The Surgery Show

I was thrilled when Doctor Foot Doctor offered to supply pictures of my surgery, though I was admittedly a little apprehensive. Fascinating or nauseating? I’ve certainly received plenty of views on that question. And better, I’ve heard that thanks to these pictures, my readership has extended to some interesting places! Overall, The Surgery Show has been a great hit.

A couple years back I had a hernia repaired. Beforehand, I searched the web for some pictures, being the naturally curious type, and wondering what exactly they intended to do to me. Quick lesson: abdominal surgery is not pretty. After a few shots, uh, you don’t want to go there anymore.

But somehow biomechanics held fascination. And the possibility of seeing my very own foot, and the subsequent understanding of the work done, held even more. I found the pictures truly amazing and not at all nauseating, an opinion helped, I’m sure, by the relatively bloodless environment of the foot under tourniquet. But there’s no other way I could have appreciated what my crack surgical team did without seeing those shots. And the shot of the thread-thin remaining strand of the once thick and meaty tendon spoke a thousand words.

And the reactions! You’d think I was posting porn, the span of awe versus disgust! My first few post-surgical ventures out were to our church, since I’ve got folk band practice on Tuesdays plus of course our “weekend gig”, so the first people to hear about these shots were my church crowd. My band-mates know my obsessive side and so weren’t at all surprised at this image-posting twist. But to my surprise, my pastor was utterly thrilled, exclaiming, “I love surgeries!” His glee was doubled when he learned that the photographer was one of his parishioners! I won’t identify that person any further to keep the HIPAA lawyers happy, but another huge thank you to you.

My co-workers have had all kinds of reactions, which I’ve absolutely loved. In short, this has been way too much fun! You have to turn your head at the car wreck, you can’t help it. Even at today’s office holiday luncheon – my first foray back to our sales office – they’d express amazement or disgust, but in either case hustle over with sandwiches and potato salad in hand and glue their eyes to that sliced wheel, that mangled tendon, that curious strip of decellularized equine pericardium.

But the best bonus of all was hearing today that my blog posting made it back to none other than the makers of that strip of equine linguini, Pegasus Biologics. Apparently they like to see pictures of their product in action (and who wouldn’t?), and it was easy to pass on the blog, resulting in a few new eyeballs scanning my prose within their hallowed halls. Pegasus folks, if you’re still reading, hats off to you. I’m thankful for your work and your product, and honored at you attention. And if this thing actually heals up strong like I hope, I’ll be doubly so. Just one question, though: Was that horse a thoroughbred?

Optimistically Bummed

Crutches stink. If you’ve been on them, you know this. If not, you don’t have a clue. You think they’re great fun. You grab your friend’s (hopefully when he’s sitting down) and hop across the room with glee. But when you really can’t afford to drop weight on that busted and/or patched up lower appendage, you quickly learn the truth.

In my case, one screw up and all this work goes down the tubes. Tendons sewn but not re-grown (I worked for minutes on that rhyme, kindly appreciate it!) are rather fragile, even with the best horse artistically wrapped around them. Which leads us to today’s theme, that while this medical adventure is, for all we can see, proceeding well, it takes a long time.

This saga seems like it started eons ago, which is probably because it did. With perfect hindsight I would have skipped the five weeks in leg armor leading up to surgery, but who knew? We had to play the game and give it a shot. It was a long shot. We lost. C’est la vie.

It’s now been two and a half weeks since the surgery, two and a half weeks on crutches. Give me a wide open space, I can move pretty well on these things. (Heck, my manager Steve tells me he actually did the Manchester Road Race on crutches several years back; my arms ache just thinking about it!) But just try to navigate through the house – and my wife keeps a neat house, mind you – and frustration mounts. Everything is slightly out of reach. Hop? Or grab those things again? Worst is the inability to carry most anything, since you need your hands. I’m quite sick of being rather useless with anything other than the keyboard.

