One never realizes the value of things until there is a prospect of losing them. Even little things assume an importance beyond compare when there is a threat that they will no longer be there on the morrow. And as they say the prospect of hanging on the morrow wonderfully concentrates the mind.
I never realized that the big toe on your foot served any purpose at all well than just being there. But a few months ago, when there was a possibility that I would no longer have my right toe anymore, my whole body recoiled and I instinctively rebelled against the possibility.
It started with a little white boil on my right toe which I ignored till my wife persuaded me into visiting a podiatrist. Dr Ross hummed and hawed and finally poked the boil to determine what was in it. “Aha,” he said triumphantly, “just as I thought. It is an excess of uric acid caused by gout”. He sent me home with instructions to keep washing it with warm water. Three days later, however, the white boil had turned black and swollen and my doctor promptly sent me to the hospital predicting dire consequences in case of delay. According to him, the boil had now been infected, could turn gangrenous which could, in turn, impact my weak heart. Early next morning, an orthopedic surgeon, Dr Cobey, short, shy and speaking in monosyllables, turned up at my bedside, took one look at the toe and pronounced that it needed to be amputated right away. From a little boil to an amputation seemed too drastic to me and I demurred and asked for 24 hours to make up my mind.
I was told that while lacking a big toe may not be aesthetically appealing, it does not impair the ability to walk or run. During the Vietnam War, apparently, one of the drastic measures to dodge the draft that young men considered was to shoot off a big toe. An amputee, according to legionnaire's legend, would be unfit to trudge across rice paddies or move fast to escape enemy fire and so it would disqualify an enlistee from the armed forces. On the other hand. “if you do have your toe amputated, it doesn't mean you'll never run again," I was told. It is true that the big toe carries the most weight of all the toes, bearing about 40 percent of the load, and is also the last part of the foot to push off the ground before taking the next step and a nine-toed gait may be less efficient, slower and shorter, but it is no less effective. Although running on fewer toes takes some getting used to, people can modify their style, train their muscles and practice balance exercises to compensate for a lost toe. Since running a marathon was not on my lists of things to do, all these reassurances were not really necessary. Regardless, the big toe myth has legs – the biggest concern is that, without a toe, you will be confined to a wheelchair. Of course this is not true. Customizing shoes to fit oddly numbered toes helps patients adjust to their imperfect gait and quickly get back on their feet. "We have several patients who have had all toes amputated and they walk fine. You lose some balance, strength and ability to propulse in gait, but they walk fine as long as they are in appropriate shoes with customized inserts and toe fillers." Incidentally it seems that prosthetics for big toes have been around for quite a while. An Egyptian woman was outfitted with wooden toe prosthesis in approximately 1000 B.C., says Andreas Nerlich, a pathologist at Ludwig Maximilians University of Munich.
All this I learned as I pondered this decision—to amputate or not to amputate. I was sure, however. that I needed a second opinion from a second expert. Dr Gunther, tall, thin and a Steve McQeen look alike, was brought in, examined the toe and said “ Perhaps we can save it but in any case, even if we fail, we can always amputate it”.
The next few days a number of medicines were tried and the toe seemed to be responding till two other experts turned up to advise me. One determined that I needed insulin injections to control the sugar levels and so prescribed three injections a day and another four to determine the sugar levels. I told her that that any long term regime which required me to prick myself seven times a day would not work and she needed to examine other options. After a heated debate, she left and said would be back the next day. A tropical disease specialist suggested that I could go home but with an intravenous antibiotics tube attached to me for the next two months. Again, I felt that the intravenous system had more perils of contamination at home and asked for an alternative. I later learnt that Dr Cobey was a Nobel Prize winner for his work in Cambodia on dealing with victims of land mines. Clearly there amputation was the best remedy for gangrene in the absence of other medical support. During all these disputes in the best heart hospital in Washington, my family stood by alternatively urging me to be reasonable and encouraging my intransigence.
To cut a long story short, the doctor came back with a regime of a single injection and three pills while the tropical disease specialist agreed to replace the intravenous injection with two strong antibiotic pills. Dr Cobey, too, now agreed to the more measured, alternative regime.
I learnt some important lessons along the way — always distrust instant diagnosis even from the most distinguished doctors, always ask for a second opinion and always ask the doctor for alternative approaches in medicines.
And oh yes, I still have my toe!
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