Archive for July, 2010

Flash Back: Correcting The Toe Problem

1 Foot beforeDr. Roukis shared the following operating room pictures with me. I will share them with you. You will see the tools and how and where they were used.

They removed the Orbital Fixator. Then worked on my hammer toes. Since the second toe was so long, it was decided to shorten it. This would give a good contour allowing for my foot to fit into a shoe without rubbing the end of it causing an ulcer that could be problematic. After the removal of part of the toe bone, the skin was rolled down and stapled in place. I called it my Chinese Sharp-Pei toe, or “dog toe”.

2 Tools Used in surgeryFrom the looks of the pictures, the third toe was a lot of work and difficult to straighten. In fact it still isn’t straight and Dr. Roukis frowns at it each time he sees it.
Third toe
The big toe was beginning to turn in. Not sure what they did to 3 Stapled toesstraighten it, but I know they drilled holes using a small drill and a template in05AANNIT order to insert the staples. The little toe posed another problem. It had had an ulcer, but it turned into somewhat of a callus upon healing. It was decided to amputate that bulge so it would not be likely to form another ulcer.

I am amazed when I look at my feet now. It is difficult to believe all this work was done as scaring is nearly impossible to detect. Seeing the pictures of them using a hammer and chisel, all the clamps, staples and other little metal pieces to fuse my toes to my foot was certainly interesting and educational. I can wiggle my toes, but they are quite stiff and probably always will be. All the Wrapped up aftermetal and staples that were implanted will stay in my foot.

Now for the challenge of splint and plaster casts.

Second Surgery: Orbital Fixator Removal and Hammer Toes Straightening

P8160028Just to give you an idea about Dr. Roukis’ sense of humor, when it came time to do the removal of the Orbital Fixator, we had to do the usual paper work connected with surgery. He just had to contemplate whether he should, or should not remove it. As if I didn’t need, or want this to happen.

Fortunately, I only had to wear it two months as the healing went well. My glucose had been well under control as a diabetic. This and all the positive things in my life, I contribute to the healing. The surgery was scheduled for August 29, 2007. Pre Op went fine. Dr. Roukis just wanted me to talk with the anesthetist and make sure they gave me something that would keep me from vomiting during surgery as had happened before. When I asked the anesthetist about the medication, he said I hadn’t had a problem. However, after he read the doctors report he gave me some medication to take before coming in for surgery.

This was a day surgery and would not require staying in the P8220017hospital. Time came, this time, very early AM as we had to check in at 6 AM. We had about an hour 15 min. drive to the hospital. Max had to load the wheel chair in the back of the van before we could leave. It was the last trip with the fixator.

After checking in at Surgical Services, doing all the “stuff” they wanted, I was then sent to OR Reception. One of the patients was a medic that I had seen in limb preservation. He recognized me saying, “Aren’t you one of Dr. Roukis’ patients?” With that we visited a bit. As we headed off to our surgeries we wished each other luck. Just one more thing that tugs at my heart strings.

P8160023 copyOnce in my gown and robe, then to the bed and waiting area prior to surgery. Dr. Shade, Dr. Roukis’ assistant, came to sign my right leg with her initials VLS and the other leg NOT! We laughed. Dr. R came in and went over everything with me that was to happen during surgery and after. When finished he excused himself to get the operating room ready.

The anesthesiologist did a great job, no bruises, and no vomiting in OR. They gave me a shot to “relax me” and left to check if they were ready for me. I watched as everyone was moved to their destination. There were eight of us. I was the only one left. Two guys came bouncing in, surprised to see me there. They said, “Did they forget you. There’s no one else here…..” Who knows what else they said as I went out like a light.

