Health Care in America: An Open Letter to Beth Israel Medical Center

I have sciatic neuropathy down both sides of my lower left leg. For me that means I don't feel my foot from my ankle down. I've likened it to my foot being asleep, only the nerves never wake up.

I can pinpoint exactly when this started, Monday, January 23, 2012. The day I went in to Beth Israel Medical Center in Union Square to have outpatient achilles repair surgery. I had spent much of the previous year trying to stay out of the operating room. I had been diagnosed with micro-tears and had been in severe pain for a few months before I was finally able to schedule an appointment with a foot and ankle surgeon (I won't go in to the hoops involved in simply finding a specialist who takes my insurance). I had done everything I could to keep from going under the knife, I had heard stories from many people about how long the achilles can take to repair, however, no one had mentioned neuropathy as a side effect.

After being in severe pain over Christmas and spending my birthday at the doctor's office I finally conceded the need for surgery. So very early on the morning of January 23rd I found myself taking the subway to Union Square with my rented knee-walker and checking in for surgery. That morning I met the anesthesiologist who told me he would put me to sleep and then give me a popliteal sciatic block, otherwise known as a nerve block behind my knee. And the trouble began. 

I wasn't in much pain post-surgery, which probably should have been a sign. On my post-surgery diary I begin commenting on numbness in my leg on January 30th and had emailed my surgeon's PA. By February 7th I was referring to it as neuropathy and commenting that my surgeon was "surprised". It continued to be one of my top concerns at post-surgery appointments until March when the surgeon finally conceded to my seeing a neurologist. He recommended one at Beth Israel - I made an appointment with one at Hospital for Special Surgery.

It was fifteen weeks after surgery when the surgeon finally said I could start to transition out of the walking boot into sneakers with a lift. I was ecstatic until I discovered another side effect of the neuropathy. Since I can't feel the ball of my foot I roll my ankle as my brain searches for a position that feels secure. The end result is that my ankle is constantly swollen and in severe pain and my gait has become so slow tourists in Times Square move more quickly then I can. I continue to be fearful of causing damage, but when I emailed a photo to my surgeon and asked about wearing some sort of brace I was told that he did not want me constricting the ankle. So my mobility and ability to live my daily life has been severely compromised as even simple things like walking to the kitchen to feed the cats causes pain and my ankle has taken to permanently resembling a softball. 

And here we are, I have had an EMG (Electromyogram) showing definite neuropathy (an MRI of the lower sciatic nerve is scheduled for later this week). Both the surgeon and the neurologist have said that the best case scenario is that the nerves re-establish feeling in a year. And the only treatment option - physical therapy (PT).

So, why this letter? What do I hope to accomplish? My physical therapists office is reporting that my insurance is beginning to limit and deny the number of sessions I can have. While I am one of the fortunate self-employed who can afford insurance, being self-employed and limited in my ability to work when I can barely walk means I do not have the money needed to pay for PT and other treatment options out of pocket. 

I have had many people tell me to sue, I may be naive, but I don't like how litigious our society has become. It bothers me that people seem to think they should get rich because someone else screwed up. I am not looking for some huge payout. I simply want enough to cover my out of pocket expenses related to trying to care for and rectify this injury created during my surgery. 


I am not looking for compensation for pain and suffering or even lost income. I have made, have been forced to make, the decision that my primary job for the next year is working to convince my nerves to find a path to connect my foot to my brain. I need to make every effort to insure that this is not a permanent disability. 


I want the opportunity to discuss this with someone. I have left multiple messages with the Beth Israel Patient Representatives Office, but never heard back, leaving me to write this letter in hopes that someone will finally respond.


Thank you.


Erika Clark

Back in the Saddle (or on the Therapy Table)

I'm delicate. Or at least my ankle is. That is the take away from Carlos' conversation with Dr. Hubbard. He was impressed that based on my description alone Dr Hubbard was able to name the BAPS board that seems to have caused my need for a cast.

Carlos also told me at least twice this morning that my physical therapy may feel boring and quiet for the next few weeks, but that is what's required to get my ankle back on track without risking any damage. It was a quiet session. Part of the problem was that at least two of the exercises Carlos wanted me to do to help strengthen and stretch other parts of my leg and back required me to put weight on my foot - making it a non-starter. No band exercises that would stretch the achilles. Instead it was some massaging to get fluids flowing and deal with the tightening of muscles tired of the bondage boot, followed by some leg raises with the weight on my knee and then spelling the alphabet with my foot. Finally some stretching and ice.

It felt more like maintaining the status quo then moving forward, but I am putting my trust in Carlos for the next two weeks until I see Dr. Hubbard again. I am already mentally reminding myself to pack sneakers and my wedge flipflops for my next appointment.

PT again on Friday, not with Carlos as it's an insurance evaluation appointment. My therapist and I have to convince them that I need more appointments. Silly, but that's health care in the US!

Back on Track

I emailed Dr. Hubbard yesterday to say that while I was having minor twinges, it was much less then the pre-cast pain. And that when I felt along the tendon I was no longer feeling the need to kick in agony. Happily, his response was no MRI and I can return to physical therapy. So, I have made an appointment to see Carlos on Tuesday and left a message reminding him to call Dr. H.

I celebrated my clearance with a walk in the Spring weather yesterday and am going to try to get some photos shot today. Trying to decide if I should push it with a trip to the Botanical Gardens tomorrow. Probably not, but I need the activity!

We'll see how next week plays out.

Back in the Bondage Boot

Friday I hobbled in the green cast to Union Square, watched a group of people unfurl an "Occupy Wall Street" banner and then went to see Dr. Hubbard and Marco.

Happily Marco removed my cast, but with my foot still tender Dr. Hubbard ordered an x-ray to check that the screw holding the achilles in place hadn't pulled out. It hadn't, so he put be back in the bondage boot with orders to email him Thursday with a pain update. If the pain is still there I will have to have an MRI to check the actual tendon.

So far it looks like I get to miss that claustrophobia. The pain was there on Friday, but seems to be okay now. I did have some pain during my photo assignment yesterday, but that could be simply because it was my first time on my feet for an hour, trying to move around to get the shots I needed.

