Lucky Number Eight

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Lucky Number Eight

I took some time to recover from my surgery on March 9th and finally got the motivation to write this blog post.

Recap time!

Surgery Day: My surgery was scheduled in the morning, which I was oh so grateful for. I have to admit I was not extremely nervous and felt at peace with whatever the surgery would bring. I was feeling cautiously optimistic that I had a non-union. I remember waking up after the surgery and the first thing I asked was if it was a non-union. To my surprise my implant was a union (ultimately good news), but there were other issues that my surgeon found and addressed.

Once I got to my recovery room my surgeon came and waited to talk with my parents and I. Even though he wanted to wait to tell my parents, he honestly couldn’t wait to tell me first. The main goal of the surgery was to visualize the implant and to make sure that it was healed. After he confirmed that there was a union he decided to explore the peroneal tendons (a known area of my pain). He made the incision larger to visualize the tendons. Upon doing so he was able to see that there were four different issues.

1)  My surgeon found a rather large ganglion cyst in the joint space. A ganglion cyst is a fluid-filled sac that occurs in a joint or on a tendon sheath. He aspirated and excised the cyst to prevent it from reoccuring.

2) He found that I had hypertrophy of the peroneal tubercle (enlargement of the peroneal tubercle). The peroneal tubercle is located on the lateral aspect of the calceanous and is a bony projection that everyone has. My surgeon removed the excess bone. He observed that my peroneal tendons near the tubercle were thinning and would have torn if it was not addressed.

3) The next problem my surgeon found was a low-lying muscle belly of the peroneus brevis which he removed. There are two tendons that make up the peroneals: the peroneus brevis and the peroneus longus. A low-lying muscle belly is said to be a rare anomaly, but my surgeon said while it is rare it is seen.

4) The last issue my surgeon fixed was by releasing a tight peroneal tendon sheath.

My surgeon said that any one of these issues he found could have been causing my pain. My parents and I are hopeful that this will resolve the extreme pain that I was experiencing prior to the surgery.

The recovery process would start similarly to my other surgeries: non-weight bearing, take percocet for pain once the nerve block wore off and administering the Lovenox shots (anti-coagulent). I was not completely sure what the rest of the recovery would be, but firgured I would find out at my post-op appointments.

First post-op appointment: My surgeon removed the surgical dressing and examined the incision. He also evaluated my range of motion and had me do several resistive tests. I had only slight pain/discomfort with those tests. Considering that I was three days out from surgery he thought everything looked great. He wanted me to go into my boot, but to continue non-weight bearing. The purpose of having the walking boot was to be able to take it off and do some basic range of motion exercises. My surgeon stated that it was important to move the tendon to prevent the tendon from getting tight again.

Ellie

Ellie – my surgery mascot

Second post-op appointment: By this appointment I was approaching the two week mark and had regained some energy. I was getting around more on my crutches and was tolerating having my foot less elevated. At this appointment my surgeon was to remove the sutures and evalute my healing. He re-evaluated my range of motion and resisitive tests. This time I did not have any discomfort with them. One thing that I love about my surgeon is that he takes his time to assess and think things through. He did give me the okay to start putting weight on my foot. And in a few days I could get my foot wet.

Initially, putting weight on foot was a bit painful and I was very dependent on my crutches. I am now two and a half weeks out from surgery and can do some walking without my crutches. I am still keeping my foot elevated while I am sitting. Next week I get to slowly transition into my sneaker! My surgeon did tell me to not be surprised if I have to go back into the boot if I cannot tolerate the sneaker. This recovery process is progressing much faster than my other recoveries, which is quite refreshing.

Side note: Just because I have had eight surgeries does not mean that I am exempt from pushing myself too hard and having setbacks. A few days after getting permission to put weight on my foot I was feeling rather restless. I wanted to get out of the boot and into my sneaker. Yes, I knew that my foot wasn’t ready, but I was determined. I put my sneaker on and walked with my crutches for a few minutes. At the time it didn’t hurt, but the next three days I had more pain and discomfort with walking. Needless to say it was not worth pushing my foot to do something it wasn’t ready for.

If anyone has questions about my surgery and recovery please feel free to comment down below!

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Patience is a virtue – what it means to me

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Patience is a virtue – what it means to me

These last few years have been some of the most challenging as I have dealt with my foot reconstruction surgeries, but it has forced me to grow and develop as a person.  I have been thinking a lot lately about patience and the phrase “patience is a virture”. This phrase does resonate with me and helps describe this season of life I am in. Without patience my worries and expectations would completely consume my days. I do have moments like that, but that is absolutely normal and part of being human.

