SURGERY DAY!- LEFT FOOT

Up at 4:30am. I have to be at the hospital by 5:30am. My surgery is scheduled for 7:30am sharp. Remember to choose something comfy and easy to wear.

At the hospital I had to sit and answer questions (DOB, SS, etc.), give ID, insurance card, choose someone for Power of Attorney, pay hospital balance up-front (my insurance covers 90%. I had to write a check for approx. $370). I received my wristband and was reunited with my mom.

Later I was taken by a nurse. I was weighed. I changed. They wanted ALL my clothes off even though this was surgery for my foot. I kept my undies on. I was asked to state what day it was and what was going to be performed on me. They also took a urine sample. After giving the sample I realized it was for a pregnancy test. But I had already had this done (paid) for such a test for Dr. West some weeks earlier. I explained. They made a call to the lab to disregard my urine sample. (yay!) My IV was also done at this time.

I had to sign a form at this time for the crutches I would need later. Apparently, the crutches are billed separately by a company other than the hospital.

I sat on a gurney with the privacy of a curtain and my mom soon was let in to sit with me. I was given a marker and was told to write "yes" on the foot that was to have the procedures. I did, but I also drew a happy face on the bottom of my right foot. I put my sock back on that foot to hide it. I was hoping that in the operating room it would bring a few chuckles. (I was pretty sure that Dr. West would view my right foot while working on the left. My right foot does not have Brachymetatarsia.)

Soon an intern who works with Dr. West came over, introduced himself and asked if he could see my foot. I removed my sock. He took a look touched a few toes and was done. He asked if I had any questions. I said, "Yes. I was told I get a continental breakfast with this thing. Someone lied to me." ;oD This of course broke the ice. (I wanted everyone to experience a little humor before going into this thing.) 

Another nurse soon came who would be involved in the surgery and introduced herself. She too asked me to name what was being performed on me.

Then Dr. West came in. We were all in good spirits. He took the marker and signed his initials right next to where I wrote "yes" on my foot.

He took a digital picture of my foot, them placed his hand on my shoulder and bowed his head to prayed for me. Yup, Dr. West is a believer! ;o) He prayed aloud with me and my mom right there while the two nurses where going through paperwork. 

There are times in life where you feel you are perfectly situated at the right time and place... this was one of those moments. (I can not tell you if my surgeon does this with all his patients. But I feel pretty confident in stating that if his patients let it be known that they are followers of Jesus Christ, that he will most likely feel the liberty to express and show his own faith as well.)

He left before my mom could start blubbering. ;o) She was very touched by his gesture of prayer. Soon we were making jokes again.

For the most part my humor was accepted. The Anesthesiologist was a little taken aback however. Her point being that if I'm cracking jokes she is unable to determine if I'm really disoriented or not. "Surgeries are canceled when patients are asked questions and the wrong answer is delivered." (I understood her point and told her I understood, but her delivery on this point wasn't the best.) I felt that she is the one usually cracking the jokes... (maybe I was stealing her thunder?) a few minutes later she administered the anesthesia in a forceful manner.... it was very painful. (I had anesthesia admitted 10 years ago for a surgery and felt no pain whatsoever.)

Considering the anesthesia isn't delivered by needle directly into my arm, but an injection into the IV tube.... you'd think there would be no pain... but she managed to delivery it too quickly and the pain was practically unbearable. 

No time to complain as I would very soon be out. Approximately 4.5hrs later I awoke to Dr. West saying something to me that I couldn't make out. He left. I felt myself go under again, but not before I felt someone remove my catheter and hand me a zip-lock bag with my undies in it! LOL. Then I awoke to see a woman at the end of the gurney trying to tell me how to use crutches. It was much to early! I couldn't understand her. I was disoriented. They even got me up and placed the crutches under my arms. All I kept saying was, "I really shouldn't be on crutches right now." ;o) Drrrrr.

Moments later I was being wheeled out. I was in and out of consciousness. I then found myself at my parents, in bed, and took the strongest pain killer as directed by my doctor (Roxicet). The day before he instructed me to not wait for pain, but to take it as soon as I got back from the hospital. 