This morning my foot is generally sore, but no isolated pain the way I had before the cast. Hopefully this means I can avoid an MRI and go back to physical therapy. I did speak to Dr. Hubbard about not wanting to return to PT unless I knew he had spoken with Carlos about what my foot is allowed to do - he agreed. I absolutely do not want a repeat of this! As it is I know my recovery has been set back by at least three weeks. I should have remembered none of my surgeries have ever been smooth and easy.

Honestly, I suspect I am losing some perspective on the whole thing. I am depressed that I can't get out and shoot, even if it just walking through the botanic gardens and catching some of the early blooms. I had to turn down a residency because I knew I wouldn't be ready to walk enough to get the photos. I hate feeling forced to be this inactive.

I was excited to start PT because it meant I was on the mend and it was a real step towards getting my life back, now I am left in a limbo, hoping that if I stay pain free Dr. Hubbard will let me return soon. Forget the month I spent basically stuck in my apartment - this is when I need people to amuse me.

Monday, Monday, Can't Trust That Day

Who knew I could miss the bondage boot! Friday I couldn't even keep up with an elderly neighbor who is recovering from a heart attack, has arthritis and walks with a cane. Saturday it took me over an hour to walk 5 blocks to the market, buy seven items and walk home, and that was without a line for the cashier. Sunday a neighbor asked me for a favor to walk her dog as she had to catch a train - I didn't time how long the six block walk took, but I was more then ready to elevate my leg when I got home.

Today I had a simple day planned with minimal walking - best laid plans and all that. I had to drop off a portfolio and thought I'd stop and grab a chai at the nearby Starbucks. I got yelled at by the manager for ordering additions off the menu and was told I was a "trouble maker". I walked out and took a bus to my favorite coffee place where they are friendly and willing to make my drink to order. I am left wondering what ever happened to customer service!

A bit more walking then I had planned, so I'm postponing some of today's errands until later this week. With multiple friends offering to inflict physical harm on the physical therapist I have decided what I really want (and am not going to get) is him running all the errands that have become more difficult for me this week.

The problem with the cast (besides it's bulkiness) is that I can't feel where I setting my foot down, so I walk very slowly and continue to overcompensate. And even in the cast the heel hurts making me a bit terrified that this has set me back much more then one week. I have already had to cancel one photo shoot and have one a week from today that I can't cancel, but have no idea how to do if I am still in the cast. That is a big fear for me, that I will see Dr. Hubbard Friday and he will decide I need more time in a cast and even more limited mobility - I am not going back to the knee walker!

Just When I Thought I Was Out...

Marco emailed me yesterday in response to my worry saying it was probably nothing, but they had decided I should come in today. I cancelled my physical therapy and worried.

This morning I woke up with the ankle so stiff it didn't even want to bend enough to go in the boot. This did lead to one positive discovery - my tall cast shower bag fits over the boot. This meant I was able to confidently stand in the shower, which made me briefly happy.

I was also relatively pain free until I had to climb the stairs from the subway platform. After the longest wait I've ever had in Dr. Hubbard's waiting room (made some what surreal by the high school or college football player afraid of an MRI and a doppelganger for actor John Daley) Dr. H. asked me some questions, poked my heel, made me bend it and decided I hadn't torn the incision, but may have pulled it.

So to show my Irish I am now sporting a green cast from my toes to just below my knee. I picked the color. I get to wear this walking cast for a week as we give my heel some quiet time. I miss the bondage boot. At least wearing it I could tell where my foot was. In the cast and cast bootie I find myself over compensating for my fear that I am not lifting my foot high enough. As I said to Marco, I now have a truly eclectic collection of left footwear.

In the cast for a week, followed by a re-evaluation. I am just hoping this hasn't pushed my recovery back too much. I took a cab, rather then trying to walk through the subways, to my afternoon appointment. I did make a detour to visit the physical therapy office. I cancelled my appointments for next week and told both Ed and Carlos that no one was allowed to touch me - once I'm allowed to return to PT - unless they have spoken to Marco or Dr. Hubbard about what they can and can't do. I thought I was being good not hitting anyone with my new cane.

I am not finding this as light as I've been playing it. This has made me angry and worried and depressed. I thought everything was going so well. As a friend keeps reminding me this is not the worst thing -  it just sometimes feels like it.

PT Bad - Bad PT

So what are the signs I've pulled or torn something?

I had some pain during PT yesterday and Edward changed the exercise. I spent most of the afternoon with my foot elevated and periodically iced, but had pain every time I walked and some swelling when I went to bed. (I didn't have any swelling after PT on Monday.)

If it was generalized heel pain I wouldn't worry, but this has been sharp pain in one part of my outer heel / ankle. Even in bed last night it would twinge irregardless of if I was moving my ankle. This morning I wrapped it with the elastic bandage in a vain hope that the extra stability would help. It hasn't. Basically, with every step or so I get a sharp pain just to the left of my incision site about where my heel and ankle meet. Even sitting quietly here I have a throbbing with a periodic sharp twinge up the back of my heel.

I have emailed Marco and Dr. Hubbard in hopes of reassurances that this is normal stretching pain and not to worry. And trying hard not to think about it until I hear from one of them. What I really need to know is if I should cancel tomorrow's physical therapy and let my heel have some quiet time over the weekend. I definitely think photographing the parades this weekend is out.

Physical Therapy is Hard

I surprised myself by coming home today in pain. I did not think the little bit of stretching and activity I did today would hurt. Carlos had warned me. He gave me a rubber band to do exercises at home, but said that if I was in pain tomorrow to leave off until Wednesday.

Don't even feel like I did that much. Started with a painful massage as Carlos worked to get the low and fluid retention moving in my calf and foot. Then leg lifts with a four pound weight followed by drawing the alphabet with my foot and ankle circles. We finished with the rubber band stretches and ice. I guess I was still frozen when I left, it wasn't until I got home that I realized how badly I wanted to take the brace off and just prop up my foot.

When I was finally willing to venture off the couch five hours later, I discovered my heel very tender and a bit cranky at being stretched to the 75 degrees or so that the boot requires. For all the pain, I know Carlos is being sensitive and is concerned that I might tear the stitches holding the achilles together.

