The picture above shows "post surgery" and "pre-surgery" x-rays of my foot. The picture on the left was taken 10 weeks post surgery (the first day my doctor allowed me to wear a shoe on my left foot), and the picture to the right is an x-ray taken 2 weeks prior to my surgery. The "before" picture reveals considerable arthritic bone growth around the joint. It also shows a bone chip on the inside of the left big toe which may indicate a prior injury where the ligament pulled away from the toe bone and ripped a bone fragment away with it. The x-ray also shows that the toe bone is kicked to the right so it appears to be slipping off the toe bone. Finally, the very small gap between the foot bone and toe bone highlights that most of the cartiledge is gone and it is "bone on bone".
At some point in my childhood I apparently injured my left big toe, but never did anything about it. I always figured it must have been during soccer or some other sport, but quietly admit it could have been one of those clumsy toe-stubbings that hurt so @#%* much for several minutes and then goes away. Regardless, it happened, or so says my doctor who looked at the x-rays of my left big toe.
And with time, the cartilage between the bones wears away...and eventually it is nothing but bone on bone. Each year I could tell it was getting worse and worse. Running and tennis, in particular, caused severe inflammation where I would spend weeks on the sidelines barely able to walk. When my foot got better, I became active again.....and the inflammation would return. It was a predictable cycle of health, pain, and continued deterioration.
Of course I occasionally went to a doctor who took x-rays, assessed the results momentarily, and predictably acknowledged "yup, you've got a bit of a problem there." Eventually, after hearing about people getting hip and knee replacements, I asked the doctor about a toe-joint replacement surgery. It seemed logical to me that if major, weight-bearing joints could be replaced with a slick combination of titanium and polyethylene, then why couldn't my sore big toe get a smaller version. My thinking was flawed. Apparently, it is the very smallness of these toe joints combined with the surprisingly complex role they play in everyday activity and balance, that makes current toe-joint-replacement surgery problematic. Even after seeking out one of the top sports-medicine doctor/surgeons in New England, I was given the sad news that current "state-of-the-art" for dealing with this problem is toe fusion.
In January of 2009, my doctor encouraged me to hold out as long as I could, in hopes that new, proven technology would be developed that would make toe-joint replacement surgery the superior option based on long-term patient success, resumed activity, and minimal complications. As is usual with healthcare-related matters, what is most critical is the data captured over a long period of time. What may appear as a technical breakthrough or innovative genius today, all too often becomes debunked with sad data provided by the early patients.
After experiencing a grim summer of athletic activity where any efforts at regular running, tennis, or even the mild-mannered golf were rebuked by my painful, swollen toe...even to the point that I couldn't put on a darn shoe....I decided that I needed to seriously explore toe fusion surgery. Initially, I went online and googled "big toe fusion" or something like that, and poured through dozens and dozens of horror stories about people that have had toe fusion. Actually, I was surprised so many people in the world had ever had toe surgery....and they all seemed to be miserable. "Fusion failed....going back for my second/third surgery....more pain than ever before....can't wear shoes....etc" And then someone reminded me that the only people that post online are those experiencing problems and searching for solutions. I know this is not entirely true and that there are many who post wonderful encouraging pieces, but my first impression as a potential patient wasn't so positive.
Tail between my legs, I returned to my doctor and informed him that I couldn't wait. This was seriously impacting my active, athletic lifestyle and I couldn't stand it any more. Please tell me again about the current "state-of-the-art" in toe surgery, my prospects for success, and time required for recovery. Of course in this day and age of legal liability no doctor will tell you what you want to hear or even, possibly, what he or she truly believes because all risks must be disclosed and there are no certainties....and as a result it is almost impossible to get a clear cut recommendation or projection. All I can suggest is ask the doctor "if you were me, what would you do?" After asking all my well-prepared questions, I was convinced that I needed to go ahead with this EVEN THOUGH I never got clear cut answers to so many of my questions. I had received enough data points (Internal: pain, lifestyle impact, progressively getting worse: External: doctors saying it is bad, other doctors supporting that fusion is state-of-the-art, other doctors saying my sports medicine doctor is one of the best in the country), that I went ahead and scheduled surgery.
