Posts tagged ‘posterior tibialis tendon surgery’
Someone’s Got a Screw Loose…
I promised you a less-than-perfect-day and we certainly had one this week. I’ll return to the travelogue soon, but first, a real-time update on the Saga of The Foot.
Faithful readers will recall that just a little over a year ago, the CE exercised the pain and suffering clause in our marriage by rupturing his posterior tibialis tendon. This is one of those body parts you don’t know exists until something goes wrong; its purpose is to support the arch of the foot. All you flat-footers out there, get thee to a podiatrist forthwith – orthotics as well as other measures can help if the condition is caught early on.
Note the difference: the foot on the left has a normal arch, the foot on the right is flat, indicating a problem with the PT tendon (image from mdmercy.com)
The CE’s condition was so severe that he had to have his entire foot re-built, which is why he chose to have the amazing and esteemed Dr. Ferkel (who literally wrote the book on this surgery) at Southern California Orthopedic Institute (SCOI) perform the surgery.
Dr. Ferkel, baseball nut and surgeon extraordinaire (image from scoi.com)
This involved cutting into the heel, removing a piece of it and re-fashioning it to stabilize the foot. The tendon was completely ruptured, which means that it basically rolled up like a windowshade and had to be teased out and looped together with another tendon in order to restore function to the foot. (Sorry, I should have mentioned you might need a barf bag before you read this paragraph.) Every physician, nurse, x-ray tech and other human being who has looked at the CE’s scar gets very wide eyes and says “Wow! You had a BIG surgery!” Very reassuring…
Post-surgery last year
The foot is now almost fully functional, although it does appear that the CE has some residual sensory nerve damage. This could have resulted from the original condition, the surgery or the nerve block that was done pre-surgery. He can walk, but he does have significant pain in the foot. He has also had pain from the ginormous screws they put in his heel to hold things together, and he jumped (okay, truth be told, he’s not jumping all that well these days…) at the chance to have them removed.
Yes, THOSE screws!
Last time around, he was in the hospital for two nights, in a cast for a few months and in a boot for what seemed like a lifetime. We knew this time around would be less of an ordeal – for one thing, it’s an out-patient procedure, but we didn’t know much else.
The CE and Natalie, Dr. Ferkel's assistant at the pre-op appointment: WHY is this man laughing?
So it was a relief to learn that although the procedure required general anesthesia, there was the possibility that the CE could bypass having a cast and go straight to wearing that familiar old boot. I never thought I’d be happy to see the boot again, but it’s much better than a cast!
And I was amazed to see how quickly he rallied after the surgery. Here he is just a few hours later:
A few hours post-surgery: they gave him the screws as a souvenir (yes I know there's a bad joke here, but I'm not going there)
Another bonus, since we spent the night in the Los Angeles area, was that Victoria took a break from her studies at USC to come visit!
Victoria just aced a big test! Congratulations!
He’s in considerable pain, but hopefully the heel, at least, will hurt less now that the screws are out. Since he’s on crutches for the next week or two, the CE is staying down in the poolhouse with Chloe, Rosie and Birdie for roommates, but he’s already feeling well enough to hobble around. PG brought lunch yesterday and we had a picnic with the chickens.
Is it wrong to eat chicken salad in front of the chickens?
"I hope he gets well soon so he can throw the tennis ball for me!"
Thanks to everyone for the calls and well wishes, to Victoria for the fruit and the visit, to PG for lunch and to Ashleigh for keeping us afloat until the CE is back to his usual superhuman self.
Polloplayer edit: a fair amount of traffic arrives here via searches for “posterior tibialis”. For related posts on this subject, see “Break a Leg?”, “Getting a Leg Up”, “Cast and Characters”, “Ups, Downs” and “Das Boot and Das Molt”
In Transit
Packed up our suitcases and BigFoot for a trip to NYC yesterday. The Foot arrived in surprisingly good shape but my brain still needs a bit of transition time.
The doc says everything is healing normally - as if there's anything "normal" about those giant screws in his heel! Happily, they didn't set off the airport metal dectectors as we went through security.
A full blog update will be forthcoming. For the moment, however, all that is important to know is that Hope has started laying again, that the trees in Central Park are gorgeously garlanded in gold and red and that all the animals are in good hands during our absence.
