Day 4 through 10 Post-Op

The days following my surgery were relatively uneventful. I adhered to Dr. Wu's advice and did not leave my uncle's house for over a week. One important item to keep in mind is to do core and back exercises during this time as well. This will help prevent your back from becoming strained due to sitting all the time. I also found that standing every now and then was also important for the leg (and back) muscles.

Otherwise, I hobbled around the house okay, and spent most of my time keeping my feet elevated and continuing with my toe exercises. Keeping my feet elevated for the first week was important because it was uncomfortable when my feet were down and the blood was concentrating down to the bottom. With assistance, I was able to shower each day and we developed a good and efficient routine. Again, those foot covers are life savers! My pain level, at rest, was pretty much at zero after the 3rd day. I never had to take any pain medication after the 2nd day, which was great! The only time I experienced some pain was when I performed my toe exercises and was stretching the muscles/ligaments. This was to be expected and my right foot was a little more painful, whereas my left foot had no pain. The swelling also was not as significant as I thought it would be. The picture below is so far the worse I've seen, with some bruising around the big toe areas. I checked in with Rachel and Dr. Wu and they said it was to be expected. Rachel had provided me with some bruise ointment to use 2-3X a day, as needed. I used the ointment just a few times throughout the whole week. Also used ice packs when needed. 

At Day 10 (October 29th), I was finally able to leave the house - hooray!! I had a follow-up appointment with Dr. Wu. Getting out of the house was not too difficult. Again, I needed to walk slowly and luckily my uncle's place has an elevator. I felt bad taking so long to just even walk to the elevator, but I kept telling myself not to rush and that people can wait a little longer for me to get in. 

When I got to Dr. Wu's office, I had to wait for a bit because we were early for our appointment. The secretary, Grace, was very courteous and led me to the sofa where she then placed a platform in front of me to help me elevate my feet. Once Rachel was ready for me, she called me into the room to take new X-rays. At the same time, she also gave me the X-rays that were taken intra-op (during surgery). I didn't have an electronic copy available of the intra-op X-rays, so I had to make do with taking a picture of them (sorry for the poor quality). The X-rays look great though! I've also put a picture of my feet "before surgery" to act as a little comparison.

After the X-rays, Rachel checked both my feet to see how far back I could bend them. My feet were registered to be 80 degrees on my right and 75 degrees on my left. They were a little tight in the morning, but I know I needed to keep exercising so I could get to 90 degrees for both. Rachel then went ahead to take off my bandages. Luckily, I didn't quite know what to expect so there was no anxiety. But this part was somewhat painful. Even though the cuts had mostly healed, they still stung when the bandages were quickly removed and alcohol wipes were used to clean them. I was sucking in my stomach a bit to help me cope with the pain. It wasn't a sharp pain, but a very sensitive feeling that was uncomfortable. Rachel then went ahead to cut and remove some of the stitches. Again, it was not a pleasant feeling, but luckily she is so good at doing this, she removed everything quite quickly to minimize the pain. After she finished cleaning, she placed some clean surgical tape on my cuts, asked me to place my feet back into my surgical boots and then walk to a different room.

Dr. Wu joined us not too long afterwards. He asked how I was doing and how the pain was. I told him I had no pain and had not used any pain medication since the 2nd day. He then proceeded with adding additional surgical tape to secure my feet. Then he started to create the synthetic forefoot cast around the mid-to-top section of my feet. It was fascinating how he created this cast and it was definitely different than the casts I was used to seeing. The picture below shows the finished product. The casts do eventually become a little tight over time, which can contribute to some additional swelling of the toes. But overall, the swelling is still not that bad.

