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Old 09-16-2007, 11:51 AM   #1
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Things I Wish I Would Have Asked

I had my ankle fused last year. As I have written in other posts, I ended up with a staph infection and a crooked big toe. I am a little over a year out and have yet to see a big decrease in my pain. Of course, I still have hope that my pain will be relieved once my toe is realigned.
Here is a list of questions I wish I would have asked my surgeon before I had my surgery:
1. Will you be performing the entire surgery or will you be overseeing the procedure? (Many surgeons have their residents perform the survery under their watchful eye)
2. What is your rate of infection? What is the rate of infection of the hospital?
3. Who will be in charge of pain management? What do I do if my pain is greater than the med you prescribed?
4. How long will it be before I should notice a decrease in pain?
5. How will my scars look once I have hearled?
6. If I am in severe pain (10 on a scale of 1-10) in the middle of the night what should I do?
7. What is normal discharge around the pin sites and what would be a sign of an infection?
8. How many of these procedures do you do in a year?
9. What is the age/level of activity of your average patient?
10. Why do you believe in the method you have chosen?
11. What could go wrong? What would you do to correct it?
12. What can I tell my family and friends to expect? How much care will someone need to provide for me once I get home?
13. On a scale of 1-10 how serious/complex is this procedure?
14. How long before I can enjoy my daily activities again?
15. How long before I can reach my goal of .... (Mine happens to be taking my family to Disney World)

I hope this helps someone else who is considering having their ankle fused or any other surgery. These decisions are not easily made and should not be made quickly. While I am pleased with my surgeon and have faith in his abilities, I believe asking these questions would have helped me to be better prepared.
Feel free to post your questions.

 
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Old 09-17-2007, 11:33 AM   #2
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Wink Re: Things I Wish I Would Have Asked

Hi i was just reading your story,i am supposed to be having a total ankle replacement next month,my walking has got so bad and im walking with a limp im just 50,how are you know honestly as i am thinking to get a second opinion,sometimes i think am i doing the right thing,i feel like one leg is shorter than the other,how was your life before the op thanks teresa/

 
Old 09-17-2007, 07:24 PM   #3
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Re: Things I Wish I Would Have Asked

I am not really sure how things are going to turn out for me. First, my surgeon says I am not really done healing until about 18-24 months out. I am twelve months out now. Also, since my toe is crooked I am unable to tell if the fusion has relieved my pain. My gait is very awkward, since I cannot push off with my big toe.
Before the surgery, I was in a lot of pain. I was on meds, but they didn't seem to help. I couldn't do much housework and my leisure activities were limited. I went from walking 5 miles a day before I broke my ankle to just barely making it through the grocery store. I am glad I took action and did something. I just can't say exactly what the result is yet.
I am in the process of scheduling my next surgery which should happen in early November. I will know more after that.
Thank you for your interest and good luck with your decision.
I believe a second opintion is almost always a good idea. As a matter of fact, I wouldn't tell the 2nd dr the recomendation of the first dr until after he has drawn his own conclusion.
I hope the questions on this post help you also.

 
Old 09-18-2007, 08:36 PM   #4
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Re: Things I Wish I Would Have Asked

Hi Step

I wish I would've asked more questions too before my last surgery. I didn't think I had a choice but to have the ankle fusion because my leg was so crooked and the pain was so intense.

What type of surgery are you having in November?

Sincerely
Mus

 
Old 09-20-2007, 05:42 PM   #5
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Re: Things I Wish I Would Have Asked

My surgeon wants to do the Keller Procedure on my toe. I'm not sure this is the best option for me since many people who have it done say they have trouble pushing off with their big toe when they walk. I love walking/hiking, so I really don't want to lose that ability. Also, my goal is to go to Disney World with my family and be able to walk the park without terrible pain.
Thank you for your interest.

 
Old 09-21-2007, 10:28 AM   #6
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Re: Things I Wish I Would Have Asked

Hi Step,

I am as of today 21st Sept, one year out of having a subtalar fusion. If you have ever seen any of my previous posts it has not been an easy year, once the boot came off. I was use to be very active. I have just been signed off by my Ortho who has said that I must work through the pain I encounter, I have complete fusion. Now I am back to walking my dogs for about 2 hours a day, I have four and take them in groups of two!

It is true it does take 1-2 years apparently. I am improving (I do not want to jinx this) the pain is descreasing and the stiffness is better.

