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!

Week 15 — Post-Op Highlights

Howdy.
A picture is worth a thousand words right? I'm definitely visually adept, but there is more going on than this photo can tell. So I'll tell you. ;o)

IN A SNEAKER!

Saw Dr. Yes last week. I've graduated into sneakers. Went out and got a good pair. I choose a men's (I need the extra width) Nike Air Max Run Lite +2. They were the most comfortable to me out of the selection. I also choose them because I would be able to add some comfort insoles in them without a problem. I needed a sneaker that would have enough space top-to-bottom (vertically) in the front.

I got 2 kinds of insoles. One for Heel pain relief and the other for the Sole.

I wanted them both in a men's size for the extra width, but was only able to find one. ;o(

Nothing seems to take the pain I feel away, but this is better then just the insole that came in the sneaker from the manufacturer. ;o)

Because the ace bandage would be too bulky, in a sneaker my Doc gave me this snazzy TIGHT sock. It does my scars good. (Remember the post I made about pressure being the best thing for scars?) 

My ankle and foot need the support (especially while driving my stick shift) so the sock is a good thing. But I do find that my foot starts to ache after about 5 hours. It's too snug after that time.


But I still wear my ace on top of that for ankle support.

PAIN
Let me be clear, while I am now out of my boot and off crutches, I'm walking with a great deal of pain and discomfort.

There are three things going on in the pain department:

    1. Both front and back of the sole of my foot
        are quite painful when I walk. It feels as though have metal         plates there, right under the skin of my soles.

     2. The Achilles tendon (Heel cord) is very tight

     3. My sciatic nerve

I had complained of this pain maaaany weeks ago and after describing it again to Dr. Yes this past week, he simply told me what it was. GO FIGURE! He gave me stretches to do.

The exercise was to stand arms-length away from a wall. Place palm of hands flat on wall, lean into wall by bending elbows... bringing the body toward the wall while heels remain on the floor. I found that this addressed the Achilles tendon, but not my sciatic nerve pain. 

I knew nothing about the sciatic nerve so I looked it up. I found this stretch was the best one so far:


For me however, I need more than this stretch. (The pain is persistent.) I have sent an email (because it's the weekend) to both of my doctors explaining the pain even though I am doing all the stretches, and requesting actual physical therapy. I'll let you know what they say. (In the meantime I've started taking Advil for the Ibuprofen. I'm hoping it relives the inflammation.)


WALKING

Stretching the Achilles tendon (heel cord) is Soooo necessary. With effort, I am able to go up stairs one foot in front of the other like normal (need bandage on).

But going down stairs is a totally different story. There is no limberness in that tendon. Until this happens to you, you never realize how it actually helps you go down the stairs.

I'm working daily to stretch this out. While I do not have permanent improvement in my sciatic nerve, I do experience permanent improvement in this tendon with my stretches. ;o)

There are stretches on YouTube for this tendon, but I find they aren't the best for those of us who have had Brachy surgery because we can not fully put weight on the foot yet. This is what I came up with that works best for me:

SLEEPING

I'm now enjoying full sleep through the night! YAY! ;oD

CONGESTION
This is improving also. (See: STRANGE)

NUMBNESS

(the images used to show the numbness areas in this post are old images of my foot. Just the highlighted sections are current status.)

8th Week — Post-Op Summary

A bit of a breakthrough this week. YES!

The first bit of good news is I finished my taxes! ;o) At a turtles pace, but they are done! Yay!

That soon was coupled with an unseasonably warm day this week. I got to open my windows and let some fresh warm air flow through the apartment. (I can't walk Missy yet so she does all her business on her wee pads— the venting was needed. ;o)

PAIN

Heel pain I had last week diminished. Looking at my scars I decided it was time to bathe without a plastic bag on my foot. (I had not wanted to do this until the skin had really bonded together well— I didn't want incisions to reopen.)

Running water on my foot...OMG, this was amazing!!!!! I hadn't done that in 52 days!!! It was awesome. I gently scrubbed my foot with soap and water. (Had only periodically washed with a damp washcloth.) It was dreeeeamy!