Walking in these casts has proven to be more interesting as it is a hard cast and now my feet are somewhat elevated. It kind of feels like I'm walking in cycling clip-on shoes as a comparison. This cast helps keep my feet secure and helps to ensure that the straight alignment of the feet are maintained. Again, doctor's orders are to stay at home with feet elevated as much as possible. Dr. Wu said I could go out to eat, but it is important that I don't walk too much and use my crutches. Eventually, after 1-2 months, Dr. Wu will suggest for me to stand a little more to start re-building the strength in my feet muscles. 

Before I completed my appointment, I went ahead to schedule my last appointment with Dr. Wu before I head back to the US on November 30th. At the next appointment, he will be providing me with additional instructions and exercises to use when I am back home.   

My uncle treated us to a nice lunch afterwards in Repulse Bay. He said that since I've been couped up in the house these past 10 days, we should eat a nice, stress free lunch. The staff at this restaurant were wonderful and very accommodating. It was the perfect setting as there were few people eating and I could take my time hobbling around the restaurant. The food was great too. Below are pictures of the restaurant and outside, plus me trying to tackle the front stairs. Slow, but I made it down to the bottom successfully!

Day 3 - Discharged from the Hospital

My second evening at the hospital passed without incident. Again, I was fighting jetlag, but everything else was okay. I was being discharged from the hospital that morning, around 11am. I had eaten some of my leftovers in the morning so when my mom arrived, we went ahead to have me shower once more before I left the hospital. 

Dr. Wu paid me one last visit in the morning. He checked again on my pain level and my progress with my toes exercises. I was able to get to about 70-80% bend after all my exercises the day prior. He seemed pleased with the progress and told me to continue with my exercises, but this time do them every hour instead of every 30 min. I had very little pain during rest (probably a level 2) and had stopped taking pain medication the night prior.

The rest of the morning was spent wrapping up my hospital accounts, getting some last minute pain medication from the pharmacy (which I didn't need but took with me anyways), and making sure everything I brought was packed up. The discharge process was very smooth and they provided me with a nice summary of the surgery that was performed on my feet. I was also given some discharge instructions to follow.

Here I am being wheeled out of the hospital to my uncle's car. I was then taken back to my uncle's place to rest and recuperate. Dr. Wu's orders were to not go out of the house for at least this first week. It is better to keep my feet elevated and not walk too much. Also below is one last view from the peak, provided by my friend. :-)

Day 2 After Surgery

It was Day 2 after surgery and as time passed, the pain was less and less. After about mid-day on day 2, I opted to not take anymore of the pain medication they provided. One, I didn't feel like I needed it and two, the codeine in the medication gave me nausea. I had brought some Advil with me so I felt that if I needed pain medication, I'd prefer to use Advil instead. Again, I was surprised that there was not very much pain. At rest, the pain had dropped to about a 4-5 level already by Day 2.

The nurses came in, early in the morning, to change the dressings on my feet. I was briefly allowed to see my feet post-op, but was only able to snap a couple of quick pictures. Changing of the dressing was not bad and was not very painful.

 

Dr. Wu then visited me soon after the bandages were changed. He took notes on my pain levels, how I was feeling, and re-wrapped some of the bandages around my feet. He also said that it was important to start my physical therapy exercises today. I was to do three exercises, three times in a row, every 30 min. You can say that I definitely kept myself busy on Day 2! The three exercises he taught involved bending the toes backward and the goal was to get them to 90 degrees over time. This was where it tended to be more painful - when I started doing these exercises. Dr. Wu acknowledged that I needed to work through the pain because as I did the exercises more often, the pain would eventually decrease. He was right of course and by evening time, the pain had lessened and I was more flexible than I was in the morning. He also advised that I wiggle my toes as much as possible to help with the swelling and tightness.