Even this simple task required some forethought. When could I afford the time? According to my research earlier, my foot would be non-weight-bearing (read: crutches) for 2-4 weeks. After that I figured that I would be in some kind of removable boot, where all my weight was applied to my heel when I walked, until week 6-8 after surgery. My assumption was (is) that I begin walking regularly in normal shoes sometime after 6 weeks and that after 3 months I could resume some light impact activity/athletics. Total recovery, I gathered, would be one year post-surgery. Oh, and I would have to assume that I would probably have to stay home from work for at least a week after surgery.
I selected Monday, January 25, 2010 as the date for my surgery. It was on the heels of some business travel, the holidays, and a major regatta I was competing in.....and it was three months away from the next major competition I planned to attend. Plus it's cold in New England in the winter. A few days before the surgery, the doctor's office called to confirm that I needed to be at the hospital at 6 a.m. and that I need to fast with no food or drink after midnight.
I woke up around 5 a.m. the morning of the 25th and jumped into the shower for a good scrubbing prior to surgery. Though anxious, I was really looking forward to getting this surgery done so I could get rid of the constant pain and resulting physical restraints. When I went downstairs, my mouth was dry and all I wanted was a big glass of orange juice....no doubt my desire heightened by the forbidden nature of it. Fasting was for a reason, and I would honor it.
It was rather surprising to see how busy a hospital is at 6 in the morning. Apparently everyone scheduled for any kind of morning surgery is sent to the same surgery registration area. After filling in the required paperwork I joined the masses in the waiting tank. I went back and forth between reading the paper and people-watching. So many different folks and mannerisms out there....and clearly everyone didn't visit the shower that morning for a good scrubbing!
By 6:40 or so my name was called and I was brought back into the pre-op area where many people asked me pretty much the same questions over and over. Name? Birth date? Why are you here? When was the last time you had anything to eat or drink? Are you allergic to any drugs or latex? What has been your past experience with anesthesia? Tell me about this incident in your medical records? Please read and sign these papers. I am guessing that I signed three different consents that morning.
Around 7:15 a.m. my doctor came in to see how I was doing. He verified which foot and toe was going to be operated on and with a black magic marker wrote "yes" on my left leg and a big arrow pointing towards my increasingly popular left big toe. I have heard about surgeries gone bad where the wrong part of the body was operated on, so this simple precaution made me feel more at ease. Then my doc reminded me of the risks and potential complications, "including potential death", and asked me to sign a release. Before he left, my doc advised me that most patients spend the first night after surgery in the hospital and asked if I planned to do so. I told him that I would probably prefer to go home after surgery, but was curious why most people stayed at the hospital. He responded that it can be quite painful post-surgery and it is easier to control that pain with intravenous narcotics in the hospital. If I went home, they would prescribe pain-killers, but they would not be as effective. I said I will wait to see how I feel after surgery, but most likely would go home.
Intravenous was inserted into a vein on the back of my left hand and a small device was strapped over my left index finger to measure oxygen in my blood. They also had me strip down to nothing and get into one of those ultra-fashion hospital johnnies. All in all I was very impressed with the thoroughness, professionalism, and bedside manner of all the hospital staff I encountered.
Around 8 a.m. I remember them wheeling me into the operating room where there were several people, including my doctor, awaiting my arrival. The anesthesiologist must have released the general anesthesia into my veins just as the door opened because I don't even remember hearing it close.
I remember waking up feeling quite groggy lying down on my hospital cot with an oxygen mask over my mouth and nose. "How are you feeling?" a nurse asked me. "Fine, but really sleepy," I replied. Eventually I sobered up, sat upright, and began to engage in conversation with the post-op recovery staff. I am sure that I was far more loopy than I seemed to think I was. At some point I noticed an x-ray image of my toe sitting on my lap. I was looking at it and observed the two screws that had neatly been put in place. At the time, it looked good to me, but clearly I didn't have all my faculties so I was incapable of comparing some of the finer details to the pre-surgery images I had seen. Around then, my doc stops by and grabs the photo and says "oh, that one is mine for the files." I didn't have the presence of mind to ask him for a copy that I could take home with me for my deeper amateur inspection.
The doc then tells me "technically, your procedure went well. The bone, as you know, was heavily damaged and we needed to remove that bone until we got down to healthy, blood-bearing bone that would successfully fuse. We did that and feel good about how things look." My doc again may have suggested that I spend the night in the hospital so they could better manage the pain. In my yankee-stubbornness I must have again suggested that I would be fine and could handle the pain and would prefer to go home. Of course I felt that way at the time because I couldn't feel anything at all on my left leg beneath my knee. How bad could it get? He then gave me prescriptions for both Oxycontin and Oxycodone with suggested dosages. He also added that I may need to up those dosages by 50% in the first one or two days. He also prescribed an anti-nausea medication and, before I left, a nurse suggested that I take a stool softener.
