Shoes, Stitches and Shrimp ....

We are going to head to Chicago early afternoon tomorrow (Thursday), instead of stopping in central Illinois to stay with family. The "snow situation" sounds okay for Chicago, but you never know. I think it only snows when we have an appointment.

Pray for okay weather, and that the stitches look ready or healed (i.e. can be removed). Obviously we don't want to take them out before it is fully healed. You never know for sure, but we want keep them in longer than usual. Friday will be 2 1/2 weeks since we "restitched." I have the Chicago orthopod an update yesterday and she said that I made her day with the news. I think we are on the right track. We'd be really good if we could get more movement in the toes and get into a normal shoe. The shoe situation is definately more challenging in the winter months. I am intending to ask her about blood circulation as well; my foot looks purplish more than it should.

I realized today that I'm not going to make our "student goal" at work this year. I am out of student visit dates between now and the end of May. I have 7,500 students scheduled and 9,000 was the goal. It is a bit of a bummer, but numbers are not everything. I keep telling myself that we've operated four times since last spring, so my marketing and driving abilities were limited. Everyone will get over it and life will go on successfully.

This Friday (Feb. 1) is the one year mark from my first and biggest surgery in Chicago. Last year this time, we were meeting with the Chicago orthopod and going over all the details of what would happen at the hospital. I had shrimp and a pina-colada the night before surgery & hoped I didn't get sick the following day! I clearly remember her telling me that I had an "A+ operating team." She was right. Still thankful for her realationship, willingness to e-mail, taking extra time with us at appointments, and for her perseverance. I've thought about going to med school lately .... it is something that I've considered in the past. A female ortho surgeon in St. Louis would be a first.

Hoping for clear direction on the stitches .... will update the blog after we get home.
Jenny

Five Days & counting ....

It has been a fairly quiet weekend at home. I had to work at a summer camp fair booth for JA on Saturday afternoon, so it feels like a short weekend. Not sure if the steroid is actually working correctly or not … the medicine cycle ends on Tuesday, but it is not really much better. The foot looks like it is having an allergic reaction to something. Benadryl hasn’t done anything. I thought perhaps it was the tape over the gauze, but that is not it. This was the first weekend that I discovered multiple clothing items that are now too big because of the weight I’ve lost over the past three months.

The incision is very dry and so itchy! Friday can’t come soon enough to reduce the ongoing itch! It is hard to tell if the stitches have worked & it has healed properly or not. I guess we’ll know more a few days after the sutures are removed. I think it could go either way.

I’m fairly confident that we are going to continue to have an issue wearing shoes. I don’t have enough movement in the toes to be able to push into a confined shoe. It seems like there should be a way around this, but I haven’t figured it out yet. I’m planning to discuss it w/the Chicago orthopod on Friday. Her suggestion in the past has been to keep looking for anything that works, but this is easier said than done. It is a bigger issue in the fall/winter months, when a sandal style doesn’t work. This doesn’t sound like a big issue, but I’ve been wearing two different shoes for the past four months and we have to get this to improve. (It is also not good for the hip situation)

We’re planning to leave for central Illinois on Thursday after work and will return to STL on Saturday. Hope you are enjoying warmer temps outside …looking forward to being “stitch free” in a few days. Still hoping & praying that the incision holds together.

je

Good news ....

Good news! The pathology report came back from the biopsy that was taken during surgery last week. There is NO bone or soft tissue infection ... yippee! The Chicago orhtopod also thought that the incision line looked good (based on e-mail pictures) and told me to plan to see her on February 1st to have the stitches removed. We used much heavier suture material this time, which appears to be helping. I am hoping to get back to exercising after the stitches come out.

She called in a short-cycle steroid prescription to help with the skin on the foot that is breaking open and is overall looks rough. It is not a big deal .... something where the skin breaks down in places for know obvious reason. The foot has been itchy, but I think we are beyond the hives - still not eating wheat or the protein gluten and this seems to be helping.

I survived our student visit today, but it was a long day. The foot is tired tonight and I'll head to bed early. No more students for the next 12-14 days, so there will be a little break. I still have the classy blue scooter and am thankful that I didn't sell it quite yet.

Happy weekend!
je

Healing happening ...

Didn't you always want to see foot stitches? This looks similar to a Frankenstein show .... don't look, if you have a weak stomach.

