25 weeks - toenail drama

This post might seem a bit out of the blue, because having looked back over the blog it seems I haven't really talked about this very much, but I think that is because previously it didn't seem a big deal.

Way back when my casts came off at seven weeks, I talked about how my left middle toe was very very painful, red and swollen in this post. I thought it had been crushed by the cast a bit and so wasn't overly concerned.

I did raise it with my surgeon in my email to him, and his reply, which I posted here .

Basically he said: "I am sorry to hear that your left middle toe is very red and if it is clear that the plaster has been rubbing then I am sure this will settle quickly. If, however, it continues to be uncomfortable I might suggest you ask your GP to see it."

Now, I feel rather let down by this. I think that if he or one of his colleagues did not feel they wanted to look at it, they should have told me to make an appointment with my GP.

As it was phrased, I felt the subtext was: "Hey, silly patient, it's fine, stop worrying about nothing. But if you are a total hypochondriac, go and pester your GP and waste his precious time."

I certainly didn't feel encouraged to go and see my GP to get it checked out, and so when I continued to have problems with it, I didn't even talk about it on here, so convinced was I that it was nothing.

Well, more fool me.

It did start to become clear that the toenail had been damaged, but after reading up on runners' forums about toenail loss it seemed to be a minor cosmetic issue that would eventually resolve when the broken nail grew out and a new one appeared beneath.

So when, in the bath one day, the old one came off, and I could see a small new one below, I thought it was all sorted.

Then, when that new one became discoloured, I wasn't overly bothered as I had read that sometimes bad damage to the nail bed took a nail or two to resolve.

Well, a few weeks ago I was concerned enough to try and get an appointment with my GP. The nail was white and thick, and obviously lifting off the nail bed *boke*. My appointment is tomorrow but I have now self-dagnosed with the help of Dr Google, and it is clear that the original damage and infection have resulted in a fungal nail infection which is now very well established.

Of course, had I not been made to feel that I were being a hypochondriac, then I would have gone to the GP earlier, and got treatment earlier. Fungal nail infections are notoriously difficult to treat, and to make matters worse, most treatments can't be carried out while breastfeeding or when pregnant or trying to conceive.

I currently tick one of those boxes, will soon be ticking two, and hope that shortly I'll be ticking a different two.

Does that make sense? Basically I breastfeed the Little Lady and we are going to TTC (try to conceive) as of next month (I know, I know, TMI!) and hopefully will soon be pregnant.

So I can't treat it!

Well, there are some home remedies I might try but I'll see what my GP says when I finally get to see them tomorrow (yes it took about two weeks to get a simple appointment).

I am really upset and cross and feel so let down. If Mr Nugent had just said "go and see your GP about your toe" then I could have had help so much earlier, before it got this bad. And now, my feet are still ugly and horrid, because while the toes are straight, my toenail is grimsville.

In fact, today I pulled the second dead toenail off and underneath is just soft nail bed and white stuff, which I assume is the fungus *double boke*.

The strong of heart may enjoy the following pictures. EVeryone else should scroll to the bold part quickly.

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off you go, squeamish ones

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Ok, here we go then. Here is my bokey toenail before I pulled it off.



You can see that it looks white and a bit fringed around the edges. And I can tell you that it was just held on by virtue of being tucked under the skin at the edges. It was so easy to just prise it off gently.

This picture shows what it looks like now, sans nail.



My poor toe! It looks all gammy and grim. The white stuff does scrape off a bit but I'm worried about transferring the fungus to my fingernails, so only did that a bit before realising it was a bad idea. I think I should probably try and remove it if I can, but the skin is tender.


The next two are shots of the toenail that came off. It's really just a nail remnant, and it is very white.

Top:



And underneath:



I chucked it in the bin before thinking I should have taken it with me to the GP so they can test it, but I bet they wouldn't have anyway.

Squeamish people return here.

My Googling has found that a lot of people swear by the following home remedies for fungal nail:

1 - vinegar

2 - gentian violet

3 - Vicks Vaporub

4 - tea tree oil

Those are in no particular order. Now, as gentian violet is often touted as a remedy for nipple thrush (the things you learn as a breastfeeding supporter!) I can see that it might work on toe fungus too.

Vinegar is very popular, and as I have white vinegar in the cupboard, I may well have a go at that. I'm very intrigued by Vicks Vaporub and would love to know if anyone has tried it.

The only good thing about my nail having come off is that it is easier to get at the fungus which would otherwise have been covered by it, so I'm hopeful that perhaps in the month I've got available before we TTC, I can at least get the fungus on the retreat, and then I can stop using any prescribed treatment (as the Little Lady is nearly four and feeds about once a day, I won't bother telling the GP I'm breastfeeding and I know they won't ask as they won't expect it at this age) and get going with the vinegar (or Vicks).

I'm still really fed up about this unexpected side effect of the surgery though.

21 weeks - approaching normality

HUGE APOLOGIES! I thought I'd published this but it was still in my drafts. Sorry! I think I was going to add some pictures, but instead I'll just get this posted and do pictures for you another time. I do have videos I've been doing but I have so much trouble getting them uploaded to YouTube I may give up on them. Anyway, hope this is still useful/interesting and I'll get writing more I promise.

*should have been published a month ago, whoops*

It's been three weeks since my last update, and I'm now 21 weeks post-surgery.

Last week I picked up my new, custom, orthotics from the hospital. That marked the end of my hospital appointments at the Royal Berks, apart from when I need the orthotics replacing in about two years' time.

The orthotics are as slim as they can make them. You can see from the picture that they are really thin, but the curve of them where they support my arch and heel means that they push my foot up, which means I need to be careful what kind of shoes I wear.

I am working on a post looking at shoes, but basically my orthotist would like me to wear big, clunky shoes with very rounded toes, either completely closed or with a wide strap, and generally pretty ugly.

So far I've found I can wear my orthotics in my flat ballerinas, which have a rounded toe, because although they have no strap they grip the back of my heel and my heel doesn't slip out of shoe when I walk, which is often a problem with very open shoes.

