Update: Post-op Appointment

**Edit - this was the blog post I wrote two weeks ago about my post-op appointment. You know - the one I was going to post right after catching up on some other stuff and then, as is typical of me, completely forgot about. What with my next appointment coming up in two days, I thought it might be a good idea to actually put it up now. That way, things still make sense... more or less anyways.**

*** Edit - there are some pictures of my surgical incision at the bottom of this post. They might be a bit gross.***

My post-op appointment was two days ago on Tuesday March 22nd. My surgeon usually works in the fracture clinic every Friday. He often has ninety plus patients per clinic day. As a result, he is a very busy man and it is not uncommon to have to wait several hours to see him. This makes sense - on average he might have 5-6 minutes per patient. Some patients take less, of course, but there are others who (like me) will take more time. And there is nothing to say that there won't be an exceptionally bad day where the majority of his patients need more time than anticipated. My main point in all this is that long wait times are pretty common. That is why you are given a check in time and not an appointment time. This way patients can't complain that the doctor was late. I have gotten used to the long waits and always bring a book and bottle of water. Not that I can always concentrate - the room can be quite crowded and noisy and sometimes I am just to nervous too concentrate. As such, I have become all too familiar with the ceiling tiles in the waiting room over the years. Also, my mum noticed that there used to be posts every few meters from floor to ceiling - you can still see holes in the floor where the screws/bolts used to be. It took here years to notice (I hadn't at all), but that's what happens when you are in a room long enough - you notice everything.

But Tuesday's are good. Tuesday means that he is at the hospital but doing other stuff on a different floor or in another clinic. It also means that he is expecting you. You and maybe a small handful of other patients who really need to be seen that day and can't wait until the following Friday. This is good. It means that he is paged as soon as you check in; the normal wait time is drastically cut in half and therefore the amount of time in the waiting room as well. And because my mum and I kind of know how that system works we like to arrive a little bit early. That way we are often seen around our check in time. I am glad to say that we didn't have to wait that long to see him on Tuesday.

I didn't have x-rays taken at this appointment. Instead I was led straight back to a room with a stretcher and chair in it. The stretcher is great because it means that I can elevate my leg. My surgeon came in to see me straight away while one of the ortho technicians cut the dressing off of my leg. She was very sweet and decided to take my staples out while the surgeon was talking to me. She wanted me to be distracted so I didn't feel/notice it as much. Unfortunately, it didn't really work, but it was very kind of her to try! There were only twelve staples this time, nothing like the fifty-seven from the surgery in November, but they still hurt. Anyone who tells you otherwise is lying or has never had surgical staples before.

My surgeon talked a bit about surgery. He was very pleased with how much of the heterotopic ossification he was able to take out. Not only was he able clear out the area around the ends of the bone that are supposed to dock (meet and eventually knit together), but he was also able to remove the sliver of bone that had been sticking out into the back of my leg. As he suspected, it had been pressing on a nerve. This is actually fantastic news. If the bone had been embedded in the nerve we would have had bigger problems, like the possibility of permanent nerve damage, but since it was only pressing on it the nerve will likely recover. Only time will tell, of course, but it is a much better prognosis. There was one part of the heterotopic thing that he was not able to remove - there is a little chunk that was stuck to the end of one of my pins that they couldn't take out. He explained that this will be reabsorbed into my body over time and shouldn't cause any problems.

The images of my leg taken during surgery to make sure that all the unwanted bone was removed:

I think that these were taken with a fluoroscope, which takes a kind of moving x-ray, not the regular type of x-ray taken in the fracture clinic. All clean! Just a bit of bone stuck to my second pin. That tiny piece can be seen within the red circle in the image below.

Back to the nerve thing for a minute. I mentioned that I still hadn't gotten the feeling back in my heel or my big toe. He explained that this could take some time. Nerves heal at a rate of one millimeter per day. It is about 30 cm from the tip of my big toe to the spot that the heterotopic ossification was pressing on a nerve. 30 cm is 300 mm. Yeah. 300 mm. That means it could be a full 300 days before I regain all the feeling in my toe. That is a long time. On a much brighter note, I will have a fully functioning right leg. If it takes so long to get the feeling in my heel/foot back, so be it.

At some point, one of his students/residents was called into the room. I think this was because this resident had been part of one of my previous surgeries. He seemed to know about my case but the surgeon had to explain to him that I had surgery since the last time this guy was involved. I could be wrong though. I have seen so many different students/residents since the bone infection came back that it is really hard to keep them straight or even remember all of them. At one of my previous appointments, a very eager resident came in and asked me if I remembered him and that he had been part of the surgery to put the fixator on. I did not and several awkward seconds ensued... Apparently I make a good teaching opportunity. My surgeon explained to the resident that I had premature consolidation (bone hardened to early) at the docking site rather than the end where new bone was growing like most people do. He then proceeded to say that "she never does anything the ordinary way". I'm not sure if I should take this as a complement or not XD

One really interesting thing about surgery on March 11th: my surgeon actually removed the fixator from my leg. He left the pins in, of course, but he said it would be too difficult to operate around the outer portion of the fixator and that the fixator itself would be quite difficult to clean and would therefore pose an infection risk. I wish I had been able to see my leg without the fixator on it. Seeing that would have been good motivation to stay positive during the remainder of the time with it on, even if I had still seen the pins sticking out of my leg. He explained that this wouldn't create more slack in the system like there was after I first got the fixator - he would just put it back on after surgery and I would continue doing my turns (started again the day of surgery) and growing bone as usual.

And then the big moment I had been waiting for came. My surgeon said I had about 1.5 cm of bone left to grow as of March 11th when I started doing the turns again. Given this, he expected the fixator to come off sometime between the middle to end of April. Hurray!!!! This was wonderful news. It means that despite the complication and the unexpected surgery, the fixator might actually come off earlier than anticipated! I won't get my hopes too high, of course, because living with an external fixator means learning to expect the unexpected, but it is definitely something to aim for. Talk of removing the fixator alone, not to mention a removal date, is already really positive.

Given the amount of bone I am supposed to grow per day (0.75 mm), my surgeon expects that I will be done doing the turns and growing bone around March 31st. He asked us to schedule my next appointment with him for April 1st, which should be either the day on which or the after I am done growing bone. Unfortunately, it turned out that he would be away that day. We found that out when we were at the booking desk. The woman there wanted to put us in for April 8th, saying that was all that was available despite our insisting that the surgeon had said April 1st. Mum went back into the clinic and fortunately found the surgeon still there. He had to think a minute about what to do, then turned to a fellow surgeon and asked if he would be willing to see a "lovely patient" the following Tuesday because "she is due to dock soon". That was fine, so my next appointment was set for March 29th. Also, apparently I am a "lovely patient". I am definitely taking this one as a complement!

After the appointment, mum and I had enough time to quickly stop by Ikea so that I could buy some lovely paper lanterns to use as decoration for when I hopefully move out again in the fall.

Here I am, after the appointments, completely wiped out. Tea, then sleep. Or was it sleep, then tea? I'm thinking the later. The pain medication makes it hard to remember things sometimes. Or was that the gabapentin? I can't remember! XD

Here is my leg while I was at the fracture clinic, after the staples had been removed. My incision wasn't as long as it appears. For some reason, part of the scar left from the previous surgery split open after the surgery on March 11th. This was the bit of scar on the left hand side of the image below. It stopped around the first pin on the left. It didn't split the whole way through, just the top few layers of scar tissue.

My leg at home. You can see where the surgeon cleaned up my top two pin sites a bit so that it would be easier for the pins to track through the skin.