When the shoe's on the other foot . . .

Check it out!  Five weeks out, and I was actually able to cram my right foot into my regular shoe!  I went to the store in it, came back, and took it off promptly, but it was a good first run.  It's still too tight and pressing on sensitive incisions to be comfortable, but it's definite progress.

4-Week Checkup!

I saw Dr. B today for a one month check-in to see how the healing is going. They took new x-rays. The verdict: the bones look good, the incision looks good--go ahead and walk on it! Yay! He said I could also start putting Vitamin E oil or Mederma on it so that it will heal with a minimal scar. I'm so glad--I've been itching (pun intended) to rub something on it. It gets so tight and dry and is begging for some treatment.
Then I directed his I'm-pretty-proud-of-my-work self to that poor little fourth toe that he turned. It still looks the same as it looked right after surgery 4 weeks ago! There's a big old blackened area that just hasn't changed, and the skin around it is looking kinda gray and turning tough. Gangrene??? Just kidding, but it really doesn't look good. He took a look at it and hemmed and hawed and threw around some medical terms: "Yes, well, uh, this here is vacuum edema and this part of the skin isn't getting circulation, that will eventually slough off . . . , but I can get some of that scab off for you" (pointing to the black part).
"Okay," I said, "yeah, that would be great."
So he rooted in a drawer and came out with a little scalpel and said, "Hold really still--this is very sharp!" and proceeded to DO SURGERY without anesthesia! I immediately reverted to my Bradley method of childbirth breathing (it's well ingrained, thank goodness). Well, the scalpel wasn't cutting it (pun intended), so he got a clippery thing and started pruning away. All the while I'm cringing and breathing and thinking, "That's what I get for questioning a surgeon's work!" The surgeon's solution is always to cut, no?
Actually, when it was all said and done, I was glad he gave it some attention. He had the nurse clean it all up and dress it with Neosporin and a Band-aid. Hopefully, it will start healing more quickly now.
Walking update: putting weight on the foot in my surgical shoe is going well! The foot tires quickly (and my calf muscle is killing me from non-use!), but it's exciting to see such progress. Wonder how long before the swelling goes down and I can stuff it back into a regular shoe?
Here's an updated picture--I'll spare you the fourth toe for now. Check the incision now, because I'm going to be massaging it with Maderma everyday to create a magical disappearing scar!

Stinginggggggg!

My foot has a new trick--the incision stings and burns and stings some more!  I googled it and also called my surgeon's office and found out this is good news.  It means the nerve endings around the surgery site are "waking up" and regenerating and healing.  For something good, it sure does hurt!  I thought I had an infection at the incision site; that's how intense this new kind of pain is.  Glad to know it's actually just part of the process.
Here are updated pics--Day 18 out from surgery.

Good foot day!

Today is day 15 out from surgery.  For the first time, my foot seemed improved.  It seemed to have turned some corner overnight.  I was able to put some weight on it (heel only) and walk for a while with one crutch, rather than tooling around on my knee-walker.  It felt good to see at least some improvement.  And no pain meds today of any kind!  I think there has been some reduction in swelling, and that made the foot hurt less all around.  I hope this means the bones are healing well.

The evil sock demon strikes again . . . or does he?

Had a funny moment in the laundry room today, as I stood on my scooter, hanging and folding a dark load of clothes out of the dryer.  I was getting more and more frustrated . . . why are all of my socks coming out missing the mate?? Ugh, there's another one!  What happened here?  

Then I remembered--I've only been wearing one sock all week!  :)

Starting off on the (new) right foot

Today was stitches out day, day 10 after surgery.  I coudn't wait to get all that bulky dressing off and to see my new foot!  My friend took me down to the medical center area to Dr. B's office.  Dr. B works in a large practice of orthopedic surgeons (48 surgeons at that location, with 19 other satellite locations!).  So when you enter the waiting room there, it's this huge space filled with people on crutches, in wheelchairs, on knee-walkers, and in casts.  I told my friend, "This is where all the broken people are."  When I got called back, they took me to a place called "The Cast Room."  What a funky place!  One wall is lined with high patient tables; there's a large island in the middle with all sorts of cast saws, wrap material, cutting instruments, and miles of gauze and Ace wrap ready to be unrolled and applied to the broken people.  So they called me and two other guys back all at the same time and lined us up on tables.  Three eager Cast Room Guys in scrubs immediately reached for their saws and shears.  It was a bit of a grisly scene as they sawed and cut us out of our casts and, in my case, surgical dressings.  Long Frankenstein-like surgical sites were revealed, all stitched up, bruised, and puffy with swelling.  It was definitely not for the faint of heart.  (Neither are the pictures when you scroll down, by the way, so consider yourself forewarned.)

When I first saw my foot, I was a bit shocked, because it didn't look anything like my foot.  It was a completely different shape.  A bit surreal to see that unfamiliar thing attached to my ankle and positioned where I normally see my foot. It took me a while consider it mine.

