Getting the big toe fused today!

[cgarr]

At least 4 weeks in the boot, I see the doc in one week then back to work but only at the desk, will find out when I can be back to normal, thats why I had it done now, its snowie and 4 degrees here right now, wanted it normal for spring, the driving and flying season.

[Halm]

Thanks for the info Craig. Like I said, I may be facing this soon too. YUCK!

[pavulon]

No intent to hijack or drift here either....but it's subject related so I think it's acceptable.

Tetracaine and clonidine are only for max duration. Popliteal blocks can be challenging but placing them w/ portable ultasound makes it a snap. Some established people don't want to use US because it requires effort and/or if someone else is willing to do the block, why would they? Advantages are one poke, pre-op placement (cuts turnover time), works GREAT, safe, lasts a long time, can walk on it if necessary (certainly not mandatory), pre/intra-op sedation becomes optional. GA for thigh tourniquet pain if employed.

The ortho/podiatry group that serves us drives an hour to our rural hospital. We compete for their business. Our competition includes this group's own surgery center in their own office building, two tertiary care hospitals and another surgery center...all in their home town. We have to be better, faster, stronger than all of them or they don't do surgery here. Regional anesthesia is one way that we are able to do it....and we've never had an anesthesiologist here...only CRNAs that want to do what ever it (safely) takes to be better than others.

Glad to read that it went well for Cgarr!!!

Originally Posted by Tobra

Sorry, don't mean to hijack; I have never had an anesthesiologist even mention a popliteal block, and my mother is one. They would be able to walk, but I would expect you would have a tough time walking after that block, and you don't want them stubbing that toe after a fusion.

That is not how folks do it in California or Texas. The podiatrists do ankle blocks and the ortho guys do their stuff under general or spinal(which I always thought was a bad idea, why add risk to a procedure)If you do a popliteal block with epi, it will last pretty damn long, probably 24 hours, why would you use tetracaine and clonidine in the first place?

Good luck on the surgery, hope you remembered to skip breakfast.

[azasadny]

Craig,
Let me know how this goes as I need to have the same procedure. Get well soon!

[Tobra]

Originally Posted by Noah930

Ever try an Acutrak screw?

Best of luck with the healing, cgarr. I've been toying with the idea, myself, as I've been stuck with a case of gout this past week. Can't even sleep through a full night with this pain.

I could pop that with a little celestone in there for you and knock that right out for you. You would want to kiss me right on the mouth afterward. If you can stomach it, and the kidneys are okay, indomethacin is just the ticket for that too. Week is way too long to suffer with that stuff. Fusing the joint will not help much with gout issues. Cherry juice will help, that is no BS.

Don't dig the cannulated stuff for most things, but those look pretty cool. Pretty sure the rep has a sawbones play with stuff deal coming up in a few weeks for the Accutrac.

I see you got the 1st MPJ fused, not the IPJ, which is what I was thinking about, use similar technique, You dorsiflex the toe(to make walking after easier) about 10-15 degrees, do the screw from distal to proximal percutaneously from the plantar aspect, you can try an implant to salvage the motion, but none are all that great.

On the hijack side subject, I do the block prior to the prep, my anesthesiologist momma taught me, do good blocks, treat the nurses right.

On the subject at hand, or rather afoot, don't get anxious and go to fast, you want a solid union of the fused joint. Elevate it, ice it 30 minutes on and 30 minutes off when you are awake. Don't get cocky while it is numb, take it slow.

[Noah930]

Tobra,

Can't find celestone right now. It's on backorder from various vendors. I've been looking for a month (for a patient). Have tried indocin, but it does nothing for me. Only thing that's worked has been Motrin 800 Q8 hrs. Last time I had gout, it lasted for 7 weeks. Took the Motrin religiously for that long. Rheumatologists had nothing else to offer. Would be nice to have gone into some useless specialty like that, huh?

[cgarr]

3 month update! getting back into a regular shoe, healing very well, one more checkup in a month but no pain anymore and it feels great, getting around just fine and just in time for the summers DE's

[azasadny]

Craig,
How's the foot doing? I just had my 2nd severe gout attack...

[cgarr]

The foot is perfect, dont even think about it but now I am battling arthritis in my lower back, maybe there will be a disk fusing in my furture?