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.

 

 

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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

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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’.

 

7 weeks complete

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7 weeks complete

Hello all!

This past week I had my seven week check-up with my surgeon. I was beyond excited to get my cast taken off and get into a walking boot.

I went through the normal process of getting the cast cut off and getting x-rays taken without putting any weight on my foot. My surgeon took his time to analyze the x-rays before making a decision about when I could put weight on my foot. The bone is healing, but at a slower rate than we would have liked. The x-rays changed only slightly since we last had taken them. The bone healing is not optimal and my surgeon wants to see how things progress in 3 weeks. A slight delay in being able to put weight on my foot, but we have to make sure it is completely healed.

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The last cast!!

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Image on the left is the most recent (8/30/17) and the image on the right is from (8/17/17). The latest x-ray shows a slight improvement on the left side of the implant. The area I circled shows a small amount of bone curving inward making the implant more stable. 

In the mean time I can start to move my foot with some passive range of motion for plantar flexion and dorsiflexion. It’s typical to experience some pain and swelling with this exercise due to having my foot immobilized for so long. I just ice my foot after doing it.

It felt amazing to clean up my leg and foot. Here are some pictures just to show how much dead skin accumulates over 7 weeks in a cast. I also couldn’t help myself and itched/removed as much dead skin on my foot that I could reach with the cast still on.

Back in June when I went to a podiatry conference I remember hearing about a device that helps stimulate bone growth. I wasn’t sure if this device would be useful for this application, but I figured I would mention it to my surgeon. He took some time to think about this suggestion and admitted he hadn’t thought about using this device for my case. In the end, he thought it was a great idea to look into getting the device covered by my insurance. I am fortunate to report my health insurance is going to cover the bone stimulator in FULL (that rarely happens). I am meeting the representative for the device on Wednesday to go over how it all works and how often to use it.

On a completely different note I had a very eventful Friday night. I was experiencing some calf pain, which is a symptom of a deep vein thrombosis (DVT) or blood clot. I wasn’t sure if it was just muscle soreness or if I should be concerned about it. The more I read about the symptoms of DVT online, the more concerned I became. Ultimately, I decided it was best to call my surgeon and see what he had to say about it. The pain was about 4 out of 10 and the site of pain was hotter than the rest of my leg. My surgeon said that I was obligated to get this checked out. Since, I live in Western Massachusetts the local hospitals would not have been able to perform an ultrasound that night. My surgeon recommended I drive out to Worcester and go to St. Vincent’s Hospital, where they would be able to diagnosis a DVT that night.

My mom and I left the house at 7 pm and arrived at the emergency room shortly after 8 pm. Thankfully, the staff took me right in and started the work-up. I got my blood drawn for a test that checks for a protein called D-dimer. If the body is trying to break up a blood clot there will be D-dimer present and is the best indicator of a blood clot. I waited for a little while for the doctor to come in to perform an ultrasound. The ultrasound was to examine the femoral artery/saphenous vein and the popliteal artery and vein. Not only were the arteries and veins visualized, but the blood flow was examined. The ultrasound came back negative of a blood clot and so we waited for the blood test results. Less than an hour later we got the news that my D-dimer was negative. HALLELUJAH! The ER doctor discharged me and told me I am still at risk of getting a DVT due to not being able to walk. However, I will follow-up with my surgeon about it and will monitor the calf pain. We arrived back home around 11:30 pm and were grateful it was such a short trip to the ER.

This weekend I have been feeling like I might be coming down with a cold. I have had a sore throat and body aches. I also just have been feeling physically run down. So, I have listened to my body and haven’t done much besides rest. It hasn’t helped that since I have gotten into the walking boot my sleep has regressed. My foot has been more painful at night and the boot is rather clunky to sleep with. I am sure that I will get used to sleeping with it, but for now I will try a sleeping medication. I don’t want to become too sleep deprived because I know I get more emotional/have a harder time staying positive about my situation.

Stay tuned for my next update on the bone stimulator!

The healing continues

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The healing continues

Hello everyone!

Another successful appointment with my surgeon is in the books.

I was a bit more nervous for this check-in because I had a slight incident a few weeks ago. It was super minor, but one of my crutches started to slip out from under me so I reflexively put my foot down. I didn’t really put weight on it because as soon as I realized it had hit the floor I picked it up again. Thankfully, I didn’t get any pain from it and my surgeon reassured me at the appointment that it should be fine. New x-rays were taken and was reassured everything is fine.

My surgeon is great at what he does! He explained the x-ray thoroughly and why it makes the most sense to put another hard cast on before I transition into a walking boot. My calcaneal bone is starting to grow into the implant, but on only one side. The plan is to give my foot another two weeks in the hard cast and to be certain that the other side of the implant is flush with bone before we take any risks.

Once I have the boot I still will not be able to put weight on the foot, but in one to two weeks I can. The benefit of having the walking boot is to begin regaining range of motion in the ankle. I personally can’t wait to wash, clean and shave my leg. Oh and not to mention being able to itch every itch.

On a side note: I particularly like this quote I found for this post. It is easy to look at social media and see friends out exploring this summer, but the most important thing for my health right now is to accept were I am in my life. Not only accept it, but embrace what each day has to offer and to enjoy what I am able to do. I am also not wishing the days to go by, but I am grateful that they do seem to be going by quickly.

19 days and counting

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19 days and counting

I am doing amazingly well considering that I am nearing the three week mark. I continue to have no extreme pain and the only discomfort I have encountered is when I have my foot less elevated than I should.

I saw my surgeon last week to remove the sutures and to check on the healing process. He decided to take x-rays just to monitor the implant placement. Everything looks great and the implant is still in the original placement from surgery. The sutures were removed and the incision is healing well. As time goes on the swelling will continue to decrease. The only complaint that I have is my leg and foot gets itchy from time to time. It’s part of the recovery process and it is just something you have to endure.

Oh, I opted for a glow-in-the-dark cast this time. And yes it does actually glow-in-the-dark. I like how you can use different colored markers to decorate the cast.

Another milestone that I have reached is the completion of administering Lovenox. Lovenox is a self-administered injection that decreases the risk of developing a deep vein thrombosis (DVT = a blood clot in your leg). Individuals that have decreased mobility are at an increased risk for developing a DVT. I have done this injection before and thankfully don’t have any problem with needles.

Now that my pain and sleep has stabilized I am able to get back into studying for the MCAT. The MCAT is an admissions test to get accepted into medical school. It has been my dream to become a doctor as far back as I can remember. More specifically I have wanted to be a podiatrist ever since I started having issues with my feet. Studying for this test is a daunting task, but it does give me a purpose while I recover.

Some insights I have for those having foot surgery:

  1. If I’m going on long car rides I find it best to lay down in the back seat of our truck to provide optimal elevation for my foot. The car is fine for short rides, but make sure you still have it elevated on multiple pillows.
  2. When you are elevating your foot with multiple pillows: make a pillow burrito. Essentially, take a sheet and wrap it around all of the pillows so that they don’t shift as easily when you move around.
  3. Avoid lumpy hard pillows. You wouldn’t think it would make much difference when you have a hard cast, but it does.
  4. Don’t be surprised if your digestive system is upset after taking pain killers.
  5. Most importantly, Stay Positive! There will be days when it is difficult to smile and have a positive outlook, but do something each day that makes you happy. It is just something to apply to everyday life as well.