Cast-ing call

Halloween is my favorite time of year and I am obviously slowwed down this time. 

The reason I am slowed down is tearing the ligaments in the Lisfranc section of my left foot (don't do it... seriously not fun surgery) But I figured if the inside of my foot looks like I might know a Dr named Frankenstein then the cast containing it should be Halloween-ish too! My Dr's Nurse was a little surprised when I asked for Orange but I think I am making it work.
Here is the x-ray with the screws



and here is the foot (it's not gorry trust me.. just say ouch and move on)



Keep moving...


And finally the fun stuff! here is the cast. 

Cast by Monica Riney, on Flickr

Cast by Monica Riney, on Flickr

Cast by Monica Riney, on Flickr

Cast by Monica Riney, on Flickr

Cast by Monica Riney, on Flickr

A friend is coming over this weekend to help with the open area in the last pic. I just cant reach it. She is thinking about putting a grim reaper there. 

I forgot the back view...
Cast by Monica Riney, on Flickr

Transistion

Ok I am now well into the transition between hard narcotics and something a bit more mild Backing down to Tramadol from the narcotic pain killers is .. not fun. Tramadol is a very good pain killer but it is not as good as Hydrocodone.

Elevation and Ice are definitely my friends.

I am very happy to be able to function outside of the hydrocodone fog.. I don't like it it is unpleasant. Pain is also very unpleasant.

Pride

I have always known myself to be a proud man. Pride has driven me in many ways to improve myself. To improve my art. To Improve the world of those I love. I never spent much time contemplating Pride as a Sin. I have considered it a virtue and a spur to keep me going. I have considered it a crutch when I needed to do better, I considered it at times a virtue and one of the things that helped me pick myself up out of the mud.

My foot has taught me that I am proudful. Pride is a sin regardless of faith or lack there of. If you let it prevent you from accepting or requesting help then you sin against yourself, against your god if you believe in such, and you sin against your fellow man.

I have come to know I am proudful by being rendered helpless. I can not walk with out aid e it man or device. I can no care for my land even to the extent of mowing the grass. Today My Neighbor came and offered to mow for me. I had no clue what to say. Even when trees fell upon my house I was on the roof chain saw in hand directing traffic. I was master of my keep and knight of my hearth. I was not in need of help till now.

I should ask for help more often, I should not require self to endure with out aid. I should more often accept my brothers hand.

It is my foot that brings my low and I hope to learn this lesson in humility.

In the end I have gone to my neighbor and offered my thanks. It was hard for me and that is my sin. I should rejoice in my neighbor's sacrifice of his time on my behalf.

I am unaccustomed to needing aid, even more so asking for it. If I have offended friend or family in my pride, know that I am truly sorry. I am trying to make myself a better Man

one week

A week, wow. has it been that long? So much has happened. I have slept so much. sigh.

Last Monday morning I was ready to go. Ready to get this over and done with and start recovering. Nerve block went well. faded well. I was happy with my progress. the Fluid build up issue was scary and gave me a reality check. I have, since then, slept allot more and even tried to sleep in my own bed with my wife again. I had been in our spare bed room since surgery it didn't go bdly but it didn't go well either. I had no way to keep my foot elevated and couldn't sleep well with the sheet moving when she turned or the dogs and cats moved They were kept out of the spare room.

Talked to one of y Dr's yesterday about the fluid build up he said to effeminately keep it elevated and iced as much as possible. the same thing could happen again. So I am back in the Spare room to sleep and keeping the foot up does help.

The bones ache now as they begin to heal together and around the screws. I have my pain pills and I can always lay down and rest. After a quick hour to hour and a half trip out to the store I am sweaty and exhausted.

Fortunately I have a good support structure at home and at work. At my Lodge my officers are taking up the slack and taking care of business.

No horror stories to tell here. Just slogging through days of sleep and books and TV tinted by aches, pain, and hydrocodone.

I really was not expecting to be this worn out this fast. My Rotator cuff surgery (arthroscopic) was a cake walk compared to this as was my Septoplasty and sinus rotorouter. I guess I just didn't understand just how much I use my lower leg and how much it would take to not use it.