I am sorry you had the infection. I was advised to stay in overnight after my surgery so that they could dose me up with antibiotics. Something my ortho is a great believer in, to prevent infection. I have to say the pain management during the casting time of about 6 weeks was not too bad, the swelling was worse.

Your questions to ask the surgeon are great. I was not prepared for this length of recovery and the pain it has really been hard. Now to lose the weight!

Good luck.

I am keeping hopeful to be pain free soon. Failing that I am off to a specialist in Stanford!!

 
Old 09-22-2007, 09:57 AM   #7
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Re: Things I Wish I Would Have Asked

Thank you for the reply. I am glad to hear you are able to walk the dogs for a couple of hours a day. That is what I am aiming for.
Lately, I have been a little down. I am just tired of limited activity and gaining weight. I hope to see positive results with the Keller Procedure my Ortho plans to do for my toe.
Thanks again!

 
Old 11-23-2007, 11:46 AM   #8
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Re: Things I Wish I Would Have Asked

hope you still check this site, I am from Missouri as well having a fusion in January, would love to hear the war stories and who performed your surgery.

 
Old 11-24-2007, 07:11 PM   #9
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Re: Things I Wish I Would Have Asked

Are you having an external fixator put on?
Who is doing your surgery?
I ended up with a staph infection and two extra surgeries for that. It was extremely painful. My big toe went crooked, so I had to have a procedure done 2 weeks ago to correct that. So, I have pins in my foot now. I am praying they don't get infected.
Tell me more of what you are having done. Thanks for replying to this post.
Step

 
Old 11-24-2007, 09:55 PM   #10
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Re: Things I Wish I Would Have Asked

Step, can you tell me if you had problems when you first startedweight bearing? i am at 8 weeks after surgery and i can't seem to bear weight which i was instructed to start doing 2 weeks ago. there is sharp pain in my heel when i press down too hard. had heel chopped and moved over and screwed. i have a thread called "talonavicular fusion with heel surgery recovery" pplease advise.
Also, in your questions, you ask about pin sites and infections. did you have one? i am starating to think the sharp pain in my heel is from the screw. after i peeled away the strips from surgery about a weeks ago, noticed that the incisions areas had slight puss around them.
thanks for any info you can provide.

 
Old 11-25-2007, 05:02 PM   #11
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Re: Things I Wish I Would Have Asked

That is a great subject for a post. I found your list very helpful. I can think of a few things to add to your list.

1. what type of surgery, exactly?
2. nausea meds?
3. types of pain meds and which ones work the best and also will you give the prescription at pre-op so there is time to pick it up before surgery day (who wants to stop at the pharmacy on their way home from surgery?)
4. will there be pins or screws, and if so will they need removing?
5. more info about elevating after the first 3-4 days
6. How will I get around as in will I need to have a wheelchair, or a walker? Or will heel walking be o.k.

I bet a lot of people on this forum could add to your list, maybe we could get it all together so newbies (like me) could just print it out and bring it to their docs!
I bet that would just MAKE their day!!

 
Old 11-26-2007, 04:06 PM   #12
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Re: Things I Wish I Would Have Asked

