Out Come the Stitches

D+16

Second Post-Op appointment came and with it looking forward to removal of the stitches and hopefully a boot rather than a cast.  With a cast, I would still need to take baths.  If I got a boot, then I could take it off and take a shower.

Dr. C was pleased with how much the swelling had come down, no sign of infection, and looks like no residual bleeding.  So, she began to take the stitched out.  One by one, only pressure, but no pain.  Until the last two.  She asked me if I had taken my Percocet or other pain med.  I said no, and asked why.  She said, these last two look like they may cause some pain- closer to the bone/joint.  She told me to lay back and relax.  She tugged, I breathed and watched my Fit Bit heart rate come down and down, and down (84...72...66...58...52...) and getting a little lightheaded as I felt a lot of pressure and pain.  I did not pass out, but saw my heart rate drop to 47 as she said, "I'm finished with that part."  Whew.  I was glad, then I thought, what did she mean 'that part'...?

Well, what she continued to say was "Are you OK?  The next part is usually the worst."  Really?  I thought that was pretty bad.  I would say 6-7 on the pain scale.  Not quite unbearable, but...

What she meant was the three stitches at the tip of my toe where the screw went in are the most painful for the patient.  The screw head is flush with tip of the phalanx, and close to the skin, where the stitches are located.  Not only is there pain from the incision, the area is very tender due to the screw placement and the healing of the bone around the screw.  Here we go again.  Fortunately, there are only three stitches, and she had them out quickly and was not nearly as bad as she anticipated.

No Cast!

She cleaned up my foot and ankle and checked out the incisions.  Swelling was markedly improved and the bandages and splint she took of was not dirty.  That meant I was not walking and obeying her orders! That meant she could trust me with wearing a boot.  If she saw evidence of walking, still swollen, and reddened- incision area, it would a cast for the next six weeks to force compliance!

 The Boot

This meant I could take a shower!  And see my ankle and foot!  So, I would see Dr. C in five weeks for another X-Ray and start partial weight-bearing.  This assumed I continued to obey and not walk on my foot until then.  Crutches and the boot for five weeks.  I will get my upper body workout!

Burgers

I thought this was funny.  We ate at IN-N-OUT on the way home and found the 'handicap' table was the most comfortable, so I had to take a picture.  I got to go 'Out' and enjoy the outside world!

 Atrophy

  

 Left versus Right.  Easy to tell...

Taking a shower was awesome.  After 16 days, it was refreshing.  Being in the military, I have gone for many days without a shower, but never this long.  I can also see that my right toe that is  a little shorter than before, but not much.  Dr. C said to expect this due to the fact that the cartilage was removed at the joint.  This was the first time I saw both my legs and could see a marked difference between the Left and Right legs.  I have a ways to go to get my running legs back in shape!

Post-Op Checkup

The Checkup

Here we are at D+10 and time for my first post-op checkup.  My first trip since going under the knife and was nice to get out and feel human again!  Unfortunately this visit also included X-Rays.  This was probably the most painful moment since the surgery.  The technician had to help me pull back my toes so my big toe (aka First Hallux) was by itself for her to get a good picture for the surgeon.  Suffice it to say, my entire foot and ankle were very stiff and painful to move.  After several minutes of trying to manipulate my foot, ankle and toes, we finally got a good picture.  Unfortunately, I did not take any pain meds before the visit, nor did I bring any to take after today's poking and prodding!

Anyway, this is what my foot looks like at D+10.  Funny, one can still see the surgeon's initials on the top of my foot.  Dr. C warned me about the surgical site looking worse than it really is.  The dark black lines are actually the ink she used to mark the incision site, it is not dried blood!

The incision starts at the medial side of my big toe, comes across the top of the IPJ, and continues down towards the lateral side of the toe.  This allowed the surgeon to open up the joint, remove the cartilage, ream/drill the intermedullary canal where the screw will go.  The second incision is at the tip of the toe where she will continue to ream the canal where the screw would be inserted and drilled through the Distal Phalanx, through the IPJ, and into the Proximal Phalanx.  The screw would be counter-sunk into the Distal Phalanx so as to not 'stick out' and cause problems with wearing shoes or running. 

 It looks worse than it feels!