This is what I was looking like.

Gauze. An ace bandage on top of that. Cotton wrapped on top of that.Then a fiberglass splint running from my toes to my calf. Then TONS more cotton wrapping. And finally another ace bandage.

My leg was numb from the knee down. I was able to move my first 3 toes forward and backward— that very night. (one can do a lot when you're numb. ;o)

All this waiting and it's finally done, pheeew....

7 Days Left Till Surgery!! (The hospital called)

Howdy all!

Well my last day at work was yesterday. (vaca days before surgery ;o) I'm busy getting things done I know I won't be able to do when I get back. Yesterday the hospital called me to tell me the monies I will owe up front. (My medical insurance covers 90%, I pay 10%. More on all the cost details later on when the dust settles.) FYI: I will be billed by the surgeon, the Anesthesiologist and the hospital separately. The hospital is the only of the three that needs payment up-front, before the surgery.

As you know there is little information out there on Brachymetatarsia compared to other [bone] disorders. Even less blogs I think. I have found less then a handful that lend a real idea of what it's like and most of them are from people who have gone with the external fixator. 

So as they turn the fixator, the toe ever so slightly grows over time. This makes blog posts exciting I think, to actually see progress. So I'm not sure, as I will be undergoing the one-stage, how exiting regular status updates will be. I'll do my best. ;o)

Tootles!

Surgery is About 2 Weeks Away

Howdy! Ok so in approximately 2 weeks I'll be having surgeries on my left foot. My time is spent trying to prep everything I'll need when I return home. (and shoveling tons of SNOW!) 

I'm stocking up on things and cleaning. I'd love to get my taxes done too! ;o) Let's see how things turn out.

I'll have photos and info when I get back for sure. ;o) 

Thanks for your prayers!

Q & A with Dr. East

© www.123RF.com

In an effort to help those seeking to have reconstruction for their Brachymetatarsia (and Bunions), here are the results from my 1st visit with Dr. East.

This is quite lengthy, but VERY informative! (I hope.)

At first glance Dr. East thought both my Brachy and Bunions weren't too bad. He stated I might be a candidate for the "one-stage" method instead of the external Fixator. (I was surprised that he said this because his website only mentions the Fixator method. He may be lacking in Brachy surgery experience compared to Dr. West, and I would think even more so with the one-step method?)


After viewing my digital xrays and doing some measuring on them, he stated that I missed the candidacy for the one-step by a smidge. Turns out my conditions are actually worse when looking at the xrays. He showed me before and after photos of some of his patients. He mentioned that if I did do the one-stage, my fourth toe would not be exactly as long as the normal one on my right foot. With the Fixator however, the exact normal length could be achieved.


Dr. East uses a cadaver bone to lengthen the metatarsal. This is acquired from a "bone-bank" for about $1,000. The bone bank tests it for just about everything. But is there a chance you could get something from it? Yes, no one will guarantee anything in the health industry, and the chances are so slim they feel it's 'almost' nonexistent. The bone is dead. Has no marrow and looks like a piece of coral reef.

Sample of "a" bone
from "a" bone-bank.



My questions were as follows:




1. How many Brachymetatarsia surgeries have you done?

"A couple dozen. No one will be able to tell you that they have dome hundreds of these. But just this year I've done three."

(So let's say he's done about 30 at this point?)


2. Would I be anesthetized or would my foot be numbed?

"Both. Anesthesia would be administered as well as having your leg numbed."

3. You have a secondary location you work out of at a limited schedule. Could the surgeries be done there too?

"Yes. Either location."

4. Would you be doing the surgery or would another doctor from this office do it?

"I'll have assistance, but I do the surgery. Sometimes it's another doctor or an intern."

5. Are these surgeries usually covered by insurance?

"It's covered."

(I want to note something here. It is not a doctor's responsibility to know if your insurance covers any procedure. It is yours. DO NOT take a doctor's answer on this. Insurance companies find reasons to deny coverage AFTER a procedure all the time. Do the homework on YOUR insurer the best you can as to what is covered and what isn't. You will most likely have to pay something out of pocket.)