I also wear a pair of sporty styled shoes with two velcro straps over the foot.

As the weather warms up, I probably won't wear the orthotics as often as I should, because you cannot wear them in sandals, but I do make sure that I am conscious of my foot positioning and pronation, and I hope that will be enough to make up for it. I'll definitely wear them all winter.

Right now, I can't wear them the whole time anyway. The orthotist told me I had to build it up by wearing them for half an hour the first day, then an hour the next day, and two hours the next, and so on.

I find they do make my feet and legs ache, because the muscles are adjusting to the new positioning, so I'm still working on increasing the time. I can't wear them in the house unless I wear shoes inside, and I usually wear slippers, so it's taking me longer to build the time up, but I think that's OK.

I also saw my physiotherapist again. I know Ed has been reading the blog, so "Hello Ed!" *waves*

I had to admit I've not been doing my exercises as much as I should have been, because they make me hurt, so I have promised that over the next month I will do them regularly, and wear my orthotics, and hopefully when I go again he will discharge me.

I did go back to yoga and have done two sessions now. Surprisingly, it wasn't as hard as I expected.

During my recovery I have been making sure I did foot exercises, and calf stretches, and I found I was no where near as stiff as I thought I'd be. My teacher, Minna (who also reads this so "Hi Minna!" *waves again*) does try to tell me to take it easy but I like to push myself and I never do anything that is painful.

As expected, it was a challenge to roll over my toes to go from all fours into downward dog, for example, but I either do it one foot at a time, or I do both together but put a lot of my weight onto my hands and arms.

Over time, it will definitely get back to normal, I'm sure.

I am actually really pleased with my recovery; with my range of motion and with my lack of pain. I know I've worked hard on my recovery but I also feel very lucky and blessed.

I do still have the problem with my toenail on my left foot, but I can now see that there is a new nail growing under the old one, and the old one is growing out, so in six months that is going to be back to normal. It's irritating, but a temporary annoyance.

So there we are! I'm still doing my exercises, building up my general stamina for walking and standing, and sometimes overdoing it a bit! Some days I'm fine, some days my legs and feet really ache, but the progress is in the right direction and soon, in terms of medical appointments, I'll be flying solo!

As usual, please ask any questions or make any comments below.

18 weeks - progress and an update

We are so overdue a post, and I have not told you about quite a few appointments, that I almost don't know where to start with this. Which is partly why I've not posted, because I'm one of those people who becomes overcome with procrastination when I am behind with things. Even though that just makes it worse! I know, I'm weird.

Anyway, it's been six weeks since I last updated. Then, I was finding driving challenging, limping on the foot the orthotist had yanked the toe of, getting more mobile, and due to go back to the hospital.

Now, I have been discharged from the hospital, I've been back to the orthotist (who was nice this time!) and had my feet cast for custom orthotics, and had two physio sessions.

At my discharge appointment I was very disappointed that, once again, I did not get to see my surgeon! So I haven't seen Mr Nugent since he changed my casts at 2 weeks, and won't get to see him ever again!

Is it just me, or is that weird? I really wanted to hear how HE felt it had all gone, but that's not going to happen. I did consider phoning his office and arranging to see him, but I never got around to it (see, it's that procrastination again) and now I guess I can't see the point. But it would have been nice.

Going back to the orthotist was interesting. Mainly because I spent hours beforehand trying to buy some shoes that would fit my standard orthotics, only to be told by her that I should wait till I got my custom ones. Just as well I didn't buy anything!

She had a really good look at my feet, and commented that I have good control over my tendency to overpronate (roll my feet in). I do work hard to remember to hold them straight, and it's starting to become a subconscious thing now, so that's good, as I believe that will also help my knee problems a bit.

I'm waiting for my custom orthotics to be made. They cast your feet using oasis - the stuff florists use - in a shoe box. They just just push each foot into it and then make a cast from that, then use that cast to make the orthotics.

It hurt a bit doing the oasis, because she pushed my foot down first and my toes bent up a bit, so on the next foot I asked her to push the toes down at the same time, which was much better.

I go back to get them on April 22 and then I will have to try and find some vaguely attractive shoes that will accommodate them! I've been researching already, and will do another post on that.

As for physio, Ed is very patient with the fact that I don't do my exercises as much or as often as I should! He actually is a really great physio and listens to my silly worries and then works with me to see what we can do about them, which is fantastic.

I really need to video and photograph all of them, but I already told you about the one with the elastic band in this post, and now I also have a resistance band that I have to use to work the muscles that lie along the sole of my foot and around my ankle.

I hook it around a leg of the kitchen table, then put my foot in it with the band around the big toe side, and kind of scoop my foot. The instructions say "as if to look at the sole of your foot". I'm supposed to do this 10-20 times, two times, and twice a day, building up to three to four sets of 20, once a day.

It is extremely hard work. More so than you'd imagine. And so I'm a bit lax about it which is bad, but I do try and keep up with all my exercises as much as possible. There just seem so many now!

I do have a video of me doing it, which I made a few weeks ago, and I'll upload it to YouTube and get it posted soon.

Last time I went to see Ed, we talked about how scary it is for me to do things like sit back on my heels with my toes tucked under. Like this:




So we talked about some things I can do to improve my ability to do that without the frankly frightening levels of pain it currently causes.

He also measured my progress in terms of being able to go on tiptoe. Previously, I was achieving 35 degrees, but now I have improved to 45 degrees. I'm really pleased with that, and hope to improve it further.

Last time I posted about physio, I said that 35 degrees was two third of what Ed can do, which means he can manage about 53 degrees, by my rudimentary maths. So that's something to aim for, and maybe I could even improve on it?! (competitive, me?)

Finally, in this quick round-up of the past six weeks, I'll end with the letter I received from Mr Sikranth Kodali, the doctor I saw at my discharge appointment at the Royal Berks.

