8 Months After Cheilectomy

Wow! Eight months! I'd love to report that I am completely recovered and good as new, but not yet. However, the news is mostly good. I have resumed my ballroom dance practices: 1.5 hours Tuesday, 2 hours Friday, 2 hours Sunday, and assorted minutes gliding about my own living room. I experience no significant discomfort, perhaps .5 on a 10 point scale. Strength and control are still coming back, and I am not fully in control of spins with right foot bearing weight. Fortunately, in our new routine I am not required to any fancy ballet-style pirouette turns!

I am actually very pleased with my endurance for dancing. About a month ago I attended four 50 minute dance workshops in an afternoon and then danced vigorously for about two hours the same evening. My dogs were tired as I hobbled to the car. For some reason, my dear foot that performed so marvelously all afternoon and evening throbbed and ached all the way home, and by the time I got out of my car an hour later, rigor mortis threatened. I took Ibuprofen and went to bed hoping rest would bring a full recovery. By the next morning I was back to normal!

So, what is abnormal? The ball of my recovering foot experiences a tightness, a tension, and sometimes a low grade ache. Of course, I'm hoping all of that will go away in time. There's no more stabbing pain in the ball of my foot as I sometimes experienced prior to surgery. Significantly, I've relinquished my expectation for range of motion to match my abnormally-flexible left foot. My recovering foot is able to bend and flex within the normal range, and as I work it, strength should continue to improve.

That's it folks. My next post will be at the one year mark. Perhaps I'll have exceptionally good news to report.

Best wishes to you in your recovery process!

Achievements at 5 months Post-Cheilectomy

Here are my celebrations at this point:

1.  Hiking - I have attempted as many as 3 miles at a time on irregular terrain and really didn't experience much pain or sense of imbalance. I do still resort to icing and elevating at times when I feel uncomfortable pressure, but this is infrequent. I definitely do not feel as sure-footed as before, but I'm hopeful that eventually I'll enjoy greater function than before the surgery.

2. Gardening - It's surprising how tiring that can be!  Wielding a pick and shovel, maneuvering a large wheelbarrow laden with soil, wrestling rocks about, bending, lifting--- these all pose a strain that sneaks up and surprises me each time. My foot gets tired! Still, I can work for a half hour easily. The day that I worked for hours helping to double my current garden space was exhausting. Pressure seemed to build up in my foot and ice and elevation was a welcome relief. I thought about taking pain medication, but decided against it since rest, ice, and elevation are so effective.

3. Balance - Improved! Here I am, goofing around, on the new wall my son installed to expand the garden. That's my damaged foot I'm standing on, so I guess I'm not doing too bad. However, dancing is the real test for balance...

4. Dancing - Ahhhh... I have returned to one of my former loves: international folk dancing. For two Monday evenings in a row I walked, hopped, slid, and performed any number of moves not typical in an ordinary day of movement, and to my relief, I did okay. Pivot turns were tricky, requiring full weight on the pivoting foot to execute a controlled, graceful turn. Eek! I could tell that I need to be more consistent in daily PT exercise of raising up on to my toes with most of my weight shifted to the recovering foot. I have a strength deficit that I'd better work on remedying before my ballroom resumes in a couple of weeks. I also tried a "Zumba Gold" class last week and was able to do most of the moves with some degree of control.

5. Cycling poses no strain at all, whether on my exercise bike or out on the road. I'm currently doing 30 minutes a day of varied intensity intervals in order to get a cardiovascular workout.

6. Jogging - Hah!  Well, I've never been a runner, but I have added a wee bit of jogging to my daily walks. Think small: three or four hundred feet of jogging and a whole lot of walking. It is interesting that jogging really doesn't feel any worse than walking. I sprinkle in a bit of running to try to get more of a cardiovascular workout.

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Weight Gain with Cheilectomy

Ladies and gentlemen, I gained twelve pounds in the three months immediately after my cheilectomy. DON'T LET THIS HAPPEN TO YOU! Gaining weight is as easy as relaxing on the couch with your foot on ice, sipping the consolation drink of your choice. Losing weight, especially after foot surgery, requires persistence and pain.

I have no excuse. I knew that, basically, if I ate more calories than I burned, I would gain weight. I also knew that my caloric expenditure would plummet with the foot surgery. I definitely did not pause to do the math. Here are the hard facts: Before the surgery I consumed a given quantity of food, and after the surgery I continued to consume pretty much the same amount. Before the surgery, I was dancing fairly vigorously at least three hours each week and either cycling, walking or jogging almost daily--- burning at least 3,500 kcal each week. Does 3,500 kcal sound familiar to you? For years, doctors, dietitians and fitness professionals have used this rule of thumb: cutting food intake by 3,500 calories will result in a 1 lb weight loss, and conversely, increasing food intake by 3,500 calories (or reducing 3,500 calories of exercise) will result in a 1 lb weight gain. Doctors, dietitians, and fitness professionals now know that it's a bit more complicated than that, but you get the idea. According to this old weight balance dogma, it was a no brainer that I would gain about one pound each week just from the elimination of vigorous exercise. On top of that, I'd gain even more pounds from the severe reduction in basic movements associated with daily living. Actually, it's a wonder I didn't gain more than twelve pounds!

Friends, don't let this happen to you! Do the math. Really. Calculate how many calories you are not burning in hard physical work or exercise during your recovery, and reduce your intake by at least that amount. Easier said than done, I know. I love cream in my coffee, a glass of wine with dinner, chocolate, and second helpings.

