Day 56 - Feb 15 - No more bandages

Things are progressing well. I think today I will stop dressing Right#2 as the two wounds are dry and are no longer oozing. Geez that took a lot longer than I thought it would though. Walking has become much easier since my last post. You wouldn't be able to tell that I have injured feet seeing me walk down the street. I can go five days, ten hours a day in dress shoes barely noticing them. I even did 30 minutes on the elliptical about two weeks ago and was no worse for wear. The people in the locker room still look at me funny when they see my feet: "Buddy, you better get your shower shoes, you don't want this fungus!", I tell them and they run away with a disgusted look on their face. (Just kidding I don't really say that - leaving my malaise to their imagination is much more cruel - heh heh ;) )

The damage is deep though. My toes are still discoloured and I don't know if they will return to normal. My big toes are still firm and waxy looking at the ends instead of supple like they should be. On the surface, the skin is highly sensitive and delicate. They itch like crazy sometimes but I've been able to resist scratching. I have lost a total of four toenails and I expect to lose perhaps one more. Those lost are growing back slowly. Deeper in my toes the feeling is still not there. Or rather - it is - come to think of it the fact that I can feel the INSIDE of my toes is kinda weird no? I don't recall being able to do that before! Let's just say that the feeling in my toes is pretty abnormal - but at least they're functional. The worst part now, or at least the painful part, is on the little toe side, the part of your foot that pressures the outside edge of your ski (for you skiers out there). Although the skin didn't really get much damage there, the freezing went deep into the bone I think and it hurts to stand on the outside edges of my feet (cause I do that all the time you know). Yesterday I went for a hike in N.Van with Shari and Cedar and I had no problem on the up. Coming down though your toes are naturally jammed into the front of your boots/shoes - my toes weren't very happy with me. Oweee. I fully expect this last phase of recovery to be very, very slow, but it seems that from about now forward, my feet shouldn't hold me back from most of my activities - although running or skiing should probably wait - hold on, those were my activities before... okay I take that back. But hey I can walk normally!

I have taken pics of this and the last post but haven't gotten around to posting yet. Just need to get unlazy for a second to do that. Perhaps now. Perhaps not. Okay I did it. Wow they look good!

Day 34 - January 24 - Patience (Warning: Gross Pics Ahead)

In the two days following my last post, nearly all of the old skin has peeled off of my toes. This wasn't a pleasant experience as it was pretty stuck on there and it took some time and effort to get it off. I was encouraged to do this as it is supposed to enable the skin underneath to heal up faster. Both of my big toenails came off in the process - quite by accident actually after an excruciatingly painful day in some dress shoes (for work) I got home and found that the nails had separated from the skin underneath and with a small
amount of leverage they peeled off FORWARDS from the back to the front. With them came the bulk of the dead skin around the rest of my big toes. The nail of Right#2 came off too (which by the way is still an open wound and requires daily dressing changes.
The patience part of this ordeal might already be apparent to you. It is now Day 34 and the wounds have still not closed completely. The rest of my toes are still numb and stiff, the tissue underneath is not supple as your digits normally are. The new skin that has been revealed is shiny, waxy looking and unbelievably sensitive and fragile: the pinky toenail of my right foot has managed to cut into the toe next to it and make it bleed; the spot where it rubs aches enough to make me cringe when I walk. I am told that it may be a total of SIX MONTHS before I am 100% again. One down, five to go.

Day 31 - January 21 - Bye Bye Bandages (save one)

My toes are hideous. But they're getting better. Today my bandages came off at the Burn Clinic and this is what greeted me. All wounds closed and dry, except Right#2, which finished with a bandage. The nurse said she was being gentle but it felt like a belt sander as she picked and pulled and scraped dead skin away. At the end of it I joyfully, yet very carefully, slipped my feet into a pair of my own size 9 dress shoes (for work) and retired the $17 size 10 Canadian Tire duck shoes. It was a tight squeeze but I managed until I got home 10 hours later, with a forty minute shoeless break at lunch (went for Japanese and had to take our shoes off). It's actually quite a gross feeling without the bandages now. Wiggling my toes, it feels like little flaps of hardened skin tickling each other. The new skin is extemely sensitive. Next appointment: one month. I will be changing Right#2 dressings myself with flamazine (?) cream instead of Acticoat, and avoiding getting it wet until the tip and top are healed over. STILL open wounds there.

Day 27 - January 17 - Panic

"Panic is a part of the 'fight or flight' response common in all mammals which causes a sudden rush of epinephrine (adrenalin) to be released, one effect of which is peripheral vasoconstriction (closing off of blood vessels in distal parts of the body, esp. skin) in order to maximize blood flow to the 'core' - large muscles, brain, heart, lungs - to facilitate da fightin' or flightin'. Less blood = less heat = faster frostbite." - Dr. Jeff (my little brother)

I had a moment, or rather about 15-30 minutes on that day, nearly a month ago now, when I was in a state of panic. Real, frightening panic. I wasn't lost - bear right and I would hit the trail eventually. I could see the road and I had a map and compass and a bearing on the car. I had food, water, a headlamp, even a lighter that I had forgotten about. Heck I even had a cell phone with a good signal. But before I got all of that straight in my head, all I could think about was that I had taken a wrong turn and I was separated from the group - I was lost - I only had one hour of light left, who knows how much skiing, and the slide alders were relentlessly snagging me - impassable obstacles between me and my escape, fuck did I go over the bluffs when I should have kept right? ..it was really fucking cold, my puffy was in the car, what if I break my leg or twist an ankle - I'm dead! jesus I might have to dig in and spend the night. Panic.

