Julie, you've come back today
as a follow up
from your last appointment
with us.
And at that point,
we made a request
to the foot surgery team
to see you.
Am I right in understanding
that you now are going to have
some foot surgery?
Yes, I think after everything
we've done so far,
the pain is now too bad
and I think foot surgery
is the way to go.
So just to recap,
we've looked at your footwear.
And you've actually
seen the orthotist
and they supplied you footwear
with some made insoles.
We've tried a soft splint
on the big toe
to try and alleviate
the problems around there.
That helped for a while?
Yes, it certainly kept my feet
going for quite some time,
but unfortunately,
they've deteriorated
and the pain is now too bad.
Yeah, so it really is that pain
that's sort of sending you
towards this.
- Yes, yes.
- Okay.
So you've got a date.
- Yes, three weeks time.
- All right. Okay.
And the team
will have talked to you
about what to expect on the day
and how to manage
the period afterwards?
Yes, some details
but not everything.
Yeah, there's a few questions
I'd like to ask as well.
Okay, have they told you,
it's day surgery you're having...
Yes.
So it's going to be
under local anesthetic?
- Yes, I think so, yes.
- Okay.
So I wasn't sure quite how much
I'd be able to do afterwards.
When I to come out certainly
in the first 24 hours or so,
what I'll need to do.
I think the advice is that
you will need somebody with you.
So is there a family member
or somebody that can help you?
- Yes. Yes.
- Okay.
Did they then sort of talk
about what you can expect
of how you'd be
in the next few days
and then a few weeks down the line?
- In briefly, yes.
- Yes.
I think the way it works is that
the first 24 hours
you must have somebody with you.
But ideally,
at least for the next week
there's somebody there
that's really there
to support you.
Okay.
'Cause, you know, we talked about
you should be resting,
you should be
elevating your leg.
But that is really
you're either on your bed,
you are mobile enough
to get to the bathroom,
maybe then to lounge,
to lie on the sofa.
You really don't want that leg
to be dependant.
And you're probably
not going to be able
to put much pressure through it,
you'll just be loading
the back of the heel.
If you're not in a cast,
they'll give you a surgical shoe
to protect the foot.
But it is really just
loading enough to stabilize you.
Okay.
So we will need to also talk
a little bit
about mobility and stuff.
So that's kind of
really the first week or so.
By about week two,
you may be thinking,
they'll be looking
to take stitches out.
But you still might be able
to load the foot
a little bit more.
It's really partial loading,
it's not full loading
by any means.
Will I be able to walk
around the house
and, you know, carry out
even making a cup of tea
or answering the phone
and things like that?
I think, you'd want
somebody else to do it,
because if you make a cup of tea
in your kitchen
you'd think you'd get it
to wherever you sat
and if you're not able to load
that leg probably,
that's going to be difficult.
You're going to need
some sort of walking aid as well
and, you know, that's going
to need sorting out,
because with your hands...
That's an issue.
Yes, I don't have crutches
or anything at home.
So do I need to sort that out
beforehand
or will they give me those
in the hospital
and fit them properly,
at the time of the surgery.
I think probably
given the hand problems you've got,
it'd be a good idea
up front of your surgery,
you actually ask the therapy team
to see if they can see you.
Just to get those issues
sorted out for you
because you don't really want
to be going into the hospital
on the day and finding
that they haven't got
the right device for you.
Because I won't be able
to put weight
through my foot initially
at all?
- No.
- Okay.
It is really just steadying you
and that's about it.
- And it's always through that.
- Right.
So that really takes...
The first couple of weeks,
you're really quite restricted,
you have the stitches out.
And then you may...
Depending on what they've done,
you may be able
to get into an oversized trainer.
You still,
the emphasis is still on rest.
When you say rest,
do I need to be confined to bed
for a period of time
or can I walk around the house
intermittently?
Do I need to keep my leg up
or can I sit in a normal chair?
You need your leg elevated.
So I think by elevated we mean
at least level with your pelvis,
if possible slightly higher,
because it's all about gravity
and stopping the swelling
building up in your foot.
The more foot swells,
the more painful it will be.
So if you're getting pain,
it's probably because
of the swelling at that time.
All right.
So in terms of your activity,
it's really only to do
what you have to do,
and that's those essential things.
Okay.
So you need to be thinking
about having plenty of things
to keep you amused
during those first few weeks.
So if you like reading
or whatever,
that's the sort of thing
you need to have arranged.
So I need to get someone
to look after me...
