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Z-plasty? WTH is a Z-plasty? (Yet *another* nahtacruz blog)


JLMoran

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2 hours ago, JLMoran said:

And why the heck is there suddenly a page about the merits of robovacs in the middle of my live blog?!? ??

Well shoot.  Who knew Joe would flip like a switch this soon? 

I thought we had at least another day of robovac talk left in this thread.  Do you know how hard it is to talk about robovacs on a cruise forum?  It rarely seems to fit the conversation.

Glad you are feeling better Joe.

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I forgot something in that last update. Our younger daughter (aka the artist, whose work I’ve shown in earlier live blogs) got her acceptance notice for the summer Japanese Language and Cultural Immersion program that she applied for nearly a year ago!

Assuming she’s able to get vaccinated in time and nothing else comes along to muck things up, she’ll be spending 4 weeks with a host family in Kyoto from mid-July through mid-August.

This is a huge deal for her. She’s been self-studying Japanese for almost a year now, and has been saving money from her part-time job to help pay for it (until her job was let go due to COVID-19 anyway). She hopes to live and work in Japan after college; she wants to get into character design for one of the smaller video game firms there. We’re really happy for her!

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How exciting her dreams are coming to fruition.... I hope she can get vaccinated prior to going as the Olympics are on at this time and I imagine there will be a great influx of people from all over the world ...My son is being recruited by a video game developer in Germany so he may be off on his adventure soon too..... unfortunately we in Australia have not had a vaccine roll out yet  so I have got my fingers crossed he can get one before he has to go....It is very hard for the young ones to plan and get ahead in these times it is nice (for a change) to hear a good story

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Glad you're feeling better! Good to hear you're off pain meds quickly. 

19 hours ago, JLMoran said:

And why the heck is there suddenly a page about the merits of robovacs in the middle of my live blog?!?

That's what happens when you leave us unattended. LOL

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18 hours ago, Lovetocruise2002 said:

At least we didn’t start talking about pizza! Lol

Fun fact, I leave the pizza stone in the oven. When not cooking pizza I just toss whatever pan on top of it. My wife says that's why things cook slower, I think the oven is just garbage. ?

Edited by sk8erguy1978
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Not really much to report. There is some kind of "tape" that was covering the incision site, and that's now started to come off on its own. Underneath, I can see what looks like a nicely healing incision. That's as descriptive as I'll get, to spare those with more sensitive constitutions. ? 

And we checked our daughter's bank account balance, to see how much see had actually saved up from work for the trip to Japan. She was thrilled to find out that even though she hasn't worked since February of last year, she was so aggressive with her savings during the time she was working that she has almost enough to pay for the whole thing! She had originally been saving up for a used car that she wanted to buy when she turned 18; but between learning about this program, and realizing that if she does move to Japan there would be no way to keep any car she bought, she decided when she applied that it was better to use the money for this. My wife and I will be paying the balance on the tuition along with her airfare, but she's done a great job of learning about saving, budgeting, and putting off some of those "instant gratification" purchases to be able to hit a longer-term goal.

Oh, and we found out that 10% of the trip cost is being covered by the program operator through a merit grant thanks to her grades. Kudos, kiddo!

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Last night was my first without any pain meds, and my second sleeping in my own bed instead of our recliner. Woke up at 5 AM, but given I got 9-1/2 hours of sleep the night before and have a ton of extra sleep I'm not particularly bothered by it. Feels good to be off those meds and have a fully clear head again.

And the tape fell off this morning, so I got my first good look at the whole site. It looks to my eye like it's healing well, so I'm hopeful that I'm beating my surgeon's odds and powered up enough "Wolverine factor" to make this work. I get the sutures out this coming Tuesday, so that'll be the acid test.

Oh, and I'm sitting at my computer while I type this. Last couple of mornings I've been managing about 1-1/2 to 2 hours of combined sitting and standing, including making omelettes for my younger daughter and myself yesterday morning. Gradually adding more "normal" sitting time to the day; I definitely overdid it a bit yesterday with all the paperwork I had to fill out for the Japan trip, but Advil and elevation settled it down again.

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Good news. It looked a lot better this morning than when I went to bed last night, and so far pain levels are back to where they were two days ago.

Sent the doc’s nurse a photo and spoke with her directly. She said the pain was most likely a combination of the front part tearing a bit (she could see that in the pic), but only superficially; plus normal pain from the sutures being pulled and tugged as I move around. No follow-up or delay in getting the sutures removed is needed.