It is getting better but it is also very very slow

Third day out and the ER visit.

Well everything had been going well. I was being good, taking my drugs and watching TV. Friday afternoon just after lunch my foot started aching so I made sure and elevated it. I relaxed and watched my movies. About 2:00 PM it was getting close to time for me to check my pain meds and my alarm woke me up from a short nap. The first thing I noted was that my foot hurt. upon looking down toward said appendage I noted my toes were purple and looked like sausages.

To be perfectly honest it took me a few minutes to connect the discomfort in my foot and the purple toes. As my mind woke up and I realized the discomfort was numbness in my toes and correlated this with the color my heart rate decided it was time to catch up to the party and it seeped into my groggy mind that I had a problem.

I called my wife and told her what was going on and told her I was going to an ER. My wife being of far more stable mind and with out a back load of Hydrocodone, She told me to sit still till she got here and call my Dr to find out where he wanted me. When she got home she checked the dressing and found it icky and full of fluid. I followed instructions and we ended up in the Ortho ER of the small surgical hospital where I had surgery.

In the end it was a drainage issue. The surgical drains were doing everything they could and my dressings had just soaked up more than they could handle and were cutting off circulation. It ended up being a stressful _no big deal_ visit to the ER. the dressing is changed the drains and surgery sites cleaned and I slept like a sweaty rock on pain killers all night.

It could have been much worse, If I had ignored it, If I hadn't sought help when I saw there was an issue. This would continued to have drainage problems. I could (probably would)  have gotten an infection. Lots of things _could_ have happened. In my case there was a problem albeit a minor one that was easily remedied. Without remedy it could have been far far worse.

I will take an afternoon in the ER and having the foot redressed and cleaned. Each of us is part of our medical care staff. No one knows your body better than you. Don't be afraid to say "hey something isn't right here"

Day 2

Well the beginning of Day two after surgery any way. Yesterday wen't well over all. I slept quite a bit. In between naps I surfed the internet and worked on mobility with the knee crutch. Even though it takes a few seconds to put on it is a much much more stable non weight bearing solution than crutches. I can't compare it to a knee scooter as they are unsuited to my home. I am able to get easily to and from the rest room and up and down stairs without assistance. I am still using a cane with it for an extra measure of stability due to the pain killers, however I don't think it is required. It is more of a magic feather.

The nerve block stated wearing off about 1 PM Yesterday however as I had already began the Painkillers on a schedule I have experienced only moderate pain levels (4 to 6 out of 10) It is hard say when the nerve block had completely worn off.

Today will likely be Netflix and maybe reading.

Surgery

Well yesterday it happened. I spent all morning wishing for food and drink while doing some last minute walking about and shopping with my wife. I took my last stand up shower for a while and scrubbed with the hibicleanse stuff I was given in pre-op. The super soap had been on my todo list every day since Friday before the Monday cut time so in all I scrubbed from the neck down with the stuff four times to help avoid MRSA.

During check in with the nurse My BP was once again up but today on top of the pain, no drugs and nervousness I was also told to not take my BP medication Sunday as it has the possibility of interfering with anesthesia.

I dressed in my surgical gown (got keep my undershorts on for once) and answered the eternal battery of questions while having my IV tapped and my foot shaved of all hair up to just below the bulge of the calf muscle.

Then I returned to waiting. My wife joined me and was knitting as I surfed Facebook and e-mail and many warm wished and prayers sent my way from friends and family.

Once in the OR I transferred over to the plinth and watched the ultrasound screen while the anesthesiologist gave me a sciatic nerve black from the knee down. I highly recommend the nerve block. I am writing this at 7 AM the morning after surgery and though I know it will slowly wear off through the day today It has been spectacular for my wife and I to be able to get me transported deal with the pharmacy and situated for the night.