On the lighter side, my younger daughter likens my one-legged state to a flamingo, and desperately wants to dress me up in pink. I’ve come to refer to myself as a permanent Captain Morgan advertisement, and I don’t even drink the stuff. Any other one-legged jokes you can think of, just send them over.

But Doctor Foot Doctor had told me two to three weeks in the splint, then back to the leg armor. And so with today’s follow-up visit, there was the slightest ray of hope. I was so wishing to gain my freedom from the crutches. Alas, it was not to be. Despite good behavior, my sentence has not been commuted. And worse, when I shift back to the air cast in about a week, the crutches don’t go away. Instead I keep using them, but only slowly start adding weight over the course of a couple more weeks. Doc is optimistic on my prognosis, but wisely cautious.

To my engineering head, this makes perfect sense, of course, and I’m fully with the program to ease back oh-so-gently in hopes of not damaging this fragile repair. But I can’t deny that I am just a little bummed. Oh ye who yearn from freedom…

Ingrained

I can’t make this stuff up. While my foot is still sheathed in bandages, resembling, as my co-workers put it, a huge wrapped up meatball grinder, while I still hobble on crutches, while I consciously yearn to run, my subconscious is at it as well. I ran a marathon last night in 2:61. Yeah, 2:61. Dreams are like that.

Yesterday I’d told myself that I’d unwrap the meatball sub today and have a look at the work in progress. Perhaps that spawned the nocturnal mind warp. In that nether world, I’d taken off the bandages and, despite orders not to move a thing associated with this appendage, gone for a walk. Next thing you know, I was jogging, then running in pure joy, then had joined up with a bunch of other runners, entirely exhilarated, then we’d been running so long we realized we’d almost covered a marathon and might as well finish it. We hammered the finish, which was, oddly enough, officially marked, measured, and timed, and that’s where I clocked the 2:61. Even in my dream I was rational enough to wonder why it wasn’t a 3:01, but sure enough, it was a 2:61. It was so real, I’ll bet it’s out there on CoolRunning somewhere, if I only knew the name of the race.

Amidst the pleasure of my accomplishment and the elation over the fact that my foot felt fine while running, the shame of having broken Doc’s orders quickly took over, and as a schoolboy in trouble – because somehow I was back in school – I tried to find an excuse for why I’d been gone for three hours. Somehow, “I was at Phys Ed class” didn’t cut it with the teacher.

I swear, I can’t make this stuff up.

When I was 18, back in my First Lap days, and contracted meningitis (see It’s August and I’m Still Alive), I came out of the coma only to be asked by the doctor if I was British. I found that odd, being firmly Italian and Polish, but it seems that I’d been mumbling in a British accent while I was out. At the time I was a die-hard Monty Python fan (who am I kidding? still am…), and it was pretty clear that the mind takes you to your comfort zone in your subconscious.

Which is why I was really quite pleased to wake up this morning and recall this dream. In my conscious life (I think it’s conscious, or to paraphrase René Descartes, “I wonder if I think, therefore I am”), I tell people – especially non-runners who don’t understand our obsession – that running is a part of me. Yet I wonder how much of that is truth and how much is wishful thinking of one’s ideal self-image. But when it pervades the subconscious, it gives you reason to believe the former, and I find comfort in that. It is indeed ingrained.

Comfort is a good thing at present, since my foot has been rather swollen and quite uncomfortable the past few days. Doctor Foot Doctor told me to expect that approaching the two week mark, as my body starts to really kick into overdrive on healing. I’m hoping the last couple days are just an early onset of the process and not a harbinger of worse to come.

Yet I have to believe I’m over the hump. While the last few days have been uncomfortable, the day is creeping closer to getting off the crutches, moving back to the air cast phase, then getting back to normal. And running. And just to make it really feel like getting over the hump, God threw us a heck of a hump last week. For those of you who live outside of New England, we’re still crawling out from under the arboreal and associated infrastructure wreckage of our worst ice storm in decades. Timed perfectly for me, arriving at the peak of my Gimpdom. Saying to me, in a way, “If you can get through this while you’re hobbled, you can get through a lot.”