I know you're hurting and you want to reward yourself. You deserve to reward yourself! Just don't do it with food!

Chiropractic Care for Cheilectomy: 16 Weeks after Surgery

Chiropractic Care?

One hundred twelve days (16 weeks) after my cheilectomy, my friend, Suzanne, suggested that I go to her chiropractor, a very nice man who also does amazing work with extremities. That sounded a bit weird. I have not been a big consumer of chiropractic care, but I felt abandoned by my physical therapist, and I trusted Suzanne. What could it hurt? Both the surgeon and my PT had said that basically, I might experience pain, but I won't hurt the toe joints or the repair.

Ten days after PT graduation the nice chiropractor manipulated and popped some of my toe joints. Nothing alarming. Then, he sat on the floor for a closer examination. His conclusion? Bad news. This may be hard to explain because I can't fully visualize it myself. He said that there seemed to be an imbalance in the way ligaments are pulling on that right big toe, and it is likely to lead to the development of a bunion on that foot if left uncorrected. He suggested that I seek out a good podiatrist who could fit me with an orthotic. Really??? NOT what I expected or wanted to hear. He may or may not be right. If it truly takes six to nine months to recover from this surgery, then it makes sense to me that it's just too early to tell. I plan to revisit his suggestion many months from now when my foot is fully healed and I know what my new normal really is. Four months into recovery is still early. Meanwhile, I'll go back to him a few more times. The work he did actually manipulating my foot seemed to be beneficial, and I'll take all the help I can get!

Last PT - 14 weeks, 3 days after Cheilectomy

Physical Therapy--- Over?

Evidently, at 14 weeks, 3 days after my cheilectomy, I had made enough progress for my physical therapist to say goodbye. My big toe strength and range of motion in extension and flexion were back within normal limits, although not even close to my other big toe's range of motion.

I had mixed feelings about "graduation." I still experienced pain with movement. I couldn't walk more than 3 mph, couldn't do basic ballroom dance steps. Range of motion was not where I wanted it to be. It had been very beneficial to have someone with strong, knowing hands manipulate my toe joints, pushing them beyond my usual limits, giving me guidance, encouragement, and homework. Okay, to be honest, I felt a little abandoned. Suddenly, I was left to my own devices, encouraged to continue all of the daily stretch and strengthening exercises that had brought me this far. I was to trust the process, be patient and persistent.

I could do that, but I wanted more help with this seemingly never ending recovery process.

Slow Progress - at 11 weeks 5 days after Cheilectomy

Delusions of Quick Recovery

I am frustrated with the speed of my recovery, and I have to admit that I brought this on myself.  My surgeon told me flat out that most of her patients are not even happy they had the surgery until 6-9 months post op.  She also told me of one patient (only one), a marine, who was back to full duty in three weeks.  She was very clear with me that he was by far the exception.  So what expectation did I set for myself?  What I'm realizing is that deep down, I figured that if he could do it in three, I could do it in six.  Weeks.  Not months.  I was hoping I'd be able to rejoin my dance team for the June and July performances.  Nope.  Not even close.  I'm unhappy to report that 6 - 9 months is probably a more reasonable expectation.  Perhaps I need to stop dwelling on all the things I still cannot do and focus on evidence of progress.

I can walk, with pain, at a pokey 3 mph pace.  I can ride my stationary bicycle at a calorie-burning pace.  My toe, foot, and leg strength seem to be improving; the PT toe raises are less painful and easier to do.  My range of motion has certainly increased.

No quick recovery for me, but I am making steady progress and have cause for gratitude.

First Ballroom Shoes, a Painful Experience at 9 Weeks, 2 days Post-Surgery

Not Happy!

I finally tried putting on my dusty old ballroom practice shoes, hoping to try out a few moves.  To begin with, my right shoe was uncomfortably snug because of the continued swelling around the big toe joint.  As for trying out a dance move--- perhaps a mellow little Night Club Two-Step--- dream on!  The first picture that I took of my feet made me realize how abnormally I was standing as I tried to avoid putting weight on the big toe.  In this second picture, you can still see my right leg curving outward in pain avoidance!  I just couldn't put weight normally on my right foot, much less dance on it. I am so disappointed, even though I know that this is unreasonable.  No one said I'd be good as new in a mere two months.

I want to rejoin my dance team!  I want to resume my usual breakneck stride! I have been riding my indoor bicycle vigorously for 30 minutes each day, but I'm unable to walk at a calorie-burning pace, and clearly ballroom dancing is still unattainable.  I've gained eight pounds in two months!  Not happy!

And all of this complaining is not making me any happier!  Enough already.  I'm going to do my PT exercises and attempt to count my blessings...  (Still scowling.)

Picking Up Glass: PT 45 Days After Cheilectomy

Heavy Lifting

Try doing a couple sets of these... Pick up a squashed glass marble with your big toe (and a bit of help from its neighbor toe), and then drop the marble into a new pile. Move all of the marbles to the new pile. Now, do it all over again. And again. That's it: one of my three PT exercises for the time being. The other two exercises are more focused on stretching the big toe tendon underneath my foot. 

It isn't the joint or my incision line that are causing me trouble these days. It's that rascally, stiff tendon down under. I'll also be rolling the sole of my foot over a tennis ball and---yup, you guessed it--- if it doesn't cause some discomfort, it probably isn't helping much!