So perhaps it is a good thing that most of tomorrow will be spent in front of the computer. I will continue to elevate and ice and we will see what PT with Edward brings on Wednesday.

Busy Friday

Two packed buses passed before one stopped to pick me up this morning making the 14 block, 20 minute walk or 10 minute bus ride, into a 30 minute commute. Fortunately I had budgeted extra time before my physical therapy appointment and was there on time.

Edward did my assessment. Having been my therapist in the attempts to prevent surgery he knew my heel. I was able to flex to 8 degrees (I believe Edward said zero is a full flex). I also did fairly well on the pointing. This appointment was more about seeing my post-surgical range of motion and what we needed to work on. I re-iterated the note on my prescription, that Dr. Hubbard is adamant that I do not walk or put any weight on the heel unless I am in my boot.

My first proper PT appointment is Monday with Carlos. We joked a bit about his needing to remember what the term "gentle" means before my session. So for the next two weeks I have PT three times a week and then we will have to re-evaluate for my insurance.

Spent the rest of the morning running from one meeting to another and then hanging out waiting to meet a friend for lunch. Now home and waiting for another appointment and then friends over for dinner. All while trying to convince my body not to give in to the cold germs that seem to be attacking.

Hospital Charges, or Why Do We Need Health Reform

Just forget for the moment my right as a woman to have my birth control options covered by my insurance. Even if, as in my case, I would use it less for safe sex and more as one of the options to lower my familial risk of ovarian cancer. Today I find myself dumbfounded by the inflated rates hospitals charge insurance companies in the US, just to actually get paid a portion of the bill.

I received a bill from the hospital for my achilles surgery. I am lucky, I have health insurance with a $75 surgical co-pay. The hospital billed my insurance $9,881.65 (this does not include an additional $3,895.00 billed to my insurance from the anesthesiologist). Honestly, knowing some of the bills for medical procedures in the US, that doesn't seem incredibly high (the surgery, not the anesthesiologist) until I look at the break down for the bill.

Anesthesia (this is for the actual drugs, not the doctor giving them)      758.00
Ambulatory Surgical Recovery Room Time >3.5 to 4 hours                830.00
Surgical Time Level 1 91 - 120 minutes                                            4000.00
Suture for Anchor Level 5                                                                  975.00
Cutting Blade Level 1                                                                         163.00
Custom Pack Level 4                                                                         325.00
Tourniquet Level 6                                                                           1625.00
Drape Level 4                                                                                    975.00
Thromibin 5000U Vial                                                                        230.65

Of that $9,881.65 bill, my insurance paid the hospital $4,115.06 (they paid the anesthesiologist $1,544.66). Basically less then half of what the hospital was charging. Yet, a friend in the health care field once explained that if the hospital charged my insurance $4,115.06, my insurance would only want to pay half of that. It is a ridiculous cycle where the ones getting screwed are the uninsured. But, of course, there is no need for health care reform!

My rant for the evening. 

Doctor's Appointments

Can't decide if it is a plus or minus that I was in and out of Dr. Hubbard's office in less than 30 minutes. The plus certainly came from not having to sit in the waiting room for more than 5 minutes and I got most of what I needed dealt with - even if I wasn't 100% happy with the answers. It was just a surprise when I left the office and reached the sidewalk to realize it wasn't even 11:30 (I had walked into the office just after 11:00).

With Marco on vacation, I had Greg as my PA. I had met him briefly the morning of my surgery. He looked at my heel and recorded some notes on the computer. I mentioned my neuropathy concerns and that Dr. Williams had recommended a neurologist. He thought it was a good idea to schedule an appointment and get the opinion of a specialist. Dr. Hubbard didn't fully agree.

Dr. H. did clear me to start physical therapy three times a week, though he again emphasized that I am not allowed to walk without my bondage boot. He said I should wait until after I have started physical therapy before considering seeing a neurologist. Told me that if it was related to the surgery, it was probably from the nerve block the anesthesiologist used, not from the surgery itself. He also recommended I see his choice of neurologist at his hospital.

When I got home I called Dr. Williams' recommendation and left a message. We'll see when she can see me and what she has to say. In the meantime, I see Dr. H again in three weeks and have my physical therapy evaluation on Friday. I have decided I want Carlos as my therapist this time. I like Edward, but I suspect Carlos will make me work harder - the way Matt did after my knee surgery.

Life goes on. Looking back the past six weeks feel like they have flown by, but the day to day living seemed to take forever.

Have I pushed too far?

I was supposed to spend the evening out. A consulate cocktail reception and then dinner with friends. This morning getting out of bed I was reminded of my pre-surgery life. A heel that hurt, even in the boot, when I tried to walk. I wound up shuffling around and setting myself up on the couch with my foot elevated for some couch and book time for most of the day as well as cancelling my evening plans.

Scared myself. I thought I was being good. I did walk a bit Saturday. This time I walked to the mall shopping and then took a bus home. I did some grocery shopping Sunday, but nothing major. I thought I was falling withing the parameters of being conservative. Yes, I was cane free all weekend, but both Dr. Hubbard and Marco had told me it was okay.

I'm sure I'm just being paranoid end everything is fine. Worst case it is sore from being idle for six weeks. But I have to say I am very glad I have a follow-up appointment this week!

A Change in Plans Means Pushing Limits

After hearing from my building super that our elevator was going to be out of service all day I scheduled a quiet day at home catching up on my Hulu queue and some new books. Then I got a call telling me that an old friend passed away a week ago. I hadn't seen him since my mother's memorial service four and a half years ago, but that the vibrant, kind man I knew - a man only seven years older than me - could be gone hit me surprisingly hard.

I tried to find the right, non-trite words to express to his wife how sorry I was for her and their children. And then because I was still feeling so strongly, I hobbled down the five flights of stairs so I could get it in the mail today.

It was only after I got downstairs that I realized I hadn't put on a stamp and didn't have any in my bag. I took the bus to the Post Office, bought stamps, mailed the note and then decided to wait out the time before the building elevator was restored by looking at laptops to replace mine that is on it's last legs (or should I say bytes).