Could have been those few minutes of panic that caused the frostbite. Now day 27 and still I am Gimpy McGimperson.

Day 24 - January 14 - {{CRINGE}}

Today I was hoping to walk out o the clinic with fewer bandages but alas this was not to be. In fact this visit turned out to be one to of the shakiest that I've had, mostly because the nurse completely shook my confidence in her competency/experience in dressing wounded toes. After a week of being in the bandages, they had dried to my toes quite firmly; she promptly yanked them off with a little sterile water for lubrication. Dead skin, which could have easily been cleaned off was left to hang off of my toes while she sloppily gooped the gel on, slapped on the Acticoat then attempted to wrap the toes in adhesive foam, leaving at least a half an inch of dressing protruding from the end of my toes. This caused concern that I would be able to fit into my shoes at all, not to mention the question of whether the bandages would stay attached for longer than a day (they have). It was the messiest job I have experienced since the get go - even hastier and messier than my trip to the walk-in clinic in Sherwood Park.
Thankfully, my toes have been getting better each day. I retired the cane the day after my last post and have been hobbling around on my own, albeit quite slowly. I still lack any real sensitivity in my toes, but I am confident that this will come back with time. In my next trip to the burn clinic next week I hope to walk out sans bandages so that I can have an actual get-my-feet-wet shower and fit into my shoes. At that point I will also be able to join a new gym close to work - the inability to shower thing is the only thing holding me back.
Highly relevant to my frozen toes, today I attended a Toastmaster's meeting at work and was randomly given the table topic to speak on "How to stay warm in the cold winter". Actually it had more to do with preventing a cold, but I spun it around so that I was talking more about how to prevent your toes from freezing off. Solution: stay warm.

Day 20 - January 10 - can't kick the cane

I know my toes are here to stay but wow, sometimes it just feels like they're ready to snap off. Right #2 is the worst. There is still a long recovery - I have absolutely no strength in my toes and the feeling is still mostly absent. I tried going without my cane today (I've been managing at work to go up and down the stairs between the 26th and 29th floors), but that didn't go so well. So the cane stays.

Day 17 - January 7 - Ten little piggies stayed home

Today was my first visit to the burn clinic at the Vancouver General. It is also the day that I learned that I would be keeping all of my toes, so suffice to say, it was a good day.

The dressing change went smoothly and quickly, the nurse being no-nonsense and going straight for the jugular, manhandling my toes through the old bandage removal, cleaning, photographing (here they photograph the toes for their records), and finally redressing. By my next visit in a couple of weeks, I will hopefully be done with bandages altogether, although Right#2, which seems to be the worst overall, may still need some TLC. In my first sense of weak-stomachness during this whole ordeal, I cringed as she cut away the skin. While all of the other toes have lost skin on their tops, their pads underneath hard, sickly in colour and likely dead, are still intact. Right#2 on the other hand is now an open wound around its full circumference - a naked little piggy.

In another first today, I was astounded by the lack of bedside manner of my doctor, presumably a specialist as I was in the burn unit after all, when he expressed his dismay that I had not been changing my dressings daily. Well as a matter of fact I do just happen to have plenty of stock of Acticote silver dressings, ample gauze, gel, sterile water, saline, tape, not to mention the expertise to assess, clean and dress my own swollen and blistered toes. Despite this, his diagnosis was agreeable - all my them are mine to keep.

Day 15 - January 5 - the most expensive pedicure known to man

I think I'm on the mend. I hope. Today was my third dressing change and while the pics are quite gross you can see that the swelling has gone down substantially. I have some bogginess on the big toes that comes from too much moisture in the bandages, and the ends of the first two or three toes have yet to sluff off (hopefully it's that easy) but today I could actually spread my toes. Also, the pain is still faintly numb and achy, but it's there on the tops of pretty much every toe. One blister, on left #4, has even healed over so that it didn't need to be bandaged up today.

With frostbite being such a rarity in Vancouver, there was a parade of doctors and nurses coming through the treatment room to observe. I don't mind the attention at all, made all the more enjoyable in that most of them were of the pretty female persuasion. Ironic that after ice climbing and skiing in the backcountry for nearly 10 years in the often bitterly cold Rockies that I wouldn't get serious frostbite until my first backcountry foray on the balmy west coast.