The screw would naturally compress the two bones together at the IPJ and over 6-12 weeks would heal like any broken bone would do.  So, over the next six months, the joint will continue to heal and become one fused bone, rather than a distal and proximal phalanx, it will be distimal phalanx!

Dr. C was pleased with the healing, but the stitches were not ready to come out.  She replaced the Steri-Strips and re-bandaged the foot and ankle.  Her only concern was there was no signs of bone healing yet, but no worries.  Everyone heals at a different rate.  She reminded me to not poke or scratch at the foot and ankle.  And continue to obey her (and my Wife's) instruction and NO WEIGHT BEARING!!!

It is probably all in my mind, and when talking to Dr. C and reading up on ORIF (Open Reduction, Internal Fixation), I realize the sensations I feel are part of the healing process.  When I think about the 2" Screw in my foot, I can almost talk my self into feeling the screw.  I know that I can't really feel the hardware, but I swear I can feel it!  It is a weird sensation in the foot, but those sensations will gradually go away.

 The Screw, and it is not loose!

This is why they want the patient out during these procedures!  Being in a dentist chair and hearing the drill is uncomfortable enough!  I could not imaging the sensation, albeit only pressure with no pain, of seeing the surgeon pull out a big ol' Black and Decker drill and drill out and ream a bone in your body.  Ugh. 

Not the Actual Drill...

We Have Come a Long Way

Go back only 150 years to the U.S. Civil War and think about how we conducted surgery.  It was rather simple:

1.  Get Shot by a musket ball.

2.  Hope not to bleed to death as you are carried back to a barn, house or church.

3.  Lay in line hoping the surgeon sees you in time, again hoping not to bleed to death.

4.  Buddy lays you on the blood-stained kitchen table or pew.

5.  Surgeon says, 'the leg has to come off before infection sets in!'

6.  One person gives you a big stick to bite down on and gives you a big swig of whisky to help with incoming pain.  Another soldiers lays on top of you to keep you from moving.

7.  Hopefully you pass out at this point.

8.  The surgeon wipes off the saw from the last amputation and begins to saw...

9. If you survived this far, and haven't bled to death you would possibly still die of infection.

One of My Convalescent Leave Tasks

 

One of my tasks to complete during this time of recuperation was to design an album of paintings my mother-in-law has done over the years.  This is part of my in-law's 50th Wedding Anniversary.  It is called 'Blue Heron Studio' and has painted may different works of art over the years.  It came out pretty good, and hopefully she will enjoy the finished product. 

The Routine without Drugs...

D+3 through D+7

The Routine

For the next five days, I developed a routine.  Get up as normal and take a 'bath' after everyone else had theirs and were about their day.  I never really slept well on my back and on top of the bedsheets.  I would wake up every 2-3 times a night as the pain medication wore off.  Or, more commonly, I had rolled over and found a sharp pain shooting up my foot because I had bumped it in the night.

By the following Sunday, D+5, I stopped taking the Percocet and started taking Motrin/Ibuprofen.  I did not like the side effects.  I did feel a little uptick in pain, but was not worth the constipation, dry-mouth, nausea, and loopiness it gave me.  I was also edgy to my family when I took the pills.  The pharmacy gave me enough Percocet to last me two years, it seems.  Way too many!

The worst, I will say, was the constipation.  They gave me a laxative to take along with the Percocet.  But when you finally have to 'go' at three in the morning, sitting on the toilet with all the blood rushing to your foot makes for an extremely painful experience.  Not worth it!

Maybe it is just me, but the 'feel good' was there for a little bit after I took the Percocet, but I didn't feel the need to continue to take the meds.  I certainly wasn't Dr. House and had to have my fix every four hours.  However, I did some research on the couch.  Now, I don't have a chronic pain condition that the fictional Dr. House had, nor real people with real chronic pain.

However, I do have an appreciation for how it could be easily to become addicted.  It is my understanding that addiction is nearly non-existent up to around the initial five days of use. However, when someone crosses the 10th day, addiction skyrockets.

I just hope my unit Drug-Demand-Officer doesn't announce a drug-test in the near future.  Looks like my spit and pee are good-to-go.  But lay off my hair...

D+7

 

Sadly, I was in no shape to go to church on Sunday.  I was able to watch all of it on Livestream, which is a great ministry our church does for those who are not able to physically attend.  I would find myself doing this the next Sunday, too.