First Brisk Walk: Day 39 after Cheilectomy

Thought it was time to try a real walk down the road... I walk around school often throughout the day, but never very far or fast. So, this evening after some PT exercises and manual stretches of the sole of my foot, I put on my athletic walking shoes and set out, hoping to get a little exercise. It was not what I'd call a workout---at least not a cardiovascular workout. Three miles per hour, tops, was the best I could manage while trying to maintain normal weight transfer all the way through that final painful push off the big toe. It is so difficult to choose pain! How much easier it would have been to just limp, but that won't get me anywhere. If pain leads to gain, I guess I choose pain. 

No Pain, No Gain in PT: 38 Days after Cheilectomy

No pain, no gain--- absolutely true with regard to this recovery process.  Melissa, my PT, gripped my foot, wiggling and wrenching it until every muscle, ligament, and tendon screamed for mercy.  I kept my mouth shut lest I be told again to put my big girl panties on. Truly, I saw red, visualizing a zealous chef snapping chicken bones with her bare hands. I spent long agonizing minutes with my great toe bent back while Melissa massaged and manipulated the stiff, shortened structures in the sole of my foot.  Massage sounds so tender, but tender it was not.  Like last time, I was shocked to survive the torture, stand, and walk better than before. I even tried standing on my toes for the first time. Pretty amazing! Here's a photo of my foot executing an impressive bend.  Not without pain, but wow!  Just Wow!  

2nd Post-Op: Day 33 after Cheilectomy

No Pain, No Gain

Pain is usually a warning signal--- our bodies telling us to slow down or stop an activity. My surgeon, Dr. Kessinger, confirmed today, though, that for my great progress to continue I must endure the pain of forcing my toe to the outer limits of its current range of motion. She said that if I'm not challenging the joint and nearly in tears, I'm not doing enough. I'm not fond of pain, but I guess I've been doing okay. It's been 4 1/2 weeks since the surgery, and she said that my toe function and range of motion is similar, on average, to patients after nine weeks. Celebration!

I also picked up some interesting and useful information from the nurse. I learned that the smaller joints in the body such as in the hands and feet take the longest time to heal. When I asked about the value of massaging vitamin E into the scar, she explained that vitamin E or Vaseline would be equally fine, because it's actually massaging the scar that helps to heal the suture line and minimize scaring. Finally, she informed me that sun is the enemy of scar healing; she urged me to wear sunscreen on my scar, treating my scar like a newborn with tender skin that must be protected from harmful rays.

Ah, if only my physical therapy exercises were as easy as putting on sunscreen!

Physical Therapy, Day 28 after Cheilectomy

Productive Pain?

Physical therapy is not for the faint of heart. It hurts! I learned this years ago while recovering from rotator cuff surgery. On Thursday, one day shy of four weeks since my foot surgery, my physical therapist friend, Melissa, grasped my foot with a vice-like grip and kneaded my muscles and bones and fascia and scar tissue for 45 minutes with force that left me grimacing and struggling not to moan. In a mistaken plea for advice, or perhaps sympathy, I asked if perhaps I should take a couple of Ibuprofen before the next visit, to which she promptly told me, with a distinctly unsympathetic twinkle, to "put your big girl panties on." Direct quote. Hmphhf! Clearly, pain is part of the process, but sympathy is not. I was shocked at the force with which she kneaded my incision line, as if working some really hard, old plasticine clay in an attempt to get it to loosen up. If I didn't trust her so much after years of successfully rehabilitating other body parts, I might have run screaming from the room. Evidently, sustained force is required to break up scar tissue. After 45 minutes of pinching, crushing, squeezing, wiggling, kneading, stretching... I stood up. Walked. And the shocking thing was, my gait was more normal than before. She didn't cause permanent damage, but actually made it better!

Big Toe Boogie & First Pedicure: Day 29 after Cheilectomy

Big Toe Wanna Dance!!

As I mentioned before, I'm hoping to return to my ballroom dance team as soon as possible. I've gained a lot of range of motion since my April 1st surgery, but my right toe is far behind my normal left toe. I need a lot more range of motion, and I also need to be able to load that joint. My new PT exercises seem to focus on this: applying weight appropriately as I roll forward from the ball of the foot to the big toe and actively push into the floor. Oh, how we take these simple movements for granted when everything just works.

Here I am in the passenger seat where I caught my big toe doing a boogie on the dashboard, flexing and extending like a champ. Of course, I still can't bend it up very far. I'm only four weeks into the recovery period, so I guess it's early still.

So here's my first ever dancing toe video: 15 seconds of cuteness. Yeah, I know, my toe has grown very narcissistic! Still, I thought folks out there considering this surgery--- or recovering from it--- would like to actually see another kindred toe in movement. Best wishes to you and your dancing toes!


First Pedicure  

Hot water, massage. a little pampering... What's not to love? Actually, not much. None of the foot scrubbing, massage, and manipulation was painful except at an area removed from the actual incision line. The painful area had been visibly bruised in the weeks following surgery, but the bruises are long gone. However, a tender area remains. It's evident that this foot underwent some serious trauma, and it's going to take a while to bounce back.

By the way, shown here is now my favorite sandal to wear. Comfy Birkenstocks protect the joint but also allow more motion than my other pair. Movement may not feel fantastic, but it's what the joint needs for recovery. Actually, at this point in time, my stride feels pretty good, as long as I don't race around. A slow to normal walk feels pretty dang normal. Nice! Now, the PT exercises are another story... Not nice.  Not.  Not nice... but necessary.

