Round Three – Third Foot Surgery in 3 years in May

There must me something about the month of May, this year will mark the third year in a row I’ve headed into hospital and under the surgeons’ knife.

This will be my second hospital admission this year and 8th in 4 years.

So I’ve skipped a lot of updates so let me fill in some blanks.

In May 2012 I had both the sesamoid bones in my right foot removed as they were very badly inflamed. What I didn’t quite realise at the time is the way the bones have to be removed they essentially destroy a large part of the structure around the ball of you foot.

In my case I also had a significant bone spur in the big toe. What was meant to be a straight forward surgery wasn’t.

I had the surprise of having to wear a post OP shoe for 6 weeks which meant anytime my operated foot was on the ground it had to be in the specialist shoe.

It’s not a nice looking shoe and the sole is rigid to stop any flexing of the foot. Which is fine, but it altered my ability to walk so badly I elected to wear two so I had some chance of walking evenly.

Things weren’t going well and I attended the foot and ankle clinic for “complex cases” it’s the place where the primary practitioners meet and review your case. It’s a room full of about 10 people Physio’s, Podiatrist’s and surgical interns, chaired by my specialist food and ankle surgeon. Think of an episode of House M.D. but the patient is there too.

Attended this clinic twice and both times the suggestion was to modify my already specialist rocker bottom shoe to be more like a moon boot and off load pressure off the ball of my foot and what is known as the 1st MTPJ.

Rocker shoes off load the forefoot and as a result the wear on them is quite different. Normally shoes last me a couple of years, right now they are lasting only a few months. It’s hard because the shoes to start with are around the $250 mark and then require a further modification which is around $100.

Anyhow I reached the 10 month post OP mark and I couldn’t cope with the pain and discomfort anymore. I headed back to my surgeon to review my options.

My surgeon told me initially that I’d make a full recovery from the sesamoidectomy, but it was obvious this wasn’t the case. In the foot and ankle clinic my surgeon said his approach would be to fuse the toe. I was and am still not convinced that was the way to go.

When I apply pressure to the toe/foot I get a pain response, it’s not as bad as it was, but it means I often limp or alter the way I walk. This isn’t a good thing, it impacts my ability to do virtually anything physical. The simple task of going for a walk around the block or the beach or even getting down to the floor isn’t good.

In trying to off load pressure on one foot I managed to sprain the ankle on my other foot several times and in the end resorted to wearing an ankle brace on “the good ankle”

The surgeon wanted to fuse my toe and I wanted that to be the absolute last resort surgery (surgery is and always will be a last resort)

I said to the surgeon that it felt like a tendon or something was grabbing when I was flexing my toe. The surgeon said this could be a number of things and it warranted investigation. However he warned me that there was a good chance that if this came up blank a formal fusion of the joint was the way to go. I mentioned the above to my GP and he could see both my point and that of the surgeon.

My GP did make the point that my situation was like someone that needed a knee replacement but kept putting it off and getting a scope (clean out done) I pointed out that a knee replacement had a clear result where fusion of my toe was still an unknown. I was happy to hear my GP make the comment that if he were in my situation he would have done the same.

So anyway my surgeon agreed that a clean out and investigation on the restriction/painful movement was warranted.

I was sad that I had no choice but to head to surgery again, but the impact on my daily life was taking its toll. I’ve been very lucky with work they have been very understanding and supportive where they can.

So I approached work and we worked out that I would take a decent block of time off to get on top of my situation.

My last surgery was horrific, I like to think I have fairly high pain tolerance but last year I suffered both severe and sudden pain when my nerve block wore off within 10 hours of surgery then a heavy fall at home on the day of discharge didn’t help.

I knew this time around things had to be different, I can’t keep having surgery upon surgery and I need my health to be stable.

There are times when you have to trust the experts in your medical team and there are times you have to challenge then. The trick is getting the balance right, there is a time to shut up and do as your told and a time to question.

I questioned the surgeon, the next person I had to question was the anaesthetist. Last year I went into shock in hospital and the resulting mental fall out took me months to get over.

My surgeon asked for a pre surgery phone consult to take place, sadly this only occurred the day before surgery. Thankfully as it turns out the anaesthetist I had this year was the same as last year, which meant they had all my medical records and could review what was done last year.

Having three foot surgeries in as many years means you get used the challenges you face Post OP. I’ve done mountains of research and learnt from my past two experiences what to do.

It was weird heading into hospital the day of surgery as it didn’t feel anything strange or different, a little all to familiar for my liking. I had made a checklist and it was complete. I remember laying in my hospital bed in the few hours I had before I headed to theatre thinking I’d missed something very obviously. Sadly the more often you do something like this the more easily prepared you can be. I hadn’t missed anything, I just instinctively knew what had to be done.

In the past I have been very nervous around the admission and pre surgery process. This time I was at peace with the process. I’d been watching a couple of medical dramas on TV to both desensitise me and also remind myself that things weren’t that bad. Plus I had some new support in ways I’ve not experienced before that helped me consolidate and accept where I was at.

When I was wheeled down to the waiting area I actually told the anaesthetist that I was happy to be a wake when going into theatre (I had asked for a pre-med which the anaesthetist wasn’t keen to do) I agreed to forego the premed on the understanding that I would be asleep before entering theatre.

It turns out the type of nerve block I had it is safest for me to be asleep when its done.

My surgery was booked for what I’d consider early to – mid afternoon, which in the end meant I missed having a major evening meal, the theatre area was a lot quieter and not the rush it was on previously occasions. So much so day surgery patients were being discharged as I was being admitted.