Next, Cast Room Guys cleaned up the feet of my Cast Room Buddies and me and then wheeled us one by one to get x-rays.  When we returned, in came Dr. B, escorted by his nurse.  He stopped at the first table, checked out his work, chatted with the patient, gave instructions to the attending Cast Room Guy, and moved on down the line, until he had seen all three of us, quick as can be.  Now that's efficiency!  Then Cast Room Guys taped and bundled us all back up.  The other two needed to go back into casts, so the wrapping and wetting and forming was interesting to watch, while I just got two band-aids and a spacer and some surgical tape.  Big complaints from the other two tables at having to go back into casts while I got to go home in such an unencumbered foot.  I win!  :)  Feels GREAT to have my foot out of that dressing and ACE wrap.  Okay, enough chatter, I know you've been waiting for PICTURES!  Here they are:

Cutting off the bloody dressing--yuck.

My first glimpse. Whoa. Doesn't look too good, but both Dr. B and my Cast Room Guy commented on how great it looks! I guess that's all a matter of perspective. I do think it looks like good work, although I'm a bit worried about that space between my 1st and 2nd toes. Dr. B told my Cast Room Guy, "Put a spacer between the toes to maintain the first toe's position, but not too thick.  It looks like it might be a little over-corrected." Yeah, that's what I thought. But I'm sure it will look amazing in a few months!

So much bruising! Dr. B asked me to flex my big toe up and down.  "Sure!" I said, confidently. But when I tried to move it, it wouldn't go anywhere.  He said I've got to get it moving or it will stiffen up on me.  So he showed me how to move the joint, using my hand to force some flexing and extending. It hurt!  Sigh, physical therapy time--no pain, no gain.

The best view of my incision. Going to take a while before that looks good!

I'm worried about that 4th toe--he doesn't look happy at all!

The Cast Room--view from my exam table.

Taking out the stitches--youch!

The "before" x-rays, taken in September. Notice how the big toe bone has 

drifted off to the left, away from the small round sesamoid bones.  In the 

next picture, it's back in correct alignment. 

Sporting some new hardware.

Wow, I've never seen anything like that in all my research about bunion surgery.  I've been worrying that if I put weight on it, I might dislodge the newly fixed bones.  Now that I see the hardware, I don't think it's going anywhere, no matter what I do!

Funny how differently my feet are shaped now

Thursday is . . .

dressing-off-stitches-out-gory-pictures day!!!  Can't wait to see my new foot!

First day back to work

I went back to work today, just for the afternoon.  All the students loved my "scooter" and want one.  I did pretty well, although I did notice I was yawning all afternoon.  My desk is definitely not as restful as my recliner!  I am a little concerned that I still can't put any weight on the foot.  I'll go back to get my stitches out on Thursday.  Then I'll be able to ask all my questions.  And I can't wait to get this dressing off my foot!

First trip out!

Blackened Mahi Mahi at Sharkys

Tonight Jon and I took Zach and Elizabeth out to eat. After an entire week holed up in the house, every bit of cool evening air felt amazing, every bite of food was scrumptious, and the company was delightful!  It was sooooo great to be out of the house.  I would make a terrible hermit.  I'm not even that great of a couch potato.  My foot did fine propped up on a chair during dinner, but it was tiring on the crutches, and I'm glad to be back in my recliner.  It's always interesting to me how a bit of deprivation makes the small pleasures in life that much sweeter.  I thoroughly enjoyed going out to eat, something I do almost weekly without even really thinking about it.  The lesson of gratitude is a good one.

Day 6 . . .

Progress:  

• Yesterday was the first day I was able to space out the pain meds somewhat.
• This morning I actually slept in--not woken up at 6 am needing to take something for the pain.
•  I can wiggle my toes!

Frustration:

• I still can't put any weight on the foot, even just to touch it down for balance.
• Last night I put on the surgical shoe that I'm supposed to be wearing each time I get up, and it made my foot ache so badly within minutes that I took it off.  What's that about?

This process obviously takes patience.  I can't WAIT until Thursday when I get my stitches out.  I want to see my new foot!  I'll try to put a bit of weight on my foot today and let you know how it goes.  After all, I can't live in this recliner forever, can I?

Day 4 . . .

This is my landscape . . . has been for 4 days now.  Can't complain, really.  Comfy room, lots of good reading, yummy food, and great company.  I did get the first wave of stir-craziness today.  I tried to quell it by getting up to rinse some dishes, but the foot throbs in any position but propped.  So . . . propped it is.  All in all, I'm THANKFUL on this Thanksgiving Day 2010.

The big reveal . . .

Credits . . . Videography by Kayla . . . Ripstick Stuntman Jono.

Uphill from here . . . I hope

So here's the pain meds story: as we left the hospital, the nurse told me to start with the hydrocodone, but right before bed, change over to the stronger pain medicine, something new called Nucentra, so that I could stay ahead of the pain that would come when the local block wore off in the night.  Nucentra was hard to find (Jon had to go to four pharmacies, and when he did find one that had it, the pharmacist had to get it out of the safe!)  I started taking it, but had a horrible night. I would take the Nucentra and fall asleep, then be woken up two hours later in severe pain, but not able to take anything for two more hours.  This went on all night and all day Tuesday.  Finally, exhausted by fighting this incredible pain all day, I called and spoke to the doctor on call. She said, "Don't mess with the Nucentra.  My patients only ever have hydrocodone, and they never have a problem staying ahead of the pain.  Switch to the hydrocodone and stay on it.  Elevate your foot, and you should be fine."  It actually occurred to me in the middle of the day to try switching back to hydrocodone, but I had been convinced by the doc and nurses and pharmacists that the Nucentra was so much stronger.  As soon as I switched over, at 7 pm this evening, I felt so much better.  What an ordeal!

