Recovering from a Second Hallux Rigidus Surgery

These babies came off about seven weeks ago.

These babies came off about seven weeks ago.

The osteotomy I had on my right foot two years ago was a fair success. Not a smashing success—but it did change my walking and made everything in general hurt less. The hard callouses I’ve on the bottom of my big toe for my whole life are gone, which would imply that I’m rolling my foot more like a normal hallux rigidus–less person.

Anyway, the point is, it went well enough for me to do the second foot this year. I called for this one earlier in the school year which had the added advantage of it not being cold out, so walking around in a sandal for six weeks was not as much of a problem.

But I gotta say, this recovery has been really slow, possibly slower than the first one. The two post-surgery days at the hospital were quite a bit more painful and the morphine drip didn’t seem to do much this time. In fact they offered to take it out much earlier and I agreed (also because of this post-surgical problem that medical sites on the interwebs suggested might be aggravated by an IV). I did figure out I could wear my top-closing Naot sandals on my left foot while wearing a normal shoe on my right foot which made going out a little easier since it allowed me to ditch the post-surgical shoe sooner.

Still, it’s been almost seven weeks and my mobility is discouraging. I didn’t think the torn ACL in my right knee would bother me since it was truly not giving me any more pain, but that has been a big hindrance to my mobility post-surgery. The knee has hurt often and inconsistently with the extra weight being put on it.

Also, I didn’t realize how much harder we push on a clutch pedal than an accelerator, or even the brakes. Driving is still not too much fun, since I have to be careful not to use my big toe on the clutch—OUCH. I am going back to work on Monday but mostly because I can’t stand sitting around at the house anymore, not really because I think the foot is ready. I still can’t put too much weight on the forefoot really, so I walk very slowly and with a limp. I’ll be doing some stationary teaching (eugh), lots of sending students to do things that I would normally do, and avoiding stairs. I still hate taking off and putting on my shoes. My feet are both still really sore after any prolonged walking, like grocery shopping.

Lesson to take away from this: when they say you’ll be back on your feet after six weeks, interpret “back on your feet” with a grain of salt!

For those curious about the first surgery, I wrote about recovery here.

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Spain, knees

Just a bit of an update on the knee situation: I did go to Spain last week to visit my parents and my aunt, in Alcalá de Henares, which is where Cervantes was born, and where my mom is doing a semester as part of her university’s study abroad program.

I almost turned around at Charles de Gaulle to take the next train back to Poitiers, but after a pep talk from J I stuck it out and had a great week in Spain, even if it did involve a lot of sitting. We had tapas every night, saw the inhabitants burn their giant sardine for Ash Wednesday (a tradition which no one seems able to explain), and went to Madrid my final evening. In Madrid I got to ride around the Reina Sofia and the Thyssen museums in a wheelchair, eat really delicious pintchos (like the things we ate everywhere in Pamplona where they were spelled with a Basque x), and see a flamenco show. I even spoke a tiny bit of Spanish and got back onto Duolingo (though there are some definite issues with that app and I wish they would hire me to fix them!).

All in all it was a great trip but walking was still very hard for any sort of distance. It required a lot of concentration and sometimes it hurt anyway. So I didn’t go in to work yesterday, since I had an appointment with the surgeon anyway for my feet. The same surgeon does knees so we looked at both of them, and he thought it was by no means sure that my ACL is actually broken. Unfortunately we won’t know till my MRI in La Rochelle on March 29th (in Poitiers the first appointment was even later!). He was more shocked by the state of my left big toe which I do need to get operated on at some point but I don’t know when I’ll be able to squeeze it in.

I’ll be back at work next Monday, in time for my conseil de classe, the bac blanc, and all sorts of other fun stuff. In the meantime I’m doing exercices every day and will head back to physical therapy tomorrow evening.