While he said "it's covered", that really doesn't translate into what actually happens because my coverage states they cover 90% of out-patient procedures. (and the rules may change even further if I have this surgery done out-of-state.) There are deductibles to consider and Annual maximums that will be reached, etc. Do your homework.


6. How much do the surgeries go for?
He would not answer this question at all. We went over it several rounds, but he wouldn't disclose a figure. I explained that I do not have credit cards, and being that my insurance company will not cover 100% of it, I was trying to gauge the portion I would be responsible for. He would not give a figure, saying insurance companies find reasons to change rules, etc. I expressed that I understood and in no way wanted to hold him to a number, I was just trying to be responsible with my portion of it. I didn't want to enter into a surgery where I can't afford to pay even the 10%.


After several rounds he said, "I'd be surprised if your responsibilities were more that $1000.00 (US)"

Which brings me to the question I never asked him, because I thought of it later....

7. He informed me that removing the External Fixator IS a separate "surgery". (several times)
This means I would have a total of three surgeries (billable that way, I'm sure) on my left foot:

• the Brachy
• the Bunions
• the removal of the Fixator

I would have to go under anesthesia twice for this foot. (and once for my right foot, IF the Bunionectomy doesn't require a Fixator too!)

So I'm now wondering if the $1,000 he mentioned was for the surgeries as a complete total, or was he talking about one specific surgery, Brachy for example? 


In the west, Brachy surgery goes for about $8000. I think it safe to say NY is more expensive. I'd venture to say maybe $10,000? Thus perhaps making his $1000 judgment reasonable. Which of course would mean that was on one of the FOUR surgeries I'd be having.(My out-of pocket just for surgery alone would then be $4000. Medications and post-op care would be more?)


8. How long would the Fixator be in?

"Four weeks. Your foot would be swollen the entire 4 weeks, and even 4 weeks after it's removed."

9. Would I have a hard or soft cast?

"Hard for the one-stage. No cast if with the Fixator."

10. How many visits would we have post-op?

"Once a week. Xrays would be taken at every visit to make sure you're turning the Fixator correctly and that the bones are doing what they are suppose to do."

11. What medications would you be prescribing?
"Vicodin, Celebrex, and Duricef."


12. Have you ever had an unsuccessful Brachy surgery?

"Yes, not often but yes. It requires another surgery to remedy things."

(I have actually read that this does happen with Brachy surgeries. Sometimes the toe springs up even after being the proper length. I think that is one of the reasons for being 'under' to remove the Fixator. That's a time when perhaps adjustments ca be made?) But let's be clear here, he didn't specify what went wrong with his surgeries.


13. Would my fourth toe still have the same mobility I have now? I have very good mobility now. It bends with all my other toes.

"I'm afraid not. You may lose that."

14. He showed me 2 demos on YouTube of Bunionectomies.

"If you choose the Austin (more popular), it's easier on you and the doctor. But you choose the one you want, don't worry about me. I'll do whichever. (He was sincere while saying this.) But in your case, if you've dreamed of always having a straight line that won't be possible with the Austin on your Bunions.

The Lapidus involves much more. More painful, etc. but it will give you that straight line."

Which one has a larger percentage of re-occurrence of a bunion?

"The Austin"

15. For the Lapidus, where would you do the incision? Top or side? 

"Top"

(He also mentioned to me during a phone call after our first visit, something about not being surprised if I wake up with two Fixators on my left foot. The Lapidus, after he goes in, may require that. Example below.)

© www.youtube.com/user/Big1531Lefty

Lapidus
I'm thinking this is sort of what he means. I have sent him this video so that he can confirm this for me. I'll keep you posted. (FYI, he never answered this.)


16. I also have Bunionettes on the outside of each foot. They are extremely painful when I wear flat closed shoes. Can these be addressed as well?

"Those we can just shave down a bit."

17. How long would I be on crutches?

"Six weeks?"

18. Have you ever had surgery on your feet?

"I've had surgery on my..."

(Sorry I can't remember his answer somehow, but it wasn't his foot. Something on his leg... having to do with a muscle or sports or something. lol.)


