Where my foot's at now (and other ungrammatical updates):
It's been fifteen days since I had the operation that discovered a substantial pothole on the head of my first MTP joint on the right foot. (see diagram above). The existence of this crater was not known until the operation itself, when Dr. Carter opened me up and said, "Hey, that's a crater on the head of the first MTP joint!" (O.R. dialogue interpolated by author.)
As detailed in a previous post, the doctor has given me 50/50 odds on recovering from this operation and returning to normal foot life. Even-handed and egalitarian as they may be, these are not the odds a patient waking from surgery wants to hear; they have stuck in me hard, bringing worse pain than the sliced-open foot. 50/50 - I would have liked to have received better odds than that, after all the hell I've been through with this toe thing for last eleven months.
Sorry, on to the rest of the bald medical facts. Whingeing to come.
Articular cartilage is the cartilage that covers the top layer of the areas that make up a joint and is the area where the pothole was found. He drilled three thin holes in the pothole, hoping that scar tissue will fill it in. There is a 50% chance that I’ll do well with it and recover. There is just as much chance that I'll recover for now, but in 4 or 5 years I’ll develop arthritis and have the same amount of pain as before. However, there is just as much chance that the operation won’t have worked at all, and I'll be right back where I started, even after all this trauma. I don't like to think about this part of it.
I feel particularly accomplished at having looked at the photo my surgeon took of the joint during the operation. (He had taken it with his iPhone.) I do not have a copy of this photo, thankfully for all of you. Usually I'm a little girl when it comes to seeing gory pictures of people's insides, it's hands-over-eyes time. But it's amazing what you can stand to see when your livelihood is on the line.
There it was. That crater was plain as day, right near the opening of the joint. Dear God, I thought, I have that inside me? THAT’s on my bone? How the FUCK are we going to get rid of that?? How is scar tissue going to close that up??
It was harrowing, shocking and troubling – yet at the same time I felt a certain comfort looking at this picture. Okay – it’s not a monster, it’s not the boogie man, it’s not a tumor – it’s a dent. That’s what we’re working with. A dent. Those get repaired all the time. Cars, appliances, walls. Yes, alright, those things don't feel pain and are not made of human cells, but I mean... cuts heal, don't they? Those are kinds of dents, aren't they? Surely a dent in the cartilage can be clotted up, can't it?
We won't know for another five weeks. When I last saw Dr. Carter on Monday, he said he was pleased with the way the incision was healing. Okay, well at least there's that. I was worried my bloated discolored toe and generally yellowy foot were symptoms of an infection or some other awful complication. Thankfully no. He even commented on the looks of my toe as being quite encouraging. "Alright! Look at that bleeding!" he said while taking off my bandages. Apparently the purplish and plump state of my big toe was an indication that internal bleeding had taken place. This was what might lead to that hole filling up with scar tissue.
Still, he wants me to go see a Dr. Kennedy, a colleague of his at the Hospital for Special Surgery. This is a facility on the Upper East Side known for being top notch in joint issues, and which is also known for charging consultation fees affordable only to movie stars and heads of western states. Apparently Dr. Kennedy is an expert at transplanting articular cartilage from the knee to the foot, what's called an osteochondral autograft. Well, he may not be an expert, my doctor said, but he has done it four or five time with some success. Lovely.
Dr. K. has already seen the iPhone photo of my pothole and told Dr. C. that we should wait about five weeks to determine whether or not the drilling worked. And if it hasn't, Dr. Kennedy thinks I'd be a good candidate for the autograft. I am hoping and praying that it doesn't come to that. And I'm not entirely clear on how they will determine if the first operation has worked. The MRI's and X-rays I'd had prior to the surgery hadn't showed my pothole at all. They'd completely missed it. Alright technology - now's your time to prove yourself - 'cause I'm NOT having another operation to find out if my operation worked!
Meanwhile, I've been fitted with a blue Velcro sandal that has a hard sole. Dr. Carter wants me to walk on that as much as I can stand in the coming week, using crutches for support. If it hurts, don’t do it, but if it’s okay, keep doing it. The sandal will keep the toe stable while walking, though really it just serves to make me look, feel, and sound like Frankenstein, clomping slowly step by step, rocking back and forth. All attempts to go outside have proved so overwhelming and painful, that confinement to my small apartment still seems the better plan.
In addition to drilling in the pothole, Dr. Carter told me he reset the great toe slightly to be pointing a little straighter, away from the second toe, and slightly up. Said it should help in the recovery. Then he wiggled the toe back and forth. I didn’t feel any pain, though I was terrified I would. He asked me to try to press forward and back on his finger with my toe. I did, just slightly. He was happy with it.
Gratuitous complaint about cabs (as promised):
For my first post-op visit, I'd spent an hour and a half in the car service just getting from my apartment in Crown Heights to my mom's hotel in Sunset Park to the doctor's office near Columbus Circle. A pilgrim going Mecca would have given up and said, "Fuck it. Not worth it," if he'd had such a journey, and had had to spend over an hour just in the dregs of Brooklyn, under the shadow of the rotten Gowanus canal bridge.
I’m convinced it was a combination of nightmarish midday traffic and the Arecibo drivers not knowing what they were doing. All the while my foot was being shaken this way and that by the constant stops and endless potholes. (Potholes - my arch-nemesis.) The driver kept taking different detours, dissatisfied with the amount of traffic at each intersection on the way to the Battery tunnel. I'd even agreed to pay the toll for the tunnel because he said it would be faster than taking the bridge. We were half an hour late. On the way home, the driver insisted on taking the 59th Street Bridge into Queens, and proceeded to take the streets all the way from Long Island City to Williamsburg to Crown Heights. (This description will probably be irritating to any non-New Yorkers out there, but that's one thing about us Gothamites. We love to name neighborhoods.) There was no respite for the foot in this icy pothole-filled ride. I tried holding it up from the car floor in a thousand different ways, none of them helpful, my mother having to put up with my swearing all along the way.