I walked the block from the Post Office to the mall and then through the three stores that carry laptops, comparing prices and options. I came close to buying one before deciding to do some more comparisons on-line. At that point I had a decision to make - walk back the two blocks to a bus stop, or push forward. I got it in my head to push forward and see if I could walk the eight blocks home.

Not my smartest decision, but I've been fairly well behaved up to now. After three blocks I ran into a friend and sat with him for a bit as he had a late lunch. I don't know if that short break made the difference, but I made it home with only minor discomfort and the knowledge that I could do it.

Foot is elevated for now and I won't push it this weekend (I have a busy calendar next week). But there was some pleasure in knowing I could take another step (pun intended) towards my normal life. I am feeling so good about it I may try to schedule a small photo shoot for the week of March 12th.

Returning to Routines

I am starting to feel normal again. I still have the neuropathy (now that I've started sleeping without the elastic bandage I have noticed it is affecting my entire foot from the ankle down). I'm still wearing the bondage boot (with more walking comes the awareness that the top strap hits my upper shin right at my knee joint and puts an odd pressure on my knee). I am still afraid of my shower (I have managed a couple showers without slipping by being overly cautious). But, I feel like I am taking back my life.

I have started walking around the apartment without the aid of the cane - haven't told Marco or Dr. Hubbard. More importantly, a week after my walking restrictions were lifted, I have started getting out of the house.

When I'm home I always feel better if I can get out of the apartment for some part of every day. Doesn't matter if it is taking a walk with my camera, or meeting friends or colleagues for coffee (or Chai). Fresh air and not being surrounded by my four walls can help calm me and I can often return home with a better focus for my current projects.

So for the past two days, despite the cold rainy weather, I have walked the two blocks to the bus and gone to my favorite coffee place. Today I even brought my net book and am writing this post with a Chai latte and blueberry muffin.

Getting out of the house has also created a return to a more interesting sociology observation - mentally tracking the gender, age and ethnicity of people who offer me a seat on the bus. I have always been interested in the question of whether it is lack of courtesy or obliviousness that causes people to ignore others in greater need of a seat on a bus or subway. I observed this when my mother was noticeably ill with her cancer and have continued with my own time on crutches or boots and friends pregnancies. Ethnicity seems to play the smallest role, while overwhelmingly it is women over 30 who will offer their seats. Of men, it tends to be those over 50 who will offer a seat with those in their 20's and 30's least likely to move. It would be interesting to see if these observations are universal or simply here. Anyone want to fund trips to all major cities with a mass transit system? I will happily play guinea pig.

For now, I am simply happy to be expanding my world to beyond the loft and the doctor's office. I see Dr. Hubbard again in a week and Dr. Williams has recommended a neurologist if my neuropathy doesn't start to get recede.

The scar itself, still looks red and angry, and while I have it uncovered in the shower I have only  washed it directly with a gentle washcloth. Today is a big day for my foot and scar as I covered it with gauze, but went without the elastic wrap, which also means I am getting a better idea of how the neuropathy is impacting my foot. What I really want is someone to tell me I'm going to get back into my pretty shoes and not spend my life in hiking boots, sneakers and flats!

Bondage Boot and a Cocktail Dress

It is surprisingly difficult to find a cocktail dress that will go well with the bondage boot (not to mention shoes). I finally decided on three options that had skirts with enough length and flair to work getting in and out of cars and up and down from my seat without flashing too much leg. Two could be paired with black tights - in the vain hope of having the bondage boot recede from view a bit. I was happily dresses in my Calvin Klein dress and jacket when I walked into a brighter room and discovered that my blazer was a dark navy, so that meant changing into my third option and a cardigan and finally heading out for a nice, but very long evening.

I left my apartment at 5:30 pm, we got to the catering hall at 7:00 pm, dinner was served after 10:00 pm, we left about an hour later, and I walked back in my door at midnight. I did a bit of standing and table hopping during the evening, so was surprised at how little my foot protested when I finally dragged myself out of bed this morning. 

My foot may not have protested, but two hours after I got up the rest of me is ready for a nap! The only items on my agenda are doing a little housekeeping and laundry.

In getting ready for my evening out I did come to realize I am getting very tired of the fear of my shower. In the past month I have yet to take a shower where I don't have a threatened fall as I, or my crutches, slip on wet tile. While walking in the boot is getting easier and I am having to rely on putting less weight on the cane to get around, out of the boot I am still very fearful of trusting my foot. I suspect a large part of that is the neuropathy. If I can't fully feel my foot how can I trust it to hold me. The other is simply a continued need to baby and protect my foot and not do anything that might damage it and make all this work for naught.

I did run into a photographer acquaintance last night who reminded me how ready I am to sling my cameras over my shoulders and go for a long walk. It's surprising the prospective you can get on life by looking through a viewfinder.   

Ignoring Myself: When Three Blocks Feels Like a Marathon

I said all those things about being good yesterday and completely ignored them today.

Got up early this morning and baked a large batch triple chocolate, double toffee, pecan cookies. Luckily I discovered that my wedge flip-flop is high enough that it evens out my leg height, making standing for long periods more comfortable. Having baked, I then needed to find homes for most of the cookies so they wouldn't tempt me to over indulge.

My scheme was to walk to the bus, take the bus to lunch with a friend, then another bus to drop off cookies and get a ride home, I figured the most walking I would be doing was two blocks to the first bus and one block after getting off the second bus. HA!

I did not walk the two blocks to the bus as a friend came by to drive me (and get a dozen cookies) to the pharmacy a block from the restaurant. I picked up gauze pads for my heel and some much needed allergy medication and then stopped in the physical therapy center, on the same block, to schedule my PT evaluation for the Friday after I see Dr. Hubbard in two weeks. Then continued on to my lunch date.

The problem arose when my post-lunch cookie drop off was pushed back by over an hour and I realized going home made it more complicated. So I hatched the new idea of taking the bus to the mall and killing some time there before walking the "easy" three and a half blocks to drop off cookies.

