Observations from a Bunion Surgery Veteran
By Kristine Chapin
Bunionectomy. A mention of the word can curl the toes of young women who still slip into fashionable shoes without a single thought of throbbing pain. Yes, even they have heard about it. It's out there, like crow's feet and liver spots. Someone's mother or sister or girlfriend had bunions removed and said it was pure hell.
Most of them are reacting to third-hand information. It's actually more a straightening process than a removal. And that bump is not a growth; it's the displaced end of a bone gone rogue. Not that the process isn't cringe-worthy; it's a daunting prospect, which is why you need more than a referral form and a few ice packs to get through it.
First, you'll need to prepare for bewildering comments. When people learn you're having bunion surgery, they say things like, "Well, I guess you regret wearing those fancy high heels now, huh?" This phrase is almost always delivered with an air of superiority by a woman in practical shoes, or by a man who's unable to get a date with the gal in the three-inch, fuchsia pumps. And my own answer is, "No, I don't. Not a bit."
This is a fact: My bunions were gifts from my mother's side of the family. While I was a teenager sneaking into mom's closet to try on her camel-and-ivory wingtip heels, I was also watching my grandmother wrap her feet and slice her shoes to accommodate bunions that were, back then, inoperable. I didn't know the little devils were genetic. But they have to be. That woman never wore anything more attractive than orange crates on her feet, and she walked in pain for decades.
You need honest information, too. What does "painful" really mean? There are several kinds of pain. One of them is the reason drugs like Percocet were invented, and they work beautifully. The second kind — "pain in the neck" is the socially acceptable description — is what actually makes bunion surgery such an ordeal. If you know that in advance, you can make a few adjustments to make it less awful. Not pleasant, mind you – but ultimately worthwhile.
Do choose a good surgeon – do some homework on that – but don't expect the medical pros to be much help in preparing for this procedure. I don't mean to imply that doctors are disinterested; mine's a smart, skilled guy who cares about his patients. But they don't have time, by-and-large, to delve into your personal pain-tolerance history, ask if you happen to live in a third-floor walk-up, or find out whether you share your home with someone strong enough to drag your slippery, half-conscious body back to bed when you want to take a shower and the Percocet decides otherwise. That's why I was pleased when Julie asked me to blog my experience. It makes sense to share what you learn.
This is my second go-round with bunion surgery. My bunions started glowing pink when I was in my 40s, and I delayed surgery as long as I could — that is to say, until I could no longer find attractive shoes that fit comfortably. Surgery might be foregone entirely by someone willing to wear "accommodating" shoes forever. But I love beautiful shoes, and I want to dance in them. The selection of attractive flats has improved in recent years, as boomers increase their influence on shoe designs and women accept flats as business and dress attire...but in order to wear the pretty ones, I have to get rid of these bumps. Besides — my feet hurt.
Everybody seems to know about that woman who had both feet done at the same time because she was told the pain is so god-awful she couldn't imagine going through the surgery twice. I heard about her, too, and considered the both-feet option for about two minutes. In the end, I'm not a bedpan kind of girl. Nor could I imagine crawling around the house, heaving my abundant posterior in and out of a wheelchair, or being 100 percent dependent on a caretaker. So I did one foot at a time, starting with the least-badly affected foot. Aware that my right foot would eventually get so bad I'd endure anything to fix it, I went with the left one first. Dad used to say, "When you paint a house, always start in the back." (It's good advice that applies to more than bunions and houses.)
Preparation. Preparation. Preparation!
The first time I did this, three years ago, I had the "ignorance is bliss" disadvantage. I've had surgery before, I thought. I already know that general anesthesia makes me crabby. I had a sprained ankle and used crutches successfully. I even had a kidney stone — talk about pain! A little foot surgery can't be worse than that. I'm ready for this.
When the surgeon explained (roughly) what he was going to do, I had an understandable moment of apprehension. I had read Frankenstein. But others lived through this. I'd be fine.
And I was...eventually. However, beyond "Arrange a ride home from the surgery center" and "Rent a roll-about device," nobody told me there were things I could do to make the process significantly less miserable. I had to figure that out on my own. I'll share the big lessons up front, and hope you'll find others in this description of my experience.
- If you're carrying a lot of extra weight, lose some of it before your surgery. I weigh 30 pounds less this time than I did last time – and if you're so far overweight you think that's insignificant, go find something that weighs 30 pounds and carry it up the steps. The difference is amazing. Losing the weight wasn't easy – it never is — but I had already dragged those 30 pounds around on crutches, and I refused to do it again. I set my surgery date as a deadline. My goal was 35 pounds and I didn't quite make it, but I lost 32 pounds in 17 weeks — and having a deadline kept me honest. The method that worked for me was counting calories; 1200 a day and five 40-minute workouts a week took it off at about two pounds a week. I walked and swam because they both burn calories fast without causing (much) pain.
