As to a patient who takes immunosuppressants for
a kidney transplant, the answer to your question
as to how to handle them is to speak with the
doctor who prescribed them, and let him/her tell
you how to handle them. That being said, there
is "usually" nothing you need to do. If the
patient sustains a post-operative infection, then
the meds may be adjusted to compensate for any
oral or IV antibiotics that may be needed.
This past week, there have been one or two other
posts regarding the first MPJ, and how to address
the deformity present. For the hallux varus
patient, I don't believe anyone commented on what
appeared to be the severe osteopenia now present
in the first metatarsal. Normally I would say
that an arthrodesis is my "go-to" procedure of
choice but in this case, I suggest a percutaneous
tight rope.
That being said, as I have gotten older, have
done a lot more surgery as the years have passed
and have tried almost every procedure to address
a forefoot deformity, I have come to the
realization that if you are ever in doubt as to
what procedure to do, always go with a fusion
when you want the correction to last. We have
seen patients of ours, and of colleagues who have
performed digital arthroplasties many years ago
and the now present with corrected hammertoes
that point in every direction instead of
straight.
When possible, use a digital implant (personal
preference is a smart toe). If not possible to
use an implant, leave the digital k-wires in for
at least 5 weeks and then remove them. If you do
that, you will have a better chance of the digits
staying straight for a much longer period of time
(photo attached). And, I have absolutely no
problem fusing a 5th toe with an implant either.
Heresy you say? I use to think that, but not
anymore after having done many of them and my
patients are much happier.
It's your job to tell the patient what procedure
s/he needs, not for them to dictate to you what
they need. Otherwise, if do what the patient asks
you to do and a bad result is realized months or
years later, the prosecution will ask you why you
allowed the patient to dictate what the proper
procedure should have been.
Charles Morelli, DPM, Mamaroneck, NY,
podiodoc@gmail.com
.gif)
