Tumors, Arthritis, Propofol, and Depression

It has been a bit over three years since my last surgery, and that seems pretty impressive to me.

Well, not really. This is only my fifth overall(an average of 1 in every 11 years) and the second time that had little to nothing to do with an injury. It is also in a new area. All my prior surgeries were in my nose/sinus and my left shoulder. This one was for a foot issue that I have been dealing with since 2015 or so and a new-ish heel problem. Fun!

I suffered from severe depression and psychosis with my last two surgeries. I was curious how I would react now that the new psych stuff is much more normal to me. Oddly enough, the same stressor was involved in the first two, and I strangely allowed myself to risk having it happen a third time this week. It is kind of strange, although the third time is after the fact. I wonder if it means anything?

Setting up the problem

I have always had foot problems, at least going back to my years in the Army. After being on my feet for hours without being able to move much, if at all, my feet would be screaming in pain. I could barely walk, and it also affected my knees.

In 2015, I started getting a sensation in the ball of my right foot. Not long after that, it started up in my left foot but was not bad compared to the right. I went to a podiatrist, and he diagnosed me with Morton’s neuroma. It was a little scary because a neuroma is a tumor. I learned that it is a tad misnamed. What it is is a nerve between two bones in the ball of my foot that had become swollen. It causes a feeling like I am standing on a rock. Sometimes, it is a thin, flat rock. Sometimes, it feels like a round rock, and on bad days, a spiky, sharp rock. He gave me orthopedic insoles and gabapentin. The pills did not work, but like many other meds, I was having a few bad side effects, so I stopped that. He told me that surgery was an option, but it would make my toes numb forever - put a pin in this - and he wouldn’t do it. Every so often I would get new insoles and my feet were pretty decent.

Almost two years ago(!?!), my right heel started to hurt. It felt like something separated initially but was only a dull pain afterward. It happened at my moms, and would only hurt at my mom’s. She has real hardwood floors. It is awful. It would come and go but early last spring, after coming home from my mom’s I stepped out of my car and my right foot blew up, and I fell on my garage floor. It was very difficult to walk after that. Now, I am a butthead and didn’t go to see a doctor for about two more months. It got so bad, that I very carefully drove to the nearest urgent care. They claimed it was plantar fasciitis and gave me a giant boot that is impossible to drive with and some anti-inflammatory.

It seemed like maybe I should go back to my podiatrist and I called to make an appointment. I hadn’t gone in so long that I needed a new referral. I contacted my doctor and her nurse said they needed x-rays and the quickest way is to go to the VA urgent care. So back to urgent care for the second time in three days. They took the X-rays and changed the diagnosis to arthritis. My doctor said that she would put in a referral but I have to promise to come in for a physical. I have been avoiding that because of my feet and knees, I had gained 5 pounds or so because exercising is extremely painful. So I made both appointments and the physical went better than I had hoped for.

The x-rays showed arthritis in my heel, a bone spur right in the middle of it and every bone in my foot is degenerating. I am not that old and my entire skeleton is breaking down. My future consists of one thing:

A few days later, I started throwing up and kept at it for 2 days. I called my doctor and she said it is my anti-inflammatory and I need to eat before taking it. I said I had eaten a bowl of hot muesli before I did. So, she switched me to Celebrex. That medication makes my headaches much worse and I have constant blurry vision. 800 mg Ibuprofen - which is a ton - doesn’t even put a dent into it.

So, the podiatrist confirmed the diagnosis and gave me new orthopedic insoles. They worked well on my heel. There is always a problem and that problem is the neuroma. It made it much worse. I gave it some time and just kept getting worse.

I go back to the podiatrist and he now says I could get the swollen nerve removed. After eight years of random suffering! He also said that it would not make my toes numb, just the sides of the middle toes. That is actually an improvement as my toes are already often completely numb.

They also put down that they will inject my heel with my own plasma while I am out. I guess that is a good treatment for arthritis. It took about 2 seconds to agree on the surgery and set the surgery date as soon as possible.

That was a good decision!

The week before the surgery, I was walking with a cane and couldn’t even take Ragnar for a walk longer than 20 minutes, and could only move very slowly. That frustrated Ragnar.

I bet I looked like a broken hundred-year-old.

It really sucks. Besides missing a ton of workouts, I also missed two concerts(Lorna Shore and then Jinjer) this year that I really wanted to see. There was no seating available. That would have killed my feet and knees.

The Jinjer show was on my birthday! grrr

Beating the Anesthesiologist

It is impossible, but I always try to beat the anesthesia.

Why?

Don’t know!

I guess it is my competitive nature.

I have had terrible surgical nightmares, from being awake during a septoplasty to waking up after my second shoulder surgery getting yelled at by a nasty nurse for something.

The anesthesiologist told me that I was not going to get put completely under, they would give me enough propofol to force me to sleep. They said that they would not give me opioids during the procedure, but would block the nerves to my feet, so I wouldn’t feel anything. The part about not being completely under sounded not-so-great, but the no opioids part was wonderful. Two surgeries ago, I overdosed on them during the procedure and had to be revived with Narcan. It seems that I am very sensitive to opioids.