He was writing to my GP, and summed up my progress as: "She is having mild discomfort in her big toes otherwise she is doing fine. I can see her excellent range of motion in the first MTP joint and the osteotomy site is solid. All the X-rays done before are satisfactory. She is not 100 per cent happy as the correction of the big toe is not 100 per cent straight. I explained to her that there is always five to seven degrees of distal interphalangeeal joint angle, but otherwise the overall alignment is absolutely fine.

"She can slowly build up her activities over the next six weeks and I am pleased to discharge her."

That last bit was something of a surprise. I didn't remember him saying that to me, and so I'd pretty much gone back to normal, but from the aching and pain that followed it's obvious I should have eased myself back in a bit more. Although how I'd have done that I don't know - after a while people expect you to be back to normal and the help and support dries up, understandably.

Anyway, as of tomorrow I'm past that magical six weeks and so I'm hoping to see improvements in my stamina. Currently, my feet and knees ache almost constantly again, but more of that in my next post, which will be about all the things I am able to do now. It's a long list, hurrah!

12 weeks! Moans and milestones.

Wow! Today is a special day. It is the 12-week "anniversary" of my operation. Is it me or has that three months gone slooooooowwwwwwwly?

I'll start with some positives.

I'm still able to drive and finding it gets easier, although sometimes if I have to use the clutch too much it makes my foot hurt. But it is so nice to have the freedom that driving brings.

Other than that, there's been nothing major. I'm still doing my exercises, which I still need to photograph/video for you, and still hobbling around.

That's my moan - that my left foot is still very painful following being yanked by Emma of orthotics, and I've decided to put in an official complaint about her as I feel she's set my recovery right back.

I limp on that foot and it is still extremely painful along the top of the foot, in a line down the centre of the toe and along the foot itself.

I've noticed that whereas a few weeks ago I was thinking about how to move or do things, I am now doing things without thinking.

While that is definitely progress, it does mean that sometimes I do something my feet don't like - and they really let me know!

I'm continuing to massage my scars every day, and they still look much as they did a few weeks ago.

In fact, I can see now why so many bunions blogs start to peter out around this stage of recovery.

There just isn't much to say!

That, and life begins to get busy again as you get back to normal and there's less time for blogging.

But I really do want this to continue to be a resource for people, so I'm determined to carry on blogging and updating you.

Tomorrow I go back to the hospital and I'm hoping to see Mr Nugent. If I don't get to see him I plan to ask for another appointment so that I can.

As I have very little to say, I thought I'd leave you with some pictures of my feet in socks, with the spacers in and without, so you can see the difference the spacers make, and the shape of my feet with no orthotics or spacers.

They're not quite as straight as I hoped, but I still think they're pretty good!

Here they are with the spacers (taken in daylight):




And without (using flash):




Remember, if there's anything you want to ask me, or ask me to write about, you can message me via the comments section below each blog post. I love to hear from my readers so feel free to write me a comment. I try and reply to all comments, although it may take me a few days.

Two hospitals, one day, and three orthotics.

Thursday was a busy day, and not just because it was Valentine's Day and I was sorting through my large pile of cards from admirers for the best part of the morning.

Lol.

Actually, I did end up with three cards - one from the hubby and two from the Little Lady, bless her - but I was busy because I had two hospital visits.

The first was at the Royal Berks to the orthotics department. You may remember I'd asked to be referred when I had my casts off, and the appointment came through very fast.

It turns out that it came through too fast, and I have to go back in a month, but I did have a full appointment anyway.

I saw someone called Emma. I'm not sure what her title was because I didn't catch it (does anyone ever? They just rush their name and title at you as soon as you walk in and I'm lucky if I remember their name) and she isn't listed on the department's web page so I can't look her up.

What can I say about her? She was young, probably mid to late 20s, she was Scottish...oh yes, she nearly crippled me.

Obviously she needed to examine my feet, but she took hold of my left big toe, grabbed it and then YANKED it up towards the ceiling!

I nearly hit her!

It was so painful, but she didn't feel the need to apologise. She just carried on.

I did ask her to be more gentle, and we managed the rest of the examination without incident, although afterwards she said "I thought you were going to assault me". If I had, I'd only have been returning the favour!

I wasn't very impressed with Scottish Emma, which is a shame as we share both a name and a heritage, but she told me all about how bunions are not caused by anything at all, and are not only purely genetic (that bit's true) but "just happen". Hmmm. Not what almost every other medical professional will say, but she certainly seemed to believe it.

Another medic to add to my "do not believe" list I guess.

I came away with some insoles for my shoes, with added-on bits supposedly making them a bit more tailored to my feet.

When I go back they will see whether I need custom-made ones, which was what they were going to make for me this time but can't. The ones I was given cost £50 while the custom ones cost £150, so I imagine they'll try to avoid making some for me if possible.

This is what they look like.




The coloured bits are the added-on sections.

And this is the box, in case you're interested. Emma told me that it is cheaper to buy them direct from Talar so if you want to get some then this is the box to look for. I had a look on their website and am not sure which ones are mine exactly, but they definitely are cheaper direct.







Emma told me to wear them for short periods and build up to a full day because the foot has to get used to a new position. I figured that I am a) not walking much and b) getting used to new foot function anyway, so I'd just wear them whenever I wear my trainers.

That appointment done with, and a new one booked for next month (at which I hope I get someone else), I went to my local hospital in the afternoon for a physio assessment.

Townlands Hospital is a cute community hospital which has been saved from closure numerous times, although much of it has been shut down, including the maternity unit. These days if you want your child to be born in the town then you have to have a home birth (which is exactly what I did, although not for that reason).

We still have one building left, which houses the minor injuries unit (like a mini A&E, very useful) and the physio department, plus X-ray facilities, and other things such as clinics. My first appointment with Mr Nugent was at Townlands; it's an excellent facility to have.

Enough eulogising!

My appointment was with Ed. Unlike the RBH physio bit I went to while on Hunter ward, which was like a storecupboard, Townlands has a large room filled with equipment, although there was only Ed and me there.

We chatted about my history and operation, and Ed had a look and tested my mobility.

