to walk my dog three times a day is going to be a circus I think. If I can't find a doctor here at home for the post-op care it won't be too bad in that out West I'll have family to help me. But if I do find a doctor here, then I will have to bother people for help.


I will be drugged to the hilt first few days and unable to take myself to the bathroom! ;-D

Tootles! Thanks for following! ;-)

Q & A with Dr. West

© www.shepardinsurance.com

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.