08 January 2012

Toe Trilogy Termination

My toe has been getting progressively worse.  A week or so ago, a bunch of skin started peeling from the previously infected edge, presumably the result of sloughing off skin damaged by extensive Epsom salting and de-swelling.  While all well and good on the one hand, this apparently exposed my wounded toe to yet more infection, so over the course of the week it has been getting redder and oozier (though not as swollen as before) and ever more tender.  I went back to the 2-3 times daily soaking, which has helped alleviate some symptoms by drawing out gunk and pus--or at least for as long as my foot was in the water, after which the edges would crust back over and start collecting gunk again.

By Friday the toe was very uncomfortable and I was starting to have little shooting pains every so often.  I finally decided that I was getting pretty much over it all and was ready to let my lovely F doctor (or F.M.D., as one friend dubbed him) have his way with it.  I figured the cure couldn't hurt any worse than the daily pain, never mind the break which originally caused all this drama, and would probably be a slightly different, more manageable pain anyway.

While at the SCA Twelfth Night festivities on Saturday, I called the minor med on my highly anachronistic phone to see if the FMD was there like he has been on every other Saturday in which I've gone.  He wasn't.  Bummer.  Then I asked if he would be there today.  Score!  So I decided to tough it out for one more day just so I could let the FMD look after my troublesome toe,  because I have infinitely more faith in him after our short acquaintance than I do with Dr. Earnest, the Asshat Medical Queen or some other unknown doctor.

So after church today I went home and had some lunch, then goofed off for a bit because I'd arranged a chat time with a friend for some undetermined time in the afternoon.  She seemed to be otherwise occupied for the day, so I decided to go ahead and zip off to see the FMD.  I woke my napping husband and dragged him out of his papasan chair (aka the "Posture is for Pansies" chair), telling him that he needed to come with me just in case I couldn't drive afterwards.  I had no idea what exactly today's procedure would entail; all I could think about was the time when I had a mucous cyst aspirated from my index finger by a dermatologist, during which I felt each and every needle used, even after the numbing agent took effect (did the same thing with my epidural, actually), as well as the cautery iron used afterwards to decrease the chances of it coming back.  Ah, the smell of burning skin--especially one's own.  Yup.  Anyway, I figured it would just be sensible (and infinitely safter) to bring a backup since I know how what a wienie I can be when there are needles involved.

We got to the minor med, which was largely dead--only one other person was there--and checked in.  Maybe five minutes later the nurse called me back, stuffed me in a room, and ordered me to discard my Band-aid while I waited.  A couple minutes later, in walked the FMD.  My hero.  My knight in white-coated armor.  Let's just say I am now in love with the FMD, and I want to marry him and have his little Jewish babies.  But I'm getting a little ahead of myself.

When the FMD walked in, I looked up at him and said, "CUT ME."  He smirked, then asked, "So, did it get any better at all?"  I told him that it had indeed, but that after the Great Skin Slough of 2012 it all started going pear-shaped again.  He sighed and said it was cutting time.  I told him that was fine, because I was over it.  I asked what precisely would be involved and whether it meant removing the whole nail, which I was dreading.  He said no, then explained the procedure in detail, saying that he would basically remove a vertical slice of nail nearest the infected edge, then remove a wedge of skin from the tip of my toe to make a smooth, unobstructed "runway" on which the new nail could grow without catching.  After that, he would cleanse the exposed area, sucking out any remaining infection and gunk and spraying down the nail root, which would "cure" me.  Afterwards, I would have a dressing like a cap, which I would leave on untouched and dry for 24 hours, after which I could again begin the thrice-daily soaking, dressing it afterwards with a little Neosporin and a regular bandage.  He also told me that if this didn't work I would have to go to a podiatrist, who would basically kill that section of nail root then do the same basic procedure, after which my nail would die and the exposed skin would eventually toughen and just be uncovered.  I asked what the likelihood was that this could happen.  He said maybe 20%.  Cool.  I like those odds.  Finally, he said it would take 3-4 months for the toenail to grow back out.  Geez, dude--it's already been 7 months, and I still have a quarter inch of old toenail humped over the newer nail like a WWI bunker.  Seriously--my toenail has a hunchback.  It's awesome.  Maybe by the one-year anniversary of the break I'll once again be able to get a freaking pedicure.

