Now for a departure from my previous NASCAR-related blogs. Something that has always cut into my enjoyment of attending a NASCAR race. Foot pain.
Passing the time, rain delay at Bristol Motor Speedway. Foot problems slow me down, but by the time I'm back here in August, I hope to be MUCH better.
My whole life I've had foot
pain. Genetics gave me large feet with bunions, hammer toes, and 20 years as a
nurse have exacerbated that pain. I had always been envious of people who could
run in bare feet over gravel...I could barely even walk on it. About a year
ago, I had noticed increased swelling in the ball of my foot, the second and
third toe started "going their own way", separating when I walk, and
throbbing/burning pain in the ball of my foot extending to my 3rd and fourth
(hammer toe) toes. Enough so that after a long shift with lots of walking,
aside from my bunion pain (which is much less than that pain, because at work I
wear New Balance walking shoes with a thick, firmer, less flexible footbed than
runners, and a good arch support, the Dr. Scholl's ones that you stand on the
machine at Walmart and it tells you which insole is right for you. I will be
getting orthotics soon, but I kept putting that off, as the arch supports I had
worked fine for arch pain.
A little pre-op fun, horseback riding at Douglas Lake Stables:
Surgery Day: Fixing what God messed
up on. Well, what he has tested me with, that is.
Anyway, yesterday, I underwent an Austin Bunionectomy (fixing the bunion at the
joint of my big toe), Tailor Bunionectomy (fixing the bunion that developed at
the joint at the base of my pinky toe), straightening and pinning of the 4th
toe (hammertoe, pin to be removed in a month...basically, he broke the toe, and
reset it into a more natural angle, not the crooked, sideways toe I've had most
of my life), and, if it is found to be the cause of the ball of the foot and toe pain I've been having, removal of the Morton's Neuroma that had been tentatively diagnosed (will be confirmed with surgery) in my right foot, by
my podiatrist, Dr. Kendall Ritchey.
It had reached the point
where I either had to bite the bullet and have surgery to fix the problems, or
find another line of work. Staff nurses,
we spend the better part of our shift walking...up and down halls, in and out
of patient rooms, to the cafeteria, etc. In emergencies, we run. People who have never
had foot pain, or who just get sore feet after a long day on their feet, can
not comprehend, not really, the pain people like me, with bunions and
hammertoes, live with every day. Foot pain as just part of life, until it
starts to get to the point where you can't just live with it anymore...I had
always walked harder on that foot; back in the day, as a teen, when I used to
wear the cute little slip-on thin-soled shoes that were in style then, I wore
through the sole of the ball of that foot quickest, walking with a twisting
motion, so it didn't really surprise me that that foot started giving me more
problems more quickly.
The problematic appendage:
Here is my journal about
what my surgery and recovery. I hope by posting this, I can help others faced with foot surgery know a little bit of what to expect.
I had a pre-op testing appointment about 2 weeks prior to surgery, where they
did an EKG, chest X-ray, routine lab work, just to make sure I was basically
healthy. Anesthesia talked to me then, too.
I arrived at the hospital (MY hospital, where I work, of course!) at 6am, 2 hours prior to my scheduled surgery time, which is standard. They use
that time to get my vital signs, start an IV (often tricky, as they don't let
you eat or drink anything after midnight the night before, to prevent you
vomiting while under general anesthesia and possibly inhaling it, leading to
the risk of pneumonia...but this dehydration also makes veins collapse a bit,
so it takes talent to start IVs on a dehydrated person), and get urine for a
pregnancy test (as they do for all women within child-bearing years who have
not had a hysterectomy, even if you use contraception. They don't want to take
the risk of harming a baby with the medications they give during surgery).
My honey and I checked in at
the Surgical waiting area desk, where they gave him info on the number to call to
get an update on me (he planned to go to work after I went back for surgery,
because it was that or wear out the waiting area carpet for the 4-6 hours I was
expected to be there. Yes, this procedure is a same day procedure, I would go
home later that afternoon) and got his contact information in order to be able
to call him if needed. They will not give out information over the telephone to
anyone who does not have that patient's PIN number, which the patient makes up
and they record on the chart.
Like a restaurant, they gave
us one of those little flashy disk-shaped pagers, and when it went off 5-10
minutes later, we turned it in and were escorted to a room by our nurse. Now,
I'm horrible with names, so I won't likely remember them all, but I believe Wanda
was our nurse, and she was great. She was a nurse at Parkwest for more than 30
years, so I knew I was in good hands, and she started my IV like the pro she
was.
Of course, as anyone who has
had surgery knows, even if it's just on a foot, they make you strip down to
nothing and put on one of those gowns that flashes your backside to everyone
you pass...unless you choose to wear it backwards, in which case the nurses
will be talking about you for a long time to come. ;) But those gowns, for the
most part, make it difficult to maintain your dignity. And I still don't know
why I couldn't leave my undies on...they weren't operating ANYWHERE near
there!!
Anyway, after the IV start, and verifying that I'm NOT pregnant (Thank GOD!!
I'm 46, aside the risks of having a baby at that age, I don't want to be
putting one through college and trying to retire at the same time!!), it was
pretty much routine, answering all of
the same questions they asked 2 weeks prior, updating my home
medications list, etc.