This surgery allowed some insight into the potential problem because it removed opioids from the equation.

Apparently, I was very nervous before surgery. I had three nurses take turns distracting me while they were doing all the awful stuff in pre-op. Most guys would love attention from three pretty nurses, but that made me more anxious. A fourth nurse comes and gets me to take me to the cold operating room. I have never been in such a cold, crowded, and busy OR. The nurse was setting me up and telling me what was going on. Then the anesthesiologist told me that they were starting the propofol. I felt a burning sensation in my hand where the IV is, and I fight the propofol.

It actually worked!

Well, kind of.

I was winning for 3-5 seconds, and I regret trying.

Right after the burning sensation, I started to panic and try to yell at them to stop. It felt so awful. Almost like a seizure aura mixed with an anxiety attack.

When I first woke up, I could hear someone yelling. They were asking where they are at. It took me a few minutes to realize it was me!

I think it was a dissociative event. I was so panicked, and it took a while to calm down. The problem was that I was told I would return to the room I started in, and this was a different room. I feel so bad at yelling at nurse number five. She eventually wheeled me back to the original room where I started. I got stuck with the original three nurses. When nurse five left, I pointed at her and said that I thought I was yelling at her. The nurses laughed and said that they yelled at her a lot and not to worry because it happens sometimes.

The propofol also caused the worst headache that I have had in 25 years or so. Surprisingly, they gave me a bunch of hydrocodone. One in the hospital and enough for 4 days if I take it every 6 hours. It has been about 10 days since the surgery at I have at least 10 pills left. I still take them, at most one a day. I guess I am so used to pain, and I hate opioids that the pain has to be severe for me to take one. My foot definitely hurts.

The nurses asked about my headaches. I told them that I have had constant headaches since 1995. They seemed shocked. I guess it is strange what people can get used to.

Next time, I might not try to fight it. If there is a next time, yelling at the poor nurse bothers me so much I might not go back to surgery for any reason.

Edit: I found out much later that the propofol did not work entirely. They could not put me in a deep enough sleep, so they ended up putting me under general anesthesia. I wish I knew if that is related to my difficulties with sleep or some other reason.

Did it work?

The jury is still out on it. My foot is still heavily wrapped and will be for about 3 more weeks. In a few days, I go in to get it looked at and rewrapped. This is the easiest recovery from surgery I have ever had. No physical therapy and no rinsing out my sinuses twice a day - which is less fun than it sounds.

The wrapping sometimes bunchs up, which makes the pain in the ball of my foot worse. I am not allowed to mess with it at all. I make minor adjustments to it because I am a rebel.

I have plastic on the top and bottom of my feet and plastic between my toes. Over that is a thick layer of gauze and it is held together by a wrapping. It gets itchy, and I am not allowed to get it wet. They gave me these weird plastic legs with feet and a belt to secure it while I shower.

I bet everything below my knee reeks.

Did something change?

Perhaps I am not as depressed as I think I am.

Perhaps I am at maximum depression levels.

Perhaps I am so used to pain and disappointment from others that nothing phases me.

Perhaps my brain has changed.

The difference between this surgery and the last two is night and day.

The main difference is that I was given no opioids during the procedure this time and was given weaker opioids to take home with me. The other difference is that I didn’t have a specific person directly on my mind. They are always in the back of my thoughts. It is strange and wonderful that they popped back into my life a few days after surgery. That seems over, yet again, with no explanation for the appearance and disappearance.

At least I am taking it better this time. Yes, I am being vague on purpose.

The freaking out in recovery is not a good thing. I would love to ask an anesthesiologist if it was the propofol that caused the panic.

It doesn’t seem to bother anyone else. It bugs the crap out of me. I work hard to maintain consistent behavior, so anything out of the norm worries me.

Since the surgery, I have woken up several times because I feel extremely anxious. It seems odd that something that forces sleep could cause panic, but lots of medications have contradictory side effects.

I can’t exercise right now. I should be able to get on my inclined bench soon to start working on my stomach and arms. I hold myself up on a steep angle while working on resistance bands. By mid-December, I will hopefully be back on my indoor bike. With a lot of luck, I will be outside on my bike next spring, summer, and fall, but that might be too optimistic.

If it doesn’t work, I have a plan B. I will get a circular saw blade hot and then remove my feet. The hot blade will cauterize my ankles, so I don’t bleed out. Okay, I am only half-serious.

What is next?

It seems I am falling apart, so it is only a matter of time before something else breaks. It could be my left foot. It has the exact same issues as the right foot, yet the neuroma doesn’t hurt nearly as bad, and I feel no effects from the arthritis. We’ll see.

I don’t know where I go from here. The results of the surgery are unknown. I may be back to the level before my heel starts to hurt. That would be good. I could work on my house and yard projects and exercise without much pain.

I could end up no better than pre-surgery, and then everything gets difficult again.