C'mon clock . . . go FASTER!

Eight more minutes until the next pain pill.  This is some pretty intense pain!

A la carte . . .

Well, the deed is done!  Surgery went off without a hitch. Good thing I was on my toes during the pre-op check-in, though, because the nurse had the WRONG foot written down on the surgical orders.  She read me the procedure for the left foot, off her chart, and I said, "NO!  The RIGHT foot.  The right foot, oh my goodness. The RIGHT foot!"  I was laughing and almost shouting, because that's the sort of thing one hears about but never imagines will actually happen this close to home.  She she scratched through it and wrote RIGHT and made me initial it.  When she walked away from the chart, I said, "Jon, go over there and get a picture of that paper for my blog!"  As soon as he approached the chart another nurse saw him and said, "Sir.  Sir.  You can't read the chart!"  Sheesh.
When Dr. B came in to discuss the surgery with me, I looked on the menu and picked another procedure a la carte, just for good measure.  I told him my fourth toe is turned sideways, and so it hurts a lot and gets this horrible blister on it and what do you think?  He told me a few different options for surgically fixing it.  I hesitated, because I had asked both podiatrists that I consulted the same question, and they has said, "Yeah, I could fix it, but I guarantee you'll complain about it more than the big toe repair."  Such an important decision to make in just a few seconds!  So unlike me. What about the tons of googling and hours of research I would normally put into it? But Dr. B encouraged it, and so did the anesthesiologist standing around giving his two cents worth, so I decided to go for it!  Now I have officially had a Chevron Bunionectomy with Akin Procedure and Hammertoe Correction of the Fourth Toe. Let's hope I don't live to regret it! Here's a picture of my "yikes!" expression, just after I decided:

First post-op pic, comin' at ya:  

Last day!

Today is the last day my right foot will look like it has for 25 years.  The big ole bump sticking out the side will be gone!  It's amazing and kinda freaky to think about.  The countdown timer on this blog at this writing says 21 hours, 12 minutes.  I am racing the clock, with 10 tasks still on my "to do before surgery" list.  So this post is short!  Here, for the record, is a "before" pic of my feet.  Last day . . .

Me? Nervous? Pshaw . . .

So I've been tooling along in Julie Mode, making lists of things I need to do before surgery, and then making lists of lists so I don't forget anything.  Working the lists, checking things off as I go.  That's me, calm, cool, collected, productive.  Noooooo problem.  Being jittery about the surgery is not on any of my lists, so there's just no time for it, right?  I've actually been really excited about my surgery plans, looking forward to a pain-free foot (eventually) and looking forward to lying around with my foot up all week during a quiet Thanksgiving break.  Then I experienced one night, then two nights, of sleeplessness, my mind very wakeful, and noticed that my shoulders and neck were sore from tensing up.  Uh oh.  Maybe I'm not as relaxed about this as I thought.  Emotional check-in  . . . yup, feeling overwhelmed and cranky all the sudden.  Am I scared?  Freaked out about the loss of control over my life for a few weeks?  What's going on?

I decided to pay attention to the symptoms and be proactive.  (Aren't you proud of me? Normally I would just barrel on through, no time, no time to stop and reflect, there are things to do, so much to do!!)  I went searching and found Dr. Weil's recommendation for a pre-surgery program that actually has a double-blind, placebo controlled research backing.  It's put out by psychotherapist Belleruth Naparstek.  It is a series of audio files that contain guided imagery for before surgery, affirmations for after, and relaxation music for during surgery (earbuds--I don't want my surgeon falling asleep!).  I downloaded them and have been listening to them just before bed.  I do like them, but can't say I've heard any of them all the way through, because as Belleruth puts it, "Some people fall asleep the first few times they listen, because they are not used to being both relaxed and awake."  Ummmmm, yep.  That about sums it up!
The studies on these audio relaxation aids show that patients who used them prior to surgery had reduced blood loss, used less pain medication, experienced less anxiety, and spent less time in the hospital.  We'll see . . . for now, at least I'm easily falling asleep at night!


Next time on the blog:  The Big Reveal of the Winning Ambulation Device!

