Getting an Amputation

The beginning of 2024 did not go as planned. Below is a synopsis of the last few weeks.

 

Background

I’ve shared before about the problems that I’ve been having with my right foot – how some arthritis at the base of my big tie caused a deformity that put all my walking pressure on that spot, how the callous there broke off leaving a big hole, how I’ve been dealing with trying to get it closed up for five years, a couple of bouts of sepsis, etc.

Just before Christmas our son-in-law got COVID, in fact his entire workplace was shut down for a week. Before he knew he had it, he shared it with our entire family. The symptoms weren’t too bad, but apparently, the extra level of infection was enough that it exacerbated the infection I was already dealing with in my foot (I had just finished a regimen of antibiotic). Thus, after not feeling 100% for the week between Christmas and New Year, I started feeling even lousier. My wife and I made the decision to have me taken to the ER on the day after New Year’s. There I was diagnosed with COVID, given an at-home monitoring kit, and sent home the following morning with instructions to come back if things didn’t get better. They didn’t!

 

Round One – Goodbye Big Toe

The next few days were a bit of a blur. All kinds of blood tests, etc. They did not have a bed available in the main hospital, so initially I had a room at the end of the ER in a “flex” unit. The following day I got moved upstairs. While there I continued to get various blood tests (ever feel like a pincushion?), x-rays, a CT scan, etc. My white blood cell count was really high, my urine was the color of dark tea (indicating the issues my kidneys were having trying to clear the infection from my blood), etc. I was feeling bad enough that they had to abort my first CT scan.

By Saturday, 1/6, they had made the decision that I needed to have my big toe, and the metatarsal behind it, removed. They normally do foot surgery on Tuesdays and Fridays, so rather than the chief foot surgeon, another doctor from that office did the surgery. The doctor indicated that it would be a multi-part surgery – one that I mentally classified as “cut it off”, “clean it up”, close it up. That mental classification turned out to be mostly accurate, but the second part I underestimated.

I did take a picture of the results of that first surgery – but not one that I’m sharing as it’s too gross. At the time I was glad to finally be rid of the source of all my difficulties. They wrapped it up and I was confined to bed for a few days. Was feeling better at that point, but still getting lots of blood draws and there was still concern about my white blood cell counts, etc.

 

Round Two – What’s a TMA?

On Friday, 1/12, I went down for my second surgery. In the meantime, I had an MRI of my foot so they could complete their evaluation. Apparently the level of infection had spread through the rest of the bones in the forefront of my foot, so the decision was made not to just “clean it up”, but to do a full TMA (Transmetatarsal Amputation). This is essentially the removal of the entire front half of my right foot – all five toes, and cutting through the set of metatarsal bones behind them.

[TMA Picture]

 

Just a bit more than a “clean it up”!

The good news is that all the infection was now gone. The ulcer that I had on the bottom of my foot for the last three years is also gone. But there are also downsides to this operation.

 

Round Three – Close it up

After the second surgery, my foot and lower right leg were in a soft cast. I was under strict instruction of NWB (No Weight Bearing) for that foot. So, naturally, I remained confined to bed – a position that ultimately I would be in for two solid weeks.

[Soft Wrap]

 

On Tuesday, 1/19, I had a final surgery to close up the wound. As part of that surgery, they also did an Achilles tendon extension – making some carefully placed cuts of the tendon that will make the tendon longer as it heals and give me some additional flexibility in the ankle.

One of the interesting issues with surgery is that you can’t have any food/drink after midnight on the day of the surgery. That was not an issue with the second surgery as it was at 7am, but the third was in mid-afternoon so I had no nourishment from 7pm the day before until 7pm that night – a long time between meals. And as the meals in the hospital were all low-carb (i.e. no more than 40 carbs), my stomach was perpetually growling.

The day after the surgery I saw the surgeon in my room. Besides the NWB order, there were strict instructions to leave the soft cast in place and to have a follow up visit with him in a few weeks, i.e. the first part of February.

 

Round Four – Rehab

It took a few days to make the arrangements to get moved to a rehab facility. My first choice was at Fellowship Community – a place connected with our denomination and where some of the senior citizens from our church reside. But they didn’t have any short-term rehab rooms available so my second choice was Complete Care, a place that relatively close to where we live and where my wife would be easily able to drive to it. It’s an older facility and a bit shabby, but the staff are very caring and the food is excellent.

[Rehab menu]

 

I’m in a semi-private room and have a roommate, but he’s not terribly communicative. He’s 91, really doesn’t want to be here (he normally is in an assisted living home perhaps 50 miles away). He won’t eat the food – just wants a jelly sandwich on white bread, orange juice, and oatmeal made with milk (not water) and with honey drizzled on the top. He’s quite hard of hearing and often seems to be deliberately ignoring the staff questions to him. So we’re co-existing.

 

Next Step – Discharge and Going Home

This morning I met with the head of physical therapy for evaluation. Tentative plan is for two weeks here then discharge to home. In the meantime I have to build up my strength (especially my arms and left leg as I can’t use my right one), learn what assistive technology will work best (thinking at this point is probably a knee scooter for around home, then transition to a wheelchair at church). Longer term, I’ll need to have some sort of adaptive foot prosthesis so I can wear my shoes and get back to driving. But I’ve got a couple of months before I get to that stage as I need my foot to completely heal.

[Healed TMA]

 

This has been an interesting experience. This two+ weeks in the hospital probably doubles the total hospitalization I’ve had in my life. Even my heart attack was only four days. And then two more weeks in a rehab/skilled nursing facility means an entire month away from home – and away from the rest of my family. I’m anxious to get back to see them, but in the meantime I’ll be patient.

Whatever happens, I continue to rely on knowing that God is in control and he knows the outcome. Go God!