A "Routine" Day

On Monday (June 17) my last foot surgery was scheduled to begin at 12:30 and we were expected at Emanuel Hospital at 10:30 a.m. The original surgery in January was a long day-surgery. And unlike the March ordeal, 5 days in Emanuel's burn unit, this was to be a short day-surgery to flatten the transplant on my foot. Yay!

I started the day early, throwing in laundry, cleaning up the kitchen and fridge, and attempted to finish sewing a quilt top. I planned to fit in a bicycle ride before heading to the hospital at 10, because I didn't know when exercise would be possible again.

Emanuel Hospital called at 8:30 to say they needed me an hour earlier. I was willing to neglect the rest of my chores, but was not about to give up my bike ride, so off I went. It was a cool refreshing morning for a ride, and after a quick shower, we were off to Emanuel only 10 minutes late.

And then we waited. We could have used the hour to finish chores at home, but oh well. I was very relaxed and actually looking forward to this last step towards leading a normal life again. It was amusing to see the same staff on hand as was there for my March surgery. You don't ever want to be on a first name basis with your local hospital staff.

waiting, and waiting, and waiting . . .

The surgery was short and sweet. I took a restful nap in the recovery room. We were home by 3:30. I walked into the house on my own with little pain. Super nice to not have to use those awkward killer crutches! Craig, Daniel and I got dinner on, then I folded and put away the neglected laundry, then sat down to watch Far From the Madding Crowd via Netflix. I re-read the book earlier this year but had never seen the movie.

So Monday turned out to be a rather routine day of chores, with a little surgery thrown in. The best news is that today, day after surgery, I got in an hour of yard-work, and then a bike ride!  Normal life is a great blessing.


NOTE: There are a couple of photos below of my foot before Monday's surgery; don't scroll down unless you want to see them.  There are none yet of post-surgery because I can't remove the bandage for 5 days.

Bunion Surgery and Surgical-Site Infection: Aftermath

This recent bunion surgery and reconstructive surgeries educated me in the miracles of modern medicine--what a great time to be alive. American health care gets a bad rap at times, but I wouldn't want to live at another time or in another place. And medical insurance. I feel for those who don't have access to it. It has brought great peace knowing that whatever needed to be done to fix my problem, could be done, because insurance would provide. I'm grateful for priesthood blessings that promised me healing and peace. And for all the kind and helpful people who stepped up during this crisis--visiting teachers, ward members, family members, neighbors. Just one example of going above and beyond is my 90-year-old friend A, who carried a pot of delicious homemade soup up my 8 front steps and into my house, then came back the next day to fetch the pot, and brought a plate of treats.  Emily was there when I needed her.  Craig took over all my home duties, my care, drove me to just about every appointment, hung out at the hospital with me, cooked, shopped, cleaned, etc. etc. Thanks to everyone. I strive to be like all of you.

The Wound Clinic, or, "Where the Angels Work"

Who knew there is a such a place as a wound clinic?  For a month I was treated here 2x per week.   The staff here was so concerned and friendly.  C was my specially trained nurse and expert in wound care. On every visit though, the other staff would at the very least, open the door to my room to say hi, how ya doin'. They often came in to look at the progress of my wound, and even though it might look ghastly to a non-medical person, they always marveled and exclaimed at how much progress in healing had occurred since the previous visit.  S always photographed my foot to chart the progress. They were all upbeat and kind.

One day while I was being treated I heard a bell ring--a hand-held dinner bell type of sound--and the nurse excused herself for a minute. She later told me that the bell signified that a long-time patient was on his/her last visit, and was "graduating." The whole staff assembled to say good bye and wish them well. You can imagine the horrendous wounds (burns especially) the staff treats, and patients become part of the "family" there.

One day I showed up (no appointment) just to slip in to pick up a pressure sock, and the nurses decided they should look at my wound as long as I was there. They accommodated me in a room and located the doc so he too could take a look too. I think this place works like the parable of the loaves and fishes. There's always enough people, enough time, enough rooms, to take care of the wounded; they expand to meet the needs of the patients.

C is a proficient, kind and compassionate care-giver. My foot and leg were bandaged up to the knee, so I couldn't ever shave that prickly leg. One day I brought my razor in to use when my leg was in a state of un-wrap. C took the razor and shaved it for me. And then, and each time, coated my leg with vaseline to keep it more comfortable under the wrap. Every dressing change took about an hour and she was never in a hurry. She carefully removed the excess skin around the wound, then washed my whole foot, every time. Then she figured out the best configuration of gauze pads to absorb the fluids. At times I got teary over the gentle care that was given. These women are angels with a gift to minister to the suffering.