Around 11:30 a.m. that morning I was given a pair of crutches, released by the hospital and driven home. On the ride home I sat in the front passenger seat and rested my left foot up on the dashboard. It was only then, with the distractions of the hospital gone, that I began to assess the cast thing around my foot. First of all, I noticed that it isn't actually a hard, plaster cast. Instead, it feels like there is a hard plastic semi-boot thing that wraps beneath my foot and comes about 3/4 the way around to the top of my foot (there is a gap where the shoe-lacings would be) and continues up about 6 inches above my ankles. This plastic semi-boot is then wrapped in gauze, which in turn is wrapped by a porous cohesive elastic bandage. Interestingly, my toes were poking out the front end of the cast thing and I noticed that my big toe appeared to be at least a half inch shorter than it used to be relative to my second toe. Within 24 hours I would better understand the design intent of this boot.
The success of this surgery is very important to me and I had decided well in advance that I was going to be a model patient, even if it was not in my nature to be one ordinarily. I was going to be patient and do everything the doctor wanted me to do. In the early days this meant that it was critical that I try to keep my foot raised....above my heart, if at all possible. There aren't a lot of natural ways to keep your foot above your heart, but I settled on two locations and positions at home where I could make this happen. The first is in my bed where I stacked up 4 pillows in a pyramid (starting with big couch pillows, then smaller couch pillows, and finally a regular bed pillow). This allows me to rest my leg on the luxurious stack of pillows with my knee bent and resting at a 90 degree angle. Amazingly, this pillow configuration is very stable and incredibly comfortable such that I can sleep a whole night that way. The second is on the couch in the family room. With some pillow back supports and some firm pillows for my foot, I can spend several hours working, reading, eating, etc with my foot basically at the same level as my heart.
So after getting home post surgery I was pretty drained and, no doubt, still impacted by the general anesthesia. I went for a nap and conked out for a good four hours. It was a deep, deep sleep with crazy dreams, though I can't remember any of them. Upon waking up, I could tell that the local anesthesia on my foot was beginning to wear off as I was beginning to feel some tingling in my foot and the pain level was increasing, though very tolerable. Despite my lack of food in nearly 24 hours, I wasn't very hungry at dinner time. Nevertheless, I did eat some chicken and consumed a lot of water.
By 9 p.m. I was in bed for the night. It all started so smoothly. By midnight I was in extreme, relentless pain and this continued for the next nine hours even as I downed the prescribed pain medication every three hours or so. It was unbearable and there was nothing I could do. Now I understood why the doctor had suggested that I stay in the hospital overnight. At least there they could put me on a morphine drip and I could whitewash those initial painful hours away.
By Tuesday morning it had become clear to me that two things had happened. First, the local anesthesia had worn off by late Monday night, and second, my foot continued to swell larger as a result of the surgery trauma. That additional swelling pressed my already sensitive foot tighter and tighter against the foot-cast causing more and more pain. I realize now that the reason that it is not a solid cast is that they want the cast to be able to expand to accommodate any future swelling.
The severe pain of Monday night began to dissipate as Tuesday progressed. I can only imagine this was a result of continuous pain medication and the fact that I religiously elevated my foot above my heart which may have reduced the swelling somewhat. My doctor had also provided me with a plastic wrap that could be filled with ice water and wrapped around the cast. I did this every few hours, though I was somewhat skeptical whether the coldness ever penetrated the cast to cool the wound. I also tried placing a bag of frozen corn against my toes sticking out from my cast and could actually feel that coldness in my foot.
The problem with pain killers is that they make you very sleepy. I found that I needed to take a nap by early afternoon and would rest for at least two hours in a deep sleep. Even when you are awake, there is a groggy feeling and you know everything is not quite right. They also make my mouth feel very dry despite how much water or juice I consumed.
Getting around on crutches is fine if you have to go from point A to point B. However, if you also want to transport something such as a glass or a plate, then it is a bit more difficult. With some practice I have learned how to squeeze my right crutch under my right underarm, use my hand to hold a glass or plate, and swing the crutch forward step by step. Admittedly, there was some spillage, but necessity is the mother of invention.
