Pre-surgery – Alan

How we got here

[Note that this section has a number of actual pictures that may not sit easy with you. If you are squeamish, you might want to skip the pictures. I’ve put these pictures at the end of this posting so you can just stop before you get to them if you desire!]

I started having problems with my right foot in early 2018 (four years ago). For a while I have had an issue with the way that the big toe on my right foot was getting misshapen. It was believed that I had some arthritic growth at the base of that toe. I was developing a large bump under that point and could not bend my foot flat. It looked a little like the below.

[Bursitis]

 

But then in early 2018, it began developing an actual sore which eventually became a small open wound [see picture of my foot from 2018 at the end of this posting.] Being careful in walking, never being without shoes, etc. did not seem to relieve the issue and the wound remained. After a bout of sepsis (which may or may not have been caused by this), I eventually went to the wound care center at our local hospital. They bandaged my foot and had me wear a surgical boot for a few weeks [see picture below] and that cured the issue (at least for a while). I also switched to new orthopedic shoes which I faithfully wore.

But in 2021, all the care I had been taking only turned out to delay the issue. The sore on the bottom of my foot came back with a vengeance. [The picture at the end of this posting gives you an idea of how big the sore was.] When all the dead tissue sloughed off, I had a huge open wound on my foot. I stopped going to my local podiatrist and began seeing an orthopedic specialist.

Besides seeing him every 2-3 weeks where he cut off any dead tissue that was building up, he also gave me a prescription to get a pair of custom orthotics with inserts that helped relieve the pressure on that part of my foot. After several weeks of delay due to issues with the shoe manufacturer, I got my new shoes [see picture at the end of this posting]. That is the ONLY pair of shoes I now wear and I NEVER go anywhere without them.

The shoes (which relieve the external pressure on my foot) and every 2–3-week visits to the specialist have helped. The size of the “hole” on the bottom of my foot is definitely smaller than when I started [see final picture at bottom of posting]. But then it stabilized and refused to get smaller. So, here I am in early 2022 and more drastic action is needed. The specialist has recommended surgery that will relieve the pressure from the inside – this is known as sesamoidectomy [yes, that was a new word for me too, look it up if you like!]

He wanted to schedule my surgery the end of this month. But because my wife is having her hip replacement surgery in just a few weeks and I’ll need to be able to drive her around for a little while, we’ve had to put it off for a little while. So, I’ll see him in mid-March and get it scheduled. I’ll not be able to drive for several weeks afterwards, so that will make things interesting!

 

Sesamoidectomy – an anatomy lesson

So, what is a sesamoidectomy? Well, first, the “ectomy” is a suffix meaning to remove – like an appendectomy is an operation to remove the appendix. So, then we must ask, what is a sesamoid? A sesamoid is a small, round bone which is embedded in a tendon whose function is to protect the tendon as well as to provide a fulcrum that helps the associated hinge joint to have sufficient strength. Your patella (commonly called a kneecap) is the largest one. There are also sesamoid bones in your hands and feet. Of concern to me are the pair of ones at the base of each big toe.

[Sesamoid bones] [sesamoid bones2]

 

Because these two bones are directly behind the wound on the bottom of my foot, they are putting pressure on that spot from the inside which is contributing to the wound not healing. The plan is to remove the one to the inside of the toe as that is the closest to the wound. (Removing only of the two bones is fine as the other can still provide the fulcrum point, but if both are removed the toe flexors lose necessary leverage and can’t function, i.e., you would not be able to walk properly.)

 

Sesamoidectomy – What to expect

One would think that replacement of a hip like my wife will be going through would be much more “major surgery” than removal of a small pea-sized bone in my foot. Alas, while the incision in her hip will be larger, she can expect to be walking the same day, pain free, and back to normal pretty quickly. But that is not the case with my surgery.

While the length of my surgery will be about the same (1.5 hours), and the incision smaller, because of the location of the incision the recovery is much longer. I am told to expect about two weeks of staying in bed with my foot elevated, followed by perhaps four weeks of wearing a surgical boot so that I do not put pressure on the bottom of my foot or bend my toes. This will mean up to six weeks of non-driving and using a cane/walker/crutches to give adequate support once I’m allowed to walk.

[Surgical boot]

 

Some miscellaneous information

The good news (if one can call it that), is that despite my being diabetic [with blood sugars finally under control since starting insulin last fall], I still have good circulation in my lower extremities. Also, despite the neuropathy caused by the diabetes which means that I have no feeling in the front halves of both feet, I have taken very good care of my feet and have avoided injury (which is a problem when you can’t feel your feet). Also, I have taken such good care of the wound that I have not had any infection even though it’s been an open wound for ten months.