 -----------------


If you're wondering, I did go in with a list of questions. This is feet we're talking about here. It's important. I appreciate my appendages you know. ;-) But I made sure to be upbeat and funny. I'm a big believer in getting the best out of teachers, doctors, etc. when you demonstrate some trust. It's important not to come across as paranoid and mistrusting.


We laughed during our visit, but I don't think he blamed me for trying to get my information straight. I will try to provide a checklist of questions for you in the future if you think it might be helpful to you. (See the " DR. Questions: tab at the top of this Blog.)


ONE LAST THING. I have also asked him to provide me with 4 referrals. (Including at least 2 patients with Lapidus and 2 who have had Brachy and bunion surgery on the same foot.) Patients who have had these surgeries in the last 36 months. It would help me a lot to be able to casually ask them about their experiences.


I told him, "I have no problem with privacy of your patients, if necessary my contact information can be given to them so they can call me."


That's enough for now. Thanks for following! ;-)

Choosing— Podiatrist vs Orthopedic Surgeon

In 1999 I began looking into this. (Once I found out there was actually a name for this.) There was a doctor out West that seemed to dominate in this surgery. Now, there are more surgeons [in the east] listing on their website that this is a surgery they can perform. (but as of 'right now' I feel he still dominates, let's see if that changes.)

I am learning that not all Brachy-surgeries are created equal. Podiatrist seem to dominate this surgery when Googling, compared to Orthopedic surgeons. In 2008 I did reach out, via email, to a Podiatrist here in the East. He was kind enough to answer back via his blackberry. For the most part he was upbeat and ready to have me come in whenever I felt comfortable. I could in no way take 3 months off from work, per foot, for these surgeries, so I left it at that.

With the possibility of maybe working remotely for my company on the horizon, I am now looking into finally getting my feet reconstructed. I've done a descent amount of homework. I started off favoring the "West" doctor, (I favored his Experience) but I know I should get more than one opinion on my conditions. That's when I put the "East" doctor on my radar as well. My plan is to have a consultation with both. Dr.West will have to be by phone. BUT his office has already sent me a preliminary packet to know the steps required for a phone consultation, all that is involved to fly down for the surgery, the stay, etc. For right now I am working on getting to them a packet of all the forms and insurance information they need. I have to send xrays and photos too. Then I will be able to meet with him by phone and ask all my questions.

Dr. East is a little easier. He's local. In fact, I have already met and had my first consultation with him. For now I feel he is nice, but my decision won't be made upon niceties. I don't think he is as experienced in Brachy-surgery as Dr. West. But I may not be able to stay in the West for the moths of post-op. My employer is having its shaky times and I can't afford to be jobless. Going out West may be a bit too much to ask. Going and staying for that period of time proves quite challenging with a dog in toe as well. ;o)

The question of Podiatrist vs Orthopedic surgeon in uniquely mine as Brachymetatarsia is not my only condition. I also have bunions and bunionettes to add to the mix. There are claims that Podiatrists do lousy jobs on bunionectomies compared to Orthos, but I've read the opposite as well. To me my findings were equal. I've looked up the difference in their education requirements, law, etc. Because I have Brachy with my bunions I have decided to go with Podiatry. (If I had Bunions alone, I would have a consultation with both a Podiatrist and an Orthopedic Surgeon.)  

I feel both doctors on my radar (Podiatrists), have the opportunity to do good work. But which one will do the best job? Once I have a consultation with the 2nd podiatrist I'll have to decide

Tootles! Smile, Jesus Loves YOU! ;o)

Getting Xrays Proves Difficult

I will document all I can so that those of you considering surgery, won't have to be as lost as I was/am in doing these things as a first-timer. (I mean how many times do you actually do this in life?)  ;-)  I don't want you to feel alone. Hopefully by following my blog you won't feel that way.

I've done research off and on for years and am reasonably sure of the surgeon who will perform my surgeries. (more on that later.) He is not local. Therefore, I have to get xrays taken here and send then to him.

I want to tell you that getting someone to take my xrays has proved very difficult. Once I explained what I was doing, what I needed the xrays for, I was rejected. I called several offices and they all said "No".

