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Wednesday, June 27, 2012

Putting your best foot forward

      The saying "Put your best foot forward" has special significance given my recent foot surgery.  Not only will the surgery give me a better, stronger,  more stable foot but it will likely help with other RA issues.  
 As those of us with RA know, the more time goes by the less we are able to balance as well as we did pre-RA.  Add to that the inevitable aging process and balance can become a real trial. In addition, if you have foot problems like I did, your balance is even further compromised.  My doctor told me that thanks to my foot mechanics and other issues, I was essentially bearing my full weight on three toes per foot!  That in turn, effected my knees and hips, thus leading to my eventual decision to have the foot surgery.  
One of the interesting benefits of only being able to use one leg for balance is I am getting to practice (not by choice mind you) my balancing skills and I am getting really good at it!  And my left leg is going to be rock hard by the time I am able to bear weight....not a bad trade off.  Ahh the simple things in life....
I can say with certainty that when you are confined and movement is limited, the things you take for granted every day become so special.  When you figure out how to complete them, either by accommodating or adjusting your technique the level of satisfaction is like winning a race!  When I figured out how to get up to the second floor (with the expert help of my son) I was so happy!  It opened up a whole new location for me to be at while recuperating and that was so welcomed.  And I am sure that I have strengthened my arms as well thanks to the necessary additional stretching and lifting I have to do to accomplish tasks.  
     It's funny how being forced to slow down your pace, for whatever reason has the added benefit of making the simple pleasures that much more intense.  I have always loved my back is a place that feels like a screened in tree house, with birds singing all day and a wonderful view of the sun setting in the distance.  One of the best decisions I made with regard to this surgery was to do it in the early summer so I could enjoy the porch!  Add to that the visits from my friends to keep me company or enjoy a meal and I am really feeling very fortunate.
     One last effect that I think is of particular interest to anyone with RA is that since the surgery my RA has been subdued....wonderfully in the background.  I mentioned this to my Rheumatologist yesterday and he believes that when our bodies are dealing with a trauma or a situation unrelated to RA, that our immune systems respond accordingly thus granting us some well earned relief.  I have noticed this phenomenon before and it really intrigues me.  Another of the little benefits of my recent journey that was indeed welcome.
So as I wrap up my time of Don't Walk and enter back into the world of walking I will try to retain my newfound joy in the simple things and not let the fast pace of life overtake that discovery.