Quote:
Originally Posted by cantwalk View Post
Step, can you tell me if you had problems when you first startedweight bearing? i am at 8 weeks after surgery and i can't seem to bear weight which i was instructed to start doing 2 weeks ago. there is sharp pain in my heel when i press down too hard. had heel chopped and moved over and screwed. i have a thread called "talonavicular fusion with heel surgery recovery" pplease advise.
Also, in your questions, you ask about pin sites and infections. did you have one? i am starating to think the sharp pain in my heel is from the screw. after i peeled away the strips from surgery about a weeks ago, noticed that the incisions areas had slight puss around them.
thanks for any info you can provide.
Yes, I did have trouble when I started to bear weight on my foot. It was hard for me to step on my foot completely. For some reason my body only wanted to use the outside of my foot. It felt like it was hard for the arch of my foot to stretch or something. I also had a really sharp pain in my heel and I didn't even have anything done to that area of my foot. I'm not sure what that was all about. Gradually, over time it got easier. I can say that I wish I would have tried harder to walk normally from the beginning - even with my air cast. I walked wiht my foot pointed out instead of straight ahead. I ended up with a crooked toe. My bigi toe pointed in at a 45 degree angle. I had to have another surgery to correct it. My dr seems to think that the toe went crooked because it was stiff after walking with my foot pointed out for so long. I think my toe went crooked while I had the external fixator on and that made me walk strange. It is a classic case of which came first - the chicken or the egg.
The questions about the infection were included in this list because I ended up having one. The funny thing is it wasn't near my pin sites. It was on the other side of my leg where my dr had inserted a battery for bone growth stimulation. My symptoms were - a pain like I had never felt before. It was so bad I was curled up in the fetal position for a week. I don't remember ever having a fever, although they say that is a common symptom. The area that was infected was bright red. I never saw puss coming out of the incision, but I did have very localized pain and swelling in a very specific area. It was a round little ball on the outside of my ankle. It was so sensitive I wouldn't let anyone get near it. I went to the ER 2 times in 24 hours one Saturday, but they said the pain was from nerves that had been disrupted. They said the narcotics I was taking would not relieve nerve pain. It had to be treated with Lyrica or something like it. They gave me a prescription and told me it would take 3-5 days to work. On day 5 I called pain mgmt because it still wasn't working. They told me it could take a week. I waited a week and it hadn't gotten any better, so I called again as well as making a call to my ortho surgeon. They said to go in to ER and get checked for an infection. Sure enough, I had a staph infection and it had gone all the way into the bone. I had to have 2 more surgeries for debridement and a very painful whirlpool treatment. I would avoid all of that at all costs. The pain was very hard to manage. Bone pain is some of the worste pain anyone can experience.
It is hard to know if you have an infection or not, but it is definitely worth a call to your dr to discuss it with them. It is certainly something you don't want to put off.
I hope this helps!
Step

 
Old 11-30-2007, 09:41 AM   #13
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Re: Things I Wish I Would Have Asked

This is a great topic for discussion. Here's what I would add to the list:

1. More for the anesthesia doc; Can you have something prescribed prior to the surgery to help calm down. Personally, I didn't take anything this time around, but I wished that I did, I really started getting light headed while waiting for the surgery to get started.

2. Anti-biotics really are key, your body is being opened up and you may have some foreign bodies introduced (pins, screws, plates, etc), so if the doc hasn't mentioned them, be sure to ask. I was overnight in the hospital, and from the time I was admitted in pre-op to right when they removed the IV, I was being given a steady dose of anit-biotics.

3. This may not apply to everyone, but if you are having plates, screws, pins put into your foot, will they come out or will they stay in? What is the procedure to take them out, in the docs office or in a clinic?

4. How do you shower or bathe after the procedure? If you are non-weight bearing, how does the doc propose you handle this? I am non-weight bearing and was told to either take bath's or sponge bath until I can get on my feet.

5. Try and ask for a timeline of follow up visits; I find that's helpful if you aren't able to drive yourself, you can get friends or family lined up and you have an idea of how much help you are going to need. For example, after the operation I had, I saw him one week out, then the next week, then we jumped to 3 weeks out, I see him in another 3 weeks, and from there, I think it's once a month for 3 months. So it helps that early on I knew I needed someone once a week.

Good luck everybody, it's not an easy decision to make. One last thing, it really is an honest year before you feel back to normal. (or at least I hope everyone can get back to normal, barring any type of complications) People who haven't had surgery before or don't have foot pain to deal with scoff at that timeline, but after 2 prior surgeries, and this being my 3rd, it is a year before you are good. Take things slow and don't be tricked into thinking that after 2 or 3 months, when you feel better, that everything is fine. Take your recovery slow and try and remember to take a year when recovering.

 
Old 12-04-2007, 09:03 AM   #14
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Re: Things I Wish I Would Have Asked

dbgoLie
These are excellent questions! Thank you for adding them!
Step

 
Old 12-04-2007, 05:20 PM   #15
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Re: Things I Wish I Would Have Asked

I hope this isn't considered thread hijacking but I'd like to bring attention to antibiotics following surgery. I just had my procedure on Friday, after which my doctor gave me a course of antibiotics via the IV. He had previously given me my prescription for pain killers but not antibiotics. While at home over the weekend I called him to ask if I needed a prescription for antibiotics as well but he assured me that I had some the day of the operation but during my first pre-op visit (the following morning) he would determine if I needed antibiotics. Isn't this a little out of the ordinary? I sort of figured that antibiotics would be given in every instance of major surgery as a prevention tool. I'm worried about contracting a staph infection as the original poster encountered. Should I push the antibiotics issue further during my next visit (next week)? I don't want to end up in a bad position and regretting that I did not ask (again).

 
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