Sadly, because nobody measured my mobility before my op, we don't really know how much I have lost. Ed says there's no 'normal' so it's impossible to say, which is a shame really.

But what I do have is the ability to bend my toe 35 degrees, which is about two-thirds of what Ed can achieve, so I'm not doing too badly. I am pretty hypermobile, so I probably had much more than that, but average will suit me fine.

Apparently my toes are weak and stiff, but that's only to be expected really. Thankfully, Ed approves of all my exercises (see here and here) and just added in one more, which uses an elastic band (very high-tech!) as a resistance band for my big toes.

Basically I have to use the band to pull my toe in one direction, like towards me, then use my toe to push against that the other way, then swap and do it in the other direction. This will build up my strength in my toes.

Ed also had a look at my orthotics, and devised me a different one, for my most painful foot. It's a short-term fix for my pain when walking. The idea is that my other toes are lifted up so that when I propel off from my toes the big toe doesn't have so far to travel.

In the short-term this will help me learn a new gait or way of walking that is correct, as at the moment I'm tending to either walk stiffly, or to propel off the side of my foot.

This orthotic looks like this:




It's basically made from thin foam board (probably not the proper name for it) like the stuff you can get for crafts, and some cut up pieces of that padded sticky stuff (also not the proper name) that you can get from Boots, like this.

All very Blue Peter, but it does work.

One thing you might notice is that it has been cut to my actual foot shape. Yes, that is my actual foot shape! Amazing. I'm so pleased.

I see Ed again in a couple of weeks. Our goals are to maximise mobility and minimise pain, so we shall see if we can manage it.

Ed did say he might read the blog, so if you are reading Ed, then hello!

A letter from my surgeon

You may remember the rather unsatisfactory dicsussion I had with a doctor the last time I went to hospital, to have my casts removed.

If you don't, then you can read about it here, but basically he told me I could wear any shoes I wanted from that point on, I could drive within a few days, and didn't need to do any exercises or have physiotherapy.

I was deeply unhappy with that advice because I felt that it was, not to put too fine a point on it, wrong.

So I called my surgeon's secretary, who was lovely and agreed to print out an email from me and give it to Mr Nugent.

So I did that on the Wednesday after my Tuesday appointment. On Friday afternoon I realised I'd had a bounceback to my spam folder (doh!) so I resent it. And then I waited.

It took a long time, due mainly I think to the actual time it took for the letter to be posted, but last week I received a letter with some responses to my questions.

I had asked:

Should I be wearing trainers?

Can I walk barefoot in the house? Or should I wear the velcro shoes?

Should I be doing some exercises? The doctor yesterday said no but I have heard of just gently moving the toe up and down, and raising the foot on the toes, to increase the range of motion, and if appropriate I would like to do that - is it OK?

The doctor also said I could drive next week but I don't feel I'll be ready. When is normal to go back to driving?

My middle left toe is very red, swollen and feels bruised, and kept me awake with agonising pain last night despite me taking two codeine tablets. I think the cast has been pressing on it and has bruised it. Is this likely and should I be doing anything?

The doctor told me I could rub Bio Oil on my incisions to help the scars, so I am doing that. Is there anything else I should be doing for scar management?

How much walking should I try to do? I feel very unstable and sore, and not sure how much would be too much?

Also, the skin on my foot where the cast was is very tender, feels gritty and is a speckled red, is that OK? I rubbed all the dead skin off by hand in the bath last night so maybe I was bit enthusiastic?

Can I take the spacers out when I have a bath or do they need to be in 24/7?

My right spacer is very uncomfortable under the adjacent toe when I walk - can I cut it to make it less lumpy or is it possible to get a new one made?

So many questions! But in my opinion they should all have been answered at the appointment, without me having to ask. I'd say they are fairly basic.

Mr Nugent was comprehensive in his reply, which I've photographed removing my identifying information. I hope you can read it. I think that if you click on each picture it will open up an enlarged version for you.

He has said everything I expected to hear, really.

Yes, I need to wear trainers.

Yes, I need physiotherapy.

No, I can't drive immediately.

Yes, I can trim the spacers. Although I didn't expect to be told I could stop wearing them at nine weeks. I'm choosing to continue to wear them.

Yes I need to exercise although walking should be sufficient. I'm choosing to do some specific exercises as detailed in these posts, though, because I think they are useful.

So that's good to know. But I think that such basic information should be in a printed sheet and handed out at follow-up appointments so people don't have to ask, be misinformed, and chase.

Imagine if I'd followed the other doctor's advice? I could easily have ruined my feet. That's not good for anyone; me, or the NHS. I really do think it's time the follow-up care matched the quality of the surgery.

The big reveal part 2. Doctor's verdict.

OK, I teased you a bit in that last post, but what's a little anticipation between friends?

Back at the orthopaedics department, we were called straight in and then waited for quite a while in a side room.

There were big signs everywhere saying "do not take pictures in here" I think mainly to stop you photographing your own X-rays, but laughably claiming it was to "protect your information". Right, not to encourage me to pay a fee to access my own information from you later, then. Of course not. Ahem.

So I took off the velcro shoes, and waited on the bed.

This was my view.

You can see how much of the steri strips I let the plaster lady pull off before I wimped out. My skin is still yellow from the stuff they paint on before surgery, and if you look closely you can see how dry and flaky my skin is.

At this point, I thought the worst dryness was on the top of my foot, near my ankle, and on the balls of my feet, where I could see it cracking.

After quite a while waiting a doctor came in to see me, but it wasn't Mr Nugent.

I have to say I wasn't happy about that. I had wanted to see my surgeon, and my dissatisfaction was exacerbated when this doctor - I didn't catch his name - said "Right, we'll get new casts on you then".

What?!

"Er," I said. "I've had them on for seven weeks, I thought they came off today."

"Oh yes," he said. "That's right, I thought you were at two weeks."

Really NOT confidence inspiring!

I was not happy. I asked him my questions about driving, exercises, shoes, and he told me "You can wear any shoes. You can drive on Monday. You don't need to do toe exercises. But don't exercise till you come back at 12 weeks."