Working Full Time: Days 25 - 26

Working Full Time

On the one hand, it's been easy to return to work after only three weeks: driving a half hour each way, standing, sitting, walking through the school. There are several shoe options that feel fine. On the other hand, the strain creeps up on me. Welcome relief comes when I elevate my foot on a stool under my desk and ice it several times a day. Yesterday I had a couple of minutes of intense pain when I somehow snagged my right big toe on the low horizontal crossbar of a classroom stool, bending my toe sharply and unexpectedly upward. Yeeowww! I collapsed in a chair and sent a student of another staff member to our staff room freezer to fetch a fresh ice pack. Later in the day my foot was noticeably more uncomfortable and light shade of reddish-purple. I iced and elevated more through the evening at home and my foot seemed to bounce back to normal; well, my current normal. I have high expectations for my new and improved "normal" a few months down the road.

Back to Work: Day 24 after Cheilectomy

It had to happen eventually... back to the salt mine. I really can't complain: two weeks of medical leave followed by one week of vacation, half of which I spent in Hawaii. I'm a teacher. In my own classroom with my fabulous 5th graders, most of the time I'm able to stand, sit, walk, wiggle, fidget, shift, sashay, and elevate my leg as necessary. I did have to forgo my customary speed walking, and I tried to reduce the number of trips to the workroom. 

The only real stress on my foot occurred during those relatively quick conversations while standing with other staff in the hallway or workroom, before or after school and during recess. Two or three minutes of standing is all it takes. My attention would be drawn to the blood pooling in my foot and the whisper of a throb developing, at which time I would "jog" in place or hoist my right leg up on the nearest desk or table. Ahhhh... Flexibility is a plus. I wore the Birkenstock sandals, shown in a previous post, that provide such wonderful support for my entire foot and also protect my toe joint from excessive motion and sudden pain. 

I managed to do some toe PT twice during the day: once during lunch, and once during afternoon recess. This basically consists of rocking the big toe joint gently from front to back and from side to side. Next, I apply pressure outward on my toe, pull it down and hold, followed by pressure outward, pull up and hold. Ouch. Finally, I try to manipulate the sesamoid bones that continue to be uncooperative. After each torture session I strapped on one of my favorite ice packs for a little while. 

Everyone is surprised at how good my foot looks, me included. Visually, the healing is remarkable. As for regaining normal range of motion, time will tell...

First Hot Tub: Day 23 after Cheilectomy

First Hot Tub

Whatever made me think that this might be painful? I suppose because applying cold has brought so much relief over the past three weeks, I assumed applying heat might hurt. Nope... Bliss! I performed the required PT manipulations while in 102 degree water. Perhaps the heat will help me relax more and stretch this stiff joint. I'm planning to fit in a bit of home-style hydrotherapy every day. When I got out, I did ice and elevate. Not that my foot was craving cold; it just seemed like the right thing to do. I'm going to ask my physical therapist about the benefits of hot and cold at this point of the healing process. (Postscript: The PT assistant who massaged and manipulated my toe and foot for 45 minutes today said to limit the time in the tub. Heat contributes to swelling, and can be the enemy of healing. However, a brief period in the tub to relax and do the exercises followed by ice and elevation would be beneficial.)

First Cycle: Day 22

First Stationary Cycle after Cheilectomy

Riding my stationary cycle for 20 whole minutes felt great! That's a relief since I need to increase my minutes and ride daily; I have a few pounds to take off and some muscle mass to regain! I wore the Birkenstock sandals pictured on Day 13, Sandals in Paradise. Perhaps my athletic shoes will feel okay now. I'll try those tomorrow. The Birkenstock sandals are exceptionally comfortable, probably because they do not allow much movement of my repaired joint, and there is absolutely no irritation on the incision and suture areas.

Treacherous Walk: Day 19 after Cheilectomy

A Hike Over Lava

This was one exhausting walk! Aside from the fact that my level of aerobic conditioning has plummeted, the terrain was rugged and irregular: jagged lava chunks from gravel to rocks too heavy for me to lift. Treacherous! It took some serious concentration to walk the mile or so to get to Makalawena, one of the most beautiful beaches on the Big Island. I was as fast as a herd of turtles, and my foot hurt, but I kept telling myself that just as physical therapy causes productive pain, this pain would also be productive as long as I did my best to approximate a normal stride--- stride through the pain--- and make sure I didn't trip and injure myself. I tried to think of it as a walking meditation, which helped a bit: observing the pain with as much detachment as I could muster. The reward was nearly four hours at the beach, swimming and relaxing.

 It still seemed reasonable to maintain a dose of healthy paranoia and protect myself from dangerous bacteria by coating with both liquid and adhesive waterproof bandages. My suture holes looked well-sealed, but I hadn't examined them with a magnifying glass. Better safe than sorry on this, my second to last day at the beach!

Chillin' in the Shade

After trudging across fields of lava, bludgeoning barefooted across this beautiful white sand, swimming in the surf, and then slogging back to my beach chair, I was beat! Thank goodness we had hours to recuperate before the long, laborious march back to the car. Later, icing and elevating never felt more delicious!