As part of my recent growth, I have realized I have to lower my expectations for what I can do physcially. I still view myself as fully able bodied, however, there is so many things at the moment that I cannot do. It is healthier for me to know my limitations and expect less from myself. I am not by any means saying I have mastered this skill, but I am getting better at it.

These last few months have been particularly challenging as my surgeon and I try to find out an explanation for my pain. In the beginning of December I got a CT scan that would hopefully give some insight on whether or not I had a nonunion (bone fails to fully heal).  It took some time to get my results due to my car accident and then because of a snow storm. I did finally get those results the first week of January. The CT scan indicated that bone on the medial side of the implant may not be fully healed. My surgeon was not convinced that the scan was entirely accurate and we decided to get updated x-rays before I left. The x-rays showed some slight changes that could also indicate a nonunion. We both agreed that the next step would be an MRI to see if that would give us anymore insight on whether or not I really do have a non-union.

I meet with my surgeon and went over the MRI results this week. Unfortuantely, the MRI was inconclusive and did not give us any information on other areas of my foot that are painful. My hope was that the MRI would provide a definitive answer and then we could figure out a plan of action. My surgeon and I both were able to decide a plan of action, but it still has some unknowns. My surgeon said that the amount of pain I am having everyday warrants exploratory surgery. This entails making an incision over the implant to be able to visualize the bone. If there is motion of the implant then it will be deemed a nonunion. In the case of a nonunion my surgeon will correct it by removing the implant and replacing it with a cadaver bone graft. To ensure that the bone heals correctly several pins will be placed. The recovery for this procedure will entail 10-12 weeks of non-weightbearing. If there is no motion of the implant than there is no nonunion and the bone has fully healed into/around the implant. The recovery for this would be 2-3 weeks to allow the incision to heal.

That was a lot of information to digest and I determined it was best to call my mom before making a decision for this surgery. We both agreed that this plan of action makes the most sense right now. I have complete confidence in my surgeon and I know that I am in the best hands possible. I am believing that whatever the outcome of this surgery I can handle it. This will be my eighth surgery and my record shows that I survived all of my previous surgeries.

My surgery is scheduled for March 9th and before that I will need my pre-operative physical at the hospital. In the meantime, I am planning on making the most of my February. I will have plenty of time to gather things from around the house to be prepared. At this point I feel like an expert at it. I wholeheartedly believe that despite the uncertainty that everything will work out.

I recently looked in our yard and saw my mom’s flower beds. During the winter months they are covered with snow and are barren. As spring approaches they will come back to life and blossom with a variety of different flowers. That is how I feel about my foot. My foot is currently in a dormant season, but it has the potential to blossom like the flower beds.

As always I will share this journey with all of you!

 

Begining of a New Year

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The end of 2017 definitely went out with a bang! I had some amazing opportunities and some hardships thrown in to spice things up as well.

Before Thanksgiving I had an incredible job opportunity to work as a part-time medical receptionist for a neurologist. I have been working three days a week and have been learning a lot about the medical field and how a medical office is run. I have a new appreciation for people that work with the public on a regular basis. Not to mention trying to deal with insurances.

Early December I was able to get my CT scan done in Worcester. I was not able to get my results until two weeks ago (more on that later). Before I got my results my family and I went on a vacation to Cancun, Mexico. It was amazing to get out of the cold Massachusetts weather and soak up the sun under some palm trees. My parents wanted to go on this vacation to celebrate their 30th wedding anniversary. As much as I enjoyed our vacation I had a hard time handling the amount of pain I was in from all of the walking at the resort. While my body was relaxing, I started showing symptoms of Strep throat and was able to start antibiotics while in Mexico. Despite having a “harder” time with my physical health I was still able to enjoy each day while we were on vacation.

As much as I enjoyed vacation to a tropical area there is literally no place like home especially when you are sick. I had several days to recoup before I had to go back to work. Unfortunately, my transition back to working was not as smooth as I anticipated. I got into a car accident on my way into work due to black ice. My car ended up totalled, but I only suffered some brusing and soreness from my seatbelt. I had to depend on my parents more those last few weeks of 2017, but we made it through everything.

At the end of the year I had some time to reflect on my goals and how I should proceed with my career. I have always dreamed of being a doctor and I do want to be a Podiatrist, but as the Rolling Stones sing “You can’t always get what you want”. I had to make the difficult decision that I cannot go to medical school if my foot is still holding me back. I cannot keep postponing my career. Now I am activating my Plan B career which is to apply to master’s programs for prosthetics and orthotics to become a certified pedorthist. I still get to be in a podiatry related field and my main career goal is to be able to help people. Podiatry school would have been a seven year committment, but to be a certified pedorthist it takes four years.