Anyway, after this instructive little lecture, the FMD started to go get his implements for the procedure.  I stopped him, saying:

"If we're gonna do this, then there are three things you need to know."


"First, I am a giant pansy when it comes to needles, especially needles shoved into non-squishy body parts."

"Ooooh, and this is a nasty one, too."  (This said without humor...)

"Second, I have very sensitive skin--I tend to react to adhesives (I described the after effects of my appendectomy) and I tend to feel every.single.needle shoved in my flesh, even when I'm not supposed to, so if you really want me to be numb, you're gonna have to give me enough anesthetic to fell a Clydesdale."

"We can do that."  (Talk about your "can do" attitudes...)

"Lastly, because of those first two items, there is a distinct possibility that I will let loose a string of obscenities that would make a sailor blush."

"We're ready for you!!"

The last he said while laughing.  Seriously.  This man ROCKS.  I told him he needed to be my GP.  He just smiled.  Afterwards, he went off to collect the necessary surgical items while I sat and waited, slightly less apprehensive, bathed as I was in the glow of his awesomeness.

When he returned, the FMD told me to "try to..." but before he could finish saying "relax," I answered that I would try, but no promises.  The FMD said he would describe every single thing he was going to do to me before he did it so it would be easier for me to relax.  (I love you, FMD.  You understand the way my brain works better than my own husband.  Run away with me.)  Then he gave me a pillow and had me lie back and put my feet on the little pull-out shelf.

Next, because FMD is so awesome, he told me that he was going to numb my skin with a cold spray to make the needle prick less painful.  He warned me that it would be very cold, but I didn't care.  I've had plantar's warts both burned off and frozen off of my feet.  I can deal with that kind of pain,  I'm just not so big on the sharp and pointy kinds.  The FMD said he was actually going to stick me between my first two toes, then down the other side of my big toe which surprised me both because I didn't know there were two nerves that needed to be hit and because I'd just assumed he was going to jam it in the tip of the toe, which I was dreading. The FMD shot the cold spray between my toes till the cold was nearly unbearable, then he stuck me with the needle--which I BARELY FELT.  He warned me that the numbing agent was the worst part and would start to burn, which it did, but compared to a semi-shattered toe, it just wasn't that big a deal.  He told me every step of the way, as promised.  When he was gonna spray me, when the needle went in, when he was shooting the meds, when the needle was out.  Both times.  (Marry me, FMD.  I make awesome cookies and can sew you every white doctor coat you'll ever need).

The FMD told me he was gonna leave me there in the room to numb up good for five minutes or so, saying that oftentimes when someone felt everything during a procedure it was because doctors tended to start said procedures before the anesthetic has fully taken effect.  I told him again that he totally needed to be my GP.  He just snorted.  (I'm not joking, FMD.  Rise to the bait.  You know you want me.  My bluntness entertains you.)

When the FMD came back he did the standard poking-of-my-toe-in-various-spots to make sure I was good and numb.  I felt nothing.  So he started the procedure.  Stab.  I told him I felt whatever he was doing (I'm just annoying like that).  He asked what kind of pain it was, since he'd warned me there would be pressure, etc.  "Pressure etc." I can deal with...I told him this pain was "pointy."  He said "Okay, let me numb you a little more..."  (I love you, FMD.  You actually listen to me.)  He started again.  I said it was still pointy, then said "TOLD you I was a pain in the ass."  He replied, smirking, "You aren't a pain in the ass...you're a pain in the toe."  (You are a god, FMD.)  I don't know if he jabbed me again with anesthetic or what, I sort of lost track--but I didn't feel anything else afterwards other than a little pressure or some vaguely burning (but not really painful) sensations.  He continued to describe what he was doing.  You gotta love a man who keeps his promises.

Turns out it was just as well that I went in to see the FMD.  A couple of friends had suggested I soak in eucalyptus Epsom salts and/or tree oil and lavender and such.  I considered it, and probably would have done if I could have located the items in question, but mostly I just wanted this over and done.  This was just as well, because in the process of performing what amounted to a hangnailectomy, the FMD told me that I had quite a lot of nail jammed up in there, hiding as though under the tip of an iceberg.  Thank you, broken/damaged toenail!   As a result, my toe would have only continued to fester around this ninja hangnail until this procedure was done anyway.  This was the same conclusion I had rapidly come to myself during the course of the week, though of course I had no idea that it would be the result of my toe was being poisoned from the inside out by a giant sliver of nail.  I thought it was just some sort of infection abscess.  Whoops.