I have been walking more on the heel area over the past several days. There is not a lot of pain, but the swelling has been more than I anticipated. I'm still using ice and elevation, too. The Chicago orthopod asked for me to e-mail more pictures today, so I did that and am waiting for her reaction. A tiny spot started to bleed over the weekend and has continued on/off at times - nothing big & I don't think it is cause for concern. I was able to go see a movie on Sunday afternoon - good sitting entertainment.

The skin toward the back of the foot has been really irritated, areas have broken the skin open & it generally looks a "mess." It looks similar to an allergic reaction, but I'm guessing it is simply overall trauma to the foot. I am hoping this improves once the stitches comes out and the area can get wet. My toes are so, so stiff .... I asked the Chicago orthopod if I can manually try to move them a little. I don't want to lose motion that we worked so hard to restore.

Today was a eleven hour day at work with an evening meeting, so it has been a long day. Thankfully, no night meetings the remainder of the week, but I have students on Thursday. Will let you know what I hear from the Chicago orthopod ....

je

Pictures look good ....

I heard back from the Chicago orthopod via e-mail today and she thought the incision line looks good (so far, so good). It is zero outside in Chicago today, so I'm thankful that we're home and not there. There is no drainage, which is a good sign. She asked me to send more pictures on Tues/Wed. next week and then we're thinking of removing stitches on February 1st (yet to be totally determined). I have walked on the heel more today and got a shower this morning (with the foot covered). I relaxed at my house this afternoon and we made cookies with mom's new mixer. I have a very busy week happening at work this next week, so I need to chill this weekend.

In two weeks, we'll be at the one-year mark from our first big foot surgery last February in Chicago. If I had a dollar for every resident orthopedic surgeon that I've seen since that time, I could have a nice dinner. No one single, though. That was a long week in the hospital and chilly outside, but we're beyond that now. A lot has happened in the past year and we have grown in many ways. I need to make a list of all the things we've learned on the journey. God continues to be gracious, merciful and loving .... hoping to make it to church tomorrow.

Healing in process,
Jenny

Good Day today ....

I went back to work today, although I sat nearly all day with the foot up. I am into vacation time now and am trying to be conservative on missing days. I slept all night last night and didn't wake up at all - yeah! I was able to go the entire night without any pain medication. I am taking a little pain medication, but nothing substantial. I was somewhat tired today, but I made it .... will head to bed early tonight and tomorrow is Friday. I'll have the weekend to rest at home. I need to take a picture of the incision and e-mail to the Chicago orthopod either tomorrow or Saturday. I have not removed any bandages yet to see it. She said that it won't look real "pretty," so don't be alarmed at the visual appearance. Glad for the tip off! Thanks again for all your prayers and warm thoughts this week ... I feel like we made good progress and hopefully healing in the next two weeks will progress as planned. Happy weekend!

Stitches-R-Us ... AGAIN!

We're back from a quick trip to Chicago and generally all went well. We left work a little early on Monday afternoon and escaped the rush hour traffic leaving St. Louis. We stopped for a quick dinner along the way and arrived at the hotel about 10:00pm. The traffic in Chicago on a Monday night was like a ghost town - no traffic anywhere! Monday a long day, so we headed for our PJ's and called it a day.

At 8am on Tuesday morning, the surgery center called to say that the person scheduled before me had cancelled, so I could come as soon as possible. I was ready, so mom took me to the surgery center and came back to the hotel to move luggage to the car. It was a sunny, chilly 11 degrees in Chicago on Tues. morning!

It was like the princess had arrived when I arrived at the surgery center .... everyone was waiting and ready! I met with Dr. P & she explained her plan & what would happen during surgery. She was her usual warm, caring, self. She had also spoken with the plastic guy (several days ago) and brought him up to speed. He was fine with our decision. We did local anesthetic with a block in the foot - only partially worked, but we tried. The nurse I had start my IV was marvelous and got it on one try .... I have super tiny veins & it often takes several attempts.

During surgery they opened the wound, cleaned out scar tissue, took a bone biopsy, washed the entire area with antibiotic and then she carefully stitched with a "trauma stitch." After surgery she told me that the good news was that she was nearly certain that there was no infection, the bummer news is that it still may need to have skin grafting done - if it does not heal from the under side upward of the wound. Dr. P "set up" the wound to now grow new skin on its own, but whether or not it will is the biggie question ... it may, but if not she said she'll help me orchestrate to have it skin grafted. She did say that I could walk on my heel, but I am playing it safe with the crutches for a while. I go back to see her in 2 1/2 weeks and then we should know more if we've solved it or if there is more yet to do. Nothing was said about the oxygen treatment regime, so I guess we're beyond that.