MORE GOOD NEWS

I actually could put on a regular sock without it bothering me now. Wooohoo! (tried shoes... not happening yet.)



STRANGE (congestion)

I have to talk to my doc about this. Whenever my leg is down it changes color. (and becomes painful) I presume it's blood. The feeling of this several weeks ago was painful. Now the feeling is just uncomfortable. But the color thing is a little un-nerving. Gonna ask about it. Looks purple-ee. (what this is: see: "PURPLE-EE (CONGESTION)")

SCARS
Apposed to last week, this week I decided to go back to the ace bandage. I feel my scars still need the "pressure" for the scars.

Also, at the end of this week I decided one morning to massage my scars. (Doing it in the morning ensures any pain from it will subside by nightfall.) I thought it would be good for the scar tissue, to hopefully help heal with more flexibility.

Genius that I am, I did it too hard! The tendon underneath my Brachy scar swelled up. (made me panic a bit) and the opposite side of the heal-scar swelled up too! OY. I put the ace bandage on tight, checked it now and then. By the following morning things were fine.

A friend of mine went to physical therapy for a scar on her finger. She did confirm my thoughts about massaging the scar tissue. So I will continue, but gentler.

SLEEPING
Horrible. I have to do something about this...

LANDMARK

I'M 3/4 of the way through the 1st phase! YAY! 4 more weeks and I should be able to take my first steps! WooooHooo! 

TOE
This week I've been moving my toe as Dr. Yes recommended. Not remembering 3 times a day though. I do see immediate difference as to where the toe lays, but after a while it seems to revert back. I think I have to really do it 3 times a day and understand that it's a slow process. Let's see what happens.


Have a great week!

7th Week — Post-Op Summary

Here's how things are looking. Still swollen and quite tender. But a miracle still. This is a process, and perhaps the 'wow-factor'  that I've finally had this done hasn't hit me yet. But I'm sure as pain subsides and agility returns I'll be able to enjoy the amazing thing this surgery means for me. I'd just like to walk already, ya  know. ;o/


FLEXIBILITY

I'm bending both right and left sets of toes with all my might here.


PAIN 
This week my heel and large tendon behind my ankle have been a pain—literally. You've ever heard the saying, "It has to hurt if it is to heal" ? Well I'm hoping that's why it ached so much this week! ;0) (I want to note that I'm starting to think that I'm feeling more discomfort than I should because I'm home all day without my boot on. (against doctors orders... what if I fall?) And because I do for myself, I think my foot is getting too much movement (giggling?). Is this causing me more pain at night?)

SLEEPING
The heel pain has caused small spurts of sleeping. I awaken many times during the night tossing, trying to find a pain-free position. I can't fall back to sleep and am awake 3 hours at a time. (In one of my past posts thought this was remedies after reducing my medication, but I guess it's back)  Thank God I'm on short term disability, this kind of sleep would negatively affect my work. (It's important to note that I am off all Meds right now. I'm sure if I were on Meds I'd be sleeping pain-free.)

DR. VISIT

Dr. Yes took no xrays as there would be no noticeable changes since the xrays taken 2 weeks earlier. (No news is good news.)

WHAT WOULD YOU DO?

Dr. Yes told me to start maneuvering my 4th toe. (Put my index finger behind the base of the toe and softly press forward. For two minutes, 3 times a day.)

However, Dr. West, my surgeon, told me specifically not to touch my toe until the 10th week when he would provide the exercises I should do. If Dr. Yes is wrong in his recommendation, it is possible that my toe will pop-up like it use to. And if that happens, I would be up against an additional surgery to correct that! What would you do?

Well I decided to start Dr.Yes' recommendation because my Brachy isn't as distorted as some Brachyans. My fourth toe never touched the floor, but it didn't pop-up as severely as some other cases I'm familiar with.

I couldn't remember to do it during the day so I'd just do it once at night in front of the tube. But I noticed my foot would ache a lot more when I was trying to sleep. So I stopped. I will try again next week.