A Lift, a Lie, and a Luxury

My orthotic shoe inserts are finally ready! I went on Tuesday to pick them up from the podiatrist who I am NOT using for my surgery. I was so excited for the appointment. These inserts are a major investment and should go a long way towards keeping my left foot from getting as painful as my right foot has. They are custom-made for my feet and will have the arch support and the pronation correction I need. When I arrived and slipped them into my shoes, they felt great. Wow. Major change in the tilt of my foot! This could really make a difference, keeping my foot from turning inward and stressing out the big toe joints with every step. I did notice, though, that where the orthotic ended, about 3/4 the length of my foot, the seam between it and my shoe was quite noticeable on the right foot. He said they could shave it off to a more gradual incline at the lab. Just let him know if it continues to bother me.
As excited as I was about picking them up, I was also feeling sheepish about not choosing Dr. L for my surgery. I had already told his nurse when she called to finalize the scheduling that I was not going to do it at this time. So I was hoping it just wouldn't come up. No such luck. As the appointment was ending, he said, "SO . . . see you next week for pre-op appointment, right?" Uh. I totally chickened out.  I should have said, "I got another opinion and decided to go with someone else." Instead, I just mumbled something about considering putting it off until I had a longer break off from school. He replied, "You know, there's never a good time. You just have to schedule it and do it. But . . . it's your foot!" Yes. It is. Content with that conversation and ready to be out of there, I started packing up to go, and he said, "See me back in two weeks to check the fit of those orthotics." YIKES. In two weeks I will be in my recliner with my foot up in the air. Giant bandages around a newly constructed foot with incision running all down the big toe. No hiding that! I told myself, "It will be okay. The orthotics will feel fine, and I just won't need a follow-up appointment."
Again, no such luck. The left orthotic feels fine, but I really think I need the right one adjusted. I don't mind sending it back to the lab, because after this week, I won't need it for a while anyway, as that's the foot that's having surgery. But that means I'm going to have to call the office and 'fess up tomorrow. I'll have to say that I need him to see me this week and send off this orthotic now, because I can't come in the following week. Even if I could just drop it off and tell him what I want done to it, I would have to go back in to try it on when it was ready. Honesty = always the best policy.
So there's the lift (the orthotic lifting my foot into correct position), and the lie . . . now for the luxury--I bought new shoes! The typical foot-owner cannot understand why this is so exciting, but to me, it's a major event. I've been trying to buy new shoes to replace my worn-out Born shoes for a LONG time. But when I go to the shoe store, everything just HURTS my feet, and I end up going home dejected and empty-handed. I was down to one pair of shoes I could wear--my tennies--and I was wearing them even to work with my professional clothes. Then I found out that Dr. Andrew Weil, one of my favorite health gurus, has worked with a podiatrist to develop a line of shoes! Here's the link: http://www.weilbeing.com/. And here's the video showing how they work: http://www.weilbeing.com/technology/. So I found a Dillards nearby that carries them and grabbed a friend whose feet also hurt, and we went comfort shoe shopping. By the time we had run those clerks ragged pulling every shoe in the store out of the back in two or three different sizes, I had found TWO pair of shoes that felt wonderful! One pair are Weil shoes, and the other are Borns. Here are the ones I got:

My New Weil Balance Shoes

My new Born Quinces

8 days until surgery!  And I have LOTS to do to get ready.  Better stop blogging and get to work!

Ambulation--it's a beautiful thing

I recall learning in elementary school science class that animals are distinguished from plants by the trait of locomotion--we can move around.  As I get closer to my surgery, I've been ruminating a lot on the gift of free locomotion.  I like to go, go, go, and it's hard to keep me down.  Although I am really looking forward to the great excuse to chill in my recliner and read/watch movies for a week, after that it's pretty safe to say I'll be restless, and I'll need to return to work.  Working with multiple grade levels at my school  means I can't just sit at my desk and prop my foot.  I'm all over that building on a typical day.  I dread the thought of crutches, so I did what modern man does when confronted with a problem--I Googled it.  (Do we still have to capitalize Google when we use it as a verb??)
Who knew there were such interesting crutch alternatives out there?  I've found two I really like.  One sounds cool and fun, and the other seems more practical.  I'm currently trying to decide which has the greater likelihood of causing me to fall and break my neck (Julie Grace)!  So, Faithful Readers, let's put it to a vote.  Check out the videos in the following 2 posts and then cast your ballot.  Which one should I get?  Cast your vote in the polling place to the right. 

The iWALKFree hands-free crutch

The Amazing RollerFoot

Pop some popcorn . . .

As promised, here are videos of my upcoming surgery.  The first one IS for the faint of heart--it's just an animation.  Go ahead, you can handle it.  Click the title below to view.

Austin-Akin Bunionectomy

And for those with a stomach of steel . . .
These next three videos show a complete Austin-Akin bunionectomy, in three stages.  Very cool.

Part 1


Part 2


Part 3


Let me know what you think.

And the winner is . . .

I realize the world has been waiting with great anticipation to find out who will be the lucky person who gets to operate on my foot.  The suspense is over.  The winner is . . . my new orthopedic surgeon!

I decided to keep the appointment I had made to interview a prominent ortho guy in Houston.  I considered cancelling it after my last meeting with Dr. L, because my confidence in him increased.  But what can I say, I'm a researcher and a label reader at heart. I knew I wouldn't be completely comfortable until I had done all my checking and all my asking.  And in the last few weeks I've had a few people say to me, "You know, podiatrists are not MDs.  They're not 'real doctors.'" While I realize this could be typical medical field snootiness (after all, I prefer my DO to any MD for my regular checkups and visits), I also did some more reading and realized that the training for an orthopedic surgeon is more rigorous.  Long story short: everything about this orthopedist and his practice and the hospital where he operates was top-notch, very impressive.  I liked the way he answered my questions and his philosophy about whether to do a joint replacement or fix the bones that are there.  And when he left the room, his nurse gushed about his skill and expertise.  She said, "He did the president's mother's feet, you know." When I looked quizzically at her, thinking, "Obama's mother had her bunions fixed in Houston???"  She said, "Oh, I mean President Bush, you know."  Oh.  That makes tons more sense.  I didn't take the time to clarify whether he meant Bar, or Bar's mother-in-law.  Anyway, I feel confident going with this doc (to be referred to as Dr. B in this blog), and I went ahead and set a surgery date and time and went upstairs to take care of my pre-op work.  Now I'm dreading telling Dr. L's office, because I still need to go back there in a few weeks and pick up my new orthotics.  But I feel very settled, having the research part done and the decision made, and I feel fortunate to have such a top doc accessible to me for this important surgery.  I'm actually looking forward to getting this done.  The thought of absence of foot pain (after I recover) is a bit mind-blowing, because my feet have hurt for the last two decades.   5 weeks from today . . . gotta figure out how to add a count-down timer to my blog . . . hmmmmmm.
Next post: a video of the surgery I'm scheduled to have.  Not for the faint of heart, but fascinating to me!