Right.

So Mr Nugent told me to bring trainers, which I bought especially with money I don't really have, and now I'm told I can wear anything? And I don't need to do any exercises to improve my range of motion? And I can drive in six days' time?

I call BS on that, frankly.

I was, and am, really unhappy with that appointment. I feel that the doctor was not fully informed and I really wish I could have seen Mr Nugent.

Before I left, he got me to walk a little but I was SO SCARED that I couldn't really do it, and just put my weight on my heels. I was terrified of being in pain.

So I hobbled over to the computer and he showed me my X-rays. To be honest, I wouldn't know how good it was. I could see where the bone had been cut and moved, but without the old ones next to them, it was hard to tell anything really.

I want to know if Mr Nugent is happy with them, as he is my surgeon, but more of that later.

So, unsure about the shoes thing I put the velcro shoes on to go home and once we'd got the Little Lady to bed I ran myself a lovely warm bath so I could start de-flaking my feet.

If you want to see lots of pictures of that (my feet, not me nekkid in the bath) then look out for part 3 which is coming soon.

The big reveal part 1. Plaster room and X-ray.

Sorry everyone. There you are, waiting on tenterhooks to hear about the casts coming off, to see the final result, and I go AWOL.

Apologies.

The excuses are that my appointment on Tuesday was right at the end of the day, and by the time we got home and put the Little Lady to bed and had something to eat it was bedtime. Plus, I haven't worked out how to take good shots in artifical light and the flash on my camera bleaches everything out close-up, so I needed to wait.

And yesterday was my birthday, and I decided that instead of blogging and taking pictures that I would see friends, go out to lunch, and generally have a nice day.

So, sorry, but this is the first chance I've had to write.

Regular readers will know that I had my casts changed after two weeks, then had the new ones on for another five weeks, so a total of seven weeks.

We went to the hospital and this time I had to have the casts removed before having the X-rays.

I was sent to the plaster room (last time my surgeon removed the casts) and they did the same thing - cut the bandages round my ankles and then wiggled the casts off.

The lady did start to pull my steri strips off but it made me so squeamish I almost cried so I begged her to stop and told her I'd soak them off at home.

Another nurse dealing with the lady next to me (no privacy here, this is the NHS) told me she had had one bunion done, and I got the usual "you were brave" comment about having them both done at once.

I have to say, I don't feel brave. I mean, I know the recovery has been more onerous as I've not been able to walk at all, but at least I don't have to go through this again!

After the casts were off I felt very vulnerable, so I put my velcro shoes back on and wow! They wrapped so far round my feet I had to fold one of the flaps under! Amazing just how big those casts were.

See how thin my feet look there!

In X-ray, I had the same girl again who had one of her bunions done. She was impressed with my feet, which was reassuring, and we talked about shoes. She said she rarely wears heels now and makes sure her shoes are soft and supportive. I guess I really am going to have to rethink my shoes for a while!

Once she'd taken two shots of each foot, I went back to wait to be seen by Mr Nugent.

Head on over to part 2 for the next installment.

The big reveal! Sort of. With pictures.

So. You're all here for The Grand Unveiling, yes? The big reveal. The moment of "ta-daa".

Well, I'm sorry to disappoint, but the hospital visit wasn't quite what I expected.

Yes, the casts were removed, and yes, there are pictures of my feet, but they were quickly wrapped up again and put in new casts which I have to keep on for another four weeks. I know! I thought it was a long time too!

So, we get another Big Reveal in a months' time. Or actually, in five weeks' time because for some reason my next appointment is January 22, just the day before my birthday (hint, hint).

But you want to know all about today, no?

My lovely hubby drove me and the Little Lady to the drop-off point, then parked the car while I laboriously crutched my way through the hospital to the reception to meet him, and to catch the 'buggy bus' to the clinic.

It took me ages to get there - it's the longest I've 'walked' since the operation and I was pretty exhausted. I was glad to get on the buggy bus to go to the clinic.

I checked in, and was sent off to be irradiated.

As I went into the X-ray room, the technician, who looked younger than me, said "Oh you've had both done! I didn't think you could have both at the same time."

It turned out that she had had one bunion done in February this year, although not by Mr Nugent, and she needed the other one doing but "can't afford another six weeks off work".

That's one reason I had mine done together - the recovery is slightly more awkward because you don't have even one good foot, but once it's done, it's done.

The technician had metal screws in her foot, whereas my pins will dissolve, so we had slightly different procedures, but she showed me her foot and how straight her big toe is now, and I started to get a little bit excited about seeing mine.

She did two X-rays of each foot, sent them through to Mr Nugent, and I went back to the clinic where he was waiting to enact the reveal.

First, Mr Nugent cut off the bandages, and then he simply wiggled and slid the casts off my feet. I did brace myself for some pain but it was actually just really tickly! I'm not good with having my feet touched so it was hilarious.

I was pretty amazed by how my feet looked. They are so thin! Now the lump of the bunion has gone my whole foot shape has changed. Yes, I know that's the point but I just could not envisage it until I saw it. It's incredible.

There wasn't much time to take pictures, because as soon as they were uncovered, Mr Nugent was making some toe separators out of quick-hardening putty (which the Little Lady was pleased to note was pink) and then wrapping my feet up again in some fluffy padding, before putting a new cast on.

He then taped bandages over the cast, just like before, and there we were. Done.

"The X-rays look good," he said, almost as an aside. And that was it.

Actually, there was a teensy bit of gossip but I'll share that on another post. This one is all about me!

So here we go with the pictures. The initial rating on the Grimometer is zero.

In this first one, Mr Nugent has removed the cast from my right foot and is making the putty toe separator by moulding it between my toes and letting it harden. You can see that he has cut the bandage on my left foot, and it is hanging loose round my ankle.

In this next one, he has removed the cast from the left foot, and the toe separator on the right is hardening. This gives you a real idea of the new shape of my feet. They are amazeballs!