Have you ever seen a cat actually pose for a picture before? The amazing Dizzy continues to amaze us..
Something tells me we won't even be missed! Those dogs are actually smiling!
39 again!
Not sure how he does it, but the CE sailed through another birthday with his youthful good looks intact, if not his ankle. The foot continues to be problematic – lots of pain and not much sleep, but all cares were cast aside for a day of celebration on Wednesday.
The day began with Victoria and Alexandra so very thoughtfully stopping by to prepare a sumptuous CE-worthy breakfast – Eggs Benedict (one of Autumn’s eggs went into the Hollandaise sauce), potatoes and fruit.
Prepping the birthday breakfast
A celebration fit for a king - or an emperor!
Victoria found a most appropriate balloon - and yes, that's the birthday boy doing his gimp version of the Chicken Dance
That evening, dear friends Dave and Karen took us and Phyllis out for a lovely dinner.
The CE and Dave
It was a truly happy occasion with so much to celebrate, including the very exciting news that Dave and his very special friend, Karen, are ENGAGED! We are so happy for them!
The happy couple!
Das Boot and Das Molt
Expect the unexpected. After seven weeks, the hard cast finally came off and the CE is now sporting the latest in Robo-Cop fashion.
Pain and swelling included!
As pleased as he was to be freed from the confines of the cast, he wasn’t too happy the next day when his foot swelled up like a balloon. Just part of the healing process, he was told. He is now walking without crutches, but not very far. Someone told him that at the four-month post-surgery mark he can expect things to be just about where they were pre-surgery – this is a long and S-L-O-W recovery!
"Maybe your next book should be 'Chicken Soup for the Foot'"
Soaking the dogs with the dog
Hope is having to make some adjustments this week, as well – she is in full molt! I opened the door to the pen one morning and there were feathers EVERYWHERE! The fall molt is an annual rite for chickens and can last anywhere from two to eight weeks. Autumn has apparently not gotten the memo yet – she’s as feathered as ever. But poor Hope is walking around with her last remaining tail feather pointed askew and bare patches on her neck and breast.
She's horrified!
But it could be so much worse: here are some photos of molting chickens posted on BackyardChickens.com
Sad!
Sadder!
Saddest!
Some folks say that an intense molt signals an especially cold winter. The naked chicken above must mean sub-Arctic temperatures are on the way!
This is marathon weekend for Victoria and Angie – Victoria just finished her first half-marathon this morning, and Angie runs the New York Marathon tomorrow. Congrats and good luck!
Looking good!
Can’t Keep A Good Man Down.
Look who's up and about - followed by the usual parade of animals...
The CE is most definitely putting his best foot forward. Another cast change this week, and now his foot is angled almost at normal – much more comfortable for him than the previous “neutral” cast positioning. He is doing daily crutch laps around the pool, and – a very important milestone – hitched a ride to the local casino to play poker yesterday. That’s progress!
Now that we’re seeing light at the end of the tunnel, the foot, the whole foot, and nothing but the foot can finally be shown. This photo is from a week ago after the 40+ stitches were removed:
OUCH! And don't forget - there are incisions in the heel and on the other side of the foot, too!
He began to understand why he is in so much pain when they showed him his xray that day:
Yes, those are three-inch screws in his heel. Yikes!
another view
Another post-op appointment with the doctor next week where I’m guessing he will increase the weight-bearing recommendation. And maybe, just maybe, someday, life will return to what passes for normal around here…
Plan B
The CE was thinking that by two weeks out of surgery, it was time to don the Hawaiian shirts and charge back into action.
His first outing was to church last Sunday
He and his cast even went out to dinner
He made it up to the house to pay some bills and insisted he was ready for a few outings. For all I know, he might have been contemplating an afternoon of bowling or a game of pick-up basketball, but instead, there was the Smackdown. Pain is, apparently, your body’s way of telling you you’re an idiot.
And the pain was severe.
A call to the surgeon’s office provided some clarity: “You had a big honking surgery, one of the worst cases we’ve ever seen, and you are not getting better any time soon so take your pain medication and for the sake of all that is holy, SIT STILL!”
Thus, for the remainder of the week, there has been a lot of sitting still. For him. Victoria, Alexandra and I scurry around like the mice in Disney’s Cinderella (whistling while we work, of course) and rather miraculously, things have not yet completely fallen apart.
