Archive for June, 2010

Behind the Scenes of Foot Surgeries

June 30, 2010

This article will inform the reader about the various steps that will occur on the day of your surgery. Knowing the procedures and the processes and what goes on the operating room should help make you feel more comfortable. The following description details a patients experience from the time they come into the surgical facility through the surgery and finally the discharge back to your home.  You will also meet and understand the roles of the people who will help you and be involved with your care throughout your surgical day.

Before Surgery:
You will check in with the surgical facilities reception personnel. After filling out the appropriate forms you will be escorted to the changing area. In the changing area there will be a secure place to keep your property. Even though this is secure, it is advisable not to bring valuables to the surgery. In the changing area there will be a private room where the patient surgical gown will be provided for you to change into.  After this step, you will meet with the nurses who will perform a pre-surgical interview.  They will also take your temperature, review your chart and check your blood pressure and other vital signs.

Next you will be seated in the waiting area. When it is time for your surgery you will meet with the anesthesiologist. He or she will ask you questions regarding allergies, physical conditions and if you are a female of child bearing age they will ask if you are pregnant. At this time the anesthesiologist will have you sign a consent form to administer the anesthesia. The podiatrist will also meet with you and will mark the location on your foot where the surgery will be performed. At this time, the doctor will answer any last minute questions you may have.

During Surgery:

Next, you will be escorted to the operating room (OR).
The anesthesiologist will then start a connection through an IV into your arm to deliver the anesthesia. After you are in a dream-like state of anesthesia, the podiatrist will draw out the incision site on your foot, and inject the local anesthetics to the site of surgery.
The podiatrist will then go to the scrub station to disinfect their hands and lower arms.  Also at this time, the circulating nurse will use anti-bacterial sterilizing solution to clean your foot. The purpose of this cleaning is to create a sterile field on and around the surgical site so that it is free from bacteria and therefore minimize the risk of postoperative infection.
The podiatrist and first assistant will then be gloved and gowned by the scrub nurse. All the gloves and gowns are completely sterile, which is another way to reduce the possibility of infection that could enter your body.
The podiatrist and first assistant will place a sterile drape, with an opening for the foot, over your body. This further provides a surgical area is bacteria-free.
Before the podiatrist makes the skin incision, the circulating nurse will call a “Time Out.” This is when the nurse confirms your name, the surgical procedures and location, your allergies, and the names of the podiatrist and first assistant to everyone in the room. This may seem repetitive, but through research, this provides further safety for the patient.
The podiatrist may then wrap an Esmarch bandage (looks like a very wide rubber band) around your foot to squeeze the blood out of the foot. Inflating a tourniquet around the ankle then follows this and the Esmarch band is removed. This prevents bleeding during the surgical procedure and allows the surgeon to clearly see structures in the foot.
The designated surgery is then performed, whether it is to fix a hammertoe or bunion deformity or other foot condition.
At the end of the procedure the incision site is closed with stitches and bandages are applied on the foot. Depending on the type of procedure, you may leave with a walking boot or surgical shoe on your foot.
The anesthesiologist will slowly withdraw the medication and you will soon regain consciousness.

After Surgery:
You are transported to the recovery area.  The surgeon will meet with you again to follow-up on your status.
Depending on the type of anesthesia used, you may or may not be groggy at this time. Therefore, you may or may not remember seeing the surgeon in the recovery area.
In the recovery area the nurse will monitor your progress as you return to full conscientiousness. As soon as you are able, they will get you to out of the bed and into a chair. When you are fully aware and awake the nurse will go over your postoperative instructions. Once you are able to ambulate, you will be discharged and released to proceed to go home.

Who’s Who?

Circulating Nurse: Works outside the sterile field in the operating room. Cleans the surgical site with anti-bacterial solution and performs the “Time Out” before the incision is made. Also, the circulating nurse opens all instruments and stitches in a sterile fashion for the scrub nurse and brings in any instruments that may be needed for the surgery. Documents and counts all the instruments and stitches used during the procedure. At the end of the surgery, the circulating nurse assists the Scrub Nurse in making sure all the gauze and instruments are accounted for.