While the FMD continued his slice and dice on my big toe, I queried if I could ask an unrelated question.  I told him about the whole CT report and renal mass thing.   I realized he hadn't seen the scans or report, but figured he'd have some idea how likely it was that I should be concerned.  Also, since he's always been very straight with me (to which I respond extremely well--I despise the beating around of bushes), I figured he'd tell me like it really is, which is all I wanted.  He more or less snorted in derision over my question, basically suggesting that far too many radiologists freak out over every little thing on a scan, which is why he himself only orders them when he absolutely has to (like for my appendicitis).  He also told me they do the same thing to him, though as a doctor he has the advantage of knowing how to hack into the computers to access his results and read them, so he knows when the reports are full of crap and when they aren't.  The FMD told me that in all probability it was merely a small benign cyst, which doesn't grow, doesn't change, doesn't really do much of anything except sit there.  I mentioned the part about the possible gallstones, and he said that could possibly be bad, though he still seemed somewhat skeptical about whether there were any or not.  And while I didn't intend to rag out one of his (indirect) colleagues (though I totally did, but at least I didn't mention names), he agreed the way they informed me was totally mishandled and done in an alarmist way.  He said it might be related to recent issues dealing with customer satisfaction and such, which I guess has been a significant problem of late in the medical profession.  I gather it's becoming increasingly more difficult to balance good healthcare against the demands of the ever-increasing sense of entitlement polluting our society.  Ironically, one of my friends posted this article not long after I got home today, which in part addresses what the FMD was referencing.  Read it--it's a good article.  And I say that, securely smug in the knowledge that I'm usually pretty good about this sort of thing.  I agree that some people overuse the system, but I really think that most just don't know when to go to a doctor and when not to, so they always go by default.

At any rate, I felt much better about the whole "renal mass" thing after having the FMD more or less corroborate what I thought about it probably being not a big deal given the circumstances.  He continued to work on my toe while we chatted, finally getting to the "cleansing" part, during which he flushed out the exposed nail root and tidied up from my flesh wedging.  He said he was going to let me sit for a couple of minutes to finish oozing/bleeding, after which he'd send in the nurse to bandage me up.  Then I thanked him sincerely (how often do you genuinely thank someone for hacking away chunks of your flesh?) and he left the room.  Shortly after, a couple of nurses did indeed come in to clean me up and wrap my toe, which now looks distinctly cartoon-like.  They even used paper tape to wrap my toe because the FMD told  them too; he decided not to take chances with my having a reaction to the tape, even though I'd told him my toes would probably be fine since my extremities tend to react less.  I LOVE MEN WHO LISTEN TO ME.  The nurses finished up, gave me my post-op instructions and another prescription for antibiotics (from the tetracycline family, since he remembered I didn't like Keflex!), and sent me on my way.  As I walked out, I told the FMD that he was my hero, and that I had never experienced a less painful procedure.  (Marry me, FMD...right now!  Or at least consent to be my GP in perpetuity...)

All cartoon toes need to be embellished with dog hair and significant needle bruising.

I went up to the checkout window to surrender my co-pay, laughing (much to the hubs' surprise) and feeling FABULOUS.  The procedure was over, my toe was numbed to non-existence--they said it could take up to eight hours to wear off--and my relief was palpable.  I all but danced out of the office, less than an hour after I went into it.  Once in the car I informed my husband that I would be divorcing him in favor of the FMD.  He just raised his brows.  You'd almost think he was used to my dramatic tendencies.  We drove across the street to Publix to cash in my prescription and to pick up a few groceries and another bag of Epsom salts.  Once home, I put on some jammies and spent the rest of the evening chilling with my foot elevated.  The pangs of shooting pain didn't start till 10 or 11 pm, and even then they were very sporadic and short-lived.

So now you know why I love the FMD and want to run away with him and have his little Jewish babies, or at least kidnap him until he consents to be my personal physician full time.  How can you not love a man with a wicked sense of humor who actually listens to you and who goes out of his way not to hurt you?  That's often a rare commodity these days--even the most fabulous of men (whether doctors or not) don't always listen.  And let's face it, medical competence is just hot.  But hands off.  He's my doctor...

So what is it that makes a doctor great for all of you?  

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