Happy times at Butchart Gardens, Victoria Canada, May 10, 2013
I'm mostly healed and walking!

Bunion Surgery and Recovery 2013 (Part 2) AKA: My Pound of Flesh

My Pound of Flesh

Last weekend was the 4-month mark since my bunion surgery.  To celebrate, I went on a 3.5 mile city walk with a group of friends, and also rode my bike up to and around my son's neighborhood about 3 miles away.  These were fulfilling victories!  Why did it take 4 months to be able to do those simple physical activities?   Well, on January 25 I gave up my life of activity,  exercise, and service, and embraced the life of an invalid, though I anticipated that role to last only 6 weeks.  But Shylock demanded his pound of flesh, and I gave it up.  Literally.  And willingly, to save my foot.   Thus the extra long recovery.

Continuing from Part 1 of this story:

[NOTE: I have included some icky photographs of the wound at the end of the post.  After the last part of the text there will be a gap, then the photos.  That way you can look at them only if you want to.]

The plan for reconstructive surgery was in 2 parts:  first, to clean out the mess of infection in my foot and plant some antibiotic granules in the cavity.  Second, two days later the doc would take a hunk of tissue out of my arm  to fill in the cavity in my foot.  That would be watched for 3 days, then I could probably go home.  So, Monday morning, March 18, this ordeal began in Emanuel Hospital's burn unit,  the best place to treat a bad case of tissue damage.  Coming out of surgery I was surprised and grateful to find that the doctor had done both steps in the one surgery--yes!!  It had taken maybe 5 or 6 hours.  Using a high powered magnifier he tied the blood vessels from the transplanted tissue into the foot blood vessels.

I was in the ICU and awakened about every 15 minutes by a nurse w/ a probe.  He or she put the probe into the wound in my foot to test the blood flow.  Sometimes it was hard to find, and it sure wasn't pleasant having that probe rooting around in my raw flesh.  But during every single probe I made sure that I too could hear the whoosh of the blood flow, it was that important to me to know the transplant had worked.  After a while the probe went to every half hour and after a couple of days it was down to every hour.

fun times in the ICU

No one likes a hospital stay, and this one was tough for me.  Tubes and lines were hooked everywhere, and the catheter prevented me from changing positions in the bed.  I had almost no appetite the entire week; just the thought of food was nauseating.  There was an odd smell in there that made me more nauseous as the week went on.  I never figured out what it was.  After 5 days of it I finally barfed.

As for my foot, the first time the doc unwrapped it I was appalled at seeing this ghastly mound of ragged flesh perched on top of my foot, only held down by a couple of stitches.  The piece of flesh taken from my arm was about 7" long, 1.5" wide, 1" thick.  And there it was in all its giganticness.  It was not stitched down until just before I went home, because the doc had to make sure the transplant was successful first.   Pain was controlled by a spinal, and various antibiotics were streaming through an IV 24/7.  36 hours after the surgery a picc line was put in my right arm in preparation for home use.

Besides Dr. V, the plastic surgeon, Dr. C. and some of his staff of infectious disease specialists became my new best friends.  Resident physicians also made the rounds.  One of them told me a story about a friend who was paralyzed in an accident, and found that by accepting his limitations and finding new and tame activities, he was enjoying his life.  I just stared at him and he went on to talk about other things.  When he stopped in again later, I asked if he had been trying to tell me something.  He had.  And thankfully he was wrong.

Near the end of the hospital stay the physical therapists came in to help me start walking with crutches.  Amazing, all the effort it took to get out of bed just to move to a chair next to the bed.  The bathroom was the next frontier.  Then a walk down the hall which might as well have been the Oregon Trail.

That Friday Doc V stitched down the rest of the tissue transplant.  I am deeply grateful that it "took."  Modern medicine is full of miracles.  Doc pronounced me ready to go home Friday afternoon.

For the next 4 weeks I daily infused antibiotics (ertepennum) at home via a picc line, under the instruction of a home nurse, with Craig doing the hookup.    Every other day my foot had to be re-bandaged.  That was an ordeal as it involved:

a precise, methodical cleaning, including stripping off excess flesh
placement of Xeroform (a petroleum-pregnated patch of gauze) on the wound
layers and layers of thick pads strategically placed
yards of gauze bandage wrapped to hold all that together
tape to keep the entire thing stable
eventually a pressure sock was added to the above

And twice a week I visited the "wound clinic" which I'll post about tomorrow (and it will be the last post on this).