The other good news about Day 2 is that I could get off the bed and walk for the first time, post-surgery. Hooray! I could use a regular bathroom :-) My friend who did the surgery a year ago, paid me a visit in the hospital. She showed me some good ways to use my crutches to help me get up and down. Walking for the first time was not difficult and I mainly needed to be careful to take things very slowly. My feet were a little tight when I walked, but overall the surgical boot helped mask a lot of the "impact" from walking. I was able to walk to the bathroom and back to my bed without much problem. I ended up doing that, on my own, during the rest of the night too. We were allowed to take a shower on Day 2, which was a nice treat. The hospital provided me with these two plastic covers to wrap over my feet and ensure that no water gets in. These were professional grade foot covers and they were very good. I'm so happy I have these and know I will be using these for sometime throughout my recovery.

I was fortunate to have more visitors throughout the day and evening. Family and friends brought me lots of food to eat, including dessert. I definitely was not going to go hungry :-) I had to spend one more evening in the hospital and then I was okay to go home the following day. 

Day 1 after Surgery

Once in my room, they placed ice packs on my feet immediately. There was no real pain at all. My voice was a little croaky from being intubated, but not bad. I was not allowed to eat for about 3 hours and I had a little nausea from the anesthesia medication. My feet look enormous in the picture, but it really was not bad at all. The ice packs made them look very swollen, but the swelling was very minimal.

During the first day, we were advised to not get off the bed at all. This was okay except that it made going to the bathroom an interesting experience. Using a bedpan is never a pleasant thing, but I guess it is better than other options. Luckily, it was only for one night. My pain level was tolerable. I think overall, the pain may have gotten to a 7-8 at one point, but never enough to ask for an extra shot of pain medication. I just continued to take the pain pills they provided every few hours, which was panadeine. This and the anti-inflammatory medication they provided was more than enough. Several hours later, I was finally wanting to eat something. I could have eaten earlier, but I was not very hungry - probably from all the medication I was given. Here I am trying to eat some fried rice from the hospital. It was not very good, but did serve its purpose to put something in my stomach.

My mom was such a trooper as she stayed with me throughout the entire day and into the evening. I don't know what I would have done without her and am truly grateful for her love and support. My relatives were also so nice to visit me that first evening and it was great to see them. Once everyone left for dinner, I was left to the care of the nursing and medical staff. They were very attentive, responsive, and helpful. My first evening in the hospital was very pleasant, except for the jetlag I was still fighting. :-)

October 20th (Surgery Day) has arrived!

It was October 20th, 2015 and the day of my bunion surgery! I was surprised to say that I was not very nervous about the surgery. More anxious to get it over with, but I believe I prepared well enough that I knew exactly what I was getting myself into. My surgery was not scheduled until 9:30am, but we went to the hospital early to avoid traffic. Dr. Wu currently operates out of Matilda International Hospital up on the Peak. This was a beautiful hospital and had an intimate atmosphere. The front entrance alone had a spectacular view.

Once inside, the lobby and registration desk mirrored that of a fancy hotel. Marble walls and floors, it really gave us patients a pleasant feel of the hospital. Again, it is a very intimate hospital so each time an employee spoke to you, they were not rushed and were very courteous. After checking into the registration desk, I was escorted to the 2nd floor, which was where my hospital room was. All the nursing and clinical staff were very professional and efficient. After confirming my identity multiple times (a big plus for me since this is SO important), I was given a wristband and brought back to my room. They completed the check-in process, which included taking my baseline blood pressure and temperature readings. They explained to me the schedule of the day and how I could store my belongings. I had my own locker to store my items and also a small bedside compartment to also store other items. Dr. Wu and the anesthesiologist, Dr, Chan, both came by to talk with me beforehand. They had to ask some additional questions, including my current pain level (1-10), and whether or not I had any allergies to medications. I was told to change into the hospital gown and about an hour before surgery, to perform the betadine wash on my feet. Dr. Wu's patients were provided with a betadine wash solution and sponge to soak one's feet into and to clean the feet prior to surgery. They would sterilize my feet again while I'm in surgery, but it was important for me to do this initial cleaning. They provided me with directions as they felt that patients would clean their own feet more thoroughly. Once I completed my betadine wash, I used the clean slippers they provided me and waited.