Sleeping on Tuesday night was not nearly as painful as Monday night. Clearly the swelling had subsided somewhat so it was more of a dull constant pain, but very manageable. Wednesday morning I decided that I wanted to go as long as possible with no pain-killer medications. I didn't like the way they make me feel, plus I was expecting a visitor late morning and I didn't want to come across as too loopy. Med-free actually worked pretty well and helped clear my head somewhat so I felt more peppy. By mid afternoon the pain was growing and I did take one tablet to take the edge off.
The other unfortunate side-effect of pain medications is (I hate this word) constipation. As I was leaving the hospital mid-day on Monday the last thing the nurse told me was to make sure that I took stool softeners. I did take one tablet a day, but apparently the actual dosage is closer to three tablets a day. Suffice it to say that Wednesday evening I experienced a bout that I never, ever want to experience again. So don't forget the stool softeners if you are suddenly thrust upon pain medication.
This episode further convinced me to give up all the pain-killers. By now the pain was manageable and far preferable to the side effects. After that horrible first night of agony, I never would have guessed that I would stop using the meds two days after surgery. But for me, it was the right decision. The only time my foot really hurt was when I moved it from being elevated to hanging down when I needed to stand up. As the blood rushed to my foot, I would experience 20-30 seconds of intense pain and then things would neutralize again. In my opinion, Oxycontin, Oxycodone, or any other pain-killer must only serve a very short term purpose. Anything longer risks dependence and your soul being sucked away much as the Dementors did in the Harry Potter books.
By Friday, four days after surgery, I could distinctly feel that the swelling had gone down in my foot. There was room in my cast and I could begin to flex my ankle. With some caution, I also began to wiggle my toes and observed that toes 2-5 wiggle on command, but my big toe (which by now is not so big) remained stationary. This, of course, begs new questions for me.....when they fuse the toe, what do they do with the ligaments and muscles that are responsible for toe movement? If I try to wiggle my toes will I be putting undue stress on the fresh fusion and potentially jeopardize healing?
I also began to drive on Friday and have done so throughout the weekend. Since it was my left toe that had surgery, the only limiting factor in my driving was being off the meds. Its nice to be free to get around where and when you want to. The other thing I forgot to ask the hospital about was whether I could get a temporary handicap sticker. It would be nice, though not crucial, to be able to park in some of those close spots. Regardless, my observation is that you get better service when you hop around on crutches. On Friday I had to get my car serviced and when I arrived they were simply outstanding and accomodating in every way. What ordinarily would take two hours they performed in 90 minutes, and they always asked if I needed coffee or anything else.
Right now my biggest urge is to unwrap my cast and give my foot some fresh air. Naturally, I would also like to observe the wound so I can better envision how this is all going to work out going forward. And while it is unwrapped, I'll bet my foot would love a gentle massage just to keep the oxygen-rich blood flowing through the region...with its healing and cleansing powers. OK, OK I won't do that, but sure is tempting. I feel like I could apply weight to my foot right now, though I would never want to put any pressure on the toe at this early stage.
My follow-up appointment with the doctor is set for February 9th, next Tuesday. That seems like forever for me and I am not sure I can last that long. This morning I called my doctor's assistant and asked if I could come in for my follow-up appointment on Thursday or Friday of this week. When she realized that my surgery was only a week ago she let me know that would be impossible. "But everything feels really good, and I can't stand this cast!" She informed me that the stitches needed to be in for 15 days and Mother Nature wouldn't change the rules on my behalf, regardless of how impatient I am. I understood, but it was worth the try.
I remember when I was a kid and along the way I had my share of casts. They were always cool in the beginning, especially when you had signing ceremonies and allowed your friends to sign their names and tell you nice things and get well soon. Between those moments of glory, I inevitably felt those irresistable itches deep inside my cast. I became quite adept at sliding my pencil or a ruler inside my cast to take care of that itch. But, like popcorn, once you try (itch) one, then you have to go for another. Well, I am afraid to say that this urge does not go away in adulthood. Its probably a good sign that my biggest concern is how I am going to reach an itch.
There is one thing that confuses me, however. Over the last day or two, as the swelling has subsided and there is room in my cast, I have noticed that there is a fair bit of tenderness on the top, outside part of my left foot. This soreness is nowhere near the wound from surgery. Rather it is on the outside of my foot that had to bear the brunt of my body weight as I landed on my left foot (trying to avoid pain in my toe) while walking. It almost seems that the foot is now flexing back to its normal position now that it is no longer carrying the full burden of my weight.
