08 December 2008

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.

1 comment:

  1. That's absolutely disgusting. But I can't say I wasn't warned.

    I had no idea all this was happening. Good God! I could have told you that athletic activity was bad for your health.


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