Shower Pressure: Day 18 after Cheilectomy

Shower Pressure

Not talking about the pressure of water pummeling my head as I rinse the soap out of my hair... Talking about the column of pressure created by gravity and the fluids in my body pushing down, pooling in my feet. Every time I take a longer shower---seems to take forever to wash this mop of hair--- I feel uncomfortable pressure. Have I been imagining it, or does the color look different? Today I really looked and then grabbed my camera. My right foot is a distinctly reddish purplish color. No wonder. That explains why ice and elevation always feel so good after a shower. That explains why moseying around a museum is much more difficult than a saunter down a lava tube. That explains why standing to stir soup makes me dance in place. My body needs the pumping of muscles to counteract the effects of gravity. I wonder how long I get to put up with this....

First Hike: Day 17 after Cheilectomy

One Week Since Suture Removal

Today is the one-week anniversary of suture removal, so here's a comparative photo from one week ago. Lots of change in one week!

First Hike

Well, this won't impress the mountain goats among us, but on Kilauea, Hawaii I hiked intermittently at least one mile over crunchy compact and irregular dirt and lava gravel trails: through the Thurston Lava Tube and back and to numerous look-outs along the Chain of Craters Road.

I focused my attention on trying to apply weight to the ball of my foot in a normal stride and trying to avoid rolling the foot outward to avoid pain. I am not good at welcoming pain, however beneficial it may be. Although bruising on the top of my foot is nearly gone, that is still where I feel the pain of my sandals, hence the flapping straps to relieve pressure. The majority of pain is centered on the ball of my foot. Perhaps today's challenges will help it release and perform normally.

First Yoga: Day 15 after Cheilectomy

First Yoga 

Accomplished my usual 10 minute routine, with care to not put undue pressure on the top of my foot. 'Nuff said.

Sand and Rock & Roll: Day 14 after Cheilectomy

Sand

I'm starting to think it's inevitable: sand WILL get under that bandage. If you look closely at this picture you'll see traces of Kua Bay's white sand, and this photo was taken after a hose down, a shower, and a probably-unnecessary dousing with hydrogen peroxide. I peeled off the multiple layers of waterproof bandages, relieved that under it all was this other mysterious stuff: Skin Shield, an invisible, flexible, waterproof "bandage" that I had painted on and let dry. I'm feeling reasonably protected from flesh-eating bacteria, but I have to say that the locals think that we haoles are ridiculously paranoid. Locals swim with little cuts and abrasions ALL the time, applying no bandages, liquid or otherwise. Nevertheless... If it  protects my foot and allows me to have more fun at the beach, why not? (As a postscript: I later found the Bandaid brand waterproof bandage to be far superior to the other type I had brought with me!)

Rock & Roll

My foot took on some challenges today--- an afternoon in the surf at Kua Bay, and then an evening at Laverne's dancing to a great classic-rock band. So, for you dancers out there contemplating this surgery, let it be said here that this patient attempted, relatively successfully, to bust a move on the two-week anniversary of the surgery! I'm pretty pleased that I managed four or five dances--- not full energy, and ever-protective of my foot. Range of motion is a limitation, and pain centered under the ball of my foot. My worst fear was being stepped on. Fortunately, no one did, and fortunately, my husband continues to tolerate my foot across his lap, and I even get a little massage, too.

Sandals in Paradise: Day 13 after Cheilectomy

Sandals in Paradise

There are a lot of shoes and sandals in my closet at home, but not a lot that complement this recovery process. These Birkenstocks actually work because, as you can see, the central leather piece just misses the incision line. Still, walking is a laborious, thoughtful process, feet carefully placed, and constant attention given to trying to walk normally. Easier said than done: heel strike, normal transfer of weight from back to front across that problematic ball of the right foot. Every so often, particularly when my attention falters, I experience a sharp pain in the ball. Those sesamoid bones, I suppose. Perhaps something's trying to break free. Please, let it happen soon. Sauntering through the tourist zone in Kona, I needed frequent intervals with leg elevated. I am getting impatient!

Bandaged for the Beach: Day 12 after Cheilectomy

Bandaged for the Beach

Confession... Just about every medical person I consulted discouraged swimming before the entire incision line was entirely healed--- 3-5 weeks. Now, I don't mean to take lightly the potentially horrific consequences of flesh-eating bacteria that proliferate, relatively speaking, in tropical water, but seriously folks, I was going to Hawaii and I was going to get in that water. So, the question was how best to protect myself. Here's some of the more realistic feedback... From my ER doc brother: "Slather it with Neosporin and go for it." From my physical therapist friend (who discouraged swimming): "The orthopedic office might have some Tegaderm." Ah, hah!  A lead... Then, the PA at stitches-removal (who also looked askance at swimming) provided some of this magical Tegaderm film, a highly-adhesive transparent waterproof film. So, here I am bandaged for the beach. You can see the steristrips covered by a bit of gauze, with the Tegaderm film over all. Long story short: I went in the water, swam about and floated for a bit, and the dressing was not compromised. For an extra precaution, when I got out of the water I wiped down the entire dressing with an alcohol wipe. Survived my first swim! (Postscript: the Tegaderm film became compromised at the point where it contacted the thong of my sandal as I walked back to the car. After this day, I relied completely on over-the-counter liquid and adhesive bandages.)