So I had my pre surgery consult with my surgeon and anaesthetist and everything was in place.

I went off to sleep without issue and woke up without concern.

Surgery had gone well, better than expected and I will write more on that in the future.

One thing I love about Sportsmed Hopsital is you are taken down in your ward bead and met in recovery by your ward nurse. This nurse will be on afternoon shift and with you until 10pm.

Back on the ward I discovered some flowers had arrived. I had a call from a florist before going to theatre querying which hospital I was in which spoilt the surprise a bit, but what had me curious was who the sender was.

I was only scheduled to be in hospital overnight so it really had me thinking. I was both surprised and delighted to read the enclosed card. The flowers were from the Physio practice I have worked with.

I can’t being to explain what I felt when I realised they had the sense of mind and thought to send through some flowers to cheer me up. I’ve really struggled with my foot problems and the pressure of work and home life and getting everything ready for me to go into hospital was getting on top of me.

It really is an outstanding example of the care and compassion of my medical team, especially the team of people at my Physio.

Apart from my foot issues I have other health issues as well and Sportsmed have had some problems with similar patients in recent times. As a result I had to be very closely monitored, well above and beyond the hourly post OP obs.

The nurse who was looking after me apologised for how intrusive some of this was, but I said that I knew that she was just doing her job and I in turn had to be a compliant patient.

In the end I ended up on oxygen, a pulse and oxygen saturation probe, BP cuff constantly attached and 3 lead ECG. Plus I had a drip in until midnight.

At the end of the day as annoying as some of that was, particularly when trying to turn over they had my best interests at hand and that’s all you can hope for.

The nursing staff were amazing, the afternoon shift nurse gave me a quick wash when I was back on the ward and made me comfortable.

I was on hourly obs until 11pm then I had IV fluid removal at Midnight then OBS a 2am then anti-biotic injection at 3am then OBS at 6am.

It was just after midnight I had to almost pinch myself to check that this was all real. So far it was so good, I wasn’t in any real pain and things had all gone like clock work. My concern was being able to rest overnight.

My nurse came in at 2am and I was sort of awake, he apologised for waking me and introduced himself and went about his job. I decided I wasn’t going to try and sleep for the hour between and stayed awake. Due to the monitoring I had to have my door open so I had to keep things quiet as I wanted to make sure I didn’t disturb anyone else.

At 3am the nurse came back and I mentioned that I was hungry, I was offered sandwiches and a hot drink,
I gladly accepted.

The nurse who is the first male nurse to care for me as an inpatient did an amazing job and I made sure I let him know.

I was visited by my surgeon around 7:15am and I had a list of questions already for him with some new ones.

That went really well then it was time to tuck into breakfast my first real meal in about a day and a half.

Then it was a matter of waiting for the hospital Physio to attend to talk to me and get me out of bed. Until he arrived I’d be restricted to bed post OP.

To my surprise I was encouraged to walk full weight bearing on my operated foot, even though it was completely numb. Now it’s one thing to have pins and needles and a loss of sensation when you foot “goes to sleep” but I had no feeling in my lower leg, no sensation, no feedback, nothing.

The only saving grace is I have to wear a moon boot anytime my foot is on the ground, so I had to have help to put my foot in the boot as I could not feel where it was. The boot does a lot of normal range of movement for you and takes pressure off the forefoot.

Once we got that on I was brought up into sitting which caused me to feel light headed. We paused as I had an injection which was well timed as by the time the nurse was done it was time to get me up.

I was surprised that I was encouraged to just have the Physio on his own for support, no nurse back-up or crutches. I explained I had a real fear of falling but I took him at his word that I could do it and I did.

I was very unsure on my feet to start with, but I completed the test of a walk out of my room and up to the start of the nurses station and back.

It was then I had the task to shower and get ready for discharge. I had help to bag my foot, but apart from that I managed totally unaided.

Once I got dressed, it was only a few minutes then my nurse came in and advised me that my ride was here.

A quick ride home in what was a lovely warm sunny day and I was home, after spending the one night as planned in hospital.

The past week has been hard, I’m still lacking energy and the physical strain of my limited mobility greatly impacts on what I can do.

Thankfully the pain has been well managed and I have already begun reducing my pain killer usage.

I’m spending my days dosing and watching a fair bit of online content, Netflix has been really good.

Also I’ve finally managed to find a comfortable way to prop myself up in bed and elevate my leg so thus far I’ve managed to avoid a sore back!

As previously mentioned I am currently unable to walk barefoot at all on the operated foot which makes showering a seated experience and I’m holding on to my knee walker for the moment. Wearing the boot is causing significant discomfort not only from the bulk of the boot but also pressure against the incision.

Even with additional padding the discomfort is hard to tolerate. For the moment I’m spending most of my time laying down with my foot elevated with just the bandage on and using the knee walker to get around, therefore negating the use of the boot.

I can’t avoid the boot all together though.

I don’t see the surgery until two weeks post op and because of the driving and moon boot restriction I’m unable to start any form of meaningful rehab until the 4 week mark.

I’m still in the early stages of recovery and not up to doing a lot, over the next week I look forward to that gradually improving as the days go on.

What I know from previous experience is I need to do as I’m told (which I actually am doing) and to take it slowly.

My recovery is going to be a long and hard fort one and to achieve it I have to take it literally one step at a time.

But all things considered a week in, I’m doing well and it won’t be until I start rehab will I get an idea where things are headed. I’m focussed on the positive and that’s all that really matters.

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