I don’t always share everything that goes on “behind the scenes” in my life on this blog, but I thought this was worth sharing. Life is messy more often than not. It is not our mission to take control of our lives, but to embrace each day as it comes. And when we do surrender control that is when we find peace in each day. And when life gets to be too much take some deep breaths and imagine yourself relaxing by the water!

 

 

 

 

Minor Setbacks

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WARNING: PICTURES WITH BLOOD IN POST!

Since the last time I wrote my left foot has taken some steps backwards. I would say I am a relatively positive and optomistic person, but I am feeling more frustrated and discouraged as of late. I decided I needed something to help create a positive association with my feet so I decided to get cute socks. Anyone that knows me personally knows that I love pandas and I needed some great panda socks!

My pain level has increased to a 5/10 most days, but can reach up to an 8/10. I went to one physical therapy appointment and did some basic exercises. The one exercise that triggered a significant amount of pain was the prostretch. After the appointment I was not able to do much walking (under 3000 steps daily). I also had to sit down while showering again due to the extra strain on my foot from standing for an extended period of time.

I went back and saw my surgeon to address an ingrown toenail that I had on my right foot. It was important to address the ingrown toenail before it got infected which could spread to the bone. If the bone becomes infected my previous foot reconstruction would be in jeopardy. The procedure is relatively straight forward and performed with a local anesthetic. Essentially, the toenail that has grown into the skin is removed and a chemical called phenol is used to prevent future nail growth.

Here are some pictures on my ingrown toenail surgery. It is a common procedure in the podiatry office.

While I was at my appointment I had the surgeon look at the left foot. He was not exactly sure what was going on, but he told me to discontinue physical therapy until I could come in again. He is thinking that it might be best to get a CT scan to see what exactly is going on with my foot.

I noticed that the pain in my left foot drastically increased after getting my ingrown toenail surgery. I realized after a few days that I was compensating for the pain I had in the right big toe. The one positive about the pain is that it is presenting differently than the pain I experienced before the latest operation. The pain I am experiencing is around the implant and the peroneal tendons, the calcaneal (heel) bone, the plantar fascia and below the hallux (big toe).

I was able to reschedule my appointment with my surgeon to get my left foot addressed sooner than later. With the uncertainty my mind races to what could be wrong, but nothing has been determined yet. I am also going to get my feet re-evaluated by a certified pedorthist to get new custom orthotics. I will be curious to see if getting new orthotics and sneakers will lower my pain level.

 

 

Entering my next phase of recovery

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confucius quote

Hi everyone!! It’s been a while since I last wrote a blog post. I wanted to make sure that I had made substantial progess before updating all of you.

I am walking entirely independently now! Meaning, I no longer use my walking boot and crutches to walk. Hallejuah! It took some time (approximately 2 weeks) and a lot of patience to be able to phase out of the boot. Initally the task of walking without any protection seemed daunting, but with my perserverance it was attainable. I am able to walk and stand for short stints of time and that will only increase the more strength I regain in my foot/leg.

I have been continuing to do bone stimulator and basic range of motion exercises at home. In addition, I have been using a recumbent bike a few times per week for about 2 – 5 minutes each session. I figure that even though it may seem insignificant to the amount of activity I want to be doing, this is a great place to start. Now that I can walk that also means that I am able to drive my car again. Let me tell you it feels great! While I wait on more progress with my foot I decided to get a gym membership to be able to take advantage of the weight machines. I will stick with doing upper body exercises until I start physical therapy and can get clearance for lower body exercises.

Speaking of physical therapy I have an evaluation appointment scheduled on Friday. It is wonderful to be able to start the next phase of the recovery process.

Oh and before I forget, I remeasured my calves and thigh muscles to determine if I gained any muscle. I have made a table that I can continue to update monthly for a true quantitative analysis. I decided to measure with centimeters instead of inches for the international audience.

measurements

Thanks for joining me on this journey!

 

 

Walking may commence now

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Guess what?! I can finally put weight on my foot!!

It has officially been a week since I saw my surgeon and got the okay to start putting weight on my foot. As usual I had x-rays taken and then examined to make sure that the bone was healing sufficiently. My surgeon seemed pleased with the progress. At this point I am still going to continue using the bone stimulator every day. There is no way to know for sure if the bone stimulator is helping, but it definitely is not hurting anything. (Update: The bone stimulator no longer causes pain after the treatment.)