DRIVING

I had asked my surgeon if I could put weight at least on my heel and he said 'no'. But just 2 days ago I made my way downstairs to my car. I wanted to see if I could use the area under my 1st three toes to press down on the clutch. Maybe I could at least drive myself to my doctor's appointments, right?  

NOT. No way. Didn't happen. I can't believe how hard I had to press against the clutch to get it to move only a smidge! My foot doesn't have the strength yet. I'm amazed.


BANDAGE

Attending my scars twice a day got me real tired of wrapping and unwrapping the ace bandage. It also felt a little hot with them on. So I thought I'd go get a roll of gauze, but I found something better. Isn't it snazzy? ;o) It's a mesh tubular bandage.


Very light weight and comfy.;o)

I use this type of gauze pad directly on the incision sites. Non stick (or non-ouchie ;o) With Neosporin.

I found this type of gauze uncomfortable against my incisions, so I don't use it. The non-stick pads are the way to go.
 

NOTE (Hypertrophic Scars)
I wanted to say something about the bandages and scars. I got the large size (tube bandage) on purpose so it would be loose fitting. But I don't think it's wise to do this at the beginning of a scar. Incisions need some snug pressure against them to avoid the scars becoming Hypertrophic.

Hypertrophic Example.
© Prime Health Channel

It's been proven that while doctors can prescribe topical ointments (OTC and otherwise), and/or give injections directly into a hypertrophic scar to reduce its 3D characture, THE BEST THING TO REDUCE THE HEIGHT OF A HYPERTROPHIC SCAR IS PRESSURE. 

I know this because I had surgery some years ago and have a couple of 6" scars that became hypertrophic! Think about it, a person with a scar running vertically down their abdomen demonstrates this. The scar is very 3D-like above and below where their belt line is. But the part of the scar that gets the pressure from their belt is nice and flat.

Also, I'm not sure, but it is possible that not all skin on the body is created equal. Is the skin on your neck more susceptible to hypertrophic scaring than your knees, etc.? If so, what about feet? I don't know. (I do know that the world of medicine thinks some skin pigments lend themselves more to scaring like this than others.) But I'm not taking any chances.

That being said, I will be watching my scars and if more pressure-time is needed I'll be switching back to my snug ace bandages. ;o)

Ciao!

6th Week — Post-Op Summary

Spring is on it's way!!! - © Favu Photography™

Another improved week. Hallelujah!

PAIN

Same as the 5th week, but less often— especially towards end of week. ;o) (The pain in my hip, quad muscle, and tendons behind my knee is gone for now.)

MEDICATION

This week I only took a pill at night when awakened with discomfort. But one day at 4:30am I awoke with some throbbing. I fought off the idea to take a pill— I don't want to have a habit. Two hours later it was relieved without medication. ;o)

So now it's been three whole nights without medication! YAY!

MOBILITY

My mobility and balance has improved. I've had 6 weeks of practice on one leg and it shows.

INCISIONS

My skin is peeling because of the tanning I did before surgery (stupid!). So I've peeled what I could. Then I washed my foot with a washcloth twice this week. It's a slow gentle process.  (Never wetting the incisions themselves!)

I am using maximum strength Neosporin twice a day, keeping my Raw eating lifestyle (90%), Using Vitamin E Oil, No refined sugars, and no dairy, etc.

My incisions now look like this:

SLEEPING

Beginning of this week I would wake up 2-3 times a night. I'd spend at least 2 hours awake trying to fall back to sleep.

  BUT...

Hooray!!!! Remember during the first week I said, "I have too much "awake energy". I think I'd rather be more sleepy." ?

Well I was right. It really was the medication because last night was the third night without medication and I only got up twice but was able to fall right back to sleep.

I'm on my way to normalcy! ;o)

 
NUMBNESS
Below are the ares that are numb to the touch. And you know what? While my concern has been for the utility and mobility of my 4th metatarsal... when I try to curl my toes my pinkie toe doesn't bend at all!!!

4th Week — First Cast Removed

This saw-like tool is specifically for casts.
The blade does not turn, it gyrates.
As it cuts the fiberglass you feel the
blades pressure against the cotton bandages
inside BUT it doesn't cut the bandages
or your skin! ;o)

It's been 4 weeks since my surgery. First 2 weeks was with a splint and ace bandages. Then a cast was put on for 2 more weeks.

