Counting Down

In 10 days, I should be able to walk again. I haven't walked a single step in almost 5 weeks. Right now, nothing sounds better than being able to go up and down the stairs in my own house.

I have a huge, unwieldy cast on my left foot, up to just below my knee. It's not the kind of cast I expected - plaster or fiberglass. It's a huge steel, padding and Velcro contraption that comes on and off. For the first 3 weeks, the foot and ankle were also wrapped in gauze, stretchy bandages and a thin "sock" covering. The cast strapped on over that. I had to take it off several times a day to put ice packs on my foot, and again to shower, with a waterproof rubber boot over the wrapping.

On the one hand, it's nicer than the fiberglass or plaster cast. I don't have the unbearable itch issues that I hear are unavoidable with those. On the other hand, while there's a half inch steel plate, about 14 inches by 6 inches, under my foot, on top of my foot there's little more than padding and straps to protect the area with broken bones. If something hits it, falls on it, steps on it, the results would be painful and catastrophic, so I'm extremely protective of the entire leg.

And geez, is this thing heavy and awkward! It extends so far past my toes in order to protect my feet. I get it - so many times, I've had that part of the cast whack walls and door frames. I've even had it be stepped on in the movie theater. I know why it's there. Still, imagine having a half inch thick slab of steel on your foot. Even simple stuff like sleeping is awkward. Imagine sleeping in a steel soled snow boot, and you'll have some idea what this is like.

Since the stitches came out at three weeks, I no longer need the rubber shower boot. My family finds my new foot both creepy and fascinating. It's much narrower and straighter than it was before. I can't quite get used to the big toe's nail facing upwards. The incision sites still look pretty gruesome (my middle daughter refuses to look), but that "train track" look will fade. I've had so many stitches; I am not worried about scars on my feet.

I've explained what I've had done so many times in the past few weeks. I'm tired of repeating, but thankful for people's concern.

I had most of the bone structure in my foot rebuilt. I had bunions, collapsed arches, overlapping toes, a big toe turned at a 45 degree angle, bone spurs, and shortened tendons. That's the shortened version. Apparently, almost half of the bones in my foot were not load bearing, even though they were designed to be. My podiatrist took hold of my foot and folded it lengthwise, flapping it like a wing. "See that?" he said. "It's not supposed to do that."

What I'd noticed most, of course, was the pain. I've known that I had bunions since I was 9. The collapsed arches were diagnosed about two decades later, and suddenly so many things about my feet made sense.

I have a lot of small skeletal issues. I had TMJ (joint issues in my jawbone) as a kid. I'm knock kneed, plus my knees bow backwards. Since I was 13 and fell off of a horse onto it, one knee has been noticeably worse than the other. It aches in the cold, and both knees will occasionally collapse when overstressed. I have a mild S curve scoliosis. Its major contributions are making my hips uneven, and therefore one leg longer than the other, and causing muscle pinches in my shoulder that occasionally need treated.

Of course, any time I said, "my feet hurt" or "my back hurts" for most of my life, I'd get patronizing advice to "lose weight and exercise more." Or I'd hear, "Well, so do my mine, but I'm going out dancing anyway." The older I get, the more convinced I become that our parameters are vastly different. What some people call "pain," I call "normal" or "uncomfortable." By the time I say "pain," it's knifing, and I can barely stand to let my feet touch the ground.

I hated, too, being told that my feet would feel better if I went barefoot. "It's healthier! It's the natural state of your foot!"

"But it hurts," I'd say, and thus unleash a lecture on toughening up, or giving it a chance, or something else equally annoying. I need practically orthopedic shoes with astonishingly good arch support before my feet feel better. It's in my bone structure; whether or not the soles of my feet would toughen up was not the point.

Well, let's hope that's past tense now - "needed" orthopedic shoes. I'm hoping that the new bone structure will be fabulous.

I needed bones cut and repositioned, tendons lengthened, screws and rods and a plate installed. The doctor estimated that it would take an hour and a half; it took almost three hours. "Things were a bit more complicated than we thought," he said. "That toe gave me a hard time."

I thought that cutting the bones would be the worst part, but it wasn't. Rotating that big toe really ached. I told him that at my three week checkup, and he said, "We took out and threw away the parts of the bone that hurt. They're gone now." Oh. OK.

The doctor told me that the post-op pain would be about equivalent to a broken bone. I've had those before, so I had some sense of that. The first two days would be agonizing; after that, it would get better. That's about how it worked, too. The first two days, I didn't want anyone to even breathe on me. I couldn't let the bedclothes touch the cast - the weight was too awful. The second day, a towel fell off the rack onto my foot, and you should have heard the noise I made - "AAAAAHHHH!!!!!" How ridiculous is an existence in which a falling towel hurts? Of course, part of that reaction was also shock, and the realization that other, heavier things might fall on me.

Luckily, the only other thing that's fallen on me is a plunger. The cast was off - I was getting out of the shower - so it smarted, but I wasn't terrified. It had been over a month by then.

My worst fear was messing things up while we were still waiting for the ends of the cut bones to grow together and knit. If I ripped out the screws, or tore the healing ligaments, or something else hideous, the damage might be too great to repair. The longer it's been, the more I relax. I haven't been in any significant pain since the first week, and now, in week 5, I think that things are pretty well solidifying in there.

The worst part has been the patience of waiting this long to be able to put any weight on it. I can't put any weight at all on it until I get x-rays in another week and a half, and get the OK. While I'm not in pain, and I'm getting around really well for someone with one working leg, I am practically counting the hours until I can WALK again.