- Choose at least one exercise that increases shoulder, arm and core strength. Build up some real muscle. Swimming did it for me. I've never been strong in my life, but I now have arm, shoulder and gut muscles I can see (through the fat!) and that's what you need. You'll hear the doctor say, "Don't touch that foot to the ground for three weeks," but the first time, it doesn't translate into "How do I get on and off the john while holding one foot off the ground?" This time, I'm ready – and what was an undignified embarrassment three years ago is now an inconvenience.
- Arrange for someone to be with you 24/7 for three days after surgery, and mornings/evenings for the first two weeks, at least. If possible, make it someone strong enough to help you off the floor...and someone willing to deal with anything you might emit from either end of your body. If your lover is a nurse and a weightlifter, you've got it made. Otherwise, do the best you can. Do not assume, because you feel pretty good after a couple of days, that you won't need more help. I'm annoyingly independent and want to do everything myself. I learned the hard way, in round one, how easy it is to slam your casted foot into the floor while trying to do something you shouldn't be trying to do. It's not worth the pain. Find help and make good use of it.
- Getting around with one useless foot is miserable; take advantage of every break. In Minnesota, go here (link to https://dps.mn.gov/divisions/dvs/forms-documents/Documents/MV_DisabilityParkingCertificate.pdf) for a form and instructions on how to get a temporary disability parking certificate. In other states, talk to the DMV. Get it handled before surgery if you can. You won't feel much like doing paperwork afterward.
- You'll gain lifelong respect for people who live with permanent disabilities. When you're on crutches, be careful. Anticipate drivers who won't slow down in sub-zero temps to let you cross the street at a crosswalk; deceptively civilized-looking people who open doors ahead of you and then drop them in your face; and strangers who share grisly details about a foot-wrecking experience endured by some person whom you will (with luck) never meet.
The Week before Surgery
- Go dancing. My husband and I love to dance. Based on experience, we won't be cutting a rug for at least six months post-surgery, so my birthday celebration (five days pre-surgery) was a dance-a-thon.
- Schedule a haircut. I wear my hair short anyway; now it's micro. I want to be able to wash and condition it in three minutes. You never know how long you can stand when you're taking serious painkillers.
- Get a pedicure – no polish – two days before surgery. To my amusement, a nurse called me the day before the procedure with instructions, one of which was to "wash the foot well with antibacterial soap the morning of surgery and don't put any cream on it." I haven't washed my feet without moisturizing for about 40 years, and I don't intend to start now. Additionally, I think it's not unreasonable to expect that for $8,500 or whatever they charge for this surgery, their crack team of medical professionals can figure out how to wash a foot. (Okay, that was uncalled for. I'm getting cranky...)
- Get an EKG. I had the required pre-op physical on Sept. 29, when I was 59 years old. Surgery was scheduled Oct. 7, after my Oct. 2 birthday. On Oct. 6, it was imperative that I have EKG results before I could get my bunion fixed. Sigh. I drove my one-week-older ticker back to the medical clinic. Thirty seconds of testing, perfect results...and an hour of my life I'll never get back. Oh well. At least I passed.
- Check my calendar; cancel appearances. The part-time job. The coffee klatch. Swimming. Writing. The wine tasting. The Art Crawl. Apologies and promises all around. See you in a few months...
- Do the laundry. Water the plants. Remove spendy duvet from the bed I'll live in for two weeks, and find one I can spill yogurt on without guilt. Clean those hard-to-reach corners of the bathroom floor. Do all this knowing that my husband would lovingly take care of it if I'd let him, but it keeps my mind off this feeling of going to the executioner. Everything I do is "the last time..."
- Arrange a way to keep the weight of the covers off my feet while I'm in bed. Anything that touches that foot causes pain. The first time, we used pillows — not a good solution. This time we'll order a metal thingy online. (Search "blanket support.")
- Get ready to be out of my office for three weeks. Is this possible? No one is indispensable. Still, what if I forget something? Make lists. Leave instructions. Tell myself I'm making too big a deal of this. Finally, wonder whether the thing I forgot will even be noticed. Take a deep breath. Turn off the Blackberry.
- At home, take delivery of the roll-about https://drivemedical.com/catalog/product_info.php?cPath=86_139&products_id=48#
- that will be my rented right foot for the next few weeks. This is the Cadillac of rolly things – hand brakes and front wheels that turn! Rolly-thing technology has come a long way in three years, I guess. The last one wasn't nearly this cool. (Nor this expensive — I think it's $175/month, but my insurance covers it. There are many models and sources. Shop around.)