The French Hospital Bill

Back when my feet were bothering me most with my American orthotics, in the summer of 2009, I had really hoped to be able to get my surgery done in the States. I had only seen one podiatrist in France for my feet, and in retrospect, he wasn’t that great. Had I gone back to him a second time, he may have turned out to be totally fine. But as it was, he never explained to me that hallux rigidus is a condition that is never really fixed, and certainly not by orthotics. I reorganized all my blog categories and tags yesterday (sorry if tons of posts showed up as “updated” in any RSS feeds…) and it allowed me to go back and see the progression of the problem, from 2006 till now. It was shocking to see in this post that I really thought orthotics might get me back into wearing heels within a month! I’ve long accepted that I’ll never wear heels again in my life (and frankly I think most people should never wear them anyway), so that’s no big deal, but the podiatrist could have explained to me that the arthritis was NOT going to be corrected.

It’s actually important to know that French podiatrists (podologues) and American podiatrists are not very similar. French podiatrists have more or less a bac + 3 (a three-year degree). They take care of people’s feet in terms of relieving pain, often doing things like reflexology or pedicures. They certainly create orthotics and know a lot about foot conditions, but they are in no way doctors. They can’t give a medical opinion on an x-ray, for example. American podiatrists, on the other hand, have a four-year medical degree, specialized in podiatry, a bit like a dentist’s degree. They are also foot surgeons.

Maybe that explains a bit why in 2009 I was more comfortable with American doctors and really wanted to get the surgery done before leaving the country.

But I was wrong, and here’s why: I just got my hospital bill for my stay and surgery. In all, through pre-surgery, pharmacy, and hospital costs, I’ll have paid:

  • Post-surgical shoe: 16€
  • Television access for two days in my hospital room: 11€
  • Extra costs for the anesthesiologist: 49€ (dépassement d’honoraires, in other words, he charges more than the set rate, which I knew ahead of time)
  • Anesthesiologist consultation: 1€
  • Orthopedist consultation: 1€

My mutuelle is still with the MGEN, and I pay 59€ a month (for ten months) for the coverage I get, based on my salary. Here is what they and the Sécu have paid for so far:

  • Frais de séjour (hospital stay): 1373,44€
  • Prestations diverse (various services): 18€
  • Forfait journalier: 54€
  • Chambre particulière (1-person room): 86€
  • Anesthesia: 83,92€
  • Surgery: 169.29€
  • Post-surgery x-ray: 34€
  • Pharmacy costs post-operation (including the daily injections and bandages): 183€
  • Anesthesiologist consultation: 45€
  • Orthopedist consultation: 45€
  • Five twice-weekly platelet counts: 54€

All that’s left to calculate are the cost of the nurse’s visits over these past three weeks. The last one is tomorrow so I got the bills this morning. The cost of the visits is around 300€ but the Sécu will pick up all but around 80€ of that, and the MGEN will probably pick up the rest.

All in all I think I’ll have paid about 80€ for the entire thing, unless some surprise bills arrive. Back in summer of 2009 when I wanted to do this surgery, I had just lost my parents’ insurance and was paying for the crummy UT student insurance. In September of 2009 I was on private insurance with high co-pays.

(I also am regularly reimbursed by the MGEN for other things—doctor’s visits, blood tests, allergy prescriptions, the pill, so even without the operation I take full advantage of what 590 euros per year buys me.)

I felt really well taken care of by the staff at the French hospital and I’ve felt well taken care of by the other health professionals involved in this operation. I have one more visit to the orthopedist the day before I go back to work but otherwise all the paperwork should be done. All that’s left is to start walking again! The stitches are gone (they were re-absorbable), but the shaved bone inside is still tender. I also got official notice from the Rectorat that I’ll be paid in full for the 50 days that I’m off work. (As teachers we have the right to 90 days of fully paid sick leave. After that we’re paid half for some other amount of time.)

So far, a win for the French medical system. And it’s a good thing, too, because I probably will do exactly the same thing next year with the other foot.

Foot Leave, Day 6

Hallux rigidus, what I have on both feet. They took of some boney-type stuff on top, where that silly lightning bolt is.

