Fixing "Nurse's Feet" - Journal of a nurse going through bunion and hammertoe repair and removal of a neuroma of the foot foot.

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.