Wednesday, April 9, 2008

Sesamoidectomy tomorrow

So it's been awhile since I posted. I need to get into a regular habit of blogging. I've been out of sorts for, oh, a long time now. I've managed to still be a creature of habit in one way, but that is currently being threatened.

I've worked out everyday for the last 10 years, and 2 1/2 months. I'm having foot surgery tomorrow, and while I'm hopeful that I'll be able to continue some type of workout, it's not a sure thing. Stay tuned...

So, yeah, I'm having a sesamoidectomy on Thursday morning. My podiatrist, Dr. Michael Thomas of the Poudre Valley Foot & Ankle Clinic and the Foot Surgery Center of Northern Colorado (who I've been seeing for my foot issues for the last 12 years) will be performing the surgery. I'm having the fibular sesamoid in my left great toe removed, as it has likely been stress fractured for at least the last 2 years. Oh - you HAVE to click on the above link to see the picture of the 70's guy running in vintage Nikes and long 3 stripe socks. Wow.

Some more info on the surgery and recovery:
  • There are 2 sesamoid bones in the great toe joint. A sesamoid bone is basically a "floating" bone that adds stability to a joint. I'm having the fibular sesamoid bone in my great toe joint's flexor tendon removed. So it's the sesamoid bone to the left in my big toe (closer to the rest of the toes).
  • One of the likely side effects is that my big toe will drift away from the other toes (don't laugh - it will remain attached). My doc tells me that's OK, as wearing a shoe keeps the toe in line. He said this bone being removed is slightly more work for him, but it generally has a better outcome for the patient. With the other bone removed, the big toe moves toward the other toes, which can lead to bunion problems.
  • One of the risks during the surgery is that he could cut my flexor tendon. That would be bad. Dr. Thomas said he hasn't done it yet, and he's performed hundreds of these surgeries. So that's some reassurance. Unless you're a half empty type, then he's due...
  • I'll be undergoing IV sedation, so I won't be going completely under. Apparently, one of the drugs I'll be getting has an amnesiac quality, so I'll be foggy and won't remember much. They'll also administer a local anesthetic to my foot, so I shouldn't have any painful memories anyway.
  • I find this funny (but I do get it): One of the items on the consent form states "I realize that impairment of full mental alertness may persist for several days following the administration of anesthesia, and I will avoid making decisions and taking part in activities which depend upon full concentration or judgement for at least 24 hours." And they mentioned this a few times - no important decisions for the first 24 hours.
  • I was able to convince my mom to fly out here from Illinois to help out (and help watch the kids next week while our nanny is gone). It will be nice to have her out here for this whole deal, and she'll be driving me back from the surgery. She's also a retired nurse, which adds some reassurance for the recovery process.
  • The initial recovery consists of mainly staying off my feet most of the time. They've recommended I stay off my feet with my foot elevated 12" above my waist at least 45 minutes out of every hour. I'll be wearing a surgical shoe and they recommend icing my foot on and off for 2o minutes for the 1st 4 hours after surgery, and as needed after that based on pain. Oh, and there's vicodin for the pain. And even more fun - if I have nausea from the vicodin, I have anti-nausea anal suppositories. I'm not planning on any nausea. I don't get any crutches, and Dr. Thomas said I should be fine to walk around as long as on the left side I only use my heel. And while I can't shower for the first 4 days, I am able to take baths with my left foot hanging out of the tub.
  • I'll see Dr. Thomas to have the dressing changed on Tuesday 04.15, and at that point I'm supposed to get a walking boot that will allow me to get around a lot easier. I think I should be in that boot for 2-3 weeks. I think as soon as the boot comes off, I can return to 2 hour trail runs, track workouts in spikes, and 80 mile weeks.
  • He told me I should be able to return to running somewhere in the next 6-8 weeks. Right now, I don't feel particularly anxious to jump back into it. I haven't run since early December - what's a little longer? Plus, I have plenty of cross-training options in my basement (Precor elliptical machine, Concept II rowing machine, Sportsart recumbent bike, etc.) and at the store (everything else) to keep me relatively fit. It will be based on how everything feels. I'll start with the treadmill, and eventually head to soft, even trails. I asked my doctor what should be easier on my foot, and what will be harder on the foot. He recommended initially focusing on distance over speed, soft controlled surfaces over roads and technical trails, and no track workouts. Makes sense.

So, back to the workout streak. I know I could (and may) just let it go. But the streak has gotten me out the door, or down into the basement, many times over the last decade. And we're only talking the first 4 days - after that I should be a little more freed up with the walking boot. A couple of my options:

  • Rowing with one leg. I just tried playing with this in the store, and I can probably make it work.
  • Weightlifting - I have dumbbells, a fit ball, exercise tubing, etc. which could work.
  • One legged elliptical is NOT going to work (tried it), and the treadmill is out.
  • Recumbent bike as an upper body ergometer type exercise. I just tried that, too, and while I don't know how long I'd want to do it, it's certainly a possibility.

As you can tell, I'm leaning towards keeping the streak alive. But I am reminded of what my urologist said before my last surgery: "We always tell everyone to take it easy after the vasectomy, but one patient had planned some rock climbing and didn't want to back out of it. He was back in the office with a scrotum the size of a grapefruit."

It's always good to close with a scrotal reference. More later...


GZ said...

Your posts are absolutely classic. A cross of serious with some damn funny stuff in there.

Let me know what I can do to help.

nr427 said...

Hi there, I've been researching about sesamoidectomies and came across your blog. I'm curious how your surgery went. Any side effects? Would you recommend this to others? I too have sesamoiditis (inflammation) and it can be irritating. The pain has mostly subsided but my forefoot is significantly thicker or more swollen that the rest of my foot. Just wanted to see my options and if surgery is considered a safe/recommended option. Thanks and best wishes to you.

kpthugnasty said...

I had a sesamoidectomy last week and my doctor said that recovery time until i was back playing basketball was 2-3 months. I wonder why your doctor said it was shorter. Anyways, i was put on hydrocodone and i don't recommend it! I was throwing up and sick as a dog! It also makes ya super constipated!

But - I do recommend surgery if the bone is giving you on-going troubles. My fractured sesamoid wasn't getting better and I didn't have time to waste.

twodogz999 said...

Had a osteotomy with sesamoidectomy on 12/6/10---just last Monday was able to wear a tennis shoe again. While I was in the BIG BOOT, I tackled the treadmill but that was NOT a good idea as it threw my knee and hip out of joint. Once I was in the "driving shoe" it got better, but now I have PT to get ROM back into the Captain of the Toes. Good luck! PS- kpthugnasty is also correct---skip the hydrocodone made me sick as well.. and ask for oxycodone IMMEDIATELY. Makes a big difference.

Scott McColley said...

I had a medial sesamoidectomy around 20 years ago and I have been in serious pain ever since. I cannot walk barefoot ever again. I have not been able to correct the issue using orthotics and had a doctor laugh at me when I told him I only wanted to walk without pain.

I broke the other medial sesamoid and never let the doctors remove it. It took 3 years or so to heal naturally, but I have no pain. I would recommend waiting a few YEARS before undergoing this surgery!