Hallux rigidus, what I have on both feet. They took off some boney-type stuff in the red circle. http://orthoinfo.aaos.org/topic.cfm?topic=a00168

If I count from my first day entirely not in hospital, I’m on day 6 of foot-surgery-related sick leave.

Here’s how I’ve been spending my days.

  • 9:30-11 am: Get up, eat breakfast, wait for home nurse to come. Home nurse arrives and gives me an injection (Anti-phlebitis injections can hurt, btw, and leave bruises—I still have a hematoma on my tummy from the hospital. Fun!), as well as sometimes changing my bandage and drawing blood for a platelet count.
  • 11-12 am: Watch Homeland or diddle around on the internet. Wiggle my toe back and forth about 20 degrees. Take a shower with a garbage bag rubber-banded to my foot.
  • 1-2 pm: Hobble downstairs to make lunch and do dishes.
  • Afternoon:
    • Do some work-related task, such as typing in my appréciations, grading BTS recordings, or e-mailing colleagues. Watch more Homeland. I recommend it. It’s hard to stop.
    • Violin-related things: Practice the violin, diddle around on the violin, change my strings, listen to a radio show that we will appear on next week. Actually try to play more in tune (=play scales).
    • Call J to ask him to buy some miscellaneous grocery item that I can’t get myself because I can’t drive.
  • Sometime between 4 and 9: J comes home. Eat dinner, watch tv or go see SIL, go to bed. Except this week, when J is on déplacement in Picardie, so this whole last part doesn’t happen.

This is the third time J has been sent off for the week to work since this summer. Last year he did this once, and the previous four years he worked for them, it was never necessary because the sales team was doing their job and getting them the normal amount of contracts in the region. But they screwed up and hired too many people and now he gets sent to random places—St Quentin, Caen, Laon—that don’t even make up the money for his company. He’s pretty bummed about it every time because he misses me and he doesn’t have easy access to a good rock-climbing wall to train. Tonight he’s driving to Belgium and back in order to go to a good wall.

Anyway, I was worried this second week of foot leave would be pretty depressing since I can’t leave the house and my expat friends don’t have cars to get out here. But J’s friends seem to be coming through—they’re eating dinner here tonight, I’m tutoring his little brother in English tomorrow night, and Thursday night we have a concert. So I think I may not go out of my mind. But I will finish watching Homeland. And that’s a big bummer.

Surgery Part III: Post-op

So, my surgery was pretty late in the day, and I was in no condition to leave that night. The doctor had warned me that if all went well, I would spend two nights. Wednesday night I slept pretty hard despite being woken up every two hours for tests (temperature, blood pressure, how much morphine I had asked for…). The foot hurt but not too bad, and the IV was only a little annoying. Mostly I was grateful for the morphine pump.

In the morning I ate breakfast and started taking pain-killers by mouth. I started to wonder why I had packed clothes and shower gel because getting out of bed seemed such a distant possibility. But a nurse came by at around 9 to ask if I wanted to get up and bathe, and I said yes, so she helped me put on my weird shoe and get to the toilet. They gave me some disposable wash cloths so I washed up with those. Then I threw up for the first time. I pulled the little bathroom help cord and a nurse came and helped me get dressed (as in she pulled the sleeve of my PJs over the IV rod). She told me I should try to sit in the chair that morning though I don’t really know why because it only made me throw up again, and the following nurse told me I should get back into bed if I wanted. Not making that mistake again! Anyway what with the vomiting, I was calling the nurses fairly often, and they were giving me those cardboard vomit containers (called “haricots” in French, learn something new every day!), and around 11:30 they gave me an anti-nausea pill. They said it was either the morphine or one of the pain-killers I took that morning that was making me throw up.

But I ate yogurt and apple sauce for lunch, and then stopped throwing up, and watched movies on my iPad till my visitors came at 3 pm, bearing Thanksgiving treats. By this time I discovered the biggest drag was the IV apparatus which I had to drag with me to the bathroom and which made me get up on the far side of the bed—those ten extra steps are a pain when you can only use one foot.