With no benches at the bus stop (which seems silly for a bus stop that serves a hospital), I was already dragging by the time I got to the mall, but still decided that if I was there I might as well pick up a few items. I was very aware of my foot by the time I got through the check out line and had to sit for a bit before I even tried to go outside. AMA compliance is great, putting the elevators closer to the store enterances would be better!

The first block was probably the easiest as it had benches and I was able to sit and rest a couple of times before crossing 5 lanes of traffic and continuing my journey. I am grateful for delayed traffic lights or it would have taken me two set of green lights to cross the avenue. Even with the rests on that first block, by the time I reached my destination I had managed to raise a blister on the pad of my hand and just wanted to sit down.

Hung out there for about 45 minutes, happily letting conversations flow around me, before getting a ride home. I have elevated and iced my foot and promise to be quiet for most of the day tomorrow. I don't actually want to do any damage, or set back my recovery, I was just so happy to be able to get outside and feel normal that I got a bit carried away.

If I'm honest, part of being quiet tomorrow is recovery from today and preparation for an event tomorrow night. Still trying to figure out how to pair the bondage boot with tights and a cocktail dress - don't have any idea what shoe to wear! But that is a worry for tomorrow. Also contemplating a Michael Jackson, with one glove to help add padding between my hand and the cane.

Knowing Your Limitations

Not something that comes naturally to me. I have always been stubborn and seem to like to push at immovable objects. So, I did have to tell Marco today that it was killing me to be this good for the past month. But if being this good means I can get back to work sooner, I will be good.

That came into play yesterday when I decided not to try out my new double chocolate toffee pecan cookie recipe because I knew all that standing would probably be frowned on. That said, I pushed it today by taking the subway home after seeing Marco.

Everything seemed to go smoothly with today's appointment. Removing the sutures was probably the most pain I've had since surgery - he swears he did not make me bleed. I can now get my scar wet in the shower (yeah, no more blue bag), but should keep it wrapped in the elastic wrap when it is in the boot - i.e. when I'm not in bed or the shower. He says the neuropathy is caused by my nerves being angry (his adjective) at the surgery and should dissipate as I heal and the swelling goes down.

On the plus side, I can move from crutches to a cane (as soon as I remember which side I'm supposed to use it on) and the walking restriction of half a block has been lifted to "within reason". Obviously this man does not know me well! Which leads us to me trip home on the subway.

I was so excited by the idea that I could start to get back into my normal patterns that I didn't think through how far the subway elevators are from each other. There is an elevator to the subway mezzanine just around the corner from the medical center, but the elevator to the subway platform is a good distance from the turnstiles. On the other end I had to get off a stop before mine so I could take three elevators in an almost V like pattern to get from the subway platform to the street and then walk a short block, crossing two large avenues, to take a bus that dropped my off a block from my building. Perhaps a bit much for the first day I'm allowed to walk more than half a block.

I am being good now, with my foot elevated and the gel packs in the freezer so I can ice it later. But, if I'm honest, plans are already in my head for a trip to visit my favorite baristas and a chai soy latte tomorrow. I will however take a bus as I suspect 14 blocks is not Marco's idea of within reason. Especially if I spend the morning standing in the kitchen working on my cookie recipe.

Frankenfoot

The big activity of my day was to change the dressing on my heel. As I said yesterday the gauze had moved with the elastic wrap, so this morning I put a new xeroform dressing and gauze over the suture (surprisingly easier to do alone when the xeroform is moist). But before I re-dressed I snapped a shot of the scar line.

Managed to scare myself with how large and ugly it currently looks. You can see how swollen my foot and ankle still are, even wrapped in an elastic bandage. Can't even tell if the skin has fully bonded back together. I don't remember my knee looking this bad, though Dr. Williams used dissolving stitches and held the skin together with tape, so I never saw the actual stitches. (I do remember after my first knee surgery, 25 years ago, the feel of having the stitches removed, it was a very strange feeling.) On the plus side there doesn't seem to be any blood or leakage.  

The high point of my day came this afternoon with the arrival of my lunch guest and her feel better gift - a Starbucks chai latte exactly to order. With the first sip of the spicy extra chai I could again believe in a positive future (at least for my heel).

Living in the Shower and Needing a Nurse

My MacGyver skills almost weren't enough to get me safely out of the shower this morning. The knee walker went back on Tuesday, so this was my first shower without that support. There were a couple of times I worried I was not going to catch myself as I slipped and once or twice thought about simply living out the rest of my days in my shower.

I had to wiggle my good foot across the wet tile, not putting any weight on the left foot and move the shower stool to the bathroom, sit, swivel and very carefully use my crutches on the tile floor. I don't know that I will ever take the ability to step into the shower for granted again.

The shower also caused me to notice two things. The swelling of my toes and the top of my foot is worse then when the cast was removed. I emailed Marco, but wonder if I should be elevating my foot more. I have gotten into working on my computer at the dining table for long stretches over the last few days. Besides not providing the cat with his preferred nap location, this change in location may also be affecting my foot.

Add conscious effort to elevate to my to do list.

The second issue was that the elastic bandage wrapped around my foot has loosened and moved at bit since it was first put on. I decided to try re-wrapping my foot and discovered that dealing with heel injuries is not a one person job.

When I unwrapped my foot, I found that the gauze pad had also slipped under the bandage and a portion of my stitches had not been covered. I attempted to put the gauze back in place and securely wrap the bandage, but I'm not certain how well I did. Hence my desire for a nurse or trained medical practitioner. Going into Dr. Hubbard's office to have it re-wrapped is simply not logical, nor is going to the local emergency room. I am leaning towards calling a neighbor to come help later as I'm not sure I did a good job - the suture line seems irritated by something when I'm walking and I suspect I should put a new xeroform dressing and gauze on it.

Combine that with two meetings tonight - one here and one out in the world -  and I have a very busy evening ahead. For now it's back to the couch and elevate, while dreaming of days I can walk without crutches.

Dream a Little Dream

Strange dreams last night. I only remember bits and pieces. There was a portion involving a large group of children and another involving politicians, but the part that stuck with me involved my foot.