Adding up the costs of just one of these visits, I must say that I feel thankful for our great Canadian health care system. It was only a year ago that I was (almost) living in the USA doing the same outdoor activities; a visit like this must cost upwards of $300, maybe a lot more. One to two hours with one or two registered nurses, materials (the Acticote silver dressing is $65/sheet - their cost) plus margin. Quite a pedicure, and one to two time weekly to boot.

Ange asked me today if I were upset or sad about my situation. Yes, I suppose I am. Today I got a call from the BCMC confirming that I couldn't participate in the backcountry clinic over the next two weekends, and over the holidays I missed the Marmot trip with Kyle. These things are regrettable but I was able to accept my situation very early on, the first day in fact. In light of how much worse things could have been for me (bad things did cross my mind that day on the 20th) and now especially in light of the recent backcountry accidents in Sparwood, Mt. Seymour, and Whistler, I can only be more grateful that all I have to worry about having a patient recovery. I don't think I've fully resigned myself (is that the right term?) that I could lose some toes yet, but we'll cross that bridge when we get there. That decision could still be weeks away.

Well, I start work, and my last semester of school, tomorrow. I'll have a lot less time to put into this blog I imagine, but I'll try to continue to post until I'm fully recovered. I'm learning a lot from this experience and I'm hoping that some one might read it and take a little extra caution when they're out in the backcountry too.

Day 14 - January 3 - Mr. Peanut

I tried venturing out yesterday and did pretty well actually. The streets of Vancouver, particularly the sidewalks and sidestreets (i.e. my street) are still covered with ice and snow. Like true Vancouverites residents (and the city) are counting on our balmy west coast climate to melt away the snow. It ain't happened in three weeks now: piles of snow, frozen slush, melted and refrozen sheets of ice all make for quite the obstacle course for someone with inhibited mobility, myself now counted among those. Anyone on a motorized wheelchair is guaranteed to be housebound. I, with my crutches, had enough trouble and found it easier to use them as two ice axes. That combined with my sore armpits, convinced me to replace the crutches with a cane today. Yolanda said all I need is a monacle and top hat and I could be Mr. Peanut - I do have a fedora so perhaps I could pass for an impersonator... although I think Mr. Peanut uses his cane for dancing, not to prevent himself from falling ass-over-teakettle on the street.

I also replaced my footwear - from hut booties (that are not waterproof and are starting to wear through) to $17 over-sized Canadian Tire duck shoes that have already given my ankles blisters. These new shoes wil not only keep my dry, but they won't look as ridiculous with a suit when I start my new job in the heart of the downtown financial district, on Monday.

My toes today are really, really ugly. I injected the water into the bandages as instructed. Tomorrow is another dressing change.

Day 12 - January 1 - Individually wrapped for freshness

Last night and again today I felt a need to get my dressings changed so I got a ride to the hospital after brunch and began a long, long day of waiting. Arrived at 2:30pm, got home at 8:30pm - 2.5 hours in the waiting room 2 hours of soaking my old dressings so they would come off, and about 1.5 hours of meticulously applied new dressings.

As you can see, there is some green going on underneath those old bandages, although I was told that the silver dressing actually causes green discolouration. Maybe some infection too though - the nurse said that she could smell... something. What you cannot see from the pictures, despite my best efforts to capture it, is the rainbow of sickly colours that my toes have turned since my last change on the 27th. Black, purple, blue, red, grey, and yes, green. To my surprise however the doctor and nurse were pleased with the way my toes appeared to be "healing" as if I could actually call it that. With the bandages (almost) off I still cannot wiggle or really feel my toes past the second (or is it third) knuckle. I test the function of my toes and try to lean forward, but my toes do not stop me from falling forward and I must catch myself.

Also to my surprise was the surprise that the doctor and nurse showed when they learned I had only had one dressing change in nearly two weeks, that I was not getting them far more often, even daily. Such is life during the holidays. I was instructed to get a change on the 29th then again on the 7th. Thank goodness I decided to come in today instead of wait until the 7th (another full week from now) as I thought I was supposed to.

Thirdly to my surprise was the extent to which the silver dressings decided to adhere themselves to my wounds. They simply wouldn't come off without tearing my toes underneath so I spent a large amount of time with wet gauze on my feet to moisten the wounds enough for the silver to release. Oh well, I had no where to be today.

Fourth, and lastly, to my surprise was the meticulousness with which my nurse redressed each toe individually. First cleaning each with sterile water and gauze, between toes and then carefully drying them. Application of gel, then silver, soaked in sterile water and carefully cut to the exact size of each wound on each toe. Then gauze, cut and and applied over each patch of silver, then each toe wrapped in thin strip of bandage, taped, and plastic wrapped. Finally each toe was covered with a protective little "toque". Elapsed time: must have been at least 1.5 hours.

My homework is to inject 1/2 cc of sterile water into each patch of gauze on Saturday to keep the dressing moist. And finally I am to report back on Sunday for another dressing change.

PS. the completed bandages now appear as in the final photo below. No more wrappings all around my feet. I can fit into some stretchy ski socks but not into shoes quite yet. ... It's been a long day, time for bed. Oh - and Happy New Year.