My left toes look like I'm holding them funny, but that's just how they were. I was too scared to wiggle them! I guess once I'm back in shoes and walking around they'll start to settle down.

So here are both feet with new toe separators. You can see the fading arrows on my feet from the surgery, and the slight tan I appear to have is the yellow antiseptic stuff they paint onto you prior to operating.


If you've been waiting for the grimometer warning, here it is. The next few pictures show my steri-strip stitches. I don't personally think it looks that grim, but I'll give it a 5/10 rating. If you want to avoid them, I suggest scrolling to the very bottom then slowly working back up till you see a picture of my feet wrapped in fluffy stuff. Stop there and read from that point.

Here's a small break so you don't unexpectedly see the pictures of the stitches. Off you go squeamish ones!

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...


OK, those with strong stomaches still with me? Here we go!

So these are the steri-strip stitches on my right foot. The incision is getting on for three inches long. In this one, the new shape of my foot looks like it might be Roman (see this post) which is interesting. I guess the Greek shape had only appeared because of my bunions making the big toes look shorter, because of the angle they leant at. And it means the Little Lady does have my feet, so I'll have to make sure I look after them.

Another angle of the same foot. That's Mr Nugent lurking in the background.

The left foot's stitches. There's a bit more blood here, which might be why this one has been slightly more painful.


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The next photos are back to zero on the Grimometer scale. Squeamish people can rejoin the post here.

All wrapped up in fluffy padding and waiting for a new cast.

And here they are back at home in the new casts. They don't look much different, but actually the circumference of each cast is just over an inch less than the old ones, which shows how much swelling there was immediately after surgery.

I don't think my feet are swollen at all now. They certainly didn't look it today.

I think they looked amazing, and I am so excited to get them properly unwrapped in five weeks' time!

Tomorrow I meet my new feet!

Tomorrow afternoon I go back to hospital and will have the plaster casts removed from my feet. For the first time since my operation, I'll get to see my feet, and the incisions and stitching on them, which will give me an idea of what level of scarring I will have once it's all healed.

I'm actually quite nervous.

I've obviously had a lot of time to stare at the tips of eight of my toes peeking out of my casts, and the thing that has struck me is that the big toes don't look as straight as I expected them to.

Now, I can only see the very very tips of them, just the toenail in fact, but when I point my foot up at the ceiling my big toes don't point exactly up, they point just slightly towards the outsides of my feet.

See?

This was worrying me so much that the other day I started Googling images and I did find some pictures of feet have big toes where the end joint is not totally straight even though the rest of the toe is.

I'm really hoping these are the kind of feet that I have.

It seems odd not to know, but when I think back I cannot remember a time when I did not have bunions. When I was younger I didn't know they were called that, and I don't think I realised that my feet were technically deformed, but I honestly can't picture my feet ever having had straight toes.

So tomorrow will be exciting!

In a way, it's like giving birth. Something has been happening without me being able to see it, and tomorrow afternoon I'll finally get to see the result.

I just can't wait to meet my feet!

Tales from hospital part the fourth: day 3. Homebound.

My extra night in hospital was marginally better than the first one. The nurses were quiet but I still found it very hard to sleep. I had even kept myself awake all day after my fainting episode so that I'd be exhausted enough to get off, but there was something about being in hospital that made it impossible.

I forgot to mention I'd had loads of visitors the night before: two colleagues from the Breastfeeding Network popped in around their wards shifts, my mate George and of course Andy, my husband.

We were woken in the morning and the nurse said: "Do you want to have your breakfast sitting in the chair?"

"Do I take it that means you think I ought to?" I asked (Bet those nurses just loved me!)

"Yes," she said, so I agreed I'd eat breakfast sitting in the chair, but first I needed the loo.

I got her to wheel me there,and when I came back my bed had been stripped! Seriously. I know I'd said I'd eat in the chair but I'd been planning to get back into bed for a nap afterwards.

"We need the bed," I was told. "We've got people backing up in recovery. You need to go home."

Charming. Way to go with the bedside manner.

So I had my toast, then sat around waiting to have some X-rays, get my drugs, that kind of thing. I also had a little practice at stairs under the guidance of the physios, and tried out using crutches.

We also got to have a wash! I assume we should have had that opportunity the day before, but it didn't happen, but we were brought cardboard bowls of hot water with disposable cloths, plus a washbag with soap, toothpaste, etc.

So I had a nice strip wash and felt so much better afterwards.

Here's my bowl:

In the end, a nice nurse let me stay on the ward till Andy picked me up at 2pm.

This post is quite dull, really, as all I did then was come home and get myself into bed.

So here are some pictures of my bandages to liven it up:

You can see that the bandages are like cocoons, rounded underneath. This is to stop me from putting any weight on the front part of my foot. I also have to wear some super-sexy velcro shoes whenever I get upright.

Tales from hospital part the third: day 2

So, I knew it was all going too well, despite the utter lack of sleep.

The day after surgery the physio came round to see me. Up to this point I'd been on bed rest, not allowed to get up at all, even to go to the toilet. I'll gloss over the details but suffice to say I'm glad I have good core body and upper arm strength. How elderly people manage to use bedpans without spillage is beyond me.

Anyway, I'd been lying down for hours, my feet raised above my hips, maybe sitting up a bit assisted by the rather whizzy electric bed.

And then the physio gets me up, out and walking around.

Does anyone sense disaster?

Using a walker frame, I edged gingerly and painfully around the corner of my bed, and then thought: "While I'm up, I might as well use the toilet instead of the bedpan."

In a demonstration of complete lack of judgment by both the physio and me (although she's the professional so I'd have thought she might have said no) I got her to wheel me on a chair to the toilet.

And there she left me.

I managed the business part fine. Washed my hands, then realised the world was going a bit grey, my stomach was feeling rather nauseous, my limbs were going heavy...

I pulled the help cord and heard the alarm go off.

After a while (probably not that long but it felt it) I was unable to support myself any more and getting panicky. The nausea was so bad I felt I was going to throw up all over the floor, I couldn't keep my eyes open, my head was swimming, my body was just. so. heavy.