Easy come, easy go :(

False alarm on the insurance covering my orthotic shoe inserts (see last post). I called the doc's office today in advance of my 2:30 appointment to get casted for orthotics, just to make sure they had called and gotten verification with the new confirmation code (you know, the one where she typed in all caps: "ORTHOTICS ARE COVERED" on my record?).  Dr. L's secretary said they had called with the new code and gotten a "no" again.  So I called and spoke to a different insurance rep this time, and she saw the note, but said that previous rep had been mistaken.  Yes, the paragraph she read to me saying orthotics were covered was there, indeed, but she had neglected to read the fine print, where it says: "exclusions to orthotic coverage: foot orthotics" and "exceptions to the exclusion: patients with diabetes." I scolded her for her company's ineptitude (which was really that other rep's oversight) and asked her if she realized I almost went to the doctor today for a $500 expense that I thought was covered; she replied, "I realize that, and it's a good thing you called one more time to verify."  Yes, a good thing.  Okay. What I wanted to say was, "Rooooaaaaaarrrrrrr!"
Realizing this conversation was a dead end and persisting at this point would probably just cause me to embarrass myself, I hung up and picked up the phone to cancel my appointment, but then I checked myself and texted Jon about my frustration instead.  He talked me through the decision and said we would find a way to fund this expense, because it was necessary for the future health of my feet. I thought about all the reading I had done to make sure this was really necessary and asked myself if I thought Dr. L's was the right place to go for this, and decided that I should keep the appointment.
Soapbox moment: It is VERY frustrating and VERY wrong that our insurance companies do not recognize the importance of preventive meds and devices and procedures, instead preferring to wait until there is actual disease or disfigurement before laying out a penny. I think it could actually be good business (and more moral) to cover a variety of preventive measures that could save health and thus save money down the road.  Stepping off the soapbox now (carefully, so as not to hurt my foot!) . . .
Now on to the appointment: While I was there, Dr. L said with great animation, "Oh! I have something I want to show you! The new hospital I've been operating at has these cameras in the ceiling, so I've been snapping pictures during surgery." Then he proceeded to open another patient's chart and show me the photos of his big toe joint replacement surgery, step by step!  It was actually really fascinating! "Here's his bone, you can see the degeneration of the cartilage, see how it's all yellow and squishy here? That should be all white. K, now here's the bone with that part all cut off . . . "
From me: "Oh!"  (looking at the two pieces of the bone with a huge space between them now)
Dr. L: "Yep, and that blue plastic piece there is a spacer, that I'm using to measure the size of the artificial joint I need.  And here's the new joint, in place."
Me: "Wow!"
Dr. L: "Oh, hey, he's still here, I bet.  You want to talk to him?"
Me: "Heck, yeah!"
So he runs out and drags in this patient he had just finished seeing, and I said, "Dr. L just finished showing me the inside of your toe, so I thought we'd better introduce ourselves, you know, meet."
Was that funny or dorky?  Jen?
The first thought through my mind was, "He's so young! He's like, MY age." (You see, I have this lingering perception of myself as somewhere in my late 20's, and I can't believe my foot is this bad off already.)  We had a really interesting conversation; I asked him several questions, and he said, "I really only used the pain meds for 2 days. It was really a breeze." I saw he was walking in one of those walking boots, and I said, "So how long ago did you get this done?" (Thinking I would hear 2 or 3 weeks ago.)
He said, "Last Thursday."  Wow!  That's not even a week ago!
Every part of that visit did my soul some good.  Getting to spend some time talking with Dr. L while he slapped the plaster on my feet to make the molds was helpful, seeing the pics and talking to the current surgery patient was helpful, getting to ask some more questions--very helpful.  I feel more at rest.  I'm even considering canceling the 3rd opinion appointment I have with an orthopedic surgeon later this month.  What do you think?

Persistence Provides a Passel of Pennies

Alright, so remember how disheartened I was to find out my insurance would not cover the new pair of orthotics I need? Well I picked my sad self up off the floor and thought, "I'm just going to check this out . . . what if there's a way?" I got the idea to try again from all the reading I did on the Internet, trying to decide whether I really needed a new $500 pair. From what I read, people with high arches and the foot structure that causes bunions really need to wear good, custom made orthotic support, if they don't want their feet to worsen rapidly. Considering my goal is to keep my left foot from getting as bad as my right foot, I decided I needed to get them. I noticed that the articles I read said that sometimes insurance pays, and sometimes not, depending on the diagnosis. Both diabetes and plantar fasciitis are often covered reasons for getting orthotics. I recalled that my MRI report mentioned "mild to possibly moderate plantar fasciitis. The posterior plantar fascia is moderately thickened and edematous posteriorly."  So I called my insurance company to see if orthotics were covered for fasciitis, and I found out they are covered for any condition, as long as a doc prescribes them. When I asked why my doctor's office was told no, she said, "Oh, they use the provider line, which is staffed in India. Those reps sometimes don't pull the correct information. So I'm giving you this confirmation number and I'm typing 'ORTHOTICS ARE COVERED' in all caps on your file.  Ask your doctor's office to verify benefits again, and they'll see this note."