Air Travel: Day 11 after Cheilectomy

I finally got to ride in one of those sweet little airport golf carts--- and what a relief! Walking slowly on the hard surface of Vancouver's beautiful international airport turned out to be more stressful than I had anticipated. By the time I climbed onto this rig, I was ready to elevate again. This was my first day without ice. Traveling and icing just seemed too complicated, and I hadn't want to risk confiscation of my favorite ice packs. Relying solely on elevation for pain relief worked just fine. It was easy to elevate on the car ride to Vancouver, at the restaurant with our son in Bellingham, Washington, and then on this jaunty golf cart. Fortunately, I got lucky on the plane...


Serendipity! As it turned out, my husband and I scored an empty window seat next to our two seats. This was an amazing piece of luck, allowing me to fidget about, curl up on one hip, switch to the other hip, sit in the window seat with my legs across the middle seat, elevate my leg on my husband's lap, lie down--- contort myself into just about every position but stand on my head. Actually, I think the flight would have been torture without the extra seat, and I would have had to get up constantly to prowl the aisle.

To reduce my risk of blood clots with air travel I took aspirin morning and evening for two days, and put the compression sock on before boarding the plane. Looks like I made it! Let the relaxation begin!

Driving, Suture Removal, Compression Sock, and Air Travel: Day 10 after Cheilectomy

Driving

Yesterday I took a little one-mile test drive in my rural neighborhood. Stepped on the gas, stomped on the break, and that all felt fine. Perhaps it had something to do with the way my foot normally contacts the pedal--- and my Prius is an automatic, so really, there's very little for my right foot to do! When I thought of taking that 30 minute drive this morning to get my stitches removed, my main concern was the discomfort of pressure building up in my foot, and the accompanying pain. Obviously, there's no way to elevate the right leg while driving! My husband had more than enough to do today, and driving myself seemed like a reasonable risk, so I decided to go for it. No problem! Actually, the need to move my right foot motivated me to finally learn how to use my cruise control. It worked at 34 mph and also on the freeway, so my right foot was able to dance, stretch, and tap a jazzy beat, to help pump that blood out of my foot. I did fine!

Suture Removal

Mostly pain-free, I'm pleased to report. The sutures that were at the less mobile parts of the incision seemed to adhere, so there was a bit of pain when those were removed; most slid out painlessly. The PA who I met with seemed pleased with my healing progress. She put a few steri-strips on for good measure, and then I was off on my next adventure: acquiring a compression sock at a local prosthetics office.

Compression Sock Magic

I had no idea that acquiring a sock would be such a production. I thought I'd walk in, pick one off the rack, pony up the money, and be on my way. Well, no. It's an insurance-billable item, so they had to collect all the relevant info, I had forms to fill out, electronic signatures--- the works.  After waiting a long time in an elegantly-appointed gold and burgundy waiting room (classical piano music, no magazines), I was ushered into a treatment room. More waiting. (In their defense, I could have made an appointment if I'd been less ignorant.) My "server" eventually arrived to take detailed measurements of my foot and leg. Finally, a medical-grade compression sock was stretched onto my leg, and WOW, I never would have guessed how good it would feel.  Truly magnificent! Usually, a person acquires two socks at a time per leg; one for the leg and one for the laundry. Makes sense, but I'm glad I thought to inquire about the cost before sauntering out the door with two. That would have cost me 30% of the insurance-billed $140. Gasp! Considering it's limited period of usefulness in my life, I thought, one sock would be quite sufficient, thank you. Whew, narrowly missed that unnecessary charge.

As a relevant postscript to my driving comments, the drive home was absolutely amazing. I could not believe how comfortable my foot and leg felt, all because of one very expensive compression sock. Who knew?!


Air Travel

Confession: tomorrow is my birthday. Second confession: some days ago my husband and I happened upon some cheap fights (direct) from Vancouver, Canada to Kailua-Kona, Hawaii. It just so happens that we have good friend who lives in Kona. What better place to recuperate than on a friend's couch, yard, and at the beach? The five hour flight is the primary reason for the compression sock. I've also increased my aspirin intake. Medical folks worry about a blood clot, so I'll need to be up and about and stretching the foot on the flight. I'll have to figure out how to elevate the leg. Wonder if the folks in front of me will mind my foot in the air hovering over their heads...

Holding Steady: Day 9 after Cheilectomy

Not much change to report, but each day my foot seems a bit better. Today I spent hours helping my parents prepare to sell their house, although my role was small and I took frequent ice and elevation breaks. As I sat on a plastic chair scrubbing the kitchen cabinets inside and out, I suddenly realized that I'd been sitting for quite awhile--- twenty minutes or more, perhaps--- and my foot had not developed it's usual throb and cry. It's easy for me to get frustrated and impatient, but I have to remind myself that it's only been nine days since the surgery. While I'd like to put my dancing shoes on and join my team for practice today, that's not realistic, and I'm actually recovering quite nicely!

Foot in Shoe: Day 8 after Cheilectomy

AM Report

I found a pair of shoes that I can actually wear comfortably! This is great, because the Aircast boot limits ankle movement and the flexing motion at the the toe joint that is necessary for recovery. In order to slip them on, I needed to adequately cover and cushion the incision. I used a couple of waterproof bandages lengthwise that I knew would seal really well and be unlikely to be scraped off, and added one more over top, sideways. Then, I carefully slipped my foot into my craziest, elastic-banded shoe. If I could have done a happy dance, I would have. Couldn't believe it worked! In case you're wondering, they're Skeechers that come with an amazingly cushy memory foam insert. Now, we'll see how the day goes...