Somehow, I managed to open the tricky bi-fold toilet door a bit.

"Please help me! Someone help me!" I called out. I felt like I was shouting but it might have been just a whisper. I recall the frightened face of a woman lying in bed in my sightline as I began to collapse.

Suddenly a nurse appeared with a wheelchair.

"Get in the chair!" she barked at me.

"I can't," I gasped. "I feel so ill. I need to lie down."

"You can't lie there! Get up! Get in the chair!"

"I can't..."

The next thing I knew I was slumped in a chair next to my bed, with another nurse slapping my face.

"Emma, Emma, focus, open your eyes. We need you to get on the bed."

Like a sullen teen, I replied: "I can't."

"But if you won't, then we will have to get the hoist."

"Get the hoist."

The world went black again.

Slap, slap.

"Emma! We're getting the hoist. Focus! You need oxygen."

An oxygen mask was put on my face, blasting air into my nose and mouth at hurricane speeds, suffocating me.

I pulled it off. "Don't like it!" (there's that sulky teenager again).

They turned it down and put it back then hoisted me onto the bed.

I passed out again.

...

Later, I gradually came round and lay for a while breathing the oxygen before I felt well enough to pull the mask off.

"Welcome back," my fellow patients chorused.

"You were grey! You were the colour of the sheets! We thought you were dying! It was so scary!"

Yeah, me too. In fact, I ended up crying while a lovely nurse gave me a hug.

It wasn't so much the faint; I've been there before. It was the fact that I was left in a toilet, with no-one answering the alarm call, and then being almost shouted at as though I were an inconvenience.

The physio came back later and apologised, which I appreciated. For while I shouldn't have suggested going to the loo, it was up to her to say that it was too much too soon. She's the professional after all.

Later, I indulged my time obsession by asking my neighbour how long I'd been out for. I was expecting her to say about 15 minutes. She looked at the clock, calculating. "Oh, about an hour and a quarter," she said. Crikey. no wonder everyone was so worried.

The rest of the day was uneventful. I was supposed to go home but it was decided I had to stay in another night after that episode, and there was much checking of my obs because my blood pressure is naturally low and they were worried.

The only other excitement was learning to inject my heparin that evening. I'm such a wuss I actually cried while Queen of Hunter called over: "I do it every night! It's easy! Just do it! Stop working yourself up!"

And actually she was right. The needle didn't hurt going in at all. The heparin stings afterwards but by then it's all over. I can do this!

Tales from hospital part the second

"What time is it?"

For some reason, that is always the first thing I ask when I come round from surgery. I seem to be obsessed with how long I've been in theatre.

For this surgery, I'd gone in at 1.45pm and woke up at 3.20pm, which was pretty quick as I'd read it was around an hour each foot for bunions. Either Mr Nugent is a genius or a total butcher. I'm hoping it's the former.

Forewarned as they were about my fainting episodes, the staff on Recovery kept me lying down, checked my obs almost obsessively, and only moved me towards being upright very slowly over a long period.

For once, I felt fine. No fainting, no passing out or feeling sick, just chatting away and wondering why the room looked ever so slightly like a morgue.

Just before 5pm, they decided I was fully recovered, and I was wheeled away into Hunter Ward, where I ended up in Bay B, bed 4, next to the cruciate ligament lady and opposite a lovely girl who was in having her second hip replacement despite being under 40.

I dubbed her Queen of Hunter, because she knew all the staff, and how everything worked, and wasn't afraid to ask for what she wanted: "Get me some oral morph please!"

Luckily I was out of theatre and onto the ward in time for tea, so I did get my fishcakes, mash and beans after all. They tasted like school dinners, which I've always liked, and while Michel Roux Junior won't be asking the hospital cooks onto Masterchef anytime it was perfectly OK and I'd even go so far as to say I liked it.

Here it is:

That first evening was uneventful. I got given drugs, injected (quite roughly) with my first dose of heparin and then spent the night wide awake listening to people snoring and the doctors and nurses apparently having a small rave in the corridor. I can't get no sleep..do,do,do,do,da,do,do...

Tales from hospital part the first

So here we are, it is done.

I did mean to blog before I went into hospital, but time ran away with me and I was still packing my hospital bag at bedtime the night before. If I had posted, it would have been full of fear, because all of a sudden I got really scared and nervous about having it done. Even on the morning of the surgery I briefly considered not going through with it, and had to give myself a stern talking-to.

So on Monday morning I was up at Unacceptable O'clock and ready to get in my taxi at 6.30am. It was still pitch dark and felt like the middle of the night. The driver did attempt some conversation but soon gathered from my incoherent grunts that I was attempting to pretend I was still asleep in bed, and that this taxi ride was just a bad dream, so he gave me up as a bad job and instead silently delivered me to the door of the Royal Berkshire Hospital.

I dragged myself through the hospital, pausing briefly to to breathe deeply the tantalising smell off coffee from the AMT kiosk, before hauling myself through the corridors to the far end of the hospital, past the plush bit and into the section that looks like it belongs in Calcutta.

After wandering about wondering exactly how much it would cost to put some signs up so people would actually know where to go, I found the Chesterman Suite, where people go to wait to be cut up.

I had been too keen. Almost no-one else was there, but it did mean I could bag myself a comfy seat on the burnt orange sofa near the television, and opposite the fish tank.

I filled in a form, and a menu for what I'd like to eat on the ward when I came round. I remembered the advice I'd been given by people who have experienced the gastro-offerings of the RBH, and chose the simplest thing on the menu, which turned out to be fishcakes, mash and baked beans, with orange jelly to follow. More of that later.

After a while, the room had filled up and I got chatting to a couple of other ladies. One was having her shoulder replaced, the other surgery on her cruciate ligament in her knee.

Then Mr Nugent started having chats with us. He drew two fetching arrows on my legs - "So I remember to operate on both" - and told me what he'd be doing. I was surprised to hear that I was going to have not metal pins but some made of something dissolvable, so that ultimately I won't have foreign bodies in me, which I hadn't thought much about but still felt pleased on hearing.