Part of the pleasure of having surgery where you work is that you see a lot of familiar faces. Dr. McIlrath came for
anesthesia, then they rolled me back to the holding area (passing Dr. O'Kelley
in the hallway; used to seeing me in the Birth center, not on a stretcher,
rolling towards the OR, he did a bit of a double-take....). There Judy, a CRNA
(Certified Registered Nurse Anesthetist--I don't know her last name, she hasn't
worked the birth center while I've been here) went through the plan with me.
Dr. Baird checked in, the anesthesiologist assigned to my case, and told me he
had to start another case, but Dr. Pittman would come do my Popliteal block (a
injection of local anesthetic into the nerve behind the knee that affects the
entire foot...I HIGHLY recommend having one of these!! No pain for the first
12-24 hours...me, I didn't need to take anything for pain until about 28 hours
after surgery. The numbness was disconcerting, not being able to move any part
of my foot, but it drastically improves comfort after surgery!!)
Judy chatted with me and gave me some Versed (a medication to relax me and with
an amnesic quality if a certain amount is given, it is commonly give
pre-op....you are still able to follow orders, but you're very relaxed, and
given enough, you don't really remember anything) and Dr. Pittman did the nerve
block...he propped my lower leg up high on about 4 folded up bath blankets to
get my leg up to access the back of my knee from the side and negate the need
to flip me on my tummy to inject the nerves (thankful for that...the broad view
of my pasty white Canadian butt through aforementioned open-back gown if
flipped over would make me blush forever when I see him at work!!).
He first injected some local
anesthetic into the spot where he was going to put the needle for the injection
of the nerve, which is deep behind the knee. Using an ultrasound machine placed
behind my knee, he located the nerve bundle and advanced the needle from the
side of my knee until he was able to inject the entire area...a nurse assisted
in the injections, injecting more fluid as he commanded...it was amazing how much
medication they injected, about 20 ml, but the Versed made me mildly curious,
not freaked out at the thought of all of that fluid going into the back of my
knee. Good stuff, Versed.
After 15-20 minutes my foot
was completely numb, at which point Judy injected some more Versed into my IV,
and we rolled down the hall towards the OR...and that was the last I remembered
until I woke up in recovery. Oh, the nurse in me knows that we rolled into the
OR, and I helped as much as possible move over to the OR table (I sort of
remember that, because I remember Dr. Baird or someone male telling me to move
my shoulders over a little bit more, to be centered on the OR table but that's
it....Versed is a wonderful drug!!)
In the recovery room, I
slowly woke up, and looked around....the nurse assessed me (that danged Blood
Pressure cuff that goes off automatically and squeezes TIGHT....just relax your
arm and let it do it's thing, it will keep squeezing until it does anyway) and
gave me some ice chips and I dozed on and off. No nausea, no pain...the leg
below the knee was numb. The foot was splinted, too keep it in a normal
position, padded and wrapped securely with ace bandages that I had been warned
by Dr. Ritchey (obviously used to nurses and their penchance for changing
dressings) NOT to touch until I returned to see him in one week. Wow, one week,
that's gonna be one funky smelling foot by then!! But o-kay......
I was moved back to a room in same day surgery, and had some crackers and
liquids. Dr. Ritchey called Jeff to let him know everything went o-kay, but I didn't see Dr. Ritchey myself again until dressing removal day a week later.
When Jeff got off work to come pick me up, they took my IV out, and
fitted me for my crutches. I had gotten my prescriptions ahead of time and
gotten them filled already, and had bought a knee scooter, recommended by my
podiatrist and another friend who had broken her foot and used one, so all we
had to do was head for home. Her advice: Get one with a basket on it. It sounds
silly, but she found it very handy. And I opted to buy, found one on Amazon.com
for $175...the cheapest I found to rent was $75/month, and I will need it on
and off over 3 months for sure...and if the results of this surgery are as I
hope, I'll likely get my bunions on my left foot done in the next year or
2....so it's a worth-while investment, to me. Plus, it's tax deductible.
Other things to think of...things
I tell my patients. Pain medications + decreased movement = constipation!! Get
yourself some Colace (stool softener) and take it twice a day until you get
moving around better. If you don't, beware. I've warned you. (unless you are
one of the lucky souls who get diarrhea from your antibiotic...then probiotics
and immodium!) Taking colace ahead of time will prevent the need for much
straining, or laxatives.
They wheeled me out to the
car. I went home and napped a bit, then later that night I watched TV. No
pain....blocks are a wonderful thing. BUT I had trouble sleeping that night,
because I had slept so much in the day AND the numbness actually became
disconcerting enough that I couldn't get to sleep. Not to mention that I'm a
night shift nurse, and after midnight is prime time for me!!
Sorry, timed out
there...ironically, writing this at the end of post op day 1 (POD1); the nerve block has worn off, and I
just found out that 1 Percocet 10 on a stomach that hasn't had that much more
than yogurt and popcorn and a few snacks in it all day means nap time.....who
knew?? My C-Section patients at work pop 2 Percocet 5s and continue on like
they're Tylenol!! I'm a light-weight, I guess.