First Follow-Up Appointment...15 Days After Surgery
And now it is February 9, 2010....a full 15 days after my surgery and the day of my follow-up with my Doc. The appointment was at 8:15 this morning and I was so anxious to go that I woke up around 4 a.m. in a fit of anticipation. All I want is for this darn cast to come off. I panicked at the bad traffic and was afraid that they wouldn't see me if I was late, but alas, I made it by 8:18.
Initially I saw a nurse who skillfully removed my cast. I was amazed to see the quantity of dried blood in the inner layers of gauze. When she finally revealed my toe, my initial reaction was that it was a pretty gross sight to behold. The stitches made my toe look like a Frankenstein toe with all its distortions. It also was covered in dried blood and seemed to be separated from the other four toes. I also was surprised at how swollen the foot, especially around the toe, still was. And you can see from the picture below, that the toe is now a bit shorter than pre-surgery. The nurse then removed the stitches, which didn't hurt at all, and left the room. When she left I immediately gave myself a foot massage, careful to avoid my big toe. It felt so good to get the blood flowing in there again.
This picture was taken in the doctor's office just after the cast was removed. The foot is still swollen and there is a fairly long scab throughout the length of the wound. It feels so good to have my foot in the fresh air!
Finally my Doc came in and asked how I was doing. I let him know that I was doing great and incredibly relieved to have the cast off. He then examined my foot and commented that "it looks good.....no sign of infection." Apparently that is one of the major concerns at this point. He then commented that he felt the surgery went very well. "Your toe truly was horrible. Plus, you had a bone fragment in there that had broken off." I am sure he says this to all his patients, but it made me feel better.....like the surgery really was necessary. He also added, "by the way, not sure if you have noticed, but while I was in there I straightened out your second toe." Sure enough, the second toe was straighter and no longer crooked to the right.
When he stopped talking for a moment I jumped in with my questions. "So, am I allowed to wiggle my toes? Or will that jeopardize the fusion process?" He let me know that there were two strong screws in place and my toe wiggling would not jeopardize the healing. "I thought that my toe would be fused at an upward angle so I could more easily walk. It looks like it is actually lower than my other toes." He then told me to stand up, which I had not done yet, and was quite fearful of trying. When I put pressure on my foot it all came together. "You can see that it is neither too high, nor too low." I love the confidence of good doctors.
Despite the progress of the past two weeks, it was clear that the foot was still swollen and tender, especially around the big toe area. The wound also had considerable healing to do. He referred to the black blood area on my toe as an "ulcer" that needed further healing before he would allow me to get the foot wet in a shower. Finally, he let me know that he wants three more weeks of non-weight-bearing on my toe. What this means is that I get a removable air cast and will mostly be using crutches for the next three weeks. I asked him if it was OK to walk on the heel of my cast. He response is "I will leave that up to you. If you can really do that without putting pressure on your toe, then fine. Otherwise, stick to the crutches or else you will disrupt the fusion process."
Here is a picture of the aircast boot that I got at my 2 week appointment with the doctor. Later that day I had to fly to Canada so I made the decision to leave the crutches in my car so I could have free hands to carry my bags. I have been successfully walking on the aircast ever since.
Three Weeks Post Surgery
After 3 weeks there was still a pretty significant wound and scab on my foot. In comparing the two feet, you can see that the left foot gets more red as soon as the foot is lowered. While overall swelling has reduced, there is still swelling in the area close to the big toe.Four Weeks Post Surgery
At the four week point the swelling continued to decline and the scab was ready to fall off (with a wee bit of help).
Five Weeks Post Surgery
On March 5, 2010 I went into the doctor for my 5 1/2 week checkup. First thing they did was xray my foot from several angles. I have attached a copy of one of those xrays where there are several things that are worth pointing out. First, you can see the two screws that form an "X" exactly over where my big toe joint used to be. The doctor was pleased with the healing thus far and felt as though I was ahead of schedule. He said that he looked at the xrays from several angles to see if there were signs of any gaps in the former joint, damage to the screws, or signs of infection. He then pointed out the fine line that is apparent right under the 'X'of the screws. He is looking for that line to fade away which would be a sign of the bone growing together successfully. He seemed pleased that the primary foot bone extended at a very straight angle into the tow bone....seemingly suggesting that it was a good angle for the bones to fuse together solidly. It is also interesting to see how much shorter the big toe is now. The bone structure of both the second and third toe are longer.