I’m also grateful for the availability of information on this condition and the expectation for my operation. I point to a blog written by a lady named Kim who went through this back in 2011 and posted all her updates to how things went (https://kimsfootstory.wordpress.com/).

 

Pictures – not for the squeamish

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[My foot – 2018]

 

[Corrective footwear – 2018]

 

[My foot – 2021]

 

[Corrective shoes – 2021]

 

[My foot 2022]

 

 

Pre-Surgery – Donna

Having physical limitations is a normal result of getting older. But this year both my wife and I are having issues that are going to require surgery at about the same time – for her a hip replacement, and for me foot surgery. I’m going to cover just hers in this posting and mine separately – especially as mine will have a lot longer recovery time and will result in many more blog postings.

Donna has had increasing pain in her right hip for a couple of years. She’s pretty tolerant of pain and so has been just dealing with it, but it got to the point over the past year that she finally thought she should see a doctor who could diagnose her issue and make some recommendations. They took some x-rays and recommended eventual hip surgery. However, for whatever reason, they did NOT show her the x-rays themselves. As she said when we finally saw them, “if I saw them, then I wouldn’t have waited to have the surgery!” But as it was, she just continued dealing with the increasing pain until we decided that the surgery could not be put off any longer.

In the below picture, the left image is what her left hip looks like, but the middle image is what her right hip looks like. There is a definite narrowing of the space between the hip ball and the socket, there are rough projections on the ball, and there are also bone spurs just below the ball on both sides. It’s the bone-on-bone between the ball and socket that is the cause of her pain.

[Hip Replacement steps]

 

Right now, we have the surgery scheduled for March 2nd. We already had a pre-surgery visit (when we finally got to see the x-rays). Next week she has a visit with our family doctor (who has to give written permission based on any other issues she might have [which she does not]), a visit with our dentist (who also has to give written permission because of the impact of the various medications she will be taking), and a pre-surgery phone call to discuss all the details of the day as well as the requirements during the final pre-surgery week. These are pretty simple and mostly just to prevent infection. For the five days prior to surgery, she has to wash with a special anti-bacterial soap (everything from the neck down – it’s evidently too strong to be near the mouth/nose/eyes). She also has a prescription drug that she is supposed to swab in her nostrils twice a day that will help prevent MRSA.

For those who have never investigated this type of surgery, here are some details. First, as you can see in the right-most image above, the ball of the thighbone is removed. The interior surface of the socket is the smoothed out, removing any rough patches. Next, referring to the below picture, the part called the “acetabular component” is inserted into the smoothed-out socket. As we were informed in the pre-surgery visit, if the socket is smoothed out to 53mm, then the insert would be 54mm to ensure a tight fit. The insert also has a rough surface that the bone of the socket will eventually grow into making it a permanent part of the pelvis.

[Hip Replacement parts]

 

Next, the plastic liner is inserted. Then the femur is hollowed out, again making the hole slightly smaller than the femoral stem of the insert as the whole thing is just held in by pressure – no screws, no staples, just pressure [note in the first picture that the hip muscle is pulling on the top of the thighbone and that gives the necessary pressure to hold everything together!]

The femoral stem of the implant (all made of titanium) is then just hammered into the reamed-out hole in the thigh, the ball into the cup of the plastic liner – and it’s done! There are no screws, and no stitches. The wound is simply closed up through the application of an external piece of “fabric” that is applied to the skin with a sticky adhesive. The fabric is waterproof and will hold the wound closed while it heals.

Hip replacement surgery is so routine these days that the expectation is that they will have her up out of bed and walking the afternoon of the surgery and release her to go home the following morning. She’ll have to have a cane or walker or crutches for at most a couple of weeks. We also already have her scheduled for post-surgery PT the following week – which will also be for at most a couple of times a week for a few weeks. We have some friends at church who went through this recently and they were walking normally (and pain-free!) in only a week or so. That is also our expectation for her.

And more importantly, this should relieve the pain that she’s been having and allow much easier sleep!

I wish that my upcoming surgery would get over so quickly – but that’s the topic of another series of postings.

 

Russell Lineage – helping a distant cousin

Recently I was contacted by an individual, Seth Russell, who had read some of my blogs on my Russell lineage and was asking for my assistance in determining his correct lineage back to the origins of the family name in Normandy. Seth lived in Australia where his grandfather had moved back in 1969. He had his lineage back in England for several generations, but he was having some difficulty connecting it to the main Russell lines.

I located his family tree in ancestry.com and began looking at it for consistency. Over the course of several days, we had a dialog about the problem areas and he did further research based on my comments. The below documents his research and my comments. If we are able to establish a connection, then Seth will likely be something like a 17^th cousin with a few removes thrown in as he is a few generations younger than I am.