My city was on the edge of the frozen zone and took relatively light damage compared to others to our west (check out some amazing pictures from my friend Kelly), yet still our entire city was knocked offline with unprecedented chaos. I lost power for a mere 33 hours, while colleagues of mine are still out 5 days later. Mind you, my home was out for longer than anyone else on the street because of my brilliant thought to pull the main breaker to protect things various and electric when the power was fluctuating wildly on its way to extinction. And it did just as its name implies. It broke. Advice: Don’t do that. As I learned, because you never ever pull your main breaker, it sits there, humming, warm, for five, ten, twenty years, baking the plastic to a fine state of brittleness. Guess what happens when you finally do pull it?

Fortunately we were able to land a fine electrician (recommendation gladly provided on request) on short notice, even during a regional crisis, and were back online rapidly thereafter. So we got off light. But dealing with lack of power, lack of heat, wrecked trees, and so on while on Official Gimp Status, well, let’s just say the timing could have been better.

After that, I’ve got to be over the hump. And my mind is telling me, even late at night, that it’s time to mend and get back on the roads. But hey, an ice storm is a crappy time to run anyway, so I guess if you have to be on crutches, do it then, and run your marathons at night. Sweet dreams to you.

Medical History

To hear Dr. Foot Doctor tell it, I am now medical history, but he doesn’t want any glory. Certainly if nothing else I have provided for him an interesting week, apart from the usual bunions and fallen arches. But it waits to be seen if this adventure will be successful.

Now, before you read too far, federal law says I must provide a Squeamish Alert. Yes, those of you who passed out when Sister Mary Teresa had you dissecting frogs or fetal pigs may want to shy away from the later parts of this diatribe. We’ve got pictures, and they’re graphic. You have been warned. Now back to our tale.

This afternoon was the Great Unveiling. Squeamish or not, I wasn’t sure what I was going to see. For the last three days I haven’t been able to tell what I’ve been feeling in my foot. Is it cold? Is it hot? Is it swollen beyond belief? Is it in pain? Is it numb? It seems hard to believe, but I simply couldn’t tell you. And above all, I had no idea what color it was. I had visions of a horribly black and blue appendage, nearly dead from being deprived of blood for two hours during surgery and three days of unyielding bandages.

Reality was a relief. My old friend came out of the bandages and dressings looking pretty darn good. The scar on the inside edge was long, as Dr. Foot Doctor had warned me, but not as long as I’d imagined. There were no nasty bruises from the tourniquet. And it wasn’t swollen, not one whit. Doc applied a coat of something that looked like rust inhibitor on the scar, and wrapped it back up. Piece of cake. Stay off it, see you in two weeks.

But stopping there leaves out all of the interesting parts. A couple of facts: Dr. Foot Doctor and Dr. Partner Foot Doctor, who studied under the doctor who is now the podiatrist for the Chicago White Sox, did quite a bit of research and found only 5 documented cases of my type of injury. Of these, the success rates of repair were only about 50-50, but none of them did what Dr. Foot Doctor did, which was to combine a repair using Pegasus OrthoAdapt BioImplant – the equine pericardium, or horse heart collagen ‘scaffold’ I’d mentioned in earlier posts – with Topaz radiofrequency low-temperature coblation for removal of damaged tendon. Just the use of the Pegasus in this application was pretty unusual. Certainly the guys from Pegasus must have thought this interesting enough that their rep was present in the OR for the procedure! Indeed, were he keen on a little fame, Dr. Foot Doctor could write me up as a case and make a little medical history. But he tells me he doesn’t want the fame. Fair enough.

Now, for the specifics. As an engineer, I find this fascinating, so let’s get started!