She said apart from that, everything looks great and I’m clearly doing everything I’m supposed to be as far as wound care and maintenance. Also said once the sutures come out on Tuesday that I should feel a lot of relief. It will still look a bit raw at that point; normal for this kind of surgery. Full healing will take another 2 or three weeks, and I’ll need to continue using gauze coverings throughout.

 

Oh, and she said the picture I took was great! ?

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The 48-ish hours until the sutures come out can’t go by fast enough. Far from getting better, pain around them from pulling and such is just getting worse. I’ll admit that I’m a bit of a baby when it comes to pain, but I only have just enough pain meds to me through the two remaining nights, nothing for daytime beyond Advil. I’m really getting tired of having random big zings hitting me in the middle of nothing more than sitting on the couch with my foot up, watching the bajillionth hour of TV.

 

On the plus side, I got through all 5 seasons of The Expanse with a few days off to spare. Wishing that the final(?) season wasn’t so far off.

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13 minutes ago, JLMoran said:

The 48-ish hours until the sutures come out can’t go by fast enough. Far from getting better, pain around them from pulling and such is just getting worse. I’ll admit that I’m a bit of a baby when it comes to pain, but I only have just enough pain meds to me through the two remaining nights, nothing for daytime beyond Advil. I’m really getting tired of having random big zings hitting me in the middle of nothing more than sitting on the couch with my foot up, watching the bajillionth hour of TV.

 

On the plus side, I got through all 5 seasons of The Expanse with a few days off to spare. Wishing that the final(?) season wasn’t so far off.

Find Wes Chatham (Amos) on YouTube. He'll keep you entertained while you wait. 

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Bad news. Remember how I mentioned getting "random big zings in the middle of watching my bajillionth hour of TV"? Turns out that was the entire thing tearing apart and failing. Sutures came out today, and doc and nurse agreed with my at-home assessment that the whole thing just failed. Too much strain for the incisions to stay closed and heal.

So now I'm back to Square negative 1 -- this wound is now about double the size it was when I started, because of course the doc excised all the originally bad tissue to resolve the source problem. ? 

Good news is that I was mentally prepared for this, since the doc did tell me up front I only had a 50-70% percent chance of it working. And it's sore, but not killing me like the sutures were. We're already planning on a full-thickness skin graft procedure, which he is much more confident will work since he can take enough donor tissue to relieve the problems around strain. But the site is looking angry right now; I have to take a week or two to treat it and get rid of the redness and irritation, let it heal a bit so it's ready for taking a graft.

So that means I'm back at work for that time, then will be back on short-term disability for about 3 weeks. Thankfully, my employer's short-term disability claims allow for a relapse; long as I go back on leave within 60 days for the same reason as before, they'll just reopen the existing claim and get updated info from the surgeon; no need for me to start a whole new claim or redo paperwork.

And to the doctor's credit -- he said that if he had discussed the possibility of falling back on a graft before this surgery started, he would have done it then and there. But he felt it wasn't ethically responsible to go in saying he'd do "X", and then tell me after I woke up that he decided to do "Y" without reviewing it and getting consent from me first. Especially since the original surgery had some chance of working and I should have a chance to beat the odds.

Which honestly, I'm kicking myself over because I had thought about bringing it up with the doctor when I saw him right before surgery to sign everything and go over my questions, but then forgot to do it!! If I had just said, "Hey, if you start this and find it's looking iffy, feel free to switch over to Plan B"... well, this story might have taken a very different course.

Live and learn, I guess. He might still have said, "Well, let's just get through this and see." But then again...

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@WAAAYTOOO, it’ll be done in about two weeks. I have to wait for the wound site to... not heal, really. Just stop looking like it’s on the verge of becoming infected, and get to a healthier appearance.

Ill be taking pictures every few days and sending them to the surgeon for feedback. Once he says it looks to go, then go it will.

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It's been an... interesting... 3 days since the sutures came out. Wednesday it was sore but very manageable with a combination of Tylenol and Advil. Yesterday... well, let's just say I'm surprised that I was able to get through the work day. Even with the combination of OTC meds, it was throbbing and stabbing me almost the whole day and through the night.

Then I got up this morning and it was basically done with that. Bit sore when I first got up and put weight on it, but by the time I was done with my morning routine it was pretty much fine. Some throbbing here and there, but nothing that doesn't go away just by shifting my leg to another spot on the cushion it's propped up on. And the secondary stuff that comes with an open, healing wound is also easing up a lot. Redness is going away, feels like it's firming up again.