After Mr Nugent, a lovely anaesthetist came round. I didn't catch her name, but as Paul the Doctor had advised, I mentioned wanting a Des and Remi, and ankle blocks.

"I always do ankle blocks," she said. "And I can do you a Des, but I'm not sure about the Remi. I always use Des though, the hospital would like me to use something cheaper but I only use something that I'd want used on myself if I were having surgery."

Reassuring! I warmed to her and was glad that if anyone were in charge of me not dying or feeling any pain on the operating table, it was her. She had fab hair too, all pre-Raphaelite.

Then we waited.

The anaesthetist came back after a while, and let me know that she'd worked out her list and I would have surgery probably about 12.45.

"So have a cup of tea now," she said. "You must be gasping. And then only water till 10.45 after which nothing."

A cup of tea! Fantastic.

Sadly, I was too lazy to walk to the cafe and instead went to the League of Friends kiosk nearby which, while friendly and helpful, made possibly the worst cup of tea I've ever had. Still, it was wet.

I did get so bored waiting that in the end I lay down on the sofa and went to sleep. At which point, naturally, they called me in.

I had to walk to the operating theatre, and then the lovely anaesthetist chatted to me while she put me out. Next stop, Recovery.

Another call from the hospital

The other day I got an unexpected call from the hospital.

A young-sounding girl called Cassandra told me it was a courtesy call to make sure I was OK about my forthcoming operation.

Which sounded positive.

Until she started asking me for my name and address, and whether I'd been to a post-op assessment, and when was my operation, and what time, and when was I nil by mouth from.

Don't they already know this stuff? Why phone me up to ask me?

She then asked me if I had any questions. Why yes, I do. I asked about anticoagulants, and where I am on the list, but sadly Cassandra was unable to help me.

"She probably just expected you to ask if you could take your slippers," said my Mum. "And to check you're going to turn up."

Ah, well, if that's the case, why not just ask that? I get that missed appointments cost the NHS hundreds of thousands of pounds each year, but calling me up and asking me basic questions they know the answers to is a waste of everyone's time and an insult.

I'm sorry to sound so down on a system that was once the envy of the world, but I do think the NHS needs to sort out its processes and stop wasting money with this kind of nonsense.

I really do hope they are more efficient at the actual surgery and care end of this!

A chat with the anaesthetist

I had a call this week from the anaesthetist at the hospital. I'm not sure if it is the one I'll have next Monday, or just one of the team, but she called because of what I'd told them at the pre-op assessment, about how I always end up passed out on oxygen after a general. (OK, 'always' sounds a bit OTT, I know. It's true but it has only been twice.)

At first, she was threatening not to anaesthetise me at all! Eek! So I explained what usually happens - I come round OK, then I suddenly go tingly, see flashing lights, I feel incredibly heavy, then I come round with an oxygen mask on my face. It's pretty dramatic and the nurses always look worried.

The anaesthetist was unimpressed.

"Oh," she said. "That's just a faint."

Just a faint? I dine out on this story!

She explained that as I have low blood pressure, and a GA lowers it even more, I'm fine when horizontal but put me upright and pow! Blood 'rushes out of my head' (her phrase) and into my feet, and I pass out.

Suddenly it's not such a great story, but the plus side is that I can still have my surgery, and all I have to do is make sure I'm kept horizontal for longer when I'm on the recovery ward.

So Thunderbirds are still go.

I did decide not to talk to her about wanting, as my anaesthetist friend told me, a Des and Remi. I'm saving that for the day itself. I want to see their faces when I ask.

Pre-op down, two weeks to go!

This is the first chance I've had to update since I had my pre-op assessment on Friday. Sadly, since it was the NHS, I didn't get to ask my questions as it was clear that the person I was seeing had absolutely no knowledge of my procedure at all.

The assessment block at the Royal Berkshire Hospital (RBH) is actually a Portacabin in one of its car parks. So far so very NHS. To be fair, once the staff had stopped arranging their Christmas night out and actually paid me some attention, I did only have to wait 20 minutes to be seen, which is surely some kind of NHS record.

And the people I saw were very nice. And obtained the information from me that THEY need. It's just that I didn't get the information that I need. Which was more than disappointing.

I did manage to get a leaflet out of them once I'd a) asked for one and b) insisted that they really ought to find one as telling me 'we don't have one, sorry' wasn't cutting it.

But I have learned far more on the internet than I did from the hospital and that's a poor state of affairs.

I was hoping to get a lot more detail about my expected recovery and to discuss the anticoagulants I will need post-op because of my Factor V Leiden inherited clotting disorder.

But the nurse simply assured me that I will be walking within days (er, really? Not according to the many blogs I've read from people who have actually had this done. Not to mention that for nearly two weeks I'm supposed to keep both feet elevated above my pelvis level for 90 per cent of the time. If you know a way of walking around like that, let me know.) And assured me that, I quote, "If you need drugs then they will give them to you."

Yes, I would hope that would be the case, but actually, I KNOW I will need them, my consultant at St Mary's tells me so, my common sense tells me so, and so, ya know, I'd really like to discuss them with someone BEFORE the day of surgery. Not least because as a breastfeeding mama I need to make sure anything I take is not going to adversely affect the Little Lady. Although a quick look at the excellent resource that is the Breastfeeding Network tells me it should be OK. See here.

Sigh. It's obvious the nurse had NO knowledge of a bilateral scarf osteotomy which is really annoying although not surprising, sadly.

So now I'll have to try and contact my surgeon and get a chat with him before the operation, which I can't imagine is going to be easy.

But I don't want to leave these conversations until the day itself, especially if I need heparin afterwards and will have to inject myself as I will need to learn how to do that when I am not groggy from anaesthetic and in pain from major surgery!

I do sometimes wonder when the NHS is going to finally implode from its arrogance and incompetence combined, but I guess there are just enough decent staff to keep its head above water at the moment. Let's hope I encounter lots of them over the next few weeks.