PM Report

Excellent! Can't believe my luck. The elastic bands put the slightest bit of pressure just off the edge of my scar line (I think, since it's all under the bandages). I walked slowly, trying to walk normally. Easier said than done, for sure. I kept catching myself executing a stubby little shuffle in an attempt to avoid the pain of extending that joint. Spent the day at a big family April birthdays event. I found it more difficult to stand in one place than to walk slowly, but I didn't have to do either for long. There was plenty of time to ice and elevate, but I probably didn't do the PT exercises as often as I should have. Those exercises are tricky: sliding the joint around and trying to manipulate the little sesamoid bones underneath. Attempting to walk somewhat normally in shoes felt as therapeutic as the exercises (meaning productively unpleasant).

First Real Physical Therapy: Day 7 after Cheilectomy

My monumentally talented physical therapist, Melissa Mercogliano at the Center for Orthopedic and Lymphatic Physical Therapy (COLPT), put her hands on my foot and manipulated the joint in ways I honestly did not know were possible. And gently, too. No tears. A little swearing. A bit of pain. I learned how to gently slide my joint back and forth and from side to side. I learned about those little sesamoid bones that cradle the first metatarsal bone, helping to absorb weight placed on the ball of the foot during all weight-bearing activities. Rehabilitating my foot will involve freeing up those little bones; they had seized up over time because of the bone spurs above that were restricting full extension of my big toe. It helps to have a good foot for comparative purposes. Fortunately, my left foot has excellent range of motion and perfect little sesamoid bones. Who knew? I can always count on physical therapy with Melissa to be educational! You'll find her office on the web at: colpt.com.

The rest of the day involved helping my parents sort and move. I was mostly useless, but I find I am able to stand and walk a bit longer each day before I'm driven to ice and elevate. A one point I may have been on my feet for 20 minutes before diving for a chair and an ice pack.

Movement and Pain: Day 6 after Cheilectomy

"Gotta get that toe moving," said the nurse on the phone. I had called the surgeon's office, wondering why there's no mention of using triple antibiotic in any of the post-op instructions. The nurse explained that the doctor wants the wound to dry up and scab, and ointments would slow that process down. Okay--- so far, so good, but it seems odd to not use some sort of antibacterial ointment.

Today was a day of self-induced pain, though, as I stretched the toe as directed by my surgeon, bending it up to the point of pain and holding for twenty seconds, and then pulling on the toe, pushing down to the point of pain, and holding. I'm doing it right if I'm nearly in tears. Ouch! I put myself back on pain meds to survive this torture. It was great, though, to shuffle about the house bare-footed in between sessions of torture followed by elevation and ice. I can't be upright for very long, though, before unpleasant pressure builds in the foot, and then it's back to the couch again...

Post-Op Appointment: Day 5 after Cheilectomy

Lovely day for a drive... As you can see, I've been elevating constantly---even in the car.

I was very eager to get my first look at my foot, and it actually turned out much better than expected. Less swelling, less bruising, and a neat, straight incision that appears to be healing nicely.

My surgeon kindly showed me some special ways to torture the healing toe. My goal after all is to restore range of motion and get back on my adult performance ballroom dance team. Clearly, this will not happen without pain. My new motto: grimace and bear it! Evidently, I will be icing for quite some time. As I understand it, the enemy is not pain, but immobility and inflamation. Ice and Ibuprofen: my new friends.



Finally, into the boot! What pleasure it is to walk! My husband and I stopped at a little cafe and had brunch in the sunshine; pretty good for April in Washington. Later today I will try on some of my shoes and see what might work. The surgeon, Dr. Kessinger, said that I can wear normal shoes whenever they feel comfortable. Athletic shoes may be my best bet. The boot is wonderful after hobbling around on crutches, but the boot allows no flexing of the toes.  I would like flexing while walking to supplement my other exercises.

No Drugs, No Crutches: Day 4 after Cheilectomy

No Drugs

Night time medication doses of hydrocodone and Ibuprofen sat on my night stand all night long, but I didn't need them at all!  I guess I'm done, except for the doses I plan to take prior to physical therapy.  It's a relief to no longer need narcotics on a regular basis!

No Crutches

What a pain!  Literally.  I am no expert at locomotion with crutches--- probably doing something wrong, but I have bruises on the front of my armpits and my right shoulder was starting to hurt.  That's all I need: an overuse injury related to use of crutches! I know Dr. Kessinger said no weight bearing until the post-op appointment, but I decided to be careful and listen to my body.  I've been hobbling around only when absolutely necessary, putting weight only on the heel and outside edge of my right foot.  I still spent the majority of the day (95%) with my leg elevated, and I applied ice packs fairly often.  So far, so good!  Tomorrow: post-op appointment with the surgeon.  I am looking forward to seeing what my foot looks like 5 days after surgery!

Bath Time: Day 3 after Cheilectomy

Monday... How delicious to be clean again!  Rather than wrestle with plastic bags and tape to waterproof my right leg, I opted to fill the tub and lounge with my right leg hanging out over the edge of the tub.  I was able to wash my hair and enjoy the hot water.  I know from reading other blogs that many are already in a boot at this point.  My surgeon, however, requested no weight bearing or dressing removal until the post-op appointment on Wednesday. I suppose the dressing will be removed and then replaced by my physical therapist later today.

I've been increasing the interval between pain meds, and I hope that tonight will be the last night for hydrocodone/acetaminophen.