Yes, that first picture is of my foot. I know it’s mine because the fourth toe is bent from breaking it by whacking it on the parallel bars in gym class in 3rd grade. Yes, from back in those days when I was a geek, when I’d do things like put up a sign on my little schoolroom desk that said ‘broken toe’ when I put my foot up on the support bars. As opposed to today, when I do things like put pictures of my foot surgery on the web. Yeah, back in those days when I was a geek… That and the abused toenail on #2. Clearly mine, another scar left over from Wineglass.

Now, in this picture, they’re just starting to open it up, and the angle is such that you can’t really see it. Consider this to be your warning flag. Things are going to get a little graphic from here on.

Ending for the squeamish: And here I sit, hoping that in a few weeks a beautiful butterfly of a toe will emerge from this chrysalis of bandages. The end. Pretty disappointing ending, wasn’t it? Want more? Gird your stomach and scroll on down to the squeamish part!

(Don’t scroll down if you’re squeamish…)

Continuation for the firm of stomach: First thing to realize is that I’ve cropped all these to better fit in this blog. You’re looking at my right foot from the inside edge, with Mr. Big Toe on the left. I’ve also reduced the resolution for quicker downloads. Any true med students out there are welcome to email me for the full-resolution shots!

And now, on with the procedure!

First, we open up my foot and apply cocktail forks. The little shrimp on the bed of lettuce appear in slide 4. The big white thing is the metatarsal bone, which I learned was abnormally shaped, and likely contributed to the tendon injury.


Next, let’s go in with guns, tanks, bombs, grenades and other implements of destruction and grind that nasty abnormal metatarsal down to size. And while you’re at it, can you trim those foot hair bangs frizzing wildly in the wind?


Now on to the main attraction. Dr. Foot Doctor’s theory was that the tendon was almost, but not completely severed. Had it been completely severed, Mr. Big Toe would have been reaching for the sky for more than 4 hours straight. And sure enough, when Doc went fishing for my tendon, he found a strand remaining. Perhaps 5% of the original tendon. Not completely severed, but pretty darn close. Did he nail that one or what?


Next, it’s time to go reel in the fish. Actually finding, getting a hold of, and pulling together the ends of the nearly severed tendon took quite some doing. At one point they weren’t sure they were going to be able to get them back together. But like a good marriage counselor, he gave one last mighty heave and re-united the pair with a couple of sturdy tow lines.


Next, bring on the big guns! Tase me Bro! That probe is known as a Topaz MicroDebrider. Yeah, right, he said, what’s a MicroDebrider? Well, per Merriam Webster, de•bride•ment is the surgical removal of lacerated, devitalized, or contaminated tissue. In other words, get rid of the torn and nasty stuff. The Topaz uses what’s called coblation, which means it applies radio frequency energy to do the job at a lower temperature than a laser and thereby doesn’t inflict damage to the rest of the tendon. The theory here is that the tendon will heal faster after this process.


And now, bring on the Pegasus. The mythological winged horse, which is actually a piece of horse, is laced around the sewn together tendon to provide a scaffold – or support – for the tendon to grow back together and heal. When it’s all done it looks, well, a little like a rubber band around a piece of meat. Twang.


And it’s a wrap! Stitch him up and send him forth!

I’m told that two weeks hence my body will take note of both the Pegasus and the Topaz work and get irritated and swollen. This is a good thing, I’m told, as it means healing is happening. It also gives me an excuse to get irritated. So bring it on. The swollen part I’ll pass on.

Resting Peacefully

Headquarters has moved. My tag line used to be, “Global Domination from the Basement” based on my office and command center deep in the bowels of my castle. Now it’s the living room couch. Working on from the tiny laptop screen instead of my luxurious multiple monitors downstairs does make me feel a little constrained, but my toes stay a lot warmer up here.

Speaking of toes, I’m under strict doctor’s orders not to move them – or more precisely, not to move Mr. Big Toe. But a couple of hours ago my foot sort of involuntarily twitched, and I FELT it. Yes! I felt my big toe make downward pressure contact! It’s still early in the game, but that smells like success! (By the way, my condolences go to my left big toe. It could be crushed, burned, or hung in effigy, yet it will never be known as the Mr. Big Toe. It must feel so left out.)