Once they were ready for me, the nurse escorted me down to the first floor where the operating room (OR) suites were. Again, I was thankful that I was not very nervous as I've been inside ORs before, for my work. I knew generally what to expect. The surgery was supposed to last about 2.5 hrs (1hr 15min per foot), and I would then be rolled into the recovery room to wait until I woke up from the anesthesia. So overall, probably about 3 hrs before I'm back in my room.

They walked me to the OR waiting area where another nurse perform some final pre-op checks (very impressed again). She re-confirmed my identity and asked about my allergies, whether I had any jewelry, loose teeth, etc. Dr. Wu was also sitting there and we briefly chatted about work before I walked into the OR room. Once I was inside the OR room, they asked me to lay on the bed and they immediately covered me with a nice warm blanket which had a hose pumping warm air inside. They definitely did not want me to be cold. :-) On my right arm, they were taking blood pressure readings and on my left, Dr. Chan was explaining that he was going to insert a small needle into my left hand. He said it would sting a little bit, but not too bad. Only at this point, did my nerves get to me a little and I was having jitters. But everyone was very nice and did their best to calm the situation. I chatted with Dr. Chan as well to help me calm my nerves. Once he successfully got the needle in, he then explained that I would feel a slight stinging sensation in my left hand. That was from the medication he was administering to me. I acknowledged that I felt the stinging sensation, and then I don't recall anything after that. That was probably when I blacked out/fell asleep. Haha! Next thing I know, Dr, Chan is waking me up and saying, "Nathalie, we're done now." When I heard that the first thought I had was, "Already? Really? That was fast." I literally only remember falling asleep and then waking up. The whole surgery felt like it lasted only 2 min to me! Below is a picture of them wheeling me out of surgery and everyone was surprised to see how alert I was. I guess it didn't take me too long to wake up, which was great! I think I got back to my room around 12:30pm, so 3 hours was a good estimate.

Pre-Op visit the day before surgery

It was the day before surgery and I was excited! I couldn't believe it was happening after months and months of planning. Besides planning for the surgery, I also had to get things settled at work and for when I returned home. I would not be very mobile when I returned home so I needed to be sure to have a wheelchair rented and other items ready. Taking medical leave from work was a complicated process and luckily everyone at work was very encouraging and helpful. I worked as close to the day of surgery as I could so I didn't have to take too much time off work beforehand. 

My pre-op appointment with Dr. Wu was scheduled for the afternoon of October 19th. During this time, Rachel took some additional X-rays to use as baseline for their files. I was provided with pre and post surgery instructions, and it was explained how checking into the hospital would work. She showed me how to do physical therapy exercises on my feet, which I was to do after the surgery was completed. I was also given the surgical boots and crutches to use post-op, and Rachel showed me how to use them. She had me demonstrate to her how slow I should be walking with the boots and crutches. Walking very slow and light on my feet were the main items emphasized. It was interesting adjusting to the shorter crutches, but it was not too bad. I then had one last meeting with Dr. Wu and we discussed my anesthesia options and again what the pros/cons were to the surgery. I decided to go with general anesthesia (versus spinal anesthesia), where I would be given medication and then intubated. He asked if I had any additional questions and when I was finished, I was ready to go for surgery the next day. 

Next stop was to eat as much yummy Hong Kong food before surgery! Since I had to fast for several hours beforehand, it was best to eat as much as I could and while I could still walk too! :-) I had Hong Kong Thai food and it was delicious! Curry crab with roti.....yum.

Whirlwind Visit to Hong Kong

I am very fortunate to have family who can travel with me to Hong Kong and family who lives in Hong Kong. I am very blessed and eternally grateful for this. So, during September 2015 (Labor Day weekend to be exact), I flew to Hong Kong for my first in-person visit with Dr. Wu! Luckily, Dr. Wu had appointments on Saturday mornings, so I did not have to take too much time off work. Even though I was only in Hong Kong for 1.5 days, the purpose of this trip was to connect with Dr. Wu and his staff. 