9-19 xray

Latest x-ray from 9-19-17

Currently, I am working on slowly transitioning off of the crutches and out of the boot. I need to be in my sneaker and walking without difficulty before I can start physical therapy. Each day I am able to put more weight on my foot and am walking short distances without the crutches. It is a delicate balance between pushing my foot too much and not enough. I find that this stage in recovery is the most challenging. There is definitley more swelling and pain in my foot by the end of the day. When this happens I ice my foot and endure the pain.

While I wait to go to physical therapy I am doing my own exercises. Several times a day I take my foot out of the boot to do passive range of motion exercises. I work on moving my foot in circles, plantarflexion/dorsiflexion (toes pointed and flexed) and inversion/eversion (moving the foot in and out). As expected I have more difficulty with the inversion/eversion exercises. I am doing my best each day and trying not to get discouraged with my slow progress. Any progress is progress!

There are many activities that I am looking forward to doing in these coming months! Something as small as cleaning the house will bring such joy. I am fortunate to have a family that is incredibly supportive and patient through this recovery process. My mom got me a motivational bracelet that says “Nevertheless, She Persisted”.

MantraBand

To celebrate my progress we decided to go for a long weekend to Lake George, New York. Every summer growing up we would go camping at Lake George and the surrounding area has many memories. At this point camping is not possible with my foot, but staying in a hotel was still nice. We got to enjoy the mountain scenery and experience a hot air balloon festival. It was great to get out for the weekend with my family!

Don’t forget to find joy in each day!!

Lake George

Lake George, New York

LG balloon festival

Lake George Hot Air Balloon Festival

 

Time to stimulate bone growth

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Time to stimulate bone growth

As promised I have an update for everyone on using the bone stimulator as part of my treatment.

What is a bone stimulator? A bone stimulator is a device that sends a low-level ultrasound waves to a bone to promote healing. The ultrasound device is placed over the treatment site (in my case the surgical site). The ultrasound waves travel through soft tissue into the bone and triggers the bone remodeling process.

The device is not supposed to cause pain, but my experience is that an hour or two after the treatment I have pain around the implant. I did call my surgeon just to verify that the pain is due to an increase in circulation and healing. He said to not be concerned about the pain and that since I am experiencing pain it must be doing something to help. Of course, I ultimately do not want to be in pain, but I am willing to accept that it is part of the recovery process.

I have been doing my treatment a couple hours before I get ready for bed. I have realized after about a week it is not the best time to do the treatment. Since I am in pain several hours later I am going to bed with the worst of the pain. That means not sleeping very well. I have now been doing the treatment earlier in the afternoon to try and see if that helps with my sleep. I will admit that having moderate pain (5 out of 10) does effect my mood. How could it not? I just have to keep things in perspective and remember that the pain does go away by morning.

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Everything that comes in the Exogen ultrasound bone healing system

exogen 3

Device placed on treatment site

My surgeon and I also discussed that I was getting pain after doing my range of motion exercises. He determined it was safer to hold off on the exercises because he does not want the implant to shift. It makes sense that we want to heal the bone first and we can handle any stiffness that presents itself later on. This doesn’t mean I cannot move my foot I just don’t want to push the foot too much.

I had forgotten to tell you guys about a couple of things in my previous posts.

  • After my cast was taken off I wanted to measure the amount of atrophy sustained in the calf muscle. My left calf is a full 2.75 inches smaller in diameter than my right calf muscle. Just out of curiosity I measured my thigh muscle as well. My left thigh was 2 inches smaller than my right thigh. I figured that when I start walking and building back my strength in the left leg I can measure the muscles again to see my progress.
  • When I was using multiple pillows to elevate my left foot I had not thought of elevating my right foot also. By only elevating the one foot I was causing a misalignment of my hips, back and neck. I was getting a lot of pain in my neck and getting headaches almost every day. Thankfully, I saw a great massage therapist (my cousin) that noticed this issue and recommended elevating the other foot too.

These past few weeks after getting out of the cast have definitely been testing my patience. I am just feeling overwhelmed and frustrated, which are all acceptable emotions to be having at this point. I have recently found an Ah-mazing couple that do daily vlogs on Youtube as The Frey Life. Mary Frey has cystic fibrosis (CF), which is a genetic disease that effects the lungs and other internal organs. Even though Mary has this condition she has such a positive outlook on life. Two of her favorite quotes are ‘Do what you think you can’t do’ and ‘Don’t forget to laugh every day’.