Soon, though, we'll go through the whole thing again, for my right foot. While I want it done, I can't really even think about that right now.

Tick tock!

Illness Part 3: The Scar

It's a good thing I'm not terribly sensitive about my appearance.

I knew that surgery to my throat would mean a visible scar. I was a tiny bit worried about it, but not too much. I have all kinds of scars, surgical and otherwise, and they don't bother me. I knew from a previous surgery that this particular surgeon left small scars that faded easily, so that was a comfort, as well.

A week or so after I left the hospital, I ran into a friend while out shopping. She asked how I was doing, and noticed a healing wound. "Did they do it laparascopically?" she asked, noticing that the wound seemed small.

"No. That's the surgical drain," I said. Tilting my head back, I said, "This is the scar." She gasped and visibly recoiled. "OH MY GOSH," she said.

I've gotten that reaction more than once. My oldest daughter squirmed, shook her hands and said, "EW EW EW!" the first time she saw it. My husband opined that I look as if "you've had surgery by Sweeney Todd." (A few years ago, only theater geeks would have understood the reference, but now all Johnny Depp fans get it as well.)

My family noticed, as did I, that the other patients on my floor who'd had similar surgeries had simple bandages across their throats, right in the hollow. Sometimes they had a single cotton ball with a strip of tape. I had square of gauze about six inches square across my neck, with bloody rubber tubing snaking out from underneath.

Before I had my grossly enlarged, nodule ridden thyroid removed, the surgeon came into my hospital room and marked my neck right along the natural crease, so he'd know where to cut. The actual cut, about four inches long, is therefore pretty hard to see.

The opening for the drain actually annoys me more. The tubing was held in place by a stitch on either side. When the nurse removed it, she warned me, repeatedly over a few hours, that it would "really hurt." "This has a really wide mouth that flares out under the skin," she said. She had me take deep breaths and brace myself; I was anticipating some real pain. I hardly felt anything.

The cut itself was almost an inch long. The nurse put a SteriStrip over it to hold it closed. She also clipped the stitches across my throat and SteriStripped it before I went home.

("Are you going to wear a scarf or something over that when you go out in public?" my mother wanted to know. "Nope," I said. For one thing, it was August. For another, I think that the general public can handle evidence of surgery. If they can't, oh, well.)

The surgery site appeared to heal well. The drain, however, did not. Ten days after the surgery, I sent this note to two best friends:

Reason 378 Why The Office Staff at My Surgeon's Office Drives Me Crazy

So. My incision is healing nicely, with what looks to be a thin scar, tucked into the fold of my neck. This is what I expected, based on the last time he operated on me and pre op conversations.

The drain opening (I have a drain in my neck!) is another story. When the nurse took out the tubing, she just made one of the SteriStrips for my neck incision a bit longer than the others so it would cover the hole and, in theory, seal it.

It's almost an inch long, and it's not sealing up. TMI alert! Graphic bodily info coming! They told me that if it became obviously infected - smelled bad, had pus, was inflamed and/or draining - I should call them. It hasn't done any of those things, but the SteriStrip was still across it the 2nd day out of the hospital when I noticed that the gap was widening. In the gap (warning! warning!) it looked yellow and shiny. The yellow shininess didn't rub off when I cleaned with gauze, so it's a solid. It's also not a scab. I have come to the conclusion that I'm looking at the subcutaneous fat. The gap is getting wider and wider; it's now about an 1/8 to 1/4 of an inch wide.

I change the bandage twice a day, because it looks too gross to just leave open. I finally decide to call the surgeon's office - always a treat involving phone tag - to see if I can come in and maybe get a stitch or two put in.

Nurse: It'll close on its own.

Me: It's not closing. That's the problem.

Nurse: But it will close. It won't stay open forever.

Me: It's been 10 days. It's getting wider and wider. Do you think that after 10 days those two pieces of skin will reach out and grab onto each other somehow?

Nurse: It heals from the inside out. It'll start healing on the inside. You can put a bandage on it if you want.

Me: It's never been WITHOUT a bandage. They SteriStripped it in the hospital, and I've had a bandage on it ever since that came off.

Nurse: He generally doesn't put stitches in those.

Me: Generally, they heal. This one isn't closing. Do you think perhaps I could have the doctor look at it to see if he needs to treat it?

Nurse: He'll look at it at your follow up appointment.

I finally browbeat her into giving me an appointment tomorrow. I also asked for the results of the biopsy, and pointed out that I'd called on Monday to ask for those results, and hadn't gotten a call back.

Nurse: What labs? I don't see that we have any labs here.

Me: THE BIOPSY. Of the thyroid that was REMOVED last week.

(I mean, I'm just waiting here to find out if I have cancer. No big deal. Don't trouble yourself.)

Nurse: Oh! Well, I'll leave a note for the doctor to call you.

Never mind. I'll see him tomorrow.

                I like my surgeon, but his office staff makes me almost want to resort to violence.

               

                The next day, the surgeon was at least clear and brief. "If I put stitches in that, it'll seal in the infection and it'll get worse." He recommended slathering it in antibiotic cream twice a day, which I was already.

                It eventually did heal, but it's very noticeable. It's lumpy, and much wider than the actual surgery site. Maybe I should be glad that people notice it and not the big one.

                The biopsy was negative, by the way. No cancer. The chance was small, but it was there. It was good news.

                One of my friends is a medical professional, and every time he sees me he handles my throat. "Look at that! It looks great! The swelling is going down!" he says. That makes me happy, too.