I went to see Dr. Yes today. The cast was temporarily removed and xrays taken. They look good. The bones are healing just fine. BUT I expressed my desire for an alternative to the cast. I told him I was MISERABLE. Dr. Yes and I struck a deal. It's top secret but I'll share it with you. ;o)

He said he wouldn't mind giving me one of those huge protective boots BUT that I had to promise him I would not put any weight on my foot. And to wear it while sleeping. He said he's basically covering for my surgeon out West so he doesn't want trouble from another doctor for not following procedures for the post-op care.

I promised him that I would wear the boot like a cast and not put any weight on my foot. YAY! I'm sooo happy!!! The boot is heavier, bulkier and much snugger (A cast seems to expand after time, usually it does settle a bit but gets loose because your limb is shrinking.) I will now be able to keep my skin clean and moisturized. And I can flex my ankle a little here and there when I take off the boot to watch TV. This will mean my ankle will be less stiff and weak at 12 weeks. ;o) And this flexing will help stop the atrophy of my calf muscle.

When I got home I CAREFULLY washed. I dry-scrubbed my leg to remove the dry skin.

I washed with a wet terry cloth— very gently. I did not go over the actual incisions. (I don't feel that is wise to do. I think moistening two pieces of skin that haven't bonded together well yet is asking for trouble.) I also shaved. ;o)

I then used alcohol to remove dry blood in non-incision areas. (I had a ton of dry blood underneath my foot.)

I then applied Vitamin E oil from knee down. Additionally, I used Eucerin lotion on my leg.

You can see the atrophy on my left leg.

(Guess what? I just put the boot on my right leg and discovered that it doesn't feel snug at all. This means it only feels snug on my left leg because of the surgery. Weird.)

I applied Neosporin liberally on my incisions.
Then I put gauze on, then wrapped  with
two ace bandages.

One of THEE best things about having the boot in place of the cast is that, if you recall, my toes were exposed past the edge of the cast. This did not allow me to even place my toes on the floor to REST my leg! Instead I had to pick the cast up making the tendons behind my knee work overtime!

But now I can! The front of the boot sticks out way past my toes. This allows me to give my quad muscle and tendons a bit of a break by resting my leg (not put weight on foot). This helps greatly with balance when I'm standing with my crutches as well! ;o) (But it's still painful to have my leg down. The blood rushes, etc.)

BUT STILL, AWESOME! Feels good to be able to rest it on the floor!! With the cast I thought I was loosing my mind. Praise God! 

To celebrate I had pancakes today!!!! Haven't had those in a while. YUM!!!!

4th Week — Post-Op Summary

PAIN

The pain I feel is in many different places in my foot. It's shooting pain from and to my toes. My palms are still soar from the crutches. And the tendons beneath my knee are soar from keeping my foot from touching the floor when on my crutches. (I fell on the bathroom floor last night. My leg was unaffected, but I tried stopping the fall with my hands and messed up my left palm even further.) This too will pass.

MEDICATION

I thought I'd be off medication by now, but I still need medication to be able to sleep without pain. Midweek I decided that I was in so much discomfort during the day that I would take my medication even during the day if I'm in pain. ;o(

SITTING

I still can not sit upright with my foot propped. I have to sit reclined back with my foot up to be in comfort. (Standing makes my foot swell!)

CAST

Midweek I reached my limit. The pressure the cast was putting on both my bunionectomies was too much to bear (either side of my foot). I got a pair of wire cutters and cut the cast away so those incisions had the room needed to be comfortable. It took a bit of the pressure off.  ;o)

DISABILITY

Even though my surgeon gave a 'return to work' date that is 12 weeks from surgery, Disability seems to not want to just approve that. Their actions so far is to give me approvals in small increments. I originally had 4 weeks approved, and this week when I called they approved another 2 weeks. That's 6 weeks total. Why not just approve the full 12 weeks? I dunno. Whatever.

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! ;-)