When I woke, I was in recovery. I thought I was awake, but I couldn’t understand what was being said until they moved me to another location. I had a doozy of a sore throat. Max came in. They gave me ice chips for my sore throat and a couple of wrist bands to help control nausea. Because Internal Medicine was concerned about my “High Blood Pressure” I asked the nurse if my blood pressure was high. He said. ” Hardly” and proceeded to tell me my oxygen was 97-98% and blood pressure 104 over 45. Not bad. As soon as I could get up with my new splint cast, I hopped into the wheel chair. We then headed home.

Next week, I will share what happened during surgery and the photos I was given.

History Of And My Experience With The Orbital Fixator

When I decided to have foot surgery, an entirely new learning curve was about to take place. I was ready, but apprehensive. We had already checked my surgeon out and were impressed with his credentials even though he was only 36 years old (about the same age as our son). We were very comfortable with him. He was thorough, professional, knowledgeable, had a great sense of humor and explained things so we could understand them.

In explaining what was to be expected, we were told he was going to use a device on my foot called the Orbital Fixator. This would 04Bconfine my foot so it couldn’t move at all during the first two to three months after surgery. This was to help the foot heal. I was shown the device, but I don’t remember holding it. If I did, it didn’t sink in how heavy the device was. Nor, did they suggest I tie a 10 pound weight on my right foot and practice playing hop scotch for a few weeks before. surgery. I truly thought that would have helped once I was ready to try to move around and wasn’t able to do anything, but scoot, or try to hop on my left foot.

It was awkward and very heavy. I didn’t have strength in my hip or leg enough to lift my foot. So, I often needed help. It was actually exciting when I was able to lift my foot on my own. This came about because of the exercises that were given to me before I left the hospital.

The history of the Orbital Fixator is fascinating. In 1921, in Caucasus, in the Soviet Union, Professor Gavril Ilizarov was born. He had no formal education until he was 11. His parents were illiterate. Yet, he quickly went through medical school practicing in the Kurgan region of Siberia. He was having to deal with orthopedic problems. Though he wasn’t trained as a surgeon, he was the only doctor in the region. In the 1950’s he developed and created a method for treating fractures, deformities and other bone defects. It was called the circular external fixator. (Orbital Fixator)

It is said he was riding in a wagon and started studying the hub and spokes on the wagon wheel. This gave him the insight to create the circular external fixator to stabilize the leg. He worked quietly and basically unknown until 1967 when Olympic high jump champion Valery Brumel sustained a non-union fracture. He successfully treated this infected fracture. His methods were brought to the west in 1981 by an Italian doctor.

Professor Ilizarov was the only orthopedic surgeon ever elected to the prestigious Soviet Academy of Medicine. He headed the world’s largest orthopedic hospital in . Kurgan, All-Union Scientific Centre for Restorative Orthopedics and Traumatology which has 1700 beds. He continued working an lecturing world wide in this field for 41 years until his death in 1992 at age 71.

Because of his work, he showed that controlled mechanically applied tension stress that there could be regeneration of bone and soft tissue. Various names of his circular external fixator have come about, the orbital fixator, the external fixator and in the past decade the Taylor Spatial Frame has been introduced. It has been determined the external fixation devices disrupt the soft tissue less in patients whose healing potential is compromised in the case of those with diabetes mellitus and Charcot disease.

What’s That On Your Foot?

When I am out and about in public wearing the bone growth stimulator even now, it is a conversation starter, a another chance to talk about Charcot Foot. I have worn it at least 3 hours a day on my right foot since surgery. That was three years ago. I was told to wear it for three hours a day for three years, or until it quit. I have done that, missing only a handful of days. I truly believe this device has been a big benefit in helping my foot heal. Artificial bone was placed in three different areas in my foot during surgery. It is my understanding the artificial bone is eventually replaced by your own bone.

The bone growth stimulator is a electro magnetic device that was to help my body accept the artificial bone and stimulate bone growth. This device is strapped around the area to aid in healing for the period of time determined by the surgeon.