I can still feel some sensation but I was able to rest comfortably. every once in a while I get what feels like little tiny muscle spasms in random spots of the left lower leg. The anesthesiologist warned me about these and though they are not painful it would weird a person out if they were not expecting it. He told me that is my body checking random nerve endings as they slowly wake up. sort of an "on boot self diagnostic" for the blocked sciatic

I woke up with the foot all wrapped up in a splint  dressing I get to leave on, the DR will remove this and cast it next time I see him. I have 2 incisions in the top of my foot (no pictures yet) and 3 screws. My surgeon was very happy with the health of my bones and in combination with my physical frame (I am m 6' 3") he was able to do thee fusion with three screws and didn't need to use a plate which makes the assembly more comfortable for me long term. or at least that is what he said.

We had one hic-up in post hospital arrangements our pharmacy did not have the right amount of hydrocodone to fill my scirpt. they called around and found one that did have it and we drove an extra 3 or 4 miles. Since I had the nerve block I was able to sit comfortably in the back seat with my foot up while my darling wife did the running in and out.

We stopped and get bacon cheese burgers on the way home, and about 10:30 last night I began taking my pain meds on the recommended interval and set my fitbit alarms so I would remember them . Just because the sciatic nerve is not reporting the injury and surgery doesn't mean it is not there. I plan and hope to stay on-top and sightly ahead of the pain.

I used standard crutches getting into the house and back and forth to the head through the night as I knew I would have to make some adjustment to the iWalk 2.0 knee crutch to around fro dressings and swelling. Using the knee crutch this morning was much much easier. I am still using a cane or crutch with it due to the narcotics but over all way way better than the conventional way of getting around with zero weight bearing. I don't think it is for everyone and a certain level of balance and coordination is required for its use. the fact that i made sure to spend time practicing on it last week helps quite a bit

That is all I have this morning. I will keep updating as I go.

Leave of Absence

Well my work schedule is Mon-Fri so as of clocking out this afternoon I am now on a Medical leave of Absence. Short Term Disability has been filed and according to HR I am not allowed to be at work till my Dr says it's okey dokey.

This brings some mixed emotions. I am glad I work for a company which gives these options. I am More fortunate than a great many people in similar situations. I have done a major surgery when I was a stay at home parent and my wife had to do darn near everything for several weeks including getting kids back and forth to school which was one of my normal task (that was a blown disk at L5-S1 not pleasant don't do it) It was very rough and cost far more than bills reflect. if it had not been for the help of friends and family we would not have made it. I am so very glad I am not in that spot again.

On the flip side I don't like being off work and the uncertainty of exactly when I get to go back. it is scary. I have spent all week trying to make sure everything I can do is done to prep my work site for my absence.

I am also the current Worshipful Master of my Masonic Lodge. This week with out NSAIDs and next week after surgery are definitely no go's for getting up to lodge and anything going on. Fortunately my officers are all the Models of what Masons should be and have picked up the slack. I posted the following on Facebook and mean every word of it:

"I am very grateful for my officers and the members of my lodge who have made sure the light of Masonry is tended to. It is not that they tended the flame when I am unable, it is as I am unable that I see they have tended it all along.

There may be times we think that we alone feed the fire and keep the flame alive. I am fortunate to see how many others tend the flame of knowledge and keep it alive that I might find my way back home."

I am not happy to be at home on a LOA I am not happy to be having my foot sliced open and remodeled. I am glad I am occupationally and financially able to take care of the Lemons life has thrown my way and mix them with Soda, Sweet Iced Tea and Rum. (forget lemonade)

Pre-op

Well I did Pre-op today. My blood pressure was a bit high and I reminded them that I wasn't supposed to take anti-inflammatory and was ask" well you know you can take this this and this right?"

I did not growl This is not my first major skeletal surgery. I have survived an old fashioned laminectomy and diskectomy at L5-S1 with 60% nerve impingement. I have done a rather unpleasant rotator cuff decompression, repair and impingement surgery with bone planing. I have also done a rather extensive septoplasty with bone ad soft tissue removal in all 8 sinuses.

I know damn well my foot will hurt differently than any of those, none of those hurt the same way. However I know damn well what I can take before surgery and what I can handle at work the week before surgery. and work requires I deal with a bit of pain and not take some of the drugs I want.

Acetaminophen helps .. a little and the Tramadol tends to make me slightly fuzzy minded which I don't like at work. Hence at the end of the work day when I did my Pre-op.. I was hurting a bit more than was comfortable.

sigh I will eat my narcotics next week and drool.

