Jun 22, 2014

My Upcoming Surgery for Foot Drop, aka My 50/50 Gamble

This may be my last post until my surgery on July 14th. Or maybe not. Anyway, I'll update you as soon as I can on the surgery. As usual, here's some background on the operation.

Ever since the stroke, I developed foot drop (or drop foot--I've heard it both ways), meaning the muscles and tendons that pull the foot and toes up are no longer working substantially. I walk on the side of my foot and the toes are not flat on the ground.

The American Orthopedic Foot and Ankle Society (AOFAS) says, "The surgical procedure for a foot drop is called a tendon transfer. In general, a tendon transfer is a procedure in which a tendon (and attached muscle) that is still working is taken from one part of the foot and moved to another part of the foot to try to replace the muscle function that is missing. The most common tendon transferred is the posterior tibial tendon." 

There's more. A second tendon, the peroneus longus, is severed above the ankle on the outside side of the leg. 

This tendon is then transported to the front of the ankle and the free end "is attached to the posterior tibial tendon and the anterior tibial tendon in a bridle configuration. With this construct, the posterior tibial muscle pulls on all three tendons to pull the foot up. The posterior tibial tendon is routed to the top of the foot as described above," says the AOFAS. Clever, huh!

Here's what it looks like when it's finished:  

Am I scared? Sort of. Anything could happen during surgery: anesthesia going south, infections. But do I have confidence in Dr. Dane K. Wukich? Absolutely!

As his website says, "Dr. Wukich is the chief of the foot and ankle division and associate professor of orthopaedic surgery at the University of Pittsburgh Medical Center. He is recognized nationally and internationally in this field and practices within the UPMC system and the Veterans Administration Medical Center is Pittsburgh. 

"His 80 publications include scientific articles, reviews and book chapters and he has presented over 150 medical lectures during his career. As a board certified orthopaedic surgeon with subspecialty training in foot and ankle surgery, Dr. Wukich is uniquely qualified to treat traumatic, degenerative, congenital and acquired disorders of the lower extremity. His orthopaedic training included comprehensive education in:

Amputations of the Lower Extremity  
Amputation Prevention 
Degenerative Joint Disease 
Diabetes and its Impact on the Foot and Ankle 
Joint Arthroplasty 
Limb Salvage 
Metabolic Bone Disease and its Impact on the
Musculoskeletal System 
Neuromuscular Disorders and Spasticity 
Sports Related Issues and Overuse Disorders 

Dr. Wukich examined my foot and said I am a candidate for this surgery because I have some minimally working muscles in my ankle and foot. If the operation is successful, I won't have to wear the cumbersome brace anymore. The doc said my chances are 50/50. 

How come no one in Philadelphia or South Jersey, where I am from, recommended this surgery? I haven't a clue. But I'm glad I came to Pittsburgh to find this information. 

By the way, Dr. Wukich doesn't know anything about this post. I won't tell him, either. He's a humble man, I think. But people who have drop foot will be educated on what they can do about it. "Options" is my middle name.

So I won't say "goodbye." That word is so final. Rather, I'll say, "See you later." 
3 months later:
Surgery is a success! No foot drop and my foot is flat on the floor! I'm wearing the brace for now, but who knows what the future will bring? But I'm staying positive and maybe....

Jun 4, 2014

Impulses and the Brain, aka Fuck! Where Did My Filters Go?

In 1848, in a report written by Dr. John Harlow, M.D., the doctor related the unfortunate, rock-blasting accident by a railway worker, Phineas Gage, who had a long metal rod blasted through his left cheek, through his eye, and out of the top of his head. Consequently, the accident caused damage to his frontal lobe. 

Gage survived the accident and had his memory, speech, and motor skills intact, but he had well-documented changes to his personality. (The photograph is of brain-injury survivor Gage, 1823–1860, shown holding the tamping iron which injured him).

Before his misfortune, Gage was described as organized, respectful to others, and well-tempered. According to Dr. Harlow, following the accident, he was "fitful, irreverent, indulging at times in the grossest profanity, and manifesting but little deference for his fellows." In other words, he was disorganized, had hissy fits, cursed, and disrespected others. The cause? He had damage to the frontal lobe of his brain.


The frontal lobe is so vulnerable to injury because of its location. Damage--any kind at all--to this lobe can lead to one or more of these problems: 

Change in speaking behavior
More or less problem-solving ability and creativity
Impairment of risk-taking activities
Reduction in sense of taste and/or smell
Damage to spontaneity and mental flexibility
Increased susceptibility to distractions

Finally, after all this time, after more than 5 years, I discovered, through the story of Phineas Gage, why I had no filters after the stroke. But a little background first.

Of all the parts of the brain, the cerebrum or cortex is the largest part, which is further sub-divided into four lobes: the frontal lobe, parietal lobe, occipital lobe, and temporal lobe. (There are other "areas and sections," too, but the lobes are the subject of my focus).

Responsibilities of the frontal lobereasoning, planning, organizing thoughts, behavior, sexual urges, emotions, problem-solving, judging, organizing parts of speech, and motor skills

Responsibilities of the parietal lobe: information processing, movement, spatial orientation, speech, visual perception, recognition, perception of stimuli, pain and touch sensation, and cognition 

Responsibilities of the occipital lobe: visual reception, visual-spatial processing, movement, and color recognition

Responsibilities of the temporal lobe: visual memory and verbal memory involved with hearing and speech

My brain damage was in the first and the second—frontal and parietal, the former controlling behavior and emotions when it came to my filters, or lack of them.

I remember it well. After my stroke, as soon as I was mobile, I went out to lunch with my son. It was an Indian place that had a huge buffet. We ate our meal and as soon as the check arrived, we paid at the counter. All of the sudden, a hefty man, who couldn't wait for the food, cut to my right, almost knocking me over.

I began to chant. “Rude.” Then louder. “RUDE.” Then louder. “RUDE!” Then the ultimate. “FUCKING RUDE!” That chanting at the peak went on for about a minute. My son tried to usher me out, but I was transfixed on that spot, with people in the restaurant staring at their plates. The man continued grabbing food from the buffet. That, my friends, is when I knew: my personality, formerly consisting of peace, decorum, and patience, changed--completely. My filters were loose and couldn't be roped it.

Granted, I was aphasic more that first year, more than I am now, but I was off and gone that first year, screaming at receptionists if they didn't understand me, yelling at doctors (yes, doctors) if their opinion was contrary to mine, berating waitresses by repeating my order loudly if they were not in tune with me. I was a mess. I couldn't recognize me, as if there were two of me, one shrieking and the other assessing, all because of the frontal lobe not controlling my impulses.

I am better now, though still not perfect. The word "fuck," "shit," and/or "crap" are always present if I lose my filters for the moment, like "Fuck this" or "Don't be a shit" or "This is crap." Sometimes, I'll combine them as in "Fuck! This shit is crap." 

Sometimes, saying "fuck, shit and/or crap" feels so cathartic. But not all the time, as I did that first year. 

I'm going to have surgery July 14 to correct my dropped foot. I'll write a post about the surgery soon. So if I ever do anything athletic again, I'd wear a helmet. I wouldn't want to damage the frontal lobe again. Fuck no!

Jun 1, 2014


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