I then called the surgeon I plan on going to ask for help, to see if he had a solution. I discovered they pretty much expected me to have this difficulty (would have been nice if they would have told me that from the get-go) and recommended I just make a consultative appointment with a local podiatrist and not share my plans.

I had xrays taken this week. Not only was I surprised at the severity of my bunions, but the podiatrist was as well. (Dr. East—more on him later) I carry my bunions well I guess, but the xrays show quite a severe case.  

Anyway, I'm hoping that I can document all I'll go through so it can help somebody out there. I know the information is needed because when I went searching 10 years ago there was barely nothing available. And now you get sort of just bits and pieces here and there online. So I'll be as transparent as I can.  Thanks for following! ;-)

LEFT FOOT

These are my xrays. (digitally done)

© DNC -
www.brachymetatarsia.blogspot.com

RIGHT FOOT

(The "Normal" xray on the right, is not my foot.)

© DNC -
www.brachymetatarsia.blogspot.com

My Brachymetatarsia Journey Begins

(GEES THIS TAKES GUTS. OY.)

By now you have a good idea of what "Brachy" is, so I'll move on to my personal view and experience. I've lived with this for 30+ years. It has affected a few women in my family. My Aunt, my father's cousin, my sister, and my cousin. In our family it starts at about 7yrs of age, when the 4th metatarsal bone (inside the foot, not inside the toe) stops growing. It seems the skin continues, but not the development of the bones.

I'm used to it by now. I don't wear flip-flops or open toe shoes on dates or anything, but when I walk my dog or have to make a quick run to the post office, I grab my favorite "brachy-sandals" and go. (I like them best because they hide my bunions. ;o) I don't feel 'shame' as some Brachy-ers do, but I don't think one should feel shame for feeling shame, if that makes sense.

My Brachy sandals

Family and close friends have seen my feet, so no big deal. But what bothers me at this point in my life is that I can't wear a nice low-heel, feminine, strappy sandal. I just want to do that. That is what has lead me to my final decision for correction.

As an artist I'm use to being the quirky one so this sort of fits for me I think. ;o) Growing up it did do damage to my self esteem, and as an adult I discovered it did play a reasonable role in my lack of social skills. There were no pool parties, walks on the beach, sports (locker rooms), pedicures, sleep overs, shoe shopping, etc. I avoided being involved in anything that would even have the chance of exposure. Kids can be cruel. (Let me explain that I went to 13 different schools. I was always the new kid. And was bullied because I was a new target. That being said, I never showed my feet as to not give the bullies yet another reason to pick on me. So with every move I started from scratch again. I never had a chance to develop long-term friends to build trust with.)

Anywhoo, I work in Manhattan, and before the real hot weather hits, all the girls are pedicured and flip-flopped— so are many others who don't care for their feet in the same way. I've had a front row seat on the subway to some amazing deformities. So I look at myself and figure I'm just not that different. Many have it far worse than I. Someone in a wheel chair would give their right eye to have my feet and legs. So in that context, I no longer feel cursed or emotionally bothered as an adult.

I have other blogs and if you sift through them you'll realize I'm not consumed with my feet. But this blog IS about my experience with Brachymetatarsia so it will seem all consuming as you read it.

At this point, a bit of a door to have my feet reconstructed has cracked open. It might be possible that I may be able to work remotely from home in the near future because my job has been piloting this now for 6 mo. Without this, the reconstruction will not be possible. I must work. I don't have the luxury of not earning an income for the long post-op needed for recovery.

© DNC - www.brachymetatarsia.blogspot.com

My feet are completely flat. No arch. In fact, so flat that they act like suction-cups on humid days in the sandals above. ;-) My problem at this point in my life is the physical pain caused not only by my Brachy but by the two bunions on the inside and the two bunionettes on the outside. I nurse my inner bunions now-a-days by avoided 80s-like heels. But even when I wear flat closed shoes the pain from my bunionettes is excruciating.

© DNC - www.brachymetatarsia.blogspot.com

I also have thick calluses on the bottom of my Brachy foot. In my sandals, my feet just don't look that bad from our birds-eye view. But from a healthy podiatrist vantage point— they are an absolute mess.

So here starts my new journey! ;o)