Anti Inflamitories

6 days and a wake up before surgery.

NSAIDs. Oh how I want one right now. My Pre op info says not to take Non-Steroidal Anti-Inflammatory Drugs or Aspirin for one week before surgery. Something about blood thinning properties and yadda yadda,

Oh Holly F**% Bunnies! I didn't even know or realize how much they were helping!

Tramadol is my current best friend I am still allowed to have it.

Best advice don't do this to your foot. I am sure I will say this again.

Making changes

Shower seat, Remote shower head and Peg leg acquired. The Wife is out hunting a small microwave... 8 days and a wake up till surgery..

Here is the Peg leg!

My yard is all hill and my house is all stairs and narrow so the normal knee scooter is just a joke. 

To top of the day of prep for having my foot ripped up and re-assembled I did some work in one of our bathrooms

New shower head and hand shower along with my new shower seat.. Oh Joy. 

Really Red Wasp.. Hate with wings.....

LisFranc

A Frenchman named Lisfranc is not to blame for my pain but he was the first to define why my foot hurts. He was a Surgeon in Napoleon's army. Remember in the 17 - 1800's the surgeon was not really who you wanted to see. The specialty surgery of the day was amputation.

Well Lisfranc noticed that cavalry men who had been shot/knocked/fallen out of their saddle and got their foot caught in the stirrup had a peculiar injury to the mid foot. While he was getting good at cutting peoples foot off across the mid foot joint he had lots of time to look at the bones and tissue connecting everything.

Well due to his attention to the stuff and people he was cutting up on a semi daily basis he was able to define that the first metatarsal is connected by a ligament to the second cuneiform bone which is now called the Lisfranc ligament.

I have found that in modern medicine the whole joint complex around this ligament is oft referred to as the Lisfranc joint. Unfortunately the event that has lead me to this dive into medical history and terminology is tearing the ever living shit out of the ligaments in the Lisfranc and surrounding joints of my left foot.

If you have run into this blog by some search I am guessing you have done something similar. As this injury is only reported in 1 of every 55,000 foot injuries and is further missed on standard x-rays up to 80% of the time you are probably going WTF?!

But look at those numbers; less than .2 percent of all foot injuries requiring medical attention in the US are Lisfranc, Of those (from what I can find) abut 60% are surgical, so we are down to .12%. Now if you are like me and in the 10-20% that is pure ligament (we'll call it 15%) we are down to .018% of of foot injuries.

This means that all of us who have purely ligament Lisfranc injuries requiring surgery should have gone and bought a lottery ticket instead of what ever we were doing when we hurt our foot.

For me I was on the second/third or fourth rung of a ladder and opened a compartment. Inside was a small but active nest of Red Wasps. They, being very defensive and aggressive creatures constructed of Hate and given wings, they were pretty sure I should not be there and I agreed.

I managed to defy gravity and levitate 3-4 feet straight backwards at which time I violated the first rule of cartoon physics and looked down (I must have) If you ever watched the Road Runner you know that when Wile E. Coyote (Genius) looked down real world physics came into affect.

So down I went and my left foot turned into PAIN.

A Dr visit and a few x-rays later I was assured no bones were broken and I should keep it wrapped do the RICE routine and the _sprain_ would heal

Well it did slowly get better .. to a point. and then it stopped getting better, and then I tripped and put my weight on it.. Oh the Good Lord knows that I may have created new sins by the words I said at that time.

So I called an Orthopedist who said we need to have you put weight on it and take a new x-ray.. or 30

There is a moment of disbelief when the Surgeon says "We are going to cut from here to here and put screws and plates in here"

So that is where I am now, Surgery scheduled, primary arthrodesis (bone fusion) of the Lisfranc joint as my age activity level and injury give this process the best chance of success. (I was offered open reduction fixation but the given factors are against it)

My surgery is on the 31st as I prepare and go through this I will update. I am looking to use a knee crutch rather than a scooter do to the configuration of my house and am hoping to have it this weekend.

Wish me luck!