That’s about all that happened—J came back to see me that evening when I had a real meal, though it was pretty gross for hospital food. I pumped a couple times on the morphine pump that evening but they took it out Friday morning first thing.

The doctor came to see me both Thursday and Friday mornings between his other surgeries. I had an x-ray taken in the salle de réveil that I get to keep. Friday morning SIL’s boyfriend came up to the room to help me carry my stuff downstairs where I officially checked out (handed in the TV remote, got my arrêt de travail, got my purse) and we then stopped at the pharmacy for loads of prescriptions. The only drug I’ll actually take is paracetamol, but I have a prescription to have a home nurse come every day and give me an anti-phlebitis shot (I got two of those in the hospital too) and redo my bandage and count my platelets. So I had to call a nurse Friday afternoon and make an appointment for her to come the next day.

So that was probably a lot of boring unnecessary detail—don’t blame you if you skipped some. All in all the nurses were very competent and despite the system being weirdly disjointed (I have to reserve my own room?) I think it was pretty effective. And who knows, maybe that keeps costs down? I’ll get my bill by mail in a couple weeks. During the arrêt de travail I should be paid but not for my overtime hours (if only that also meant I didn’t have to prepare the BTS oral exams!).

Surgery: Part II

My operation was scheduled for Wednesday “afternoon” (quotation marks explained further down) which meant that Ju would be at work. Fortunately, his mom is an assistante maternelle, and she only takes in teachers’ kids, so she’s free on Wednesdays.

Tuesday I finished work around 5:30 and came home to pack my bag (pjs, tooth brush, shower gel, crossword puzzles, iPad + rented movies from iTunes, prescriptions + meds). I read through the hospital welcome packet which said rooms had to be liberated by noon on the day of check-out, though you could hang out in the hospital as long as you needed. Hanging out in the hospital by myself and without a room till 6 pm didn’t sound like much fun, so when I went to SIL’s for a drink that evening, her boyfriend conveniently mentioned that, since he’s unemployed right now, he could come get me. Phew, no pricey taxis.

Tuesday night I also had to take my antiseptic shower. I thought this was the strangest thing ever till my dad explained that it made a lot of sense, to keep staph infections out of hospitals. So I washed my hair and my bod with betadine, in the precise order (hair first, bum last) that you’re supposed to, and went to bed in clean pjs all squeaky clean. I ate breakfast at 7:30 and that was my last food and drink for the day. I was supposed to report to the hospital at 11 am Wednesday so J’s mom came to get me at 10:30.

We checked in and waited at admissions for about an hour before getting my room number. I checked my purse into the hospital’s safe. Fortunately I was in a one-person room, but I did have to hang out there doing nothing till my operation at 6 (hence “afternoon”). I had to take another betadine shower and brush my teeth and put on my robe at 4, when they gave me some sort of pre-op pill. By the time the brancardiers came by at 6:20 I was no longer nervous and more ready to get it over with. I had given my valuables to J’s mom (iPad, Kindle, iPhone) so was pretty disconnected and was just watching crummy French TV (actually it wasn’t too bad, I discovered H (linked)) and doing crosswords.

At 6:20 the stretcher dudes (cannot remember the word for this in English—it’s possible I’ve never learned it…) came by and put me on the stretcher, and put a sock on the left foot so we’d operate on the correct foot, and asked me a little bit about my Americanness. I was wheeled down the hall, into the elevator, into another pre-op room, where I sat for about five minutes. Every new person who came up to me asked my last name, first name, DOB, and what operation I was there for. It sounded like a strict protocol to not mix people up (what a nightmare).