As of right now I really don't need a bandage, just padding to protect the top of my foot.  In June I'll have surgery to reduce the size, so that I can wear regular shoes again.

 Icky photos below

Day after surgery: my borrowed pound of flesh partly covered by a Xeroform gauze.  The purple X was made by the doc when that chunk of flesh was part of my arm; it designated the donor site

a few days later without the bandage, and this time it is stitched down

side view of the transplant

the donor site on my upper arm; I generously offered a big chunk of flab from my belly but the doc declined it

about 3 weeks after surgery; it really is healing!

a month after surgery, looking great

2 months after surgery, edges completely healed; this is a weird photo--it isn't really red and this wide, that's just poor lighting

2 months after surgery, side view

Bunion Surgery and Recovery 2013 (Part 1)

A bunion is a debilitating and painful deformity in the foot, as seen above

At the end of January 2013 I had an elective bunion surgery on my left foot; the right one had been satisfactorily fixed just over 3 years previously, and it had taken me this long to store up the guts to do the other foot.  Surgery is always risky and I debated back and forth about the wisdom of doing it.   After all, I could walk and run and ride my bike the way my foot was.  The old adage, "if it ain't broke, don't fix it" came to mind.  But it was "broke."   I hike and x-c ski regularly, and I call it "broke" when I have to pad my foot with layer upon layer of foam and moleskin and duct tape every single time I set off on an adventure.  And still suffer unpleasant pain.

This operation was less painful and healed faster than the previous one.  The internal hardware had improved since my last surgery, according to Doc T, and the pin in my second toe was internal, rather than external.  The stitching was underneath the skin which was more pleasant and attractive.  I went off the pain medicine after just a few weeks this time.  Even though Doc T said to wait 6 weeks before putting weight on the foot, I began at about the 4 week point putting my foot on the floor to get it used to a little bit of weight.  It was exciting to anticipate a return to normal fairly quickly.

I should mention the scooter here.  After my first bunion surgery I was on crutches for 11 weeks; what an uncomfortable dangerous time (I fell twice).  This time we rented a knee-scooter and what a joyous life-saver that was.  I could get around fast and have a little fun while doing it!   Best of all it's much safer than crutches.

[NOTE: these first 4 photos are innocuous.  Below them is more text.   Then there will be a 4" blank area to  protect those who don't want to see an unpleasant photo.  That will follow after the space]

The hardware in my newly repaired foot

All bandaged up

This is the life!  NOT

Me, my scooter, and Lil' Buddy, 3 weeks after surgery

On the down side, I got what the doc calls a fracture blister on my foot, which is basically a hematoma.  During my recovery that thing was always weepy and messy.  As my foot healed an ugly black scab formed on the top on both sides of the incision.  Doc T didn't seem worried about it.  Just over 6 weeks after the surgery we left town for a family reunion.   At my doc appointment the day before the trip he thought everything looked ok, though the surface healing was slow.  The bones had knit together as they should.

During our trip I kept my foot under wraps, because that black scab was very ugly.  And it began to smell off.  And then the incision seemed to be pulling apart, yes, my foot was unhealing.  Yikes.   I thought about going to the ER, but instead made an appointment w/ Doc T for the morning after our arrival home.

He took a look and alarmed the heck out of me when he said that I may need to see a plastic surgeon.  He carefully removed the black scab and we were all appalled to see the tissue beneath had deteriorated, and I was looking at the inside of my foot; the tendon was exposed.  A surgical-site infection had severely damaged the tissue in my foot. So by the time I left the office that day the plastic surgeon's office had been alerted and Doc T's notes had been faxed over.  I knew then I was facing a mammoth problem.  Even more so when the plastic surgeon's office got me right in that afternoon.   How often does that happen?  Surgery was scheduled for a few days hence, with a followup surgery 2 days after that; all in all the plastic surgeon expected me to be in hospital for 5 days.

My head was spinning.  And I was in shock.  And afraid.  I called my friend S for consolation; she was rationally optimistic which helped immensely.