I was walking in the neighborhood in my bondage boot and suddenly realized not only was I walking more than half a block and wasn't using my crutches. For some reason I had left them resting against a fence a few blocks away. When I walked back to them I found that someone had stolen the pair of crutches and left two mis-matched crutches that weren't even the same type or height. I was outraged some one would steal my crutches, then I woke up. Not sure what my subconscious was trying to work out, but it was definitely busy.

I have not been outside for another walk since last week. The weather has been cold and I have started to focus on the projects I had set aside for this time of recovery. It has been getting easier to get around the apartment and I have even managed to take my trash bags to the garbage shoot (albeit one at a time). My foot still feels numb and cold. I have been keeping the boot sock on almost all the time, including in bed in fear of the ace bandage un-rolling in my sleep. Even under the sock the bandage has been bunching and my foot has been feeling itchy. Here's hoping the stitches can be removed when I see Marco next week and I can start wearing a smaller bandage.

In the meantime, I am starting to think of dream photo locations once my foot is declared ready to return to work. Paris and Srinagar always top my revisit to lists, but Venice and the Scottish highlands also call. Much as I liked the Galapagos, I figure my first trip back should not involve that much water or A'a' lava. Maybe somewhere well off the beaten path (harder and harder to find these days). I have always wanted to visit Tristan da Cunha.

That said I'm in the midst of reading a biography of Gertrude Bell and have often wondered about putting together an assignment to follow in the footsteps of the early women explorers like Bell or Isabella Bird. For now, still in my boot with limits on my walking I have a bit if time to plan my trip.

Days Follow

I want nothing more then to go outside, even if it is just for a short hop. But even I am not foolish enough to try crutches and a bad foot in the snow. I love photographing in snow and right now the perfect, photogenic fat flakes are falling past my window. But I am accepting that is simply not to be this winter.

I have been inside for two days now. Thursday because I had to try to clean the apartment before hosting a meeting and yesterday because I actually got drawn into work. I had hoped I could at least make it across the street to the supermarket today and pick up the most urgent item on my shopping list, kitty litter. After looking out the window, I left a note for one of my neighbors and hope they emerge from their apartment soon.

Walking has become a bit easier, though I am beginning to remember why I'm not a fan of crutches as I build up strange calluses on my hands. I'm also not loving the bondage boot as I continue to search for a comfortable leg position for long stretches of sitting.

I'm in limbo until Marco or Dr. Hubbard approve the next move to physical therapy and more walking. For now, I will have to wait for the snow to melt before I can venture back outside and find activities to keep my mind and eye from atrophying as I count down the days to my next doctor appointment.

Beware Bitchiness Below

I have survived 17 days, that seems to be my limit. I'm cranky and starting to hate. I hate the bondage brace, I hate the way it feels like it's pinching my ankle, I hate the way it accentuates the fact that I can't feel parts of my foot, I hate the way it throws off my other hip and tightens my back muscles. I hate the limitations the surgery has put on my life. I hate to be forced to be cooped up inside. I hate being dependent on other people for even simple things like taking out the garbage. I hate that I'm only allowed to walk the equivalent of half a city block. I hate the fact that simple things like taking a walk (only a quarter of a block up my street and then back) tire me out so much that I have to take a rest after just coming down to the lobby before I even go outside. I hate the fact that such a short walk leaves me felling like I need a nap. I could go on, but I won't.

Jo and I went for a short walk outside this morning. We walked, or hobbled as the case may be, a quarter of the block and then stopped to chat with another neighbor before returning and having a good chat in the lobby. The sad part was I was already tired before I made it to the lobby just from hobbling the distance from my apartment door to the elevator. I who think nothing of walking 5 miles a day on assignments was tired by 50 or so feet and 4 steps.

Even seeing people and talking with friends has not been enough to lift the malaise of being incapacitated that has been creeping over me. I feel myself losing interest in books, movies, even work that I was so excited about having time to focus on three weeks ago. I'm not quite sure how to shake myself out of it and feel like I am going to start feeling needy very soon. I went so far as to ask my neighbors to book some baby time with their son, hoping that looking into his innocent, inquisitive face with help shake off this attitude.

I hate that I feel this way.

Tentative First Steps

Well, I have seen proof that the foot was still there under all that cotton and bandages.

I could even have Dr. Hubbard's initials tattooed on my shin if I so desired. Don't look too closely, or you'll see how much the hair grew under the cast. Marco says I can now wear the short leg sleeve to shower, but need to keep my foot at an angle so as not to pull the tendon or sutures. (I suspect I'll feel safer keeping the shower chair around for a bit longer.)

Somehow I thought it would be a horizontal scar, but it is vertical and looks like it runs from the base of my heel up to the back of my ankle - 3 to 4 inches. Right now it still has black sutures and resembles a back-seamed stocking. (No, I didn't get a picture, couldn't figure out how to tell Marco to move or how to angle the camera phone.)

When I got to the office, Marco took me back and cut off the cast, inspected my incision and put on some Xeroform gauze ("...a medicating and deodorizing agent. Ideal for use on non-draining to lightly draining wounds...") and wrapped it in an ace bandage (as seen above). Marco also took a look at my knee, which had started bleeding lightly from the rubbing and use of the walker. he put some more medicated gauze on it and said to just watch it for a while. The last thing I need is to have to go see Dr. W in the middle of dealing with my foot.

I then got my big toe x-rayed to see if I had broken it when I banged it in the shower last week. It is still  feeling swollen and generally off. The decision from Dr. Hubbard was that there may have been a hairline fracture, but no break that he could see and since it was going to be strapped in my new boot there was no worry.

I found it a bit strange that Dr. Hubbard didn't want to examine the incision himself, never before known a surgeon who didn't want to see his work, but I like and trust Marco so just noted the absence. Dr. Hubbard did come and wiggle my foot and check my strength after my x-ray. He said I was allowed "not much" walking in the new boot and need to use my crutches as added support. He seemed a bit surprised by the neuropathy on the ball of my foot and base of my toes, but thought the feeling would return.

I then got sized for what I shall be referring to as my bondage boot. Made by the same people as my other immobilizing boot, this one has more straps and an adjustable wedge to keep my achilles at angle as it continues to heal.