No comment on how wrong that is on so many levels; just GLAD I'm going to get orthotics sooner rather than later, now that I know they are covered! 

Bad foot day. . . good life day . . .

Bad foot day . . . nevertheless, I'm grateful.
I have two feet.
I have amazing people in my life.
The weather is gorgeous.
My work is energizing.
Chocolate is yummy.
And so much else . . .

On the surgery front--I'm grateful to have a loving, caring mate who is committed to seeing me through the  recovery period.  In fact, Jon and I are actually really looking forward to our QUIET Thanksgiving break.   Surgery is scheduled for 7 weeks from today!

I'm trying not to complain, but . . .

Today's post is difficult to write, because I'm conflicted and frustrated. The issues are:

• Orthotics: So I have an appointment to get casted for a new (better) pair of orthotics tomorrow.  Now I'm not sure I should keep it. I am very certain that getting a new (better) pair is the right decision for my future foot health, and I was really excited to get this going. But today I found out that this pair will not be covered by my insurance either.  I paid out-of-pocket for the expensive pair two years ago, but I was led to believe (by another podiatrist, not Dr. L) that they could easily get them covered by writing a letter of medical necessity.  Not so. Now I'm faced with paying $500 for a new pair, and I'm asking the questions: "How do I know these are better? What if there's an even BETTER pair with a doctor across town? Is it worth it to have them custom made, or should I just wear the $20 WalkFit inserts I got at Bed Bath & Beyond?" The frustrating part is, I don't know who can help me answer these questions. I trusted the guy who sold me the other pair.  Now trusting a new podiatrist for a different pair, at $500, just seems risky.  
• Surgeon: I followed the advice I've heard a few times and made an appointment with an orthopedic surgeon today. I narrowed my search by calling the practice in downtown Houston that seems to be held in great esteem in our community, and then by asking who specializes in feet.  Then I read all four of their bios and picked the one who has the most experience and accolades.  Can't get in to see him for two more weeks.  I think I do need to go, just to get his opinion and to satisfy this nagging feeling that I've not yet done enough research to settle on Dr. L. Even so, I think this might make the decision between the two difficult. And it probably delays my getting orthotics, because I want to see what he recommends about those, too.  And I can't think of who can help me answer the question: "Who is the best person to operate on my foot?" I can do lots of research, but I'm sure there's insider scoop that would be so valuable.  
• Surgery yes? Or surgery no?: This one's tough, too, although it probably shouldn't be. A few weeks ago, when my foot was so painful during the day and waking me up at night, it was easy to say, "I need to have this done." But since I started wearing the better shoe inserts and only wearing my two most sensible pairs of shoes, the pain has decreased significantly.  What does this mean? That surgery is premature at this point? It's to the point where I hope my foot will hurt, so that the decision is a no-brainer.  Ridiculous!  But that's how overwhelmed I am with all this decision-making.  Ugh.

As you can see, most of my frustration and conflict come from having TOO MUCH choice (and not enough guidance). That's why I titled this, "I'm trying not to complain."  I realize what an amazing blessing it is to have such an array of healthcare at my fingertips and to have the resources, ultimately, to pay for it.  Still, I wish preventive care were more valued by our insurance companies, and I wish I knew where to get the inside scoop on the most skilled surgeon in town, the best orthotics, and a crystal ball to divine the future of my foot if I don't have surgery.

Melancholy me

It's true, I'm sad and discouraged today because in the cool air and glorious sunshine, over 32,000 Houstonians are gathering, stretching their calves and quads, and racing for the cure.  Those of you who read my FB posts about Couch to 5K know that I was soooo excited about this race as the first goal of my running program. Then, bunion pain hit, and I had to stop running. At this point, I don't even dare walk the 5K, as I'm sure my right big toe would object heartily. I've been moping about it, but also reading two different books that are helping me put such things in perspective and look for the ultimate purpose behind some of my travails, so here's my new orientation toward my failed attempt to become a runner and toward the Komen Race for the Cure:


Starting this running program brought the degeneration in my big toe joint to light in a big way, as the screaming pain got my attention. Now, I'm being proactive: getting new orthotics and planning surgery to correct the joint structure and save what cartilage I have left. The ultimate goal is pain-free feet--a luxury I've not had since my 20's!  If I'm going to walk on them for 45 more years (and why not!), then it's time to make sure they can go that distance.  

SO: next October there will be another Komen race. It's my new goal. Will I walk it? Will I run it? Will I WIN it?  (lol, that one made me laugh)  Who wants to come to Houston and run that race with me on my new feet in a year?

Instructions . . .

