Passing Go

Three days ago marked four months since I had my surgery. At seven weeks post op (a whole week early!!) my cast was removed and I took my very first steps with my 'new' foot. As Dr. Pomeroy and my mother expectantly watched me put weight on my foot for the first time, tears pouring down my face. After 2 months of hard work, following careful instructions, and dealing with the pain and other challenges of surgery, I felt such relief as I realized I could start to use my foot again, that my journey to recovery had finally taken a giant leap forward.

In the pre-op visit to the office Dr. Pomeroy told me I "would hate him by the third month", and I can't say I disagree. Month three was frustrating, challenging, and painful. After putting weight on my foot for the first time, I went through a several week process of ditching my crutches. I had to get back on a mild narcotic for the pain, though these days ibuprofen and tylenol seem to do the trick. Mornings were the worst part of the day. There were days when I didn't want to get out of bed, when the idea of going to class made me want to curl up into a ball and cry rather than face the pain of walking and moving around. But I forced myself to get up and face that pain, often having my ankle so swollen by the end of the day that I couldn't even microwave my dinner and I faced my fear. 

A tip for all you patients out there, buy Ace Reusable Cold Compress, the kind with the fabric on the outside. Buy 3 or 4. Ice packs were often the only thing keeping me going and they made a HUGE difference. Pace yourselves. This is a long healing process and it certainly doesn't happen overnight. Getting your cast off at week seven or eight is not a magical healing card, you do not pass go and you don't get the $200. You work your butt off, dealing with pain and frustration that most people will not understand, not even Dr. Pomeroy. 

I still have a long way before I am fully healed but I can finally see that light at the end of this miserable tunnel. This surgery has taught me a lot about patience and trust. I have learned about being your own advocate and learned to trust in my doctor, even when it didn't always seem like the sane thing to do. I encourage you to ask questions, even if they seem silly. To you, they can be the most important thing discussed at a visit, even if your doctor doesn't think so. Understanding both the procedure and the aftermath is your most important asset for this surgery, even if that means searching the internet for someone like me who can help you fill in the blanks your doctor can't.

My Final cast!

At four months, I am now back in the saddle and enjoying being able to ride with minimal pain.

This is the first photo of my seven week foot, complete with the hair of an unshaved leg! That's right ladies, you won't get to shave your legs for the full 7-8 weeks and your leg will be gloriously hairy after all is said and done! Of course the first thing I did when I got home was break out the razor and get rid of the over grown hair :)

On the way home from having my cast removed! My incisions are healing nicely now and have faded from the deep pink. Over time they will become less prominent, I promise. The dry skin takes far less time to heal thankfully. 

Adjusting to Life in Bed

Adjusting to life being completely dependent on other people has been one of the most challenging aspects of this surgery. Due to the intense remodeling that occurred, it is crucial to recovery to stay in bed and keep your foot elevated above heart level. This means no getting up to prepare your own meals, no showering or bathing without aid, not even getting up to refill a bottle of water or brushing your teeth.

Aside from adjusting to a new way of life (however temporary it may be) the third week also brought the replacement of my splint and my new cast and my first trip outside the house since my surgery. At the three week appointment, the splint was removed and I got to see my new foot for the first time. Now I warn all of you potential surgical patients out there, the first time seeing your incisions can be a little scary. Luckily my incisions have been healing well, so as the medical assistant began to remove the splint, I was not met with the gruesome image I had been imagining for the previous weeks. I was met instead with 5 clean incisions and some decent bruising and swelling and my mind was set at ease.

After the splint was off, they began to remove the 49 staples from the incisions. Having the staples removed has been, by far, the most traumatic procedure that I have had to endure during this entire process. Unfortunately they do not numb the area around the staples before removing them, so it can be quite painful! A tip for all you potential surgical patients, ask for stitches if possible.

For a brief hour, my foot went without support so they could x-ray, remove the staples, and examine my progress. In that short span of time I realized how insecure I was with my own foot. When the nurse asked me to follow her to the x-ray room on my crutches, I was terrified! Thankfully I managed not to trip and the journey to the x-ray room was finished without incident.  From that point on, the trip to the doctors was fine. I was put into my very first cast and sent on my merry way with the help of my mom. The cast made everything easier, and with the staples gone, the itchiness of the incisions was dramatically better. Oddly enough, the security and support of the cast was incredibly comforting. And so begins the next phase of my healing process...

The Hell Week

As anyone who has ever had surgery can tell you, the first week post operatively is by far the worst you will experience.

The first two days after the surgery passed in a hazy mess of pain and discomfort. With this particular surgery there is a mass amount of swelling in the foot, so you have to keep your foot elevated above heart level. Keeping the foot above heart level and sitting up far enough to eat foods that don't require a straw is far easier said than done. In that first week keeping the swelling under control is paramount, so sitting up higher than the foot is a big no-no, thus eating can be a messy process. As I learned the hard way, don't be afraid to use a napkin when eating!

Now keeping the swelling down and trying to emerge from the anesthesia and drug induced haze is challenging enough, however that is not the only obstacle of the week from hell. The most difficult event of the week is getting up to use the bathroom. Now some of you may think that getting up to use the bathroom is easy, particularly when it is only a few feet away, however this is not the case in that first week. The movement of the foot from elevated pillow to sitting position causes an instant rush of blood and inevitably pain, followed by the lack of stability from taking narcotics for said pain. Anyone who has ever had to rely on crutches can tell you that they are not the most stable form of transportation and are prone to catching on the smallest of things. By the end of the fourth day post operatively things were beginning to look up for me and I tried reducing my pain medication somewhat successfully.