Scrub Nurse: Gloves and gowns the surgeon and first assistant and hands the surgeon and first assistant the instruments, stitches, and bandages needed during the procedure.

First Assistant: Assists the surgeon in holding back the soft tissue during surgery and helps with instrumentation and orienting the patient for the surgeon to access the surgery site easily.

Anesthesiologist: Provides pain medication and monitors breathing rate, blood pressure, and heart rate and rhythm during the surgery.

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Relieving Dry, Cracked Skin in the Feet

June 12, 2010

The skin contains a balance of water and fat to ensure its health. However, once this balance is disturbed, the skin can become dry and cracked.  This imbalance results in the inability of the skin to stretch properly. Extreme dryness of the skin can cause cracking. Since the skin is a protective barrier for the body, the cracking can lead to painful lesions and a potential area for bacteria to hide and cause infections. Thus, hydrating the skin is very important in maintaining the overall health of the body.
Symptoms of Dry Skin:
Generally, dry skin is dull and appears tight. In cases of severe dry skin, the texture can be rough with flaky scales and cracking.  This can result in itchiness, skin breakage, and pain.

Causes of Dry Skin:
Dry skin is caused by many factors, these are categorized in two ways. There are causes that are from outside of the body such as climate (low temperature and low humidity), environment, lifestyle, and age.  The second category are causes from inside the body such as genetics, medication, hormone changes, and disease. Additionally, dry, scaly skin can be a result of fungal infections that may be treated by a podiatrist with prescription anti-fungal medications.

Cracking of the skin is commonly found on the heels of the feet. This is caused by the enormous amount of body pressure that occurs when the heel strikes the ground. Therefore, the heels, more than any other part of the foot, need the most attention and daily care.

Treatments:
Since there are so many medications used to treat dry skin, the choice of what to use can be overwhelming. One thing holds true for most dry skin treatment; the goal is to increase water content of skin. Skin moisturizers, also known as emollients, maintain the skin cell connections, and thus, decrease scaling and cracking.

1. Skin Ointments: This treatment is greasy and does not mix well with water. Ointments are the most effective product and longer lasting, but may be undesirable because of its greasiness.

2. Skin Creams: This is the most common type of moisturizer. Creams can be blended with water. This form of therapy may be preferred over ointments due to the ease of application and the nature of the cream to blend into the skin.

3. Callus Ointments: This type of treatment for dry skin can be plant based or chemical based. Plant-based callus ointments remove and soften thick, dry skin using plant enzymes and are safe for diabetics. Chemical based callus ointments are used to remove and moisturize the skin at the same time, especially thick skin. However, caution must be noted when using chemical-based callus ointments because it can cause increase breakdown of skin in diabetics and are NOT recommended on open wounds, infected area, or inflamed skin.

4. Foot pumice stone followed by moisturizers: Foot pumice stones are recommended to be used in the shower when the skin has softened by the contact with water. The stone is rubbed against the skin, and produces friction that removes the thick skin.

5. Scalpel Debridement on Thick Skin: If the skin thickness is painful and severe, a podiatrist may use a scalpel with a blade to remove the dry hard skin. However, it must be noted that the use of a scalpel should be performed by a professional.

Ways to Decrease Dry Skin:
1. Avoid hot long showers and baths because the hot water can melt the natural oils out of the skin. Once the oils have been depleted continued contact with the water will suck the moisture from your skin.
2. Apply emollients to the skin daily
3. Use of humidifiers to keep moisture in the air can prevent dry skin
4. Wear socks to bed
5. Do not pick at dry skin because it can result in damage to the skin and cause an infection.
6. Avoid wearing non-supportive sandals for long periods of time