My family and I arrived at Dr. Wu's office a little early for our Saturday appointment. Dr. Wu's office is located in Leighton Center near Times Square in Hong Kong. His office is part of a medical floor and is very clean and spacious.

When we arrived, I was greeted by Dr. Wu's nurse, Rachel, who had been very helpful and informative during this whole process. She gave me registration forms to complete and brought me into a room to take pictures of my feet. She took pictures from various angles and also took pictures of the callouses that I had. From there, we were brought into Dr. Wu's office to have a face-to-face consultation with him. Upon meeting with Dr. Wu, I was reassured by his helpful and open nature. He was very courteous and answered whatever questions we had. He listed the pros and cons to the surgery and what to expect. He also clearly stated that the success of this surgery was also very much dependent on the patient and how well they follow the post-surgery instructions. If the patient walks too much after surgery, this will not help the fibrous bridge to form successfully. 

After we met with Dr. Wu, I was then brought to another room to perform a foot function test, that was specifically designed for Dr. Wu's office. I was placed in these tennis shoes that had sensors in them. I was then asked to walk on a treadmill, using my normal walking gait and speed. Next I was asked to put as much pressure from my heel to my toes, as I walked - to overemphasize my gait. This allowed the software to see exactly what parts of my foot were being used when I walked. The function test showed that I didn't use any of my toes for support, and that I was compensating my gait to avoid pain in my bunion. It was very interesting to see and I'd be curious to see what this test looks like after I have fully recovered. 

After my appointment with Dr. Wu, I met up with my friend who had the surgery performed a year prior. This was also very helpful as it allowed us to see that everything was okay and she was happy with the result. I had always thought to have surgery done on both feet at the same time, since the surgery was in Hong Kong. I rather get through the whole process once instead of having to worry about coming back a second time to have the other foot fixed. Luckily, Dr. Wu's technique is less invasive which makes operating on both feet more feasible. The few patients I connected with also had both feet operated on at the same time.

So, the decision was made to move forward with the operation! I was happy the visit was such a success. Now, I had about a month to prepare everything in California, before I fly back to Hong Kong for the surgery.

Second Opinions and more...

Even though I was excited about this "new" alternative technique, I still had my doubts because the technique wasn't heavily used yet for bunion surgery. Was this truly a technique just waiting for people to discover (ex. like with Lasik surgery)? Or was this technique not reliable and that was why surgeons don't perform it? I did not and still do not know the answer. What I did know is that Hong Kong is very advanced in a lot of what they do and I trusted their healthcare system to be reliable. Just because the US was not yet using this technique, did not mean it was not worth pursuing. Looking outside of the US can often help open our eyes to other ideas. Plus, I also had first hand communication from a few of Dr. Wu's patients and this was extremely helpful to me when researching my decision. 

One of the first steps I did was to obtain current X-rays of my feet and have them evaluated by the specialists. See below for a copy of my original pre-surgery X-rays. 

The deformity was not minor and I was a candidate for surgery should I choose to have it. I ended up asking opinions from a few orthopaedic surgeons/podiatrists that I knew. I can tell you this was both a good and a bad thing to do. It was good to get different opinions from different specialists, but unfortunately, almost all their opinions were different. A couple stated that the Syndesmosis Procedure (SP) would be worth trying, while others were adamantly against it, saying it would not work. The interesting part was that all the specialists I queried, had over 20 years+ experience under their belt, and all believed they were right. As a patient, it was very confusing and eventually I stopped asking different specialist's opinions because it was overwhelming. At one point, I was told that the decision was ultimately between the patient and the surgeon, and there must be an equal amount of trust between both parties in order for the surgery to be a success. The patient had to trust the surgeon and the surgeon had to trust the patient would follow their instructions during the healing process. 