You really do need
somebody to look...
Full-time for a week.
You do, really, I think,
given your health issues.
And, you know,
also plan up front, think about,
you don't want this person
to be there to look after you,
where actually they're dashing
in each day to get food,
so try and have things prepared
in advance
so that they're actually there
to help you
as and when you need help
rather than they've popped out
and you have to go
answer the front door
and things like that.
How about showering and bathing
and generally,
can I get the foot wet?
You need to keep it dry.
And certainly
while that first dressing is on,
it needs to be kept dry.
And you can get a protector,
like, a cast protector,
these are quite a strong plastic
and they come up to probably
two-thirds of the lower leg
and they've got the seal
around them.
So they will stop water
going in.
So you can use those
in the shower.
You got to be careful
that if they are plastic,
so you got to be mindful
of that in the shower.
Okay.
But, yeah, they work very well.
Once the main dressing is off
and the stitches
have been taken out
presuming the wound's intact,
you may still have
some sort of dressing on there.
I would suggest, still keep
using that cast protector
and just wash the area locally so you're
independent if you're general showering,
you don't want to be saturating
these sort of wounds.
Okay.
And how long
until I could get back to work
or drive for instance?
I think, again, that will
depend on the exact surgery
and the surgical team
will be able to advise you.
But you probably
won't be driving
until you're able
to more readily walk.
So we're probably talking
four to six week period.
But you also remember,
you need to have a conversation
with your insurance company
on these matters.
Yes.
We don't want to get caught out.
Yes.
In terms of my biologic drugs
and the other rheumatoid
arthritis drugs I take,
will I be able to carry those on
or do I need to have a break
in some of the drugs
considering I'm having surgery?
With your biologic drugs
you will need to stop.
So I'd suggest actually
you're already three weeks away
from your surgery,
so you need
to have a conversation
over the next few days
with the rheumatology team.
And they'll advise you
when you need stop
prior to this surgery.
And then they will be looking
for healing
before you can restart.
So you'll need to just keep
liaising with them
after the surgery
and they'll be able
to advise you
when you're ready
to start again.
If I'm in pain
after the operation,
will I be able
to take my normal analgesics,
paracetamol and ibuprofen?
You will.
Again, the surgical team
will advise you,
but you will be able
to take your analgesia.
I think, with foot surgery
it's what's an indication
of you doing too much,
maybe with the foot not being
elevated for long enough,
is it the foot would
become uncomfortable.
And with swelling
often comes pain as well.
So really, it's an indication
that maybe you're
either doing too much
or you're not elevating the foot
long enough.
So the first thing is
to make sure you are doing that
and you really
are keeping off the foot
in those first few weeks
as much as possible.
But yes, you will be able
to take your normal pain relief.
If you need a little bit more
than you normally get
then the surgical team will be
able to arrange that for you.
Okay.
I noticed on the sheets
that the hospital gave me,
it said to take off nail polish.
Why is that?
It's partly, there's an infection
control issue right there.
But actually, it's also,
they need to see your nail beds
because actually
they're probably
going to monitor in on there
that actually,
and that's how
they kind of monitor you,
your pulse and stuff like that.
Postoperatively,
is there any support
that might be available
for physiotherapy
or any other exercises
that will help me
regain the use of my foot
afterwards?
I think, again,
it's when those things,
have a conversation
with the surgical team.
They'll be able to advise you
if there's particular things
you need.
You'll be coming back
into rheumatology as well
so if need be, we can always
ask our rheumatology
related physiotherapy colleague
to see you.
I think we need to see
how you go,
and also in terms of podiatry,
we'll want to see you
probably in around
about three to four months
after your surgery
just to see
how you are starting to adapt.
If because of the surgery
you're starting to walk
differently
or maybe other parts
of your foot start to compensate
because of the surgery,
we might need to just help
with some sort of
special insole or sole tech.
But I think we need to just...
Once things are settled up
and the swelling is going down,
and you are in less pain
so you're more freely
able to walk,
then we need to recap
in terms of
where you are in your feet
and what we need to do.
I think the reality is
you will still be seeing us
and we will still need
to put stuff
inside your shoes
in this instance.
Is it possible
to talk to anyone else
that's had this type of surgery?
I think a good way
of getting some support would be
through the NRAS helpline.
There they've got
some trained volunteers.
One of them
may have had an experience
in what you're planning.
So I'd suggest give them a call.
Thank you so much for all your help,
I feel much more reassured now.
That's a pleasure. Thank you.
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