I think at least part of it may be all those remaining self-dissolving sutures that are still in there. I've got a bunch of clear thread poking out of me, and I'm thinking it was getting caught in the gauze or something yesterday and pulling on the wound in ways it didn't like. Not really sure since I didn't do anything different today, but it feels so much better. Still can't keep the foot down on the floor for more than a little bit, but I'm taking what I can get. Hopefully the corner is turned and I'll be healed up enough for the second surgery to happen around the 15th, maybe the 22nd if it's not visibly better until closer to the end of next week.

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Sorry to hear it did not work but on the positive side the prep work and clean out of the old wound is done and now the graft has a good chance of taking ...chin up it will soon come right Hope you get good news soon it must be trying for it to be lasting so long without resolution ....here is a little joke for you

funn.jpg

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So, I got some surprising news this morning. I had sent a photo of the area's healing progress back on Tuesday, and spoke with the doctor's nurse today after she finally had a chance to speak with him at length about it. The doc is thinking this just might heal OK on its own now, and not require a full skin graft after all.

I've been instructed to send them another photo on Monday, and possibly come in next week to get it cleaned up a little, probably have the sutures that still haven't dropped out removed so those areas don't continue to get irritated. And then I guess we'll wait and see how it goes.

Color me dubious, considering the wound center's efforts never got it better than a deep divot with a thin layer of skin that wouldn't ever hold up to miles of walking on any kind of vacation. If it actually heals OK then great, but I'm going to make my concerns and not-too-far off travel plans really clear so there is no confusion about expectations. I need this to be whole and solid and durable enough to last me to my dying day. Anything less is not going to be an option.

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2 hours ago, JLMoran said:

So since I apparently have a lot of time to kill until another surgery decision, I tried to sign up for my Covid vaccination and hit the proverbial lottery. Just got shot #1 of the Pfizer/BioNTech brew.

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Any reactions??

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36 minutes ago, rjac said:

Any reactions??

Ummm.... Joy? Relief? The start of better times?

I know what you meant. I had a bit of a headache for an hour or two after getting the shot, and I feel a little tired right now, but so far that's it. No arm soreness (I was told I could keep that away by making sure to move the arm around a bunch in the first hour post-shot), no other negative symptoms.

My wife and younger daughter got their second shots today, as well. So far they're also fine, but they said the second shot hurt noticeably more than the first one. Needle looked longer to both of them, and/or it may have been a larger amount of the vaccine in the syringe.

Full credit for us all getting our shots already goes to my sister-in-law, who also lives in NJ and has been pulling yeoman's duty navigating the web site for signing up. She's basically been putting in every waking hour not at work with doing that, and much to her credit she has not only gotten everyone in our family set up with our appointments; no, she has gotten over five hundred people set up -- friends, friends-of-friends, relatives of those friends, co-workers, and more. All elderly or with the health conditions that allow those of us in the under-65 set to get a shot (e.g., I've got asthma).

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7 hours ago, JLMoran said:

So since I apparently have a lot of time to kill until another surgery decision, I tried to sign up for my Covid vaccination and hit the proverbial lottery. Just got shot #1 of the Pfizer/BioNTech brew.

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I feel ripped off.   I got my first Moderna vaccine on Thursday and got no damn sticker.

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2 hours ago, SpeedNoodles said:

I feel ripped off.   I got my first Moderna vaccine on Thursday and got no damn sticker.

The stickers actually served a purpose. Before handing them to us, the people giving the shots would write the time 15 minutes post-injection on them. The army reservists and nurse volunteers working at the mega-center we went to would then make sure we didn’t leave our assigned observation area until that time, to ensure we had no adverse reactions.

My sticker also served as a marker that I needed to have my second shot scheduled before leaving. My wife and daughter had “second shot” stickers that told the reservists they could route them to different observation areas that weren’t scheduling follow-up shots.

It was a very efficient operation. Really impressed by how it was run, and thankful to those reservists who were all working there and coordinating it all.

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10 hours ago, JLMoran said:

The stickers actually served a purpose. Before handing them to us, the people giving the shots would write the time 15 minutes post-injection on them. The army reservists and nurse volunteers working at the mega-center we went to would then make sure we didn’t leave our assigned observation area until that time, to ensure we had no adverse reactions.

My sticker also served as a marker that I needed to have my second shot scheduled before leaving. My wife and daughter had “second shot” stickers that told the reservists they could route them to different observation areas that weren’t scheduling follow-up shots.

It was a very efficient operation. Really impressed by how it was run, and thankful to those reservists who were all working there and coordinating it all.