In order for a lineage to be accurate, there must be consistency in dates and places of birth/death compared to one’s parents. Families may move from time to time, but generally do not “jump around”, especially in former times. Also, children should be born more than 20 years after their parents, and births after parents are 40 would be unusual and births after age 50 are indicative of errors.

I have made a close examination of all the below lines, checking for this type of consistency and any remaining issues are noted in red. [Note that the last name of Russell has been left off of each line to make for better readability.]

 

Confirmed recent generations

Seth’s research for the last 300+ years (11 generations) has no questions in it. There is consistency in all dates and places. I list it here for completeness. The question is how to get from the Russell lines in England to here (see my prior blog on Russell Lineage).

·        Thomas (1680-1735)

o   Starting in Oxfordshire

·        John (1705-1782)

·        John (1743-1830)

·        William (1770-1840)

·        Charles (1804-1879)

·        William (1834-1913)

·        William ‘Buff’ (1862-1942)

·        Bertie John (1907-1983)

·        Michael George (1940-)

o   Moved to Australia in 1969

·        Mark Anthony (1970-)

·        Seth Eden (2004-)

 

First attempt

This one began at the same point as what I had called my second American line.

·        Starting with Stephen Gascoigne (1360-1438)

o   Starting in Dorset

·        Sir Henry Gascoigne (1401-1463)

·        Sir Thomas (1430-1505)

o   b. Suffolk, d. Dorset, are these places reversed?

·        Sir John (1452-1479)

o   Settling down in Suffolk

·        William (1479-1521)

·        William (1509-1559)

·        William (1537-1570)

·        William (1558-?)

o   Date gap of 98 years to his alleged son indicates missing individuals

o   See extended explanation below

·        William (1656-1728)

o   b. Oxfordshire, d. Sussex?

·        Thomas (1680-1735) continuing as documented above

As noted at the beginning, dates and places need to pass a reasonability test. In this particular instance, there are 122 years between William (1558-?) and Thomas (1680-1735). That is a sufficient time gap to allow for most likely four generations. In addition, there should be a change of location from where those before this gap lived (Suffolk) and those after this gap lived (Oxfordshire).

Many trees have put William (1656-1728) in the gap and left him being born nearly 100 years after his alleged father. And Williams’s place of birth and death is also totally contrary to the needed transition from Suffolk to Oxfordshire. But there are no available records indicating any other father for Thomas, and many trees have no children from William (1558). So, no one has found a solution that could properly connect the Russell line above this point to the one below this point. It’s quite likely that these lines do not connect at all.

 

Second attempt with small corrections applied

This one begins a couple of generations down in what I had called the first American line in my earlier blog.

·        Robert (1422-1502)

o   In Strensham, Worcestershire

·        Robert (1460-1525)

o   This generation was missing, but corrected

·        Sir John (14681494-1556)

·        Sir Thomas (1520-1574)

o   According to find-a-grave, father is John (1494-1556) - corrected

·        Richard (1543-1612)

o   b. Sussex, d. Sussex – another abrupt change of location

·        Thomas (1570-1633)

o   Continuing in Sussex

·        Thomas (1589-1641)

·        Thomas (1611-1645)

·        William (1630-1673)

·        William (1656-1728)

o   b. Oxfordshire, d. Sussex – are these locations reversed?

·        Thomas (1680-1735) continuing as documented above

 

Current Status

After applying the corrections to Seth’s second attempt, there are only two remaining errors of consistency. The first is the location of birth/death of William (1656-1728). I believe that the two locations are reversed, i.e., he was born in Sussex and died in Oxfordshire. But the second is still a significant issue, i.e., Thomas (1520-1574) was born and died in the north of England in Worcestershire, but his alleged son, Richard (1543-1612) is shown as born in Sussex in the south of England. Either one of these locations is incorrect, or Richard is not the son of Thomas.

There is an interesting comment in the second reference below that “the name of Russell was ‘somewhat common’ …”. It is used in the reference to try and ascertain which of three contemporary “John Russell’s” were being referred to – one from Worcestershire, on from Buckinghamshire, and a third from Little Malvern (also in Worcestershire). In parliament, the first was called ‘senior’, the second was called ‘junior’ – a designation that was not indicative of a father-son relationship, but a reference to who had served the longest. The third had not been knighted.

Perhaps this same type of “somewhat common” is the cause of confusion on who is the father of Richard. As of this writing, this last issue has not been resolved.

 

Resources

·        https://www.historyofparliamentonline.org/volume/1558-1603/member/russell-sir-thomas-1520-74

·        https://www.historyofparliamentonline.org/volume/1509-1558/member/russell-john-i-149394-1556