Postscript:  Showing up for physical therapy with a foot swaddled in yards of bandage was an unusual event, and my wonderful physical therapist and friend, Melissa Mercogliano, felt uncomfortable removing the giant cocoon without specific okay from the surgeon. So, what we were able to do on this first visit was limited.  By the time the call came back from Dr. Kessinger's office I was at the front desk lining up future appointments. Word to the wise: don't make any assumptions and sometimes, don't trust your instincts. I had wondered about showing up to PT prior to my first post-op visit when the written post-op instructions specifically said that the bandage would be removed at the first post-surgical visit; I had made a phone call to surgeon's office to clarify, but I didn't think to ask about the intervening PT appointment or think to ask, "But, what about the bandage? Who removes that?" I trusted that while all of this was unusual to me, it all would be old hat to all of the medical folks involved. Not so!  

Leapfrogging Meds: Day 2 after Cheilectomy

That must have been some powerful pain blocker administered by Dr. Kessinger!  I felt no discomfort at all for the first 24 hours after surgery, but by Saturday evening, pain sliced into my consciousness. Since then, I've been leapfrogging the medicines as directed: hydrocodone every 4 hours or so and 400 mg of Ibuprofen every four hours, but taken two hours into the hydrocodone cycle. Overlapping medications to keep pain at bay. That, and ice packs. Oh, do those feel good! Remember "RICE"---rest, ice, compression, and elevation? I'm doing all of it except that the bandage provides only slight compression.

Tomorrow will be my first physical therapy appointment. I am very curious to see what my foot looks like. Swollen? Probably. Discolored? Probably! So far, I'm doing pretty well, I think. Of course, I'm hoping for a super speedy recovery. My surgeon said that she had one patient, a marine, that returned to full active duty three weeks after the surgery, but that he was not typical. Most of the time it takes six to nine months before her patients are glad they had the surgery. Clearly, recovery experiences vary considerably!

Rest, Ice, & Cool Tools: Day 1 after Cheilectomy

I am pleased to report that it was an uneventful first night.  I kept my leg elevated, and awoke to my alarm clock at 2:00 AM to take one hydrocodone.  I have not yet needed to take more than one at a time, although two is permissible.  Also, the sensations in my leg returned to normal.  Whewww! And, still no pain.  Perhaps the block is still wearing off.  Who knows?  I have lounged with my leg elevated at least 95% of this first day and have applied ice packs on a regular schedule. 

As you know, if you're planning on this surgery, there are some items you will want to acquire prior to surgery.  The Therapearl ice pack that you see here is the handiest ice pack I've every used, perfect for this application.  Regularly $9.00 a piece for the smaller sized model at Fred Meyer, I stumbled upon these marked down to $3.00 each and bought three. The velcro straps allow me to apply cold to the back of my leg, just below the knee, and strap another one on the top of my foot. Extremely useful!  One stop at our local Goodwill on the day before surgery, and I had my choice of crutches and walking boots. The boot and crutches together cost just over $7.00.  Amazing! The surgery itself is certainly costing a pile of cash; I didn't want to waste any money on orthopedic aids that I'll only use for a short period of time. Good luck with your essential acquisitions!

Cheilectomy Surgery

I arrived at the hospital at 7:15 to begin the usual preparations: financial matters, monitoring of blood pressure, heart rate, blood oxygen, and placement of ports for IV--- all of the usual, I suppose. Of course, for the patient (me), surgery is the easy part.  I floated away on a soft cloud of anesthesia just before 8:45 and gradually floated back to consciousness about 1 1/2 hours later with a truly giant cocoon of bandages from the tip of my toes to just below by knee.  No pain. My surgeon, Dr. Stacee Kessinger of WestSound Orthopaedics, administered an additional local pain block after surgery to help me through what could have been a difficult first day. I kept my foot elevated for the rest of the day and strictly followed icing instructions.

I did have a tense hour or so in the early evening as I attempted without success to bend and flex my calf muscles inside that gargantuan bandage. I had been able to do it in the first few hours post-surgery, but after several hours of phone call distractions, I became unable to contract my lower leg muscles voluntarily. It was as if my brain was sending movement signals, but none of the muscles in my lower leg were following orders. I had read in my post-op instructions that "contracting the calf muscles frequently while awake, will help prevent deep vein leg clots," so I was concerned. After a phone chat with a doctor friend, I realized that I might need to take that bandage off and manually flex the foot. As it turned out, I was able to massage the calf muscles by stuffing my hands in at the back of the bandage, and also to manually flex the entire splint to create movement. It was very odd. I went to bed later and hoped for the best.

3-27-2016 My Big Toe, A Cheilectomy Journey

I'm a dancer, a walker, a cyclist, a hiker... and the surgery on my right big toe is coming up this Friday. Five more days. My heart is in my throat, in my toe... actually throbbing in my toe. I want my range of motion back, full mobility, balance, control. I want to launch into movement with power and without pain. I want to land a 360 degree spin with precision and grace.  But I am nervous about my upcoming cheilectomy. There's so much that I love to do that depends on functional feet.

Read on to follow my journey.

American Orthopaedic Foot and Ankle Society:

"A first MTP cheilectomy removes bone spurs on the top surface of the big toe joint bones. Bones spurs develop with arthritis (hallux rigidus) of the big toe, and spurs act as a mechanical block to motion, which causes pain."