During my session with my doctor he asked if I was feeling discomfort or pain of any kind. I said no. He then let me know that he felt that things were looking really well and I could begin weight bearing on my left foot. Obviously I was happy and and asked a clarifying question...."Does this mean I can fully walk on my left foot and put pressure on my toe?" "Yes" he says "so long as you are in your walking cast." Huh?? He has no idea that I discarded my crutches the same day as my 2 week appointment with him and have been walking on it ever since. Over the last two weeks I have been practically jogging in my air cast due to the extreme comfort I have felt. To make matters worse, I have to confess that I spend most of my time at home and in work without the cast on. It just feels better not having that pressure against my foot. When I walk without a cast I am careful to not put pressure on my toe. This is easy....for the past several years I have almost always walked on the outside of my left foot to avoid the pain. It has been easy for me to do the same with no cast on. I am sure I sound like a irresonsible renegade, but I am truly being careful to do nothing to jeopardize recovery. With a great surgeon, my toe was fused (and screwed) together well. I listen to my body every day and know what I can or cannot do.
The biggest disappointment was when my doctor told me that I had to wear the boot for another 5 weeks. He must have caught the look of disbelief on my face. I actually thought and expected that my doctor was going to give me clearance to wear shoes again. Back in my car I had my lonely left shoe that I was dying to put on. Doc told me that he has never seen a toe fusion heal in less than 10 weeks, and even that is on the early side. Given what appears to be my rapid healing he agrees that our next appointment can be in 10 week, "but nothing sooner." I negotiate with the hospital scheduler and manage to get an appointment for April 6 which would be 10 weeks and 1 day after my surgery. Hoping for clearance at that appointment because I have already scheduled vacation with the intent of golf, tennis, runnig and whatever else I can fit in the very next weekend.
Nine Weeks Post Surgery
The picture below was taken nine weeks after big toe fusion. The scar is still very visible, but essentially fully healed. I sense that things are going very well with the overall fusion process. There is no pain, I walk on my boot-cast with ease, and when at home or in the office I walk without the boot, though careful that I don't apply pressure on my toe as I walk. When I feel the toe area with my hand, it appears as though the bones have fully fused; the connection is solid.
Today is April 4, 2010 (Easter Sunday) and one day short of the 10 week mark post surgery. I see my doctor in two days and hope that he gives me the clean bill of health....meaning that I can begin to use my toe fully, including running and other forms of exercise. I bet I have gained 5 pounds since surgery due to my inability to do aerobic exercise.
Yesterday, for the first time, I tried to put on a shoe to see how it felt. It was great and I haven't worn the boot since. In fact last night I even joined some friends bowling at the local golf club. I was a bit fearful in the beginning and became more bold as the evening progressed. And today I felt good enough to shoot some basketballs. I feel like I could do more, but I am waiting for the next x-ray and assurances by my doc that the bone is solid.
10 Weeks Post Surgery
On April 6, 2010 I visited my doctor for my 10 week check-up. I had been anxiously awaiting this appointment because my toe was experiencing no pain and feeling strong. In recent days I had abandoned the boot cast and was wearing shoes. I was hoping for official clearance from my doctor to put the cast in the closet and begin normal physical activity.
Well, part of my wish came true. My doctor gave me clearance to wear shoes and begin light activity, but he instructed me not to run or do other hard-activity until I successfully reach week 13. His assessment, based on the x-ray to the left, was that the healing is progressing extremely well. He cautioned me to be careful and not overly stress the toe as healing was stilltaking place. Full strength, he says, won't be achieved until 6 months post surgery. In the meantime, I should expect some swelling in the area as I begin to increase activity. I inquired whether the fusion was strong at this point, and he assured me that it was. This is good news, I thought. My body would serve as an early-warning-system and warn me of overuse or premature activity by inducing swelling and pain.
At the end of my appointment, I looked my doctor in the eye and shook his hand. With luck, this is our last appointment and I wanted to thank this knowledgeable, personable and skillful orthopedic surgeon for eliminating my pain and opening the door for me to return to rigorous physical activity. He asked that I send him an email in a couple months and let him know how things are developing. I intend to make that a good news email.