With a black sock instead of the white one provided, it feels like something for a KISS costume or, as my name for it implies, a certain type of club.

We tried it with two wedges, but that put too much pressure on the ball of my foot, which didn't seem a good idea when I can't feel it. So for now, it's one wedge and lots of straps. I can take the boot off at night, but if I have to get up during the night I have to put it on or go back to not weight bearing. Because of the wedge it is also difficult to get comfortable seated. It feels like my knee is up too high and with the nerves of my heel still recuperating it is difficult to tell how much pressure I am actually placing on it.

Just the walk with crutches from the hall stairs to my neighbors door and then home had me sweating and my stomach churning this afternoon. It seems to be better this evening and I have been able to feed the cats and get from one end of the apartment to the other.

I did e-mail Marco and Dr. H for clarification on how much walking constituted Dr. Hubbard's "not much". Very glad I did. For me, even in my other boot, walking 10 or more blocks (often each way) doesn't seem like very much. Limitations for me often mean no more then 5 or 6 blocks. Their idea is no more then 1/2 a block in a given day. If I'm honest I can do that just walking around my apartment and going to the elevator and downstairs to get my mail. But I promised Marco I would be good, even though I am starting to go into Chai latte withdrawal and was counting on the new boot meaning I could get to see my favorite baristas.

For now, I am scheduled to see Marco, I was told Dr. Hubbard won't be in the office, in two weeks for another assessment. I attempted to bribe him with my chocolate toffee cookies to look the other way while I snuck in some extra walking but he didn't seem willing to bite. Obviously he does not know my baking reputation.

The other big news from the appointment is the decision to take me off the Lovenox and put me on a simple aspirin regimen. I'm thrilled, except for the fact that I'm left with over 20 unused and unopened syringes of the medication. When I went on-line for prices, I found that it is somewhere in the neighborhood of $500 of medication that neither my doctor nor the pharmacy will take back. In a country where so many don't have health insurance it seems a complete waste to not be able to find some clinic or program where I can donate the unused shots. A friend recommended a few places in NYC and I'll take some time tomorrow to do some internet research.

My other goal for tomorrow is to find someone who can pick up some allergy medication. I have been fighting with a sinus migraine for two days now and have run out of decongestant. If I'm going to be cooped up in this apartment for another two weeks I need to clear my sinus cavities!

Out Into the World

I went grocery shopping today. Well, I went across the street and picked up six items, two of which were on my list - I forgot the third item on the list.

It was nice to get outside, even if I found myself a bit scared of tilting sidewalks and discovered just how uneven the sidewalk to street ramp is when you are terrified of falling off your walker.

I am ready for Tuesday and the walking cast.

I will try to go out again tomorrow and see if I can make it farther then the market.

The Days Pass

I had scheduled yesterday as a quiet day between the expected busyness of Tuesday and today. That's what it was. I enjoyed a new book and started doing some of the preliminary work on a grant proposal. Also gave my knee a rest from the walker.

Today was an internet meeting in the morning and a face-to-face meeting in the afternoon, unplanned but hopefully productive.

My life is settling in to the monotony of week two and I simply count the hours until I see Dr. Hubbard next Tuesday and get a new walking cast. I feel less stir-crazy today, perhaps it was looking towards the future when this surgery is simply another scar on my body, or I am slipping into the ennui of the confined.

My horoscope says my creative orientation may be changing. Perhaps that's it. I think I need to leave the house tomorrow!

Outside is Nice

For the first time in a week I breathed outside air and rolled my walker over concrete. By the way, the hilly sidewalks of Park Slope showed me the walker could use stronger brakes.

Actually had a number of learning experiences today. I learned how to make a bed with fresh sheets while on it. I learned the most comfortable position when using the walker as a leg elevator (straight along the leg with your heel in the basket). And I learned rubber tipped crutches and wet tile floors don't mix well.

I had forgotten how difficult the lip of my walk-in shower is to deal with when you are hopping on one leg. Besides being fairly wide the bathroom and shower floors are at different depths. I had to stand and work it out - with a couple false starts - before even making it in to the shower. And when I tried to emerge after my shower my crutch slipped and, while I was able to catch myself, I stubbed my toe. Fortunately I had brought the walker into the bathroom and was able to maneuver it to a position where I could rest my knee and use it as a base to hop the lip. I actually scared myself when slipped and was more then happy to lie in bed for a while to recover.

You really need problem-solving skills to have surgery, especially if you live alone.

It was nice to get out of the house and see people. Most found my walker fascinating and loved the basket. Though the general consensus was that I need a bell.

I did email my knee surgeon as I noticed that the spot where the screw was removed is red and irritated and looks like it is ready to peel and bleed - not an acceptable activity when you are on a blood thinner. We'll see what they say. I also spoke to the Marco, who says that Dr. H feels I should speak to my Hemotologist about the side-effects I'm having on the Lovenox and get his opinion. Not sure why I'm the one talking to my Hemotologist and then reporting back to Marco to tell Dr. Hubbard. But hey, I'm just the patient.

Anyway, it's been a long day and it's time for me to take my shot late and go to bed.

At What Point do You Worry?

Certain things trigger medical paranoia in people. Mine seems somewhat odd until you understand the context. I get worried if I have bouts of bloating and gas. Seems minor until you know they were originally the only symptoms of my mother's stage 3C Ovarian Cancer. Since that particular cancer runs in my family, I get concerned.

I've had the symptoms for the last three or four days and decided it was time to see if I needed to call the doctor or if they were simply side-effects of the Lovenox. While I didn't see it listed on the medication website I did find multiple sites with patients on the drug, especially women, complaining. What a did find on the site was a simple sentence that had me e-mailing Marco about something I hadn't even thought to concern myself over.

The sentence reads "It is important to contact your doctor immediately if you experience symptoms such as tingling, numbness (especially in lower limbs), and muscular weakness." I've had all of those and just attributed them to post-surgery. I've had one or two moments when my legs have felt like they were going to sleep and thought I was sitting badly and pinching a nerve in my back. Wouldn't have even thought to call anyone about it.

