Posted on 10/31/2014 3:14:25 PM PDT by lee martell
I was supposed to have surgery on one of my ankles to reduce chronic pain. Eventually, I will need flatfoot corrective surgery on the right foot too. I've been ready for quite some time, and miss being able to walk without limping like an old man. The procedure would be a Sub-Talar Fusion. I have Veterans' Health Insurance only. I was less than 3 days away from the surgery date when I got a call from one of the Resident Surgeons. Apparently, he had been told that I use e-cigs and sometime actual cigarettes. My actual cig use is very low, from one to three a day, if at all. The concern was that the level of nicotine in my system would make healing more difficult. Therefore, the surgery I had waited over a year for was off. However, I was offered a chance to take a blood test, and if nicotine levels were significantly lower, I could still have the procedure in the first half of November. Was I interested? Of course I said yes, put me down for that date. The thing is, not once was I told verbatim that if my nicotine levels were to exceed a certain threshold, the doctors would cancel the procedure. I was given advisories, but never a clear directive, a definition of a 'dealbreaker' from my end of it.
Not much later, I realized that by having my surgery then in the middle of November, I would screw up the work schedule for all my coworkers. I work at a Care Facility for mentally ill adults. I had hoped to be ready by mid December to take some of those shifts open because of other's taking their Christmas Breaks. I;m probably the oldest person on staff, and I don't want to take too many chances with my position, i.e., absences due to recovery times. I realized I would be better off just dealing with the discomfort until after the holidays. I'm now waiting to get a new surgery date that is hopefully in January or February. I dealt with the change of plans logically and I think stoically. However, I felt a crushing disappointment inside, knowing that I would not be starting on the road to repair after all. I was still stuck on 'Pain Island'. I requested to meet with one of the Attending Surgeons next week, just to give them an update view on my general health and demeanor. I wonder how common it is for hospitals to cancel surgery within the last three days prior to the procedure. I've somewhat recovered now, a week since that phone call. However, I don't think that I have felt quite so down in years. The last time I felt that bad was when my mother died. Now, I have less trust in the doctors, but, I'm stuck for now. Have others had this kind of experience?
My deepest apologies for not nusing a sarc tag.
Forgot the ole sarc tag. really didn’t think it was needed
/sarc. Satisfied now?
sorry I forgot the sarc tag
see 59
LOL! You were very convincing.
It probably wouldn’t be a bad idea since a good many FReepers appear to believe the worst about smokers.
My apologies as a former smoker who will die eventually.
see 59
I quit smoking, but still actually like 2nd hand smoke from a short distance.
Oh for heaven’ sake. :-) I fell for it.
The sad thing is a post like yours is common,even here on FR.
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The risk from general anesthesia and the risk of a bad result from the surgery are separate and distinct risks. This was probably not a concern about your lungs during anesthesia but rather a concern about the compromised healing of the bone fusion from the nicotine. It was the surgeon who called you, not the anesthesia people.
Vascular supply is the key to bone healing. This is more critical when you’re talking about bone that is avascular on the day of the procedure, like the pulverized bone that would probably be used by your surgeon. It needs capillary ingrowth from surrounding tissue in order to fuse. Anything that constricts these tiny vessels will prevent healing, which would leave you with a non-union of the fusion site.
When the bone at the fusion site starts to scar without uniting, you could stop the compromising chemical and it would be too late; the process of non-union is nearly irreversible. So it matters not only that you be off nicotine before the surgery, but that you stay off.
This is all true of any bone fusion. But it is compounded by the fact that blood supply in the feet and ankles is much poorer than, say, your hands or even knees and hips. Bone in the lower extremity has several strikes against it.
This problem of compromised circulation gets worse as we get older. The older you are, the more likely your fusion will fail. Notice the line at the top of your ankles where the dark hair ended when you wee young; it’s receding.
So, add this up: diseased bone, lower extremity, fusion, aging male.
For all these reasons, it is normal for an orthopedic surgeon to insist on tobacco cessation before your procedure. And they need to see it proved by blood work. He is trying to protect you and himself from a bad result. You don’t want a failed ankle fusion.
You didn’t read all the posts did you? This was a good medical call (not a political call on smoking)
I’m tired of reading stuff. From now on I will make judgement calls on nothing but inference and rumors.
As it should be.
A proud FR tradition that we all follow.
You sound as though you have done this procedure yourself, or had it done to you or a family member. I will stay calm and hopeful. Just as when someone gets a Lapband surgery to help them lose weight, their lifestyle has to change from that point on, and remain changed. I may have to stop all smoking, even after I appear to be completely healed.
There are many great parks around here in Marin County, China Camp near San Rafael, and the deluxe model park; Tennessee Valley Park in Mill Valley; it starts as a long dirt road, gently goes over mountain sides and ends up at a beach with lots of rushing water. Both very popular parks and both very much free of charge. That is one of the things I look forward to doing and enjoying, versus just enduring as I would now. I still miss my Karate Dojo too (purple belt), but, all in good time.
sounds like they are using this as an excuse to delay your surgery. who knows how this makes them look good to their superiors.
prayers up for you.
if you know anyone who uses therapy lasers for pain treatment, they might be able to do a session on you to see how the pain reduces. over 90% of people respond well to laser therapy.
Laser Therapy you say? Hmmm. I’ll have to ask if this if offered at the S.F. Veteran’s Hospital.
I used to be a scrub tech in orthopedics and for a couple decades now have managed orthopedic surgery offices. My education is business, but I spend an excruciating amount of time with orthopedic surgeons.
If your pain is from your ankle joint lasers won’t help.
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