Now for all the things that my doctors office handled in great fashion pre operatively, I have to say, I have been entirely disappointed with the post op treatment. As my surgery was on a Wednesday, the doctor gave me a prescription for pain medication that contained enough to last five days, which brought me to Sunday evening. They had not thought to give me enough medication to last past the weekend. At this point the pain was manageable while on medication, so the idea of stopping it suddenly was a rather terrifying concept, so bright and early Monday morning I put in the call to get a refill. After two voicemails and some phone tag with the rude medical assistant, I finally received a refill prescription and my nerves were settled. My mom picked up the prescription and by 2pm I was back on pain meds. Understandably the doctor had changed the prescription to a lesser narcotic as he thought I was far enough out from surgery that my pain should be improving, and it was, however the medication that was substituted has the side effect of nausea. Suffice it to say, within 30 minutes of taking the new pills, I was curled up in stomach pain and suffering from some of the worst nausea I had felt in years...To be precise, three years, since that was the time I had previously taken that same drug after having my wisdom teeth removed. Of course I stopped the medication and was forced to resort to tylenol for the next twenty four hours. Nauseous and in pain is not a good combination, I can assure you.

The next day the office was called, and after 4 voicemails and some tears, my dad and I finally got through to a living person who gave me a very hard time about needing to return to my previous medication, scolded both me and my father for our frantic messages (which I assure you only happened after the first two messages went unanswered) and eventually relented to giving us the proper prescription. Two days later I was back to normal, the pain becoming much more manageable  and the narcotics becoming thankfully unnecessary. My first week ended and I could start to see a faint source of light at the end of this long tunnel.

The lesson learned here is to ask questions folks, lots and lots of questions, even if you feel like the office should know your information or if you feel like it is a stupid question. Chances are, the folks at the doctors office won't read your chart and will go with what they do for every other patient unless you are your own advocate. This is an issue that so many people dealing with medical professionals do not understand or are not willing to do. With a mother in the medical field, I have been lucky to have some guidance, however I have found myself several times in a bad place because I was not clear with my needs or worries, including the latest mishap with medications.  Had I simply stated, I cannot have this particular medication, the whole mess could have easily been avoided. Be your own advocate. Be brave, strong, and most importantly, aware of your own limitations and needs.

The All American Foot Surgery

This is a blog about the summer of my foot surgery, known as the All American. The surgery consists of two bone implants in my foot, three screws, and the replacement of the posterior tibial tendon. Here is a description from the New England Foot and Ankle website where Dr. Pomeroy (my surgeon) is based.

 "The All American procedure is an innovative operative approach to reconstruct the flat foot deformity. Originally developed by Dr. Gregory Pomeroy of New England Foot & Ankle Specialists in conjunction with Dr. Arthur Manoli of Michigan International Foot and Ankle Center, this procedure has now become a standard in operating rooms around the country and indeed around the world"

 I have known about my flat feet since I was about 7, when the doctor was concerned for my health after noticing my severe flat feet during an annual visit. Suggesting I wear orthotics or simply wear supportive shoes, I continued with my life, unaware that a larger underlying problem was waiting for an opportunity to make itself known.

Skip ahead to the end of my sophomore year of college. I always wore shoes with good support, exercised on a regular basis, and was on my way to begin training for my first 5k. I was feeling good and, through the use of barefoot shoes, I had fixed the muscle weakness in my knees and ankles, or so I thought. After a nasty fall, what I thought was a bad sprain started me on my journey to the All American surgery and my eventual recovery, now over a year later. I spent most of the summer between my junior and sophomore years at home and in pain due to a misdiagnosis of a sprained ankle. I went from doctor to doctor, some guessing a greenstick fracture, some guessing a ruptured ligament, all of which were wrong. After months of physical therapy, cortisone injections and walking casts, what I thought was a proper diagnosis brought me to surgery to fix what I thought was a ruptured ligament. After consulting with several doctors, I finally met Dr. Pomeroy and within minutes and a few glances at my chart, he had figured out the real problem with my foot. I was diagnosed with a ruptured tendon and given special orthotics that were designed to stall the surgery for a few years and help heal the injured tendon. Eventually I would need the surgery on BOTH feet as I have severe flat feet and despite injury. Both feet would need repair as the tendon that supported my arches would give way under the pressure and I would eventually be in a great amount of pain as a result. Fast forward from that first appointment in December to May of this year.

Almost a year to the day since my initial injury with no progress and the decision was made to have the surgery in June so as to be able to attend classes in the fall. The surgery requires eight full weeks of complete bedrest with the foot elevated above heart level. This presented several issues as I lived alone on the second floor of a lovely apartment. Within two weeks I was moved back home with my mom and frantically making preparations for the surgery and its aftermath. As I would be unable to cook, care for my dog, or even bathe myself so I was set up in the guest room on the first floor of the house. 

My surgery date came all too soon and I went to the hospital and got set up. The doctors inserted a leg catheter with a local anesthetic to numb my leg both pre and post operatively. The pump had enough juice to last for two days following the surgery, which turned out to be a god-send. Before I knew it, I was put under and then waking up in the recovery ward of the hospital. Still loopy and in pain, the wonderful nurses made sure I had enough meds and water to help me wake up from the anesthesia, though I was not fully awake until hours later.

 The procedure started at ten am and I was home by dinner time. Getting out of the hospital was the easy part of the day, for lying in wait was a set of stairs (made up of four steps) once I got home. I had not prepared myself for how truly difficult moving and getting myself inside would be. Still groggy from the anesthesia, it took my mother and I 15 painful minutes until I made it the very short distance from car to bedroom. A tip for all of you out there, getting up from the floor with crutches and only one leg is incredibly challenging, particularly when you are groggy and dizzy. Finally safe and home, I began the long eight week recovery period of my surgery in a splint with my trusty cat Mitzi by my side.