Whoops...Time to Freefall

With a surgery date of TBA sometime in March I continued with my business. Assistant Directing started. It felt good to be in the rehearsal room again and learning a play. I had a really hard time discussing my foot with the people I was meeting. I was pissed off about it actually. Most everyone has been exceptionally nice about it, but I can't help but wish I was in a different situation. I am grateful I have patient friends.

I got a copy of my MRI and X-Rays from the HSS on CD. It made me wince.

Work continued to pile up as systems conversions started and we were preparing for our annual audit. My VP had been on vacation for three weeks and we had been without a middle manager for nearly 6 months.

On the afternoon of Wednesday January 13, 2010 I got a phone call from Carlos, Dr. Ellis' office manager telling me that someone had canceled their surgery on Monday, Jan 18th, and he was wondering if I would take the slot. I said I would like to, but needed to talk to my boss first. I talked to my VP and my director and got the green light. My VP said I would need to available by phone to walk them through processes only I know how to do.

I gave the go-ahead to Carlos. He directed me to the pre and post-op directions and sent me a form to fill out and bring with me. I asked him about the cortisone shot, and if I should cancel, he said he would talk to Dr. Ellis. Dr. Ellis decided he wanted to see me again, for a pre-op eval and we scheduled that for 9am on Friday Jan 15.

I sent notice to as many of my support network as I could think of, but realized this was going to be a 'figure it out as we go' sort of situation.

On Friday morning I saw Dr. Ellis for one of the longest conversations I've ever had with a doctor. The appointment lasted over an hour. He re-examined my foot. The problem he was having is the MRI shows the most damage on the tibular sesamoid, but the most pain seems to happening around the fibular sesamoid. (there are two sesamoids per foot) The fibular sesamoid did show a severe loss of cartilage, but it was not bone on bone.

He fully examined my foot, flexion, pressure and compared it to my right foot. He was able to make it crunch in his examination...which is what happens now when I try to walk normally.

The problem here is that a double sesamoidectomy is not done because of the risk of creating a cocked up big toe. Which could mean another surgery.

But removing only one sesamoid might not take care of all the pain. He told me about a patient who had sesamoid issues and he removed one but she still had pain. He felt a great deal of regret about not being able to help her more.

We looked at my MRIs. Looked at the damaged sesamoid, and apparently I also have a small bone spur in the first metatarsal, but it was so small and not the big problem. I asked him about some things I saw in the MRI. What I did see as 'bubble', was in fact, a bubble of fluid from the arthritis.

The dark lines in the bone are normal.

There was some debate about the fibular sesamoid being necrotic...dying...we looked at a different patient's MRI and compared...nope...looked very healthy in comparison.

He told me he had talked to the senior surgeon about a double sesamoidectomy, the radiologist even asked if it was possible to remove both. The conclusion is that it's best to not remove both. The tibular may be affecting the fibular.

The other smaller issue is the tibular sesamoid is easier to remove and has a shorter healing time.

I told Dr. Ellis let's remove the one that's most damaged. If I am still experiencing pain in a few months we will cross that bridge when we get there. If we have to remove both, that's what we do. I would probably be more conservative about this surgery if I was 70, but I am 28 and can't walk.

Dr Ellis described the incision, and surgery. What the dressing would be like, a timeline for suture removal and physical work.

I asked him if I could get my prescriptions now, living by myself I would need to fill them now.

He was going to prescribe percoset, but went with vicodin when he learned I had to take anti-nausea medicine with my vicodin when I nearly tore off my finger.

I asked what I would need to clean myself...garbage bags and a shower stool, which I could get at any surgical supply store.

I went to Carlos and Angel, scheduled the suture removal. Found out I would get scheduled later that day and to call this number at a certain time if I don't find out my check-in time.

I hobbled to work.