"Nothing to eat or drink after midnight, and be here at 6:30 a.m. for 8 o'clock surgery," the nurse had told me. So there we were, 6:30 sharp. There was a short stack of forms, followed by a long wait with no coffee. Note to self: When I have my third foot done, I'm not showing up until 7.
In pre-op I had a delightful nurse named Joy. She wouldn't let me have coffee, but she did give me oxygen, which was pleasant and much faster-acting. She also remarked on the lovely condition of my feet. I told her I'd had a pedicure just for her, but I refused to wash. She said, "That's fine. We wash it for you twice. But seriously, some people haven't washed their feet for a year, and it's so gross." (Ha! I knew it.)
The surgeon came to see me. We talked about the procedure, confirmed that he'd be working on both the large bunion and the tailor's bunion (the one by your little toe has its very own name, which seems terribly cute if you're breathing straight oxygen) and that he'd scrape some of the arthritis out of my big toe joint while he was in there. I know we talked more, but I was rapidly relaxing, so I don't recall the entire convo. Joy put a needle in the back of my hand, taped it down, and took my blood pressure for the 100th time. The anesthesiologist dropped by to introduce himself and tell me that he would numb my right leg from the knee down (jolly good idea, considering) and keep me in an oblivious state throughout the procedure. Then he looked at Joy and nodded toward the needle in my hand...
The next thing I remember, someone was putting finishing touches on a white cast that covered my foot just up to the ankle and left my toes exposed. Then I was sitting up in bed, back in that pre-op space, being offered a cup of coffee — strong, hot, lovely coffee, with real cream — feeling no pain and only a slight woozy sensation in my head. They removed some kind of tourniquet device from my right calf; it had been tight enough to give me bruises I would feel two days later. (Mental note for third-leg experience: ask staff to chill out on the tourniquet thing.) My husband showed up, the surgeon checked in to say it had gone well, the anesthesiologist pronounced me awake, and a wheelchair appeared to take me to the front curb, where Jon had readied the car. We had been there less than five hours.
At home (which does happen to be a third-floor, walk-up condo) I faced a set of concrete steps up to the porch and two sets of carpeted stairs, about 18 steps each, to the third floor. With Jon at my side, left hand on the railing and a crutch under my right arm, I hopped up the concrete steps and got inside the building. Then I turned around, sat down on a step and went up the carpeted stairs by using my left foot to push and both arms to lift my butt to the next step. It wasn't fun, but I smiled anyway because it was so much easier than it had been the first time. My arms are a lot stronger now.
New Information from a Second Trip Down Bunion Lane
When I got night-gowned and snuggled in with my foot propped up high (when they say "above your heart," they're not kidding. For many days, that sucker will start to throb and burn if you drop it below your heart level for more than a couple of minutes) I was very comfortable. This was because my leg was still numb from the knee down. Had it not been, the pain would have made my snappy little trip up the stairs impossible. But I was feeling fine. Started taking the meds as directed...Percocet, 1 to 2 tablets every four hours ...and complaining about the numbness. Being unable to move my ankle was bothering me. Jon suggested that it would bother me a lot more when it wore off, so I should just enjoy the numbness while I could. Smart man.
Mid-evening, I was dozing when my foot began to "wake up." There was an itchy spot under the cast. In my Percocet haze, I reached down to see if I could stop the itch, and in the process contracted all the muscles in my right foot.
Don't do that. No matter what happens, leave that foot relaxed. It is full of stitches...at least two long rows of stitches, in my case...and bunching up the muscles pulls on every stitch. There isn't enough Percocet in the world to undo what I'd done to myself. When I stopped screaming, I started to hyperventilate. Then came the panic attack, with nausea and terrifying chest pain. I'd never had a panic attack in my life, but I recognized the symptoms described by friends who have them. As my husband tried to convince me that I was not going to die, I managed to get my breathing under control and relax until I was merely moaning, "It burns...it burns..." I fell into a restless sleep two hours later, but it took close to 18 hours for the meds to catch up with the pain.
Just keep the foot relaxed. The itch will go away.
Another handy thing I learned this time: There is something called a recirculating ice-water cooling machine. It does the job of ice packs you would otherwise need to keep behind your knee and around your ankle for several weeks to control swelling and pain. I'm using one loaned to me by my sister. The first time I did this, I used re-freezable ice packs that worked just fine — but they're fussy and you need a lot of them. This machine is the size of a small cooler. It has tubes and an electric motor to circulate cold water to a pad that goes behind your knee, and you change the ice every few hours. (Water frozen in a plastic bottle or a zip-lock bag works best.) Lawyers have placed information with horrifying photos on the Web about class-action lawsuits by people who experienced frostbite using these machines. I'm not dispensing medical advice, but I've found my device to be helpful and harmless.