I’m guessing at this point that Dr. Foot Doctor did a knock-up job. I’m basing that conclusion on root canals and gum surgery. This shouldn’t surprise you, since 20 years ago my dentist diagnosed my broken wrist. But seriously, if you ask the average person about their experiences with either procedure, they’ll typically tell you horror stories. I, on the other hand, have been lucky to have had three root canals done so expertly that I actually enjoyed them, and a session of gum surgery a year ago so beautifully executed that I took the pain meds for recreation only. Do it well, and the recovery will tell the tale. And so far, as far as recoveries go, this hasn’t been bad at all, which tells me that this was either beautifully done, or the pain meds are better than I thought.

I suspect the former. It’s about 50 hours past surgery, and I’ve only felt the tiniest twinges of discomfort from the actual area of the surgery, a three to four inch incision along the side of my foot from the ball toward the midsole. And that through times when the pain meds have definitely worn past their four hour limit.

I had a few rough hours the first night. About 3 AM, the meds had pretty much worn off, and a slight jar to my foot brought on a strong pulsing pain in my heel. A mild panic ensued. Well not exactly panic, but deep concern, because it felt like – how could this be? – it felt like spurting blood! I hadn’t talked to Dr. Foot Doctor yet, and I imagined a scenario where it had been so hard to find the tendon that they’d made slices elsewhere on my foot. I imagined I’d popped open an unexpected suture. I expected to see a red splotch start to seep through the bandages.

By morning, no Red Badge of Courage had appeared, but the front of my ankle had joined my heel in the protest of pain. None of this made any sense, of course, but with my foot wrapped in layers and a strict, Do Not Open Before Christmas (or at least Monday) dictate, I had no idea what was lurking beneath those bandages. Even though he said to call anytime, 24x7, I waited till 8 ticked around and called Dr. Foot Doctor.

Mystery solved rapidly. No spurting blood, no extra incisions, just pain from where they’d placed the tourniquet. And it had been there a surprising 106 minutes – running up against the absolute limit of 120, at which point they have to cut you off (pun intended). Dr. Foot Doctor filled in a few other details of Friday’s action. He said he’d had to extend the slice a bit to find the ends of the tendon, which were quite stretched out. He said the repair took a lot longer than planned, but went well, and I do indeed have a bit of horse stitched into me now. Whiney for me, baby, whiney! He zapped the tendon with a Topaz electronic device which either speeds healing or makes me light up under high-tension power lines. He reported that arthritis was not what was causing my limited toe motion, but an abnormally shaped metatarsal, which probably contributed to my susceptibility to this injury (and if that’s genetic, perhaps why my sister recently broke hers?). As a Buy One, Get One Free, while he was in there, he shaved the mutant metatarsal down to size. And my favorite report from the day: “You took a lot more anesthesia than we expected!” Read into that whatever you want.

Next up was the best-tasting breakfast in bed I think I’ve ever tasted, compliments of St. Ann, and a day of pleasant R&R. I’m in love with my cryo-cuff, a simple yet effective gizmo that easily recharges a boot with ice water. Beats the tar out of balancing a bag of ice on your foot! And the kids get a kick out of giving me a periodic “oil change”.

Night number two was much less eventful. My only serious complaint at this point is some cramping of my foot due to its constrained position. But the surgery area itself is still quite comfortable.

Tomorrow it’s off to see Dr. Foot Doctor for a first follow-up, and yes, he’s promised me he’s got those pictures ready for me on a thumb drive. Squeamish of the world beware, my next posting should be really interesting!

In the Presence of Saints

The local anesthesia hasn’t yet totally worn off, and the Vicodin has already kicked in. So I’m in the post-op glow zone – no pain, relief that it’s over, and the potential misery hasn’t yet arrived. The glow is enhanced by memories of the saints who cared for me today.