We left the surgery center with hugs and headed to the drive thru at Steak-n-Shake about noon for a grilled cheese. We only stopped once on the way home (more ice needed for ice pack) and mom did a great job of driving. We rented a small SUV, which allowed me to stretch out & keep the leg elevated on the way home.

Resting today and the pain is manageable .... many thanks for all your prayers. Everything went very smooth and it was the fastest trip we've made. Mom says this is trip number 14 over the past year. Will keep you updated .... eating lots of protein and thinking healing thoughts!

Wound surgery on Tuesday ....

The foot has remained the same for the past two weeks, with no substantial change. I confirmed surgery details yesterday and we are scheduled for wound closure surgery on Tuesday morning (1/15/08) at 9:45am. I need to be at the surgery center at 8:45am. We are going to do gentle debridement of the wound, biopsy the area and then close the wound. We are keeping the stitches in for 2 ½ weeks with no weight on the foot.

We will drive back to St. Louis on Tuesday after the surgery, so Tuesday will be a busy day. I’m ready to get on with it, as by late afternoon the area is hurting and just feels like it needs to be closed. Pray for safe travel, no infection, and that Dr. P there will be enough skin for her to close the area effectively. We both want this to be IT for surgery – more than you can imagine. Unfortunately all the swelling that I’ve worked to reduce over the past eight weeks, will likely return.

The skin area around the incision & the entire foot has been super itchy this week. No hives, but everything is “inflamed.” I am hoping everything calms down after it is closed or it will be a long several weeks ahead.

My foster sister and her five month old baby have been visiting us the past several days (lives in Ohio) and we’ve had a fabulous time together. This was the first time that we had seen her baby and lots of memories were made. We wish she lived closer, but it was terrific to spend time together and love her little one. It was a good break from all the foot/hive issues.

Still thankful that my Chicago orthopod is sticking with the situation and is willing to offer her medical expertise … she continues to be a blessing and says all will work out.

Blessings for a joyous weekend!
je

Wound Closure Surgery ...

Today I scheduled wound closure surgery to be done next Tuesday in Chicago by the Chicago orthopod. She is confident that she can get it to close says it will all work out. She told me not to worry or stress about it this week. Mom & I will go to IL on Monday night (next week) and the surgery will be Tuesday morning (no time set yet). Our plan is to keep stitches in for almost three weeks and be non-weight bearing during that time. She will show me how to move my ankle and other toes a bit, to try and keep them mobile. It will be three weeks of no driving, so I'll need to head back to mom & dad's house for recovery.

I'm scrambling to get things in place next week for work. I'm thankful that the surgeon's schedule allowed me to do this quickly, as it getting harder to walk. Nothing has really changed with the wound itself .... although it is an open wound, it does look "clean" or no infection on the surface. My boss was very understanding today as well when I told her the news, which was a blessing. She knew last week that it was a possibility.

At peace with our decision ....
Jenny

Tiny steps of progress ....

I’m grateful that the week ended better than it started the first four days. I sent a long, heartfelt e-mail to the Chicago orthopod on Thursday evening and explained my final thoughts on the wound situation. The kicker all week was simply the fact that the plastic surgeon was insisting on this eight week oxygen regime that wouldn’t even start until the end of January. Each daily treatment (off Olive Blvd.) would be 2-2 ½ hrs., meaning I would need to miss work most of the afternoon for eight weeks and would need someone else to drive to every appointment. From a practical standpoint, I can't make this work.

The Chicago orthopod wanted him to close the wound surgically, but he wouldn’t. She didn’t want to go against his advice, so she was taking a “wait-and-see” approach as well. She agreed that it needed to be closed, but she also said that the plastic surgeon was the soft tissue guru.

My philosophy all along is that the wound had not closed for two reasons:
1. Stitches were removed at 10 days & were barely ready to be removed, but they were taken out. Once it is open, it is downhill from there.

2. I was allowed (told it was ok) to walk on it right away after surgery and while this is probably okay for the normal patient, it doesn’t work for me. “Non-weight bearing” for 2-3 weeks would very likely have been better.

I’m not a surgeon, but my gut feeling is that if we left the stitches in as long as necessary and was non-weight bearing, I somehow believe that this might be enough to get the wound to close. I fully agree w/the Chicago orthopod that the likelihood of a bone infection or vascular problem at this point is fairly unlikely (i.e. it would have surfaced long ago, if it existed). I am not concerned about either being an issue at this point.