I had of course left my glasses in the room so I couldn’t see much of anything. I was eventually wheeled into the operating room where two nurses/pre-op people of some sort prepared me for the surgery. It was pretty cold and I was trembling so I don’t know if I was nervous or just cold. They were clearly joking around with me to calm me down. They put in an IV that started with antibiotics, pulled me out of the sleeves in my robe (not in that order) and stuck some things on my chest to monitor my heart. Then they put a big air-filled, heated pillow over my arms and torso and an oxygen mask just in front of my face. After that the anesthesiologist came and pressed it onto my face and told me to take big breaths of the oxygen. Pretty soon I could tell it was no longer just oxygen and passed out. I woke up in the “salle de reveil” with about five other people. There I got my morphine pump which I was told to pump on as much as I wanted (and I did not hesitate). I stayed there for about twenty minutes and then was wheeled back to the room where J was waiting with my iPad and phone. They made him leave while they set me up in the bed, took off the hair covering, put a frame at the bottom of the bed to keep the blankets from touching my foot, took my blood pressure, and told me I could eat in about three hours. I wasn’t at all hungry but very thirsty and I had to take my pill at some point.

Ju hung out with me then for about an hour. He said I was talking really loud and raspy, and that they must have put a tube down my throat, though I couldn’t feel any scratchiness from it. After he left, I slept till midnight when the night nurses woke me up, fed me, had me take my pill, and then let me fall back asleep. They came in every two hours that night though, and when I was eating, I did have a racing heartbeat that led them to take me off one of the meds.

As for the pain, in the salle de réveil, I pushed the morphine button every couple of minutes. They asked me immediately how much it hurt on a scale of 1 to 10 (actually they tried to get me to point to a number on a little 1-10 ruler but I couldn’t see the numbers and I could talk) and initially I said 5, but by the time I was wheeled back to the room, it was down to 2. I kept pumping all while J was there and then only once or twice during the night.

Upcoming: Part III: Post-Op

Surgery, Part I

So! I’m back home from the hospital where I just spent two nights. Surgery was totally new to me (except for my wisdom teeth in the States which was totally different) so I thought I’d post about it.

Last April, about when I went home to Texas for vacation, I decided that my feet hurt too much on a regular basis, despite the orthotics, to not go to an orthopedist and think about doing something more drastic, after all these years (six years to be exact). But I still put off the visit a little, deciding to try an osteopath to see if that could help (it didn’t, though I think it was good for my back and neck). Then there was the step where I had to go to my general practitioner for the reference. I finally called mid-July for an appointment with the orthopedist and got one for the end of August.

The orthopedist was very nice, seemed very competent, and said immediately that there was no reason to wait any longer to operate, that I’d been trying to solve the problem with other methods for too long, in short. He said to call to set up the operation about two months before I wanted it, and that it would put me out of work for four to six weeks (though, if I worked at a job with less standing and walking, I could have gone back sooner).

I called a few days later and asked for something at the end of November. I told my boss and my secretary immediately, so they knew the week of the rentrée in September. They found a substitute for me over the Toussaint vacation whom I met with last week in order to catch her up on all my classes. I gave her my current and following unit plans so that she can stick to what I planned as much as possible. I told the students the day we got back from the Toussaint vacation and told them why, because J suspected they would make up different, more dire reasons (“She’s dying of cancer!!”) if I didn’t tell them it was foot surgery, which, of course, I don’t mind telling them because I think there’s nothing more banal than that.

When I got my “convocation” for the 21st of November, I also got a note telling me to call the anesthesiologist at the end of September. I got an appointment for November 9th, which lasted about 10 minutes, because I have no medical history and I don’t smoke. At the end of the appointment, they told me not to forget to go downstairs and reserve my room. Good thing they “reminded” me because I had no idea I had to do it! With my convocation I also got a prescription for a post-surgical shoe, a note to bring crutches, and a prescription for a pre-surgery antiseptic. I went to the pharmacy in our little village for these things (except the crutches, with J already had) and they had to order the funny shoe for me.

Up till my entry into the hospital, my employers just had to take my word for it that I’d be gone, and that seemed pretty normal. I never showed them my convocation or anything.

Upcoming: Part II, The Actual Operation

(I mean, not that actual operation, as I was asleep for that, but you know…)