Birdie likes the new arrangement; he visits the CE in the pool house every day
Except for the loss of Amelia, of course.
Now there are two
We still don’t know definitively what caused Amelia’s death. I called the vet for clarification and she assured me that she had ruled out every possible communicable infection or virus.
Her best guess was that Amelia sustained an injury that affected the spinal cord and cut off nerve supply to her organs and caused them to shut down. I think that’s a stretch since we were unaware of any injury she might have sustained, but without a necropsy, we will never know what happened to her. On any given day, there are up to a dozen posts on backyard chicken web sites from people whose chickens die mysteriously; as a species, chickens are fragile.
Life is short. Autumn decides to be pro-active about finding treats.
Two chickens is not an optimum number. They are flock animals; there is safety and companionship in numbers. Under ideal conditions I would immediately bring in new chicks, but cannot do so until the CE is up and around. Time of year is also a consideration as availability is scarce until spring. Therefore, the plan is for Autumn and Hope to hang on together until spring. Although, of course, we all knows what happens when we make plans…
Ups, Downs
It’s been a good week. It’s been a bad week. Like any other week, I guess, but the lows did seem a bit lower than the highs did high.
First off, our patient is resting comfortably and more or less patiently. Maybe a tad less patiently than the week before. The infrastructure has held up (thank you thank you Victoria and Alexandra), and we got to see a bit of progress at the second post-op appointment on Thursday.
Dave brought ribs before jetting off to Australia last week. Note the ubiquitous cast lower left...
Victoria continues to prepare amazing breakfasts!
The trip to LA and back is always hard on the CE, not to mention the after-effects of having the cast removed and the wound examined. However, while the incision continues to present a wonderful opportunity for “scariest special effects”, it looked MUCH better this week than last. The doc decided to allow two more weeks of healing before we return and (hopefully) the sutures will be removed and the clunky cast will get traded out for something that weighs less than a cinder block.
The CE is not a big fan of cast-sawing. You never know how deep that blade might go...
This is Dr. Ferkel looking pleased (and you don't see too much of the gory details)
The pets have predictably managed to adapt to the new and varied living and sleeping arrangements. Soho has become quite attached to Alexandra, and, of course, Dizzy continues to woo Victoria at every opportunity.
Soho looking pathetic for Alexandra's benefit
Dizzy says "She's mine, all mine"
Cute chicks by the pool - what more could he ask for?
Birdie has learned that there really are 101 uses for a cast: #37: it makes an excellent perch!
Unfortunately, there has been bad news along with the good. Earlier in the week, we noticed that Amelia was moving slowly and reluctantly, which meant yet another visit to the vet for her. The vet didn’t find anything systemic; an x-ray revealed some degeneration to her hip so she was prescribed an anti-inflammatory medication. Somewhere along the line she apparently injured the hip and the vet surmised that she then sustained some kind of acute trauma that makes it painful to walk. Yesterday I noticed some darkened bumps on her feet and hoped it might mean that bumblefoot might be the problem. Victoria and I took her in for a re-check, and the vet wrapped her feet, but said that she has seen chickens with far worse lesions on their feet still walking comfortably. We’ve doubled the anti-inflammatory dose, but Amelia is not moving, and as of this morning, she is not eating. I am very concerned for her and I think we have to be prepared for the worst.
Amelia gets her feet bandaged
The toughest news of the week, however, was the call we received from Pollo Amiga telling us that her beloved Tahoe had been diagnosed with an aggressive and fatal form of cancer. Tahoe enjoyed fifteen active and happy years of life, which is a good run for a dog, but had faltered considerably in the past week. The decision was wisely made to spare her further suffering, and I was fortunate to be there to help say goodbye to her. Tahoe was a good dog – we will all miss her!
Happy and loved to the end!
A fitting dog quote I found:
“He is my other eyes that can see above the clouds; my other ears that hear above the winds. He is the part of me that can reach out into the sea. He has told me a thousand times over that I am his reason for being; by the way he rests against my leg; by the way he thumps his tail at my smallest smile; by the way he shows his hurt when I leave without taking him. (I think it makes him sick with worry when he is not along to care for me.) When I am wrong, he is delighted to forgive. When I am angry, he clowns to make me smile. When I am happy, he is joy unbounded. When I am a fool, he ignores it. When I succeed, he brags. Without him, I am only another man. With him, I am all-powerful. He is loyalty itself. He has taught me the meaning of devotion. With him, I know a secret comfort and a private peace. He has brought me understanding where before I was ignorant. His head on my knee can heal my human hurts. His presence by my side is protection against my fears of dark and unknown things. He has promised to wait for me… whenever… wherever – in case I need him. And I expect I will – as I always have. He is just my dog.”