There is no “extra” or fatty skin on my foot, so there is very little skin for the surgeon to pull the incision together and re-stitch. I have to really work to make it come together myself. The longer we go w/it open, the more it pulls apart. Pray that the incision stays clean & that there is enough skin for her to re-stitch, supposedly skin grafting is not an option.

Long story short, late on Friday I received an e-mail from the Chicago orthopod saying that I should give it until the beginning of next week, but that she was willing to close the wound surgically for me. If for some reason it still doesn’t heal, then I have to follow the plastic surgeon’s advice. PRAY PLAN #1 WORKS! She asked me to look at my schedule for the next two weeks. I will also suggest that we do all follow-up care w/her …. will mean more trips to Chicago, but at this point it is worth it. She operates on Tues/Thur. of each week, so I know it will be one of these days soon.

I am very, very thankful that she is willing to help and try to close the wound. It is unusual for one surgeon to do something opposite a colleague. Obviously she believes strong enough that it may work or she wouldn’t be offering to try. If it doesn’t work, I’ll be the first to admit that my thinking was wrong. I wouldn’t be offering to do 2-3 weeks on crutches, if I didn’t think it would help. This was all a huge mess and got much more complicated than it should have been earlier this week …. many thanks for your prayers. God and prayer warriors continue to be faithful.

I need to work through all the details Tues.-Wed. of this week and hopefully everything continues to fall into place. Hopefully the plastic surgeon will not be terribly upset with our decision.

“God is able to accomplish infinitely more than we might ask or think.”
(Ephesians 3:20)

Waiting Game ....

It has been a long day, so this is going to be brief. The plastic surgeon and the Chicago orthopod are not in complete agreement as to what should happen next. The plastic doctor informed me today that he will not operate on it to close the wound. Several reasons, but this is a different tune than what I heard last week. At the moment, the Chicago orthopod wants me to wait another week and see where we are at next Friday. She is not willing to do something that is opposite advice from the plastic surgeon.

Pray for patience and that the next 6-7 days go fast. This is uncomfortable, walking is hard, lack of exercise is a concern. I only have 2 weeks left with no kids at work and there is no way we are going to get this resolved before that time ends. I am having difficulty accepting the fact that the wound is very small and yet this is becoming a huge issue. I can't begin to tell you how much back/forth e-mail has happened on this during the past week; I need a break. I feel like I'm stuck between a rock and a hard place on this .... the Chicago doctor says that we will pow-wow next Friday. Not upset w/anyone on this, as I knew that wound closure is always a risk w/any surgery .... for me just more than most patients!

Hoping that one of the surgeons agrees to bring closure to this surgically and that this doesn't drag out another 2-3 weeks. Tomorrow is a new day.

je

Heard from Chicago orthopod ....

I heard back from the Chicago orthopod today via e-mail. I continue to be very grateful that she is willing to e-mail. She is more in favor of having the plastic surgeon close the wound surgically rather than continuing with local wound care in St. Louis & going the oxygen therapy route. This is my inclination and preference as well, so at least we are thinking alike. We are going to give it a few more days and see what happens and then make a final decision. She didn't think there was a bone infection or vascular issue, which is good. She thinks it is a combination of bad luck and trauma to the area from surgery that has caused scarring under the skin. I also mentioned that I didn't want to lose exercise or motion and the longer we go without either, the harder it is to get the foot moving well again.

In the grand scheme of things, this is a small deal. It will probably mean several more trips to Chicago in January, but we'll get through it. Will keep you posted and hopefully will know more toward the end of this week. Hope you are staying warm!

je

Happy New Year!

Happy New Year! We celebrated with beef fondue at mom & dad's house last night. We then got half way through a DVD, only to have a glitch in the DVD & couldn't finish the movie. So much for Blockbuster coming through!

Not a lot happening new with the foot. I've been at home most of the past four days and have been off of it for the majority of the time. It really doesn't look any different to me than last week, although I'm not totally sure what I am looking for in improvement. Trying to figure this out from six hours a way is definitely challenging. I hope to talk to the Chicago orthopod via phone sometime this week. Friday is the day that I'm supposed to e-mail the plastic surgeon but this is also his surgery day w/the holiday week, so we'll see what happens. My gut feeling is that this is not going to come together on its own. I'll spare you the digital pics that I took of the wound this morning. I can only look at it about long enough to change the bandage. It has now been 6 weeks since I've been able to exercise or walk w/the foot normally, so it is getting stiff ... another reason to get this figured out sooner than later.

Looking forward to a new year and all God has planned ... stay warm & wishing you a joyous year ahead!

je