Last night it occurred to me that I had thought through some aspects of the recovery period . . . Thanksgiving break would be perfect for a teacher to have foot surgery, right? And just a few weeks beyond that break would be another 2-week break, providing more rest for my foot.  Perfect! But then I was reading yet another article on the Internet about bunion surgery, and I ran across this little part of post-op instructions from one woman's doc: "No driving for 6 weeks." Ruh roh! THAT is just not going to work. I can't imagine trying to do my life for 6 weeks without driving.  Actually, even one day would be tricky. Mom's taxi, and all that. Maybe I can get good enough driving with my left foot? Sounds risky.  So I bugged Dr. L's office again today for the post-op instructions I meant to ask for yesterday. They FAXed them to me, but those were only for the first 24 hours. Not enough to help me plan for weeks of recovery.  I called back, and she said if she didn't have something on file already, she would have Dr. L write them out and FAX them to me.  I was impressed to see that within the hour they sent me a full page of written instructions from the doc. After about 10 mins of deciphering his true-to-form physician's handwriting, here's what I read:
Julie [I like it! The personal touch!]
1) Rest, ice, and elevation x 72 hours.
2) Stand and walk to tolerance.
3) You can drive when discomfort subsides and you can push brake without pain.
4) Removal of sutures in 2 weeks
5) Physical Therapy starts at 1 month post-op.  2-4 sessions depending on patient.
6) Pain meds: you will use every 4-6 hours for first 3-5 days, depending on which procedure is done.
If you get joint replaced, you should be back to conventional shoes in 4-6 weeks.  If you get structural correction with metatarsal fracture, you should be back to conventional shoes in 8-12 weeks.


Regarding the "which surgery" part, Dr. L says there is a possibility he will go in and find that the joint is further deteriorated than the MRI showed, in which case he'll replace the joint, rather than breaking and fixing it.

So, I'm still not sure I know how long I have to wait to drive, but maybe I can fudge by using the heel of that foot? Good thing Jono has his learner's permit!

Good day, good day, bad day, good day, good day

Two adjustments in the last two weeks seem to be changing the severity of my foot pain: I stopped running, and I changed the orthotics I'm wearing.  After Dr. L confirmed my suspicion that the expensive orthotics I bought two years ago were doing me no good, I switched back to a $20 pair that my physical therapist had suggested I buy from Bed, Bath, & Beyond.  They are firmer and provide better arch support.  Sooooo frustrating that wearing the cheaper ones would have been better for my foot all along!  
So lately, the foot pain has subsided significantly. I've taken to characterizing each day as "good foot day" or "bad foot day." This has me wondering if I should even pursue surgery.  Such a huge decision! 
I went back to Dr. L today to find out the results of my MRI.  The gist is that the fractured sesamoid seems to be an old injury, and the main concern is the cartilage loss and beginning of arthritis in my great toe on the right foot. When I told him about the pain subsiding somewhat, he said a few things: 1) It's my foot, and I decide what to live with and how to proceed, 2) It won't get any better, only worse over time, 3) I could be facing a much worse surgery situation a few years down the road because of continuing cartilage loss.
So here's what I decided for today: 

• I went ahead and made 2 appointments, one for casting for a new pair of orthotics next week, and the other for the Tuesday before Thanksgiving, for surgery. That way, I have my preferred date on his schedule, and, as Dr. L said, I can always cancel it if I decide against surgery.  
• I'm going to keep reading an eBook I ordered called The Bunion Survivor's guide to Successful Surgery and Recovery.  
• I'm going to do more investigating into whether Dr. L is the right surgeon for me. 
• And I'm going to keep monitoring my foot's pain level and listening to my inner voice about whether going forward with surgery is the right decision (good advice from a wise friend--thanks, Debi!).  

Here is the official MRI report:


Findings:
There is normal marrow signal maintained within the metatarsals, specifically the head of the second metatarsal displays normal signal intensity.
There is moderate cartilage loss and narrowing involving the first metatarsal phalangeal joint.  There is some minimal bony overgrowth involving the first metatarsal head, as well as the base of the first proximal phalanx.  There is associate joint space narrowing and mild bony overgrowth.  There is perhaps some very minimal subcortical edema involving the articular margin of the first metatarsal head, as well as the base of the proximal first phalanx.  This is however, very subtle.  
There appears to be focal small area of edema involving the tibial sesamoid.  No displaced fracture is evident. There is minimal amount of surrounding fluid at this site.  The contiguous flexor tendon appears intact and normal in signal intensity. 
The intrinsic musculature of the right midfoot displays normal signal intensity.  The dorsal, as well as the planar tendons appear intact and normal in signal intensity.
The distal metatarsals appear intact and normal in signal intensity. The joint spaces appear maintained. 


IMPRESSION:
1. There is a focal area moderate marrow edema involving the tibial sesamoid. This is reportedly at the site of patient's area of pain/trauma. As this edema is nonspecific, could represent bony contusion. However, an underlying subtle occult fracture could also be present. This could be further characterized with thin-section CT for improved bony detail. No definite displaced fracture is evident.
2. There is moderate cartilage loss and narrowing involving the first metatarsal phalangeal joint with minimal subchondral edema and bony overgrowth.
3. The second metatarsal head is normal in signal intensity, as are the remaining metatarsals. 

Fascinating! And bad news . . .