Cast and Characters
The patient is resting comfortably – more or less. There have been a few tough days, but all in all he is doing well, is in great spirits and has been very, very brave.
Lest you think he is suffering too greatly, please note that whatever his burdens, starvation is not among them.
Three squares a day, always cheerfully delivered
Victoria got up early on a Saturday to make a royal breakfast for the CE!
The temporary quarters in the poolhouse are working quite well – no pesky stairs, and it’s just a short sprint with the walker to sit by the pool for a scenery change .
Sometimes there are visitors by the pool
Dave stopped by to check on the patient yesterday
The CE’s loss became our art project:
PJG was first to sign the cast
And Victoria got quite creative with it
Vernon and Chloe represent!
Don't forget the cats!
Our new best friend
The other animals are a bit perplexed, but they’re adjusting to the new routine. Victoria has been taking the dogs to the beach a lot, so Chloe and Soho are in no hurry for the CE to recover.
Where's that guy who usually hands out cereal at the kitchen door?
Chloe guards the poolhouse
Speaking of recovery, the first post-op appointment was last Thursday. It was a tough ride in the car – eighty miles each way, and very difficult, painful work for the CE to walker himself from the parking lot to the doctor’s office and back. Then there was the really hard part – they sawed off our beautifully decorated cast and examined the incision. The CE said he knew it was bad when they exposed the foot and the surgeon asked for the curtain to be drawn. Not, most definitely, not pretty.
He will return for another appointment next week. In the meantime, they sacrificed our artwork for a snappy purple cast that blessedly weighs only about half as much as the previous one.
First you choose your color
Then they build the cast while you try not to pass out
And then, voila - new cast!
It has been a very, very busy week so I apologize for all the unanswered emails and unreturned phone calls. We’re hoping things will get easier as we go along and that life will return to something approaching normal. The way I see it, the harder I work at getting him well, the sooner he will look like this again:
The CE and his brother, the Siesta Keyster, in younger days
Getting a Leg Up.
He lives. He breathes. He computes! He has gone from:
On the bright side, he'll save a bundle on shoes...
to
What a difference a day makes!
Still a few kinks to work out as far as managing the pain, but the worst seems to be behind him. He’s still very tired but getting stronger every day. Today he even asked for his laptop, so he can’t be far from running the empire once again. And despite the post-op fogginess and pain med grogginess, he continues to beat me at Scrabble. I understand this might say more about my Scrabble skills than his and am duly humbled.
The real fun has now commenced, however. Way better than losing at Scrabble. For the next fourteen days, I have the distinct pleasure of sticking him daily with a needle! If you haven’t been worried about the direction health care is going, be very afraid now because in our Brave New World, they discharge you from the hospital with a prescription for home-administered anti-coagulent injections. (Translation: we can’t be bothered to do this for you, so hopefully someone you know can figure out the instructions to give you a subcutaneous injection without severing an artery or screwing up and letting you get a big fat blood clot.) This provides a significant incentive for marital harmony, since you never really know when you’re going to end up on the receiving end of one of these needles.
This might hurt a little...
That said, the CE is still on the fence as to whether he would rather have me or the lovely young hospital volunteer, Tanya, looking after him in his hours of need. He is one bad joke away from being the recipient of a needle someplace he REALLY won’t enjoy.
Tomorrow we head back home to the chicken/dog/cat/bird farm, where we hear things are running very smoothly thanks to Alexandra and Victoria. We are so grateful for their help and for the wonderful emails, texts, calls, flowers, gift baskets and light bulb changes received on the CE’s behalf.
On Thursday, we will head back to LA for a post-op appointment and (hopefully) a change-out of the Big Foot cast. We’re told the next step is a fiberglass version that permits greater mobility and maybe even a shower.
We think the worst of it is in the rear view mirror. Here’s to putting the best foot forward to recovery!