Days Two and Three: Reality Dawns
This is how it's going to be for a while. Lying in bed, leg propped up. Anticipating the next trip to the bathroom, just so I have something to do. Not that I'm insufficiently entertained. I carefully selected books to read while I convalesce. I have a computer with Facebook friends, and time to blog, and a huge public-radio archive full of wonderful things to listen to. (Daytime television is a wasteland to me, but I've only watched it when I'm sick.) I even have a book of NY Times Sunday crossword puzzles. It's just that these four walls are getting old. Nice that the weather is unseasonably beautiful, so the windows are open and a sweet breeze is coming in. And that brings me to something you should think about – timing.
Round one, I went with the end of January because I loathe winter. I dread each passing day of autumn, knowing what's on the way. So being trapped inside for a few weeks when icy hell was blowing around outdoors appealed to me at the time. But one should consider the open-window factor. There aren't any of those in January. If I had to do this a third time, I'd choose spring or fall.
Anyway, my days two and three are Saturday and Sunday, so I have the company of my husband, who will return to work on Monday morning after packing my lunch in a cooler and leaving me with stern orders not to imperil myself by trying to do this-or-that.
Saturday is a drug-hazed blur: sleep and wake, take painkillers, sleep and wake, take more painkillers. Sunday morning I feel pretty good. Pain is now controllable with Vicodin, which is a bit less stupefying than Percocet. I downgraded after I called my sister Sunday morning to wish her happy birthday and she said, "My birthday was yesterday, sweetheart. Are you taking those little white pills?" I wouldn't switch meds, though, if my foot didn't feel sufficiently comfortable. There's no reason to suffer any more than necessary, and the first few days are rough.
And while we're on the topic of painkillers...
Let's talk about their effect on one's lower digestive tract. I hope it is not too indelicate to say that narcotics turn my bowels to concrete, which is a bad thing when the mere act of sitting up puts uncomfortable pressure on a surgery site, and any strain greater than that (if you know what I mean) can be unbearable. Fortunately, a friend introduced me years ago to senna (product name, not the brand name) which, taken along with every other dose of painkiller, protects me from premature death-by-explosion. This is not a suggestion – it's just what works for me. But here's a suggestion: talk to your doctor about the side effects of pain medication, and get a recommendation to deal with it before you and your large intestine stop communicating.
Day Three: Company's Coming!
A visit from two college buddies, and I have an excuse to get up, wash my hair, slap on a little lipstick and go sit in the living room for a couple of hours. How exciting! And my girlfriends are bringing lunch, too — BLTs and taco soup. It was so great to sit with them, lips soft, foot aloft, just chatting and laughing. They told me I seemed almost up-to-speed mentally despite the drugs, but I still can't move too fast without feeling dizzy. (Fortunately, there's little reason or opportunity to move fast.)
Dinnertime, and an adorable stepdaughter and her husband show up with pizza and dessert. Fie, fie! I am getting zero exercise, and I shouldn't be eating this stuff! But I do. And it's good! OMG, it's so good. Still weighing myself every day. We'll see how much this little indulgence costs me.
And I must start to think about exercise. Last time, I sat on the couch recuperating with my foot in the air and my hand in a potato chip bag. That cost me 35 pounds. There simply must be a way...
Jon put a basket on my roll-about last night. He was so earnest about it – found a small bread basket in the kitchen and connected it to the handles with some plastic cable ties from his secret-man-stash in the garage. It looks ridiculous and I love it. Now I can carry books and water bottles around the house with me. There's a shop across the street where they sell bicycles that weigh about 14 ounces and helmets that cost hundreds of dollars and look like cockroach exoskeletons. Maybe they have handlebar tassels there! I could get a little horn with a red rubber bulb you squeeze to honk it!
Or I could get a life...
Last night I accidentally went 8-1/2 hours without taking any pain meds. Got overconfident and stopped setting the alarm to go off six hours after the last dose. I was in pretty bad shape by the time the stuff kicked in.
Phone calls are starting to come, thank goodness. Facebook is nice, but a little personal interaction keeps you grounded. I see my husband mornings and evenings – but he's sleeping in the guest room because I have this ridiculous pile of pillows to elevate my foot, and these cold water tubes going to the icy-pad around my knee. It's a tad crowded in here.
I've discovered I'm losing weight despite being completely inactive. Don't remember that from last time...but last time I wasn't paying attention to my weight. Now I'm aware that the next step is crutches, and I need both lightness and strength.
I have a little more than two weeks left to keep this foot off the floor. Today I start an exercise routine.