Again, I cannot explain why this technique is not yet practiced in the US, but I am hoping Dr. Fellner and his group can start a successful trend to make this procedure more well-known. In my opinion, the concept proposed by the SP makes sense. There is less trauma than with conventional surgery and a successful surgery can also lead to better foot function overall. Besides correcting my bunion deformity, the surgery may also help raise my arch a little more which can improve the way I walk. My decision to have or not have this surgery was based on my communication with Dr. Wu and his team, my communication with Dr. Fellner on the SP, my communication with other surgeons/podiatrists, and also on the testimonials I was able to retrieve from Dr. Wu's patients. Some of the patient testimonials that I heard, were from patients who underwent the surgery several years ago. There were also patients who had undergone the SP surgery over 10 years ago, but I did not query them for information. All the patients I queried were happy with the surgery performed by Dr. Wu and so far, have not seen any re-occurrence of the bunion.

By August 2015 and after multiple (after multiple) communications, I was 90% sure I would proceed with the non-bone breaking surgery performed by Dr. Wu. My next step was to meet with Dr. Wu himself to have him evaluate me in person, and for me to also get a sense of who my doctor was. Since March 2015, I had not met nor spoken to Dr. Wu and felt this was an important step before I made my final decision. I would be performing this surgery out of the country (I live in California), and a decision like this would need lots of coordination.

First Introduction to Syndesmosis

So I was having brunch with two girlfriends, back in March 2015, and the topic of wearing heels came up. I was asked why they didn't see me wearing heels much and I gave them that face - the ugh, I've got bunions face - and told them that its too painful to wear heels. Up to then, the life involving my feet (aka "feet life") have been around which shoe I should wear that day that won't cause me pain. Or if I were to wear a shoe that causes pain, how much pain will it be and can I wear them for more than one day? I think most everyone that has bunions will understand what I'm talking about. We are so limited by the shoes we wear and even if we are good, and wear flat, comfortable shoes, these "comfy" shoes may or may not help with the pain. I've worn custom orthodics the majority of my life and although it may have slowed the progress of the bunion, it definitely did not improve the overall condition. The bunion (and possibly the pain) would only get worse over time.

A couple years ago, a podiatrist saw my feet, and told me right away that I needed surgery. I was disappointed to hear the news, but knew that it would eventually come down to me making a decision on what to do with my feet. He of course, proposed to me the traditional osteotomy that is practiced all over the US and the world. This involves breaking the bone and shifting it to the correct position. He also told me that if the bone is not perfectly aligned, the bone may shift back. I have always been familiar with this type of surgery and my thoughts have always been very negative about it. I've heard so many stories where this traditional surgery failed, and the patient ends up having the same bunions come back. Why on earth would I want to do a surgery where the probability of failure was "high" in my opinion?? I was very reluctant to even pursue researching the surgery, but thought I had no other option.

Then, during that same brunch I was having with my girlfriends, a new option was suddenly presented to me! One of my friends had a friend who just recently underwent bunion surgery. She was gracious enough to reach out to this friend for more information. The information that was sent to me was about a different technique used for bunion surgery, which does not involve breaking the bone. The non-bone breaking surgery was performed using the Syndesmosis procedure (SP). More information can be found on Dr. Wu's website (http://www.bunioncenter.com/), as I won't be able to do it any justice describing the SP here. I quickly jumped onto this website and researched as much as I could about the SP. I got quite excited and felt like I may have found a surgical option worth looking into.

From what I understood, only Dr. Wu has been performing bunion surgery using the SP. There does not yet seem to be another surgeon who has looked into this type of procedure except Dr. Fellner, who will open up a practice in New York. Dr. Fellner had visited Dr. Wu in Hong Kong and observed his technique. His view about the SP can be found on his website here http://www.bunioncenternyc.com/. I was happy to have found this option and this referral led me to do quite a bit of research over the next few months.