Let’s step back a bit. In the hospital, after surgery my left leg was Leg missagerwrapped in a device that was to prevent and reduce atrophy and increase blood circulation and stimulate the muscle since I wouldn’t be moving much the next few days. This was called Electrotherapy. In 1855 the developer, Guillaume Duchenne, explained alternating current was superior to direct current as there were fewer complications. During the 1940’s, the US War Department investigated the application of electrical stimulation not just to retard, or prevent atrophy, but to restore muscle mass and strength.

On my right foot was a bone growth stimulator. There are three P9220003categories of electrical bone growth stimulators: invasive, semi-invasive, or noninvasive. Mine was noninvasive and I will give you some information about it. Mine was a Pulsed ElectroMagnet Field (PEMF). This device uses low-energy electromagnetic fields promoting healing by creating electical currents to stimulate bone formation and calcification. The currents stimulate bone cells changing the cell wall structure enhancing bone union. I was able to wear it on the Orbital Fixator, casts, the boot and my shoes. It was pretty easy to use as it had a strap that was placed around my foot. I wore it three hours a day which was an automatic setting. It beeped when it was done. Once done we merely took it off and plugged it in for recharging. The FDA approved ultrasound bone growth stimulators in 1996. I am pleased my surgeon chose to add this to my recovery plan. I believe it made a difference in my healing.

Next I will tell you about the Orbital Fixator.

Don’t Stop Doing Things You Love

Prior to all the surgery, I had judged student art shows. I was P8170033called to judge the student art work at our county fair I wasn’t sure I could in a wheel chair. Reviewing what needed to be done the decision was made that Max could help me. But, first we really needed to get my surgeons input. Fortunately, he was very supportive of my trying to do as many things I normally did as long as it didn’t interfere with the healing process. I was to use my head.

The judging took place less than 6 weeks after the surgery. I was still in the Orbital Fixator. It was awkward and I found it hard to allow others to place the award stickers where I wanted. I even went back to the fair to watch the reactions students and parents had to my judging. This actually gave me a great deal of confidence. I was tired after both experiences a good tired, however.

Being at the fair was a good experience as I was quite comfortable in crowds where I didn’t know people. The County fair was a P8270107different situation as I knew many of the people, vendors, exhibitors, entrants and attendees. While upstairs looking at the beautiful flowers and displays, one of my former student’s parents stopped me to find out what had happened to me. I explained Charcot Foot to her. She said that there was a vendor downstairs she thought had the same problem and told me where to find her. We went down to talk with her and sure enough she had Charcot also. She was in an electric wheel chair and basically unable to walk. Hopefully, she will tell her story here later.

One of my good friends wanted to have a surprise birthday party titlefor one of her young friends, but I couldn’t go up the stairs into her house for the party, so she decided to have it in my studio. We did much of the planning by phone. Max and I went shopping for the decorations and some party favors. Judy brought all the goodies. It was definitely a surprise. One of the guests was about two years old. We had great fun blowing bubbles. It was wonderful being a part of something that was such fun for everyone.

After my second surgery and all of the fun of the first surprise birthday party I decided to surprise Max for his 70th in September. Thank goodness for a phone. I called a local P9090006restaurant and arranged for our son to pick up the main meal, Judy brought a cake and balloons. Max walked in when we were setting up. He was shocked as he hadn’t heard anyone drive up to the house. He was even in the room next door. This was a chance for me to feel pretty independent even though I couldn’t walk. I found I could still get things accomplished.

Because we love the theater also, we were able to attend the local theater nearly all season and a theater in Seattle. Not many in wheel chairs attend, but they certainly can. The ushers were extremely well aware of my needs and were helpful as there was special seating for me. They took me to the elevator, or made parking available for us. We just needed to talk to someone in charge

It is frustrating to be confined. If you are facing surgery or recovery, have a place you really like to stay. Surround yourself with things and people you enjoy. As soon as possible, start doing what you love even in moderation, or with the help of others. Maybe find something new, never tried before, you might be pleasantly surprised how beneficial it will be.