Monday, June 25, 2012

Expect the unexpected

     I am happy to say that foot reconstructive surgery number 1 is complete!  PHEW!  Glad to be able to say that.  It has been nearly three weeks and my foot is doing great so that is the really wonderful news and what I am really pleased to be able to share. 
     I have learned a great deal from this experience not the least of which is that it has been quite the roller coaster ride!  Just like the unexpected drop offs as you make your way through a roller coaster, the aftermath of the surgery has been filled with some really interesting (can you say pains in the butt?) challenges that despite my almost obsessive planning were not even on the radar!
     On the one hand I stocked up on enough dry goods supplies to take care of my entire neighborhood in the event of a natural disaster.  So I had that covered.  What I did not expect, despite knowing that there would be a number of bumps in the road, were some other items I will go over here in the hopes that it might make for a smoother path for others coping with surgery as well as for my next one.
     First and foremost I did not expect that my foot would do so well and that other "side effects" would be the challenge. For instance, I have never been one to take pain medication other than Tylenol now and then.  Now I remember why....I HATED the way it made me feel!  I was so happy to get off of it I cannot tell you.  Thanks to a nerve block given just prior to surgery I literally had no pain to speak of.  The nerve block lasted nearly 36 hours and so by the time it wore off the pain was inconsequential.  However, the very well-meaning folks at the hospital really drill into your head the need to "stay ahead of the pain".  So despite not having any, I still believed I needed to take the medication to break the pain cycle before it took hold.  
What I did not know was the charming side effects of the pain medication....dizziness, disorientation, constipation that was horrific and on and on.  In my zeal to follow the rules I think I overdid my desire to follow through to the point that I did not stop to consider if maybe a slight adjustment might make sense.  That would have helped to avoid some of the annoying side effects.
I am now officially a lover of adjustments and will try to move from my previous attachment to rigidly following the rules to the point of absurdity.  The next little hurdle I encountered involved overdoing it while ON the pain meds. Not being one who has had that experience in the past yet being a person who craves personal independence, I came home and despite having two wonderful caregivers (my husband and my son) I still did far too much far too quickly. I have this awesome device, a knee walker that is my absolute lifeline.
I use it to get EVERYWHERE and since I cannot weight bear at all on my foot it is my sole link to independence.  I would highly recommend it to anyone having foot surgery that will require no weight bearing.  That said, I did not fully understand that my body would need some time to adjust to how I move on it;  how I get it up over small floor lips, etc.  I tended to simply "dead lift" the front end which meant my back did all the work...well, three days in and now weaning off of the pain meds. and my back was not fact it was in full revolt with tendons and ligaments in total spasm!
So now my foot is still not in any pain, yet I have had a reaction to pain meds., constipation, and now a back that is screaming at me!  I began using ice on it, my family gave me massages, I actually went to a massage therapist, and sleeping was not going well at this point.
     Next up was my first follow up appointment with the surgeon and that went great...he was very pleased with the healing and the incisions looked good.  They removed 17 stitches, some I felt nothing, some stung pretty bad but all in all it was fine.  I was fitted with a boot to protect my foot and told to wear it to sleep, shower, etc. 
As you can see it is quite the boot!  Looks and feels like a ski boot and weighs about as much as well.  So that night sleeping with the boot and trying to adjust to a bad back...not a pretty night in my house.  The next morning we took off the boot and to our dismay my ankle was swollen and purple and very sore.  We quickly put ice on it and then called the surgeon's nurse to see what to do.  She started by saying "well, you don't sleep with boot on or take a shower with it on, just wear it for protection as needed."  We explained that was not what the orthopedic technician told us (all three of us heard the same instructions so it was not just me in my pain filled state of mind) and that we got no WRITTEN instructions as to the use of the boot.  
At any rate, she said just to take care of it and all should be well.... Easy for them to say.. ..I was not a happy camper at this point because remember my foot is FINE but all the other "stuff" is becoming increasingly annoying!  
Not to get off topic but I have to mention at this point that if not for the care and support of my son and husband and the visits and cards and food, etc. from my friends I would have been a raving maniac by this time.  That constant companion of a support team has once again proved beyond measure its importance in recovery for anyone who has any medical issues to handle.  They have kept me together just like a puzzle!

So a few days later I notice that the center incision is "leaking" some orange thin liquid and so my son calls the nurse to make sure that we are not in need of a visit to ensure that this is not an infection starting.  She assured us that this is not unusual and to just dab it off and keep an eye to make sure that it does not become pus filled, red, etc. or if I begin to run a fever.  That, thankfully, as of today, has not happened so I am hoping that we have truly turned the corner on this one and the ups and downs may
now be leveling off.
One really important recommendation I will make beyond what I have mentioned already is that I have developed a "tip sheet" for future surgeries (I am doing the left foot in about 6 months).  It is already a full page in length and contains a lot of useful information.   The unique thing about this type of surgery is the fact that getting around is a huge consideration.  For instance I knew that you were supposed to take pain medication after you eat but my son (who just recently had surgery on a broken leg) told me that eating just after taking the pill is also critical and will really relieve any nausea.  So knowing I could not get up and run downstairs to get some food in the middle of the night when my alarm would go off indicating a need for another dose, we made a peanut and butter and jelly sandwich and cut it into 4 squares so that I could eat one before and after the medication and that lasted both times during the night that I had to medicate. 
  I will post my "tip sheet" in a later blog just so that folks can see the kind of little things you can do to make your life run more smoothly and with a lot less stress while recovering.  I am confident that the next time around I will be better prepared to handle the unexpected and if something unexpected happens I will hopefully be better suited to cope with it!