These people are saints. Every one of them. I only wish I could remember them all. And even though I asked for a lot of names, I have unfortunately forgotten most. I can blame the amnesia effects of the anesthesia, but mostly I just forget things.

From the time I arrived at our local Marlborough Hospital at 8:30 this morning until I left at 3 PM, every single person I encountered – and there were lots of them – was cheerful, helpful, caring, and competent. And they do this day in, day out. If any of them were having a bad day, they certainly didn’t show it.

Let’s recount the action and call the role: All of the nurses at Surgical Day Care. Saints I-Wish-I-Could-Recall-Their-Names. Warm greetings. Cheerful and happy even while covering the mundane paperwork. Extra effort all around to be sure I knew what was happening. And when the IV went in – which to me is the worst part of anything like this – and went in a little on the painful side, extra effort to get it right, get it comfortable, and make me happy.

The taxi drivers, Saint Bud and Saint Bob. These gentlemen wheeled me around a couple of times during the day, and they do this for fun. Volunteers. Purely out the goodness of their hearts.

The pre-surgery prep room nurses. Saint Giselle, Saint Jacqueline, and others who’s names I’ve also lost, I’m terrible with names. Constantly attention to any and all trivial needs. Staying with me to chat. And one who I’ll call Saint Shocked who walked in and expressed amazement that I’m 45 (no, she didn’t think I looked old and decrepit, quite the opposite). Go ahead, butter me up, at that point I couldn’t help but love it. Of course, I credited our running lifestyle for not looking my age.

The OR nurse, Saint Rhonda of the Operating Room, who also did my pre-op interview. And who, like many of these saints today, took great interest in the whole story that led up to this day. Gee, I might have even gained a couple more blog readers today!

Saint Anesthesiologist, alleviating my worries about the possibility of ‘being there’, since I wasn’t to be all the way out under general anesthesia. Of course, he was right.

Saint Dr. Foot Doctor, who, earlier this week, spent a lot more time than you would ever expect to get with your doctor, discussing this procedure in great deal. And who went the extra length to bring in his digital camera to give me images of the procedure for later blog material (the squeamish being welcome to bypass that one, but I’ll find it fascinating). And of course, his partner, Saint Dr. Partner Foot Doctor, who teamed on the procedure. These two guys simply exude competence, and their reputations back it up, yet they are completely there for me, all the time.

Saint X-Ray Technicians of the Mobile Cart. A minor supporting role, but again, cheerful, caring, another reason to smile on an otherwise stressful day.

Saint Physical Therapist, teaching me how to get up stairs on crutches.

And Saint Enid and the other nurses handling the final details and seeing me off.

Plus of course Saint Everyone Else I Missed. And there are lots of them. Many of whom gave me their names (I promised them no last names online!) but whose names fall into the abyss. There was a Susan in there somewhere.

As for the surgery itself, well, that’s almost a foregone conclusion. I won’t know how successful it was for some time. But I now have that strip of horse in my foot, giving me horsepower, the ability to run like a horse I hope, and, well, we’ll leave out that third and obvious bad joke. Dr. Foot Doctor also used a process known as Topaz, which, best I can figure, uses an electrostatic probe to treat the tendon to increase blood flow and thus speed healing. And as a Buy One, Get One Free, he also shaved down the suspected arthritic build-up that was restricting the motion of Mr. Big Toe to begin with. Or at least that was that plan. I’ll learn what he actually did and how it went on Monday.

As for now, my foot is half-casted and wrapped in so many layers it reminds me of those padded bop’em suits. And then it’s sheathed in a very cool (literally!) ice water sleeve that comes complete with a thermos unit to cycle in more cold as needed. So much easier and more effective than a bag of ice. Ain’t medical technology grand? And of course, there’s the meds. Ahhhhhh…

So now it’s R&R at home with Saint Emily and Saint Laura, my daughters, who are getting valuable vocational training as waitresses. But most important of all is St. Ann, my very own angel, and the love of my life, who’s making this recovery, as well as every day, a joy.

I cannot say thank you enough to all of you.