Part 2 tomorrow: My Pound of Flesh

[BLANK SPACE, then 1 more photo]

4 weeks after the surgery; the bones were healing well, the incision was not

My Victory Over Radical Bunion Surgery—the Final Chapter

About a month after my radical bunion surgery on November 20, 2009, my foot was still painful and very swollen, and losing the crutches was in the distant future. Yet I made a goal then to hike demanding Dog Mountain at the end of May, something we do most years during wildflower season. It was an aggressive target yet I knew that having a reward to work towards would do wonders for the rate of my recovery. At the same time my friend Carolyn and I began making plans to climb mighty Mt. St. Helens the end of August. That was one trek I was aware might be too far a reach.

Nine weeks after surgery I drove a car for the first time and a couple of weeks later put the crutches away. And I quit using the wheelchairs at the grocery store. Limping was part of my life for three or four more months and that gradually diminished. I kept up some of the PT exercises and foot massage until mid-summer, and in May and June went to acupuncture to speed healing. Even now the ball of my foot is still puffy and the second toe is still stiff. It may always be that way.

On June 4th, I achieved my first goal of climbing Dog Mountain!  Read about that here.

And la-di-dah, on 2 Sep I slaved my way up Mt. St. Helens as if I had not had bunion surgery nine months earlier!!  That climb is tough for me even in the best circumstances and it was an even greater victory because of the hard months of work and care it represented!

reaching the summit of Mt. St. Helens

Katy, Carolyn, me, Tim at the summit

Ups & Downs of Bunion Surgery

My Mom had her first bunion surgery when I was in about the 6th grade (1966). She had been in misery foot-wise for decades. I remember her struggle with those old-fashioned wooden crutches and the hideousness of her feet with their new set of personal railroad tracks. My strongest memory though is the way she guarded her feet like they were Fort Knox. Whether she was walking or sitting we kids could only get so close before she shooed us away. Apparently the pain was so extreme that she couldn't tolerate the thought of her feet being stepped on by her little darlins, even after a few months had passed. 

So, I swore I'd never do bunion surgery, never go under the knife for the sake of painful bunions. Over the years mine enlarged and I discovered new ways to lesson the misery of being on my feet. Sensible nannie shoes, when I could find them, were a lifesaver. Until that didn't work anymore. When my bunions progressed I started stretching the nannie shoes to fit, and then when they got bigger I put layers of cushioned bandaids and moleskin and even foam padding over the bunions.  When that was no longer enough, I looked into the very surgery I once resolved never to have.

And here I am 8 weeks post-radical bunion surgery. It's been a slow, sometimes tough recovery, marked by milestones of relief. After two weeks the pain went from all-consuming to very manageable. On Christmas Eve, the most special gift was taking my first shower in five weeks. Sitting in a camp chair while the hot water ran over me was heavenly.

At the almost seven-week point I hit bottom. My foot was swelling badly from edema so walking without crutches was not even on the radar. Finally the doc recommended physical therapy and I broke down in the PT's office. Then I came home and promptly tumbled down the stairs. Thinking I had broken my healing foot, I laid at the bottom wailing in my own personal pity party. 

Diligently employing physical therapy has been the greatest thing though. To know I have the power to help my foot helps me see the end of the road. The PT gave me a pressure sock that fits tightly on my foot and it feels wonderful while holding down the swelling. I have labored diligently in PT even though some of the exercises give me the willies (like massaging the scar tissue--hard). On Thursday I experienced the most wonderful thing--she showed me how to make my right foot take walking steps again. And now I can put weight on that foot and even stand without crutches for a while. My foot looks more normal instead of like an inflated balloon, and on Thursday I was able to put a shoe on it for the first time in two months.

But you know the biggest plus of all?  That ugly knobby painful bunion is gone forever!

Recovery

Guess I’ll just write an update about the surgery since I went to the first follow-up doc visit today. The pain has diminished a lot in the last 24 hours and it’s good to not be taking much medicine because it makes me so spacey and I forget what day it is and whether my dreams were real events or figments of my imagination.

On the x-ray today the screw, staples and straightening of the bone look real good. There’s also a very long pin in the foot that will be removed next week. The doc changed the dressing. Stitches come out next week. I’ve still been spending most of the time lying in bed reading, because if I’m up for too long the foot throbs uncomfortably. But being up for two hours for the doc appointment was just fine so I expect to be upright (at least sitting) more often now. Thanks to everyone for your positive thoughts and prayers.

Check out the photo of my foot (w/out the air cast on). That’s a self-portrait of the foot doctor wearing a Santa hat.

Happy Thanksgiving!

A Room Without A View

This has been my view for the last 48 hours. And will be for more to come. A year ago this week we had our entire family here together save one, for TG. This year the Palmers are vacationing in Boston and the Conders in North Dakota!

That's it for today.