I've had to baby my feet since my early 20's.  At age 16, I watched my mom go through painful bunion surgery.  Looking at my own two feet, I could tell I had inherited her problematic foot structure.  I pretty much assumed that her painful bunions were my future.  Looking back, I wish I'd known that I could be more proactive in keeping my large toe joints from drifting and creating those painful bunions.  Good orthotics for the last 20 years probably would have gone a long way.  But, that's water under the bridge.  For the last 20 years, all I've done for my feet is try to wear sensible shoes instead of pointy-toed heels.  My shoe choices have been driven by comfort rather than fashion.

All that changed when Hurricane Ike roared through Houston in September 2008.  When I saw the storm coming, I loaded up 2 of my 3 kids and hit the road, traveling to St. Louis, where I grew up and my mom and 3 of my sisters still lived.  The drive was long (13 hours), but the trip was worth it!  My oldest daughter was in her junior year at Washington University in St. Louis, so we got to visit her and hang out with family for 9 days--Hurrication!--until our schools could reopen.  One night as I left my sister's house in the dark, I thought I had stepped down the last of her cement steps, but there was one more.  I twisted my left ankle, terribly injuring tendons on both sides of the foot.  Swelling, bruising, and lots of pain eventually led to an MRI, which revealed I have an extra bone in my foot, an accessory navicular bone, which can cause the types of foot structure problems I suffer from.  My physical therapist suggested I get orthotics.  So I visited a podiatrist and paid out-of-pocket for a pair of custom orthotics (insurance company denied this important preventive health care expense, of course!).  After about a year and lots of anti-inflammatories and physical therapy, the pain in that foot simmered down to manageable.

Fast-forward to the present, September 2010.  I got very excited in the past few weeks about a running program called "Couch to 5K."  I finally found something that would keep me motivated to get out there and exercise, and I was excited about the goal of running the 5K in the Susan Komen Race for the Cure.  But then my right foot got dramatically worse.  It began hurting all day long, and I was icing it a few times a day just to get through.  I finally had to face the music and say, "Julie, you've got to stop this running program!  You can't be a runner if you have bad feet."  But my foot had been hurting more than usual all summer, well before I started running, so there's something else going on, too. I've been trying to buy shoes all summer, but can't because my foot hurts too badly.  I see a comfortable-looking shoe on the rack, put it on, and yelp in pain, slipping it off as carefully as I can.  Everything presses on that big toe joint; everything hurts. Then my foot started waking me up at night, screaming in pain.  I decided I'd better figure out what's going on.  I saw 2 podiatrists this week.  The first one I saw  just pushed surgery, without even showing me my x-rays and explaining why.  He was full of ego.  Really turned me off.  But on Wednesday of last week, the second doctor spent an hour with me, going slowly through my x-rays, and explaining everything he saw.  It fascinates me to look at x-rays and see what's going on inside--I should have gone into medicine, apparently.  Listening to him show me what he saw on the x-ray, it makes sense that my foot is hurting so badly!

First, there is a small bone in my right foot that is broken into 3 pieces. You can see it if you compare the left foot to the right foot.  There are two small, round bones under the base of the big toe bone, called the sesamoids.  You can see them through the toe bone on a normal x-ray.  On an x-ray of a foot that has a bunion, the large toe bone is displaced, so one of the sesamoids seems to be on the side of the big toe bone, because the bone has drifted off-center for years.  So if you look at those 2 little bones on my right foot x-ray, you can see that the one that's still under the toe bone is broken into 3 pieces.  BUT, he's not even sure that's what's causing the pain.  It might be an old break that never healed.  More concerning is what's visible in the spaces between the metatarsals and phalanges.  On my 2nd through 5th toes, the spaces are good-sized and well-defined.  It's not really space, of course; that's where cartilage is.  But on the large toes, the spaces are fuzzy and smaller.  And the large toe bone has white areas just beyond the space.  This means the cartilage is worn away and the bone is developing arthritis.  Groan.  I suspected as much.  

The last interesting thing on the x-ray is that you can see the extra bone I have in each foot, the accessory navicular.  It's rare (2-12% of the population), and it's the primary cause of all my foot mechanics and eventual bone structure problems.

Here's a frustrating little tidbit I learned at my appointments: both doctors said the orthotics I paid so much money for 2 years ago are not helping my feet.  They are too flexible and don't have a high enough arch. Apparently, some docs prescribe this type because they are easy to get used to, so they don't have to listen to patients complain about their orthotics killing them during the break-in period.  Ugh.  Frustrating. 

So, I had hoped, when all this pain started up and I sought the help of podiatrists, to find a way to get my foot back to functionality and pain-free without surgery.  But now I'm not sure that's going to be possible.  Apparently, with cartilage loss already beginning, it's all downhill from here.  But Dr. L. wants to get an MRI first, to see what's really going on with the cartilage and with that cracked up sesamoid. It will tell him what he has to do when he gets in there, just fix the bunion, or replace the entire joint.  Dr. L. suggests Thanksgiving for surgery.  So this blog is my attempt to document my journey forward.  I think the decision to let someone cut on my foot and mess around with the bones is a huge one.  I've heard so many horror stories about bunionectomies gone wrong, including my own mother's.   I'm on my feet all the time as a teacher.  I don't want to make any unwise moves that will result in lifelong foot pain or deformity.  On the other hand, that's basically what I've got right now, so I'm open to the possibility of surgical intervention, and I'm cautiously moving forward.  MRI results on Tuesday . . . we'll see what he says.