Ah, ok. They left it to us to monitor our own times and make sure we scheduled our 2nd appointments online. Ours was also very efficient, but left some up to us. That was fine for me, but I suspect some struggled with trying to figure out what the heck a QR code was, and what to do with it, lol.

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So I saw the surgeon today, and it was a very productive visit. First off, I explained my long-term goals with this to him:

  1. I want this to be the last such operation needed, with the results lasting to my dying day
  2. I want to be able to resume taking a daily walk for a mile or two, along with doing some kind other exercise a few times a week (cardio, light free weights, etc)
  3. And I want to be able to go on a lot of vacations between now and said dying day, which will likely require walking around for even longer distances

Based on all that, he agreed that just leaving this wound to heal as it is isn't a viable option. It won't be durable enough. So second surgery is back on the table.

But, because of that need for durability, he proposed a second option besides full-thickness skin graft. A procedure called a Reverse Sural Artery Flap. I'm not going to into the details of it here, beyond saying that it's most definitely more complicated than the skin graft but that in exchange it carries a significantly higher chance of success. Like, a skin graft has mid-80s to low-90s confidence in this location, but this alternate procedure bumps it up to 97%+ without requiring some of the really crazy stuff the most complicated plastics procedures can need.

I will just say here, unless you are yourself a surgeon or doctor or someone else used to these kinds of things, do not look up this procedure. I did because I wanted to fully understand it, and there are a lot of images and videos that are just... not pleasant to look at. Especially during lunch hour. ?

One caveat of that other procedure is that it requires a very solid blood supply in the lower leg. He wants me to get an MRA (basically an MRI but with contrast dye to view the blood vessels and how good they are), and based on that we can make a final choice between the two. Just going by my pulse in the two testable spots on the foot, he's pretty confident that the MRA will come back solid. But he still wants it so he knows going in that it's good, rather than starting the procedure and then finding out mid-way that I didn't have as good a set of plumbing as we first thought.

Another caveat is that the procedure itself requires a skin graft onto the donor site, because of the way it's done. So I'll still be dealing with a graft. Oh, and the first week of recovery has to be spent in bed with the leg elevated, followed by a couple of weeks of slowly increasing the time it's descended. How I'll do that without putting pressure on any of the areas that will be painful AF for that whole time I have no idea, although the surgeon did say my leg would be wrapped up pretty ridiculously for that first week; hopefully enough padding to distribute any pressure from pillows and such. And compared to the triple arthrodesis and shin-ankle fusion surgeries I had on the right foot 10 and 7 years ago, this is not even close to "nightmare" level.

The final caveat is that the result is, well, fugly as all get-out (based on the handful of "post-recovery" pics I found, none of which are an exact match for my situation but do give a clear idea of what to expect). But I'm not going for fashion model looks here, I just want a foot that's solid. I've gotta wear knee-high compression socks every day anyway (Bombas to the rescue!!), so 99% of the time it'll be a non-issue. And if I go swimming... well, I'll just have to be ready for some stares and possible comments.

So that's it for now. I have to get that MRA scheduled, and I also have to let the site heal up a bit more. And in any event, I can't do the surgery before April 12, when I'll have had my second Covid vaccination shot and enough time to get over the likely side effects it triggers. But this is progress, and even with the extra delays and all I should be in solid shape for when summer comes around. Which is good, because I'd like to do some kind of getaway with the missus while our younger daughter is in Japan.

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29 minutes ago, WAAAYTOOO said:

if it will give you the results that you are looking for, it will be worth it....eventually.

Best of luck !

Raye, this is exactly why I’m not shying away from it. I put off getting the big foot surgeries on the right side for a decade, having been told that they’d be nightmares and that life afterward would be problematic. Well, they certainly no cake walk, but knowing the outcome and how well I still move for my needs, I’m kicking myself for those extra 10 years of pain. Not making that mistake a second time, especially with a surgeon I feel this comfortable with and who has as much experience as he does.

Edited by JLMoran
Autocorrect doesn't recognize the name Raye?!? ?
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3 hours ago, JLMoran said:

I will just say here, unless you are yourself a surgeon or doctor or someone else used to these kinds of things, do not look up this procedure. I did because I wanted to fully understand it, and there are a lot of images and videos that are just... not pleasant to look at. Especially during lunch hour.

Too late..... ?

To be fair though, I'm the guy who watched my wife's c-sections intensely and was fascinated by them.  I've also been a butcher since 1985.  ?‍♂️

On a serious note though, it really is amazing what can be done medically nowadays.

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