Marco's response was that my numbness and tingling may be related to swelling, and to call the office tomorrow. I'd buy that, except it feels like I've had almost no swelling. Within the first 72 hours the cast around my foot and ankle felt loose enough to shift around in and the spot where the top screw was removed from my knee has been getting irritated by the knee pad on the walker (especially today, but we'll go into that shortly). I've added a call to Dr. Hubbard's office to my To Do list tomorrow.

I was on the knee walker more today then I have been since my surgery. I baked. Almost home-made red velevet cupcakes - I decided I was not up to making them from scratch - and pink vanilla cupcakes. Not going to cook a four-course dinner until I can stand on my own two feet, but I can make treats for my Council meeting tomorrow. It was also surprisingly tiring. It seems sad that it is not yet 8:00 pm and I'm ready to hop (crawling's not an option at the moment) into bed.

My MacGyver Moment

Had a bit of unexpected excitement this morning that taught me a couple of valuable lessons. I had just sat down on the couch with my breakfast when my knee walker rolled across the room. (One of the joys of living in an old loft building are the slanted floors!) I sat there trying to figure out what to do. My cell phone was in the walker basket, so calling for help was out of the question. With no visitors scheduled for today, I couldn't just wait for help to arrive. I thought about sliding on to the floor and scooting across the floor on my tush, but couldn't figure how to get back up without the use of my left leg. I decided to wait until my next door neighbors took their dog for a walk and yell for help. Only problem, they didn't hear me (and I hurt my throat and made my voice very hoarse).

Finally, my bladder had me deciding I had to rescue myself. I was able to scoot myself down the couch until I could reach a footrest with my right leg. I hooked the footrest and pulled it close and piled it high with pillows. Fortunately it goes with my Eames chair and was wide enough for me to rest my left knee and hands as I bent over and shuffled across the floor to the recalcitrant walker.

Lessons learned, make sure the walker hand brake is locked when I'm on the couch and if I really hurt myself no one is going to hear me. Not a pleasant thought, though it does justify my taking my cell phone with me every time I went into the bathroom for the first three days (might even start doing that again).

After lunch I did some more household chores and stared at the bed trying to work out how to change my sheets tomorrow. I did figure out how to unload the dryer, fold and put away the clean clothes.

Tomorrow celebrates my one week anniversary (what is the official gift for one week post-op?) and the beginning of my life intruding on my recovery. I have to try to bake red velvet cupcakes tomorrow, though the true excitement comes on Tuesday when not only will I leave the building for the first time in a week, I will also attempt to take a shower (which sounds both cleaner and scarier then the sponge bathes I have been giving). Definitely have to have someone on call for that.

Wish me luck!

Pushing

Every now and then I seem to need to push boundaries - be it in relationships or other parts of my life. Today was one of those days. This morning I started to respond to an e-mail and realized I didn't have all the information I needed. My options were to call and text people on a Saturday morning or see if the information needed had arrived in my mail as promised. I decided to go the independent route (huge surprise I know) and loaded my crutches over the handle bars of my knee walker and bravely set forth from my apartment.

I had to stop and stare at the stairs for a bit, working out in my head exactly how to get down - and half hoping a neighbor would come out I could hand my mailbox key. I was able to hop down the stairs with the aid of a crutch and the railing and then at the bottom (admittedly only 4 steps) reach back and gently maneuver the walker down as well. Took the crutches with me as I managed to turn myself around in a small elevator (did I mention the walker has a huge turn ratio) and then get back on the crutch to hop up the first step in the lobby, before discovering that the windowsill opposite the mailboxes was the perfect height to sit rather then hopping the remaining step. Valiantly made it to my mailbox and dumped my mail in the bag I had remembered to bring with me before repeating the journey in reverse back to my apartment.

I have to admit, by the time I got home I was more then happy to collapse on the couch for a bit and hadn't even tried to venture outside. But now I know that, while tiring, I can manage to leave the apartment. Though I know I will be yelled at for doing it without supervision. I had made certain my cell phone was accessible in case I needed to call a neighbor or ambulance.

I did decide that besides a bicycle bell the knee walker could use some sort of storage or base for crutches for when have no choice but to climb stairs or for getting in and out of cars.

My throat has been worse today. I don't know if it was because my liquid for the day was a tart lemonade, but the raw painful spot never seemed to get coated with phlegm the way it was earlier in the week. It made talking very uncomfortable, which kept me off the phone most of the day. Marco swore it would clear up on its own, so far not so much. Other then the ER, which is stupid for this, I can't figure out how to see a doctor. I'll have to call my Primary on Monday, maybe his office has a secret entrance that doesn't involve steps. I know he has another office, but going out to Gravesend / Sheepshead Bay.

On the information I didn't need to know, but now need to share - I read the small print on the generic Lovenox syringe container. "Each syringe contains 30 mg enoxaparin sodium injection derived from porcine intestinal mucosa in Water for injection." I guess if people are willing to get botulism injections in the hope of looking younger I should not complain that pig gut snot is keeping me from getting a blood clot.

Pushing It

Haven't taken any pain meds since last night. Some pain, but I prefer a clear head and haven't been debilitated. Just would really like a clear throat! Woke up around 3am with that giving me more pain then the foot.

I still haven't made it farther then the steps in my hall, but have discovered more independence around the house. This morning I swept the floor. Can't say it was perfect, but did get some of the cat hair and other bits off the floor. Fortunately I have a long-handled dustpan, so I could get the small pile off the floor. Makes me feel a lot better about hosting my Condo Board meeting next week. My apartment won't be perfect, but it will be relatively clean. 

Still bored, but wound up with a semi-unplanned Bradley Cooper festival. A friend lent me the re-make of "The A-Team" as an easy movie. It is that. Then watched the movie from my movie group this month, "All About Steve", not my favorite Sandra Bullock movie, but it definitely had an interesting ending. Then decided if I had started a Cooper marathon, I should keep it going and watched a couple episodes of "Kitchen Confidential".

I am going to go nuts if I don't get out of this apartment, this mornings roll to the hall stairs did not do it, so my goal for tomorrow is to just get to the lobby. Don't even have to leave the building, just need to see some new walls!

