Today was a life defining day.
This morning I had my final pre-op appointment before my right foot surgery. There was a different look in my eyes from the time I woke up. It was a combination of worry, nervousness, sorrow, and excitement that I would finally know my fate.
I waited for just over an hour past my appointment time in the waiting room. The earliest I have ever been seen is maybe 45 mins past my appointment time, so I knew before coming in today that I would be waiting. That 1 hour was excruciating. I tried to listen to some music, but I ended up turning it off because it was as if my thoughts were shouting over the sound of it. It was hard to not let my mind wander to the worst case scenarios.
When I finally got called back, I went and waited in a patient room. Then, got taken to do some x-rays of my right foot, and back to the room. More waiting.
Finally, my surgeon's PA walked in and went straight to the computer to pull up my X-rays. He showed me a comparison picture between my left before surgery when it was collapsed to my right now currently collapsed. My feet looked literally identical. Eerily similar. No more questions at that point about if I was going to have surgery.
See for yourself:
My doctor came in and used the computer tools to draw lines on my talus bone that, when extended, were supposed to line up with my first metatarsal. He demonstrated how my right foot is 15 degrees off, whereas my newly reconstructed left foot is only 2 degrees off now.
He then checked out my feet. He asked a lot of questions about how my posterior tibial tendon had been feeling. I told him that it was not nearly as painful as when my left collapsed because that one was so badly inflamed from running. With my right, one day, it just decided to fail. I have pain and inflammation on some of the bad days, but mostly it is just intense pressure on the medial side of my ankle since it completely collapses when I walk. We got to talking and he said that my case is atypical...OBVIOUSLY...we all know that at this point. He told me that he thinks that if he fixes the structure of my ankle, that there is a good chance that my tendon will be fine.
What's the benefit of not transferring the tendon? Less surgery procedures. Faster recovery.
What's the risk of not transferring the tendon? Another possible surgery down the road.
He really left it up to me, but I agreed with him. I am only 25 years old. I would much rather do less and take the risk of having to have another surgery, than do more than needed and risk not being able to run again with a transferred tendon in both feet. The flexor digitorum longus that they use for the transfer is no where near as strong as the posterior tibial tendon. I will have to be very careful going forward with my left especially because of this.
I came prepared with a number of questions as I normally do:
1) How rare is my case and why do you think this happened to me? Really rare and no clue. We both sat there baffled trying to come up with some type of explanation, but there really isn't any. I fit none of the typical criteria for those who have this condition.
2) What can we do to better manage my pain for the second surgery? I reminded my doctor that I spent 3 and a half days in the hospital, that the nerve block didn't work, that the dilaudid (hydromorphine) drip didn't relieve my pain, and neither did percocet. He said that we have to really hope that the nerve block works this time. He said that since it didn't work, my pain probably peaked too high before the drugs had a chance to do anything. For pain management, it is all about staying ahead of the pain, catching up doesn't work. I learned this lesson on my own after the first surgery. I didn't think about it in relation to the nerve block and IV drugs. So, we are going with the same strategy, just hoping it actually works this time.
3) Can I do one less week in the hard cast this time ( 2 weeks soft cast + 3 weeks hard cast, instead of 4)? Yeah. That will be fine. Later in the conversation, he came back to this, and said that I can go straight to the boot after the surgical splint. He said that the primary reason for casting after this surgery is to keep the tendon fully rested while it heals. No matter what, since the boot comes on and off, there is no way to keep your foot completely still; however, this surgery is different. It will primarily be bone work except for the calf and achilles lengthening. I will still be non-weight bearing for 6 weeks, but he doesn't see a reason why I have to be casted, of course as long as I am compliant with the non-weight bearing. There is no doubt in my mind or his that I will follow his instructions, so that will be the plan. Straight to the boot after the soft cast!!! He wants me to start moving my foot around and working on the flexibility just weeks after the surgery, other than dorsiflexion which will affect the gastrocnemius recession. This also means that I get to return to PT sooner, which means I will be back driving sooner, which means I will be ready to walk flexibility and strength wise as soon as I am permitted to start partial weight bearing, which means I will be walking with no assistance sooner, which means that I will get to work towards running again sooner, which means that I will get my life back sooner than expected.
4) I'm flying to a conference next week, any special precautions? Yes. Take blood thinners. He gave me a new prescription for this trip and for after the next surgery.
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Surgery II Plan:
Medial displacement calcaneal osteotomy (saw off my heel bone and reattach it to the correct position with a titanium screw through my heel)
Lateral column lengthening (add an extra bone to assist with rebuilding a normal arch)
Gastrocnemius recession (lengthen my calf and achilles tendon)
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This appointment was so different than the ones before. It didn't hit me until tonight that the major difference is that he didn't treat me like a patient, he treated me like a colleague. With a PhD in Exercise Physiology, my field is not that far removed from the orthopedic world. In fact, the two fields completely intersect and cross over each other. Today, he told me everything straight, nothing was sugar coated, and he explained the scientific/medical reasoning for everything that he was going to do for this surgery. Before the first surgery, he talked to me like I was a kindergartener. Most people need their hands held and need to be sheltered from the truth. I am just not that kind of a person, especially when it has anything to do with science, especially medical sciences. The way he treated me in our first encounter is not a criticism, it is exactly how he should have behaved. My doctor has excellent bed side manner. At the time, he didn't know me and my personality. After all, I only met him one week before the surgery since I switched surgeons at the last minute.
I left the office feeling much better about my situation. I know that my surgeon has my best interest in mind and that he is going to do everything he can to help me get my life back.
So the surgery prep begins...13 days and counting.
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New Hobby: Cross stitching. I searched long and hard at the craft store trying to come up with something that I would actually be able to do while sitting with my legs elevated for the next two months. I got several designs that all have great and relevant messages for me at this point. That section of the store was speaking to me, as if I was meant to find it.
~Lap desk with Laptop cooler for editing my dissertation and preparing for my defense after surgery.
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DISSERTATION
Put in more hours today. I am not done yet, but I am inching closer and closer.
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Reflection
Today, my appointment with the doctor was much more laid back and casual than I expected. I am looking forward to having the other surgery because I know that it is necessary to get me back to where I want to be.
I started prepping for my surgery and found a new hobby.
Found out that I have another job interview next week. Now, that makes 3 interviews for next week. I might actually get my first real job offer!
Made more progress on my dissertation.
The pieces of my life are starting to come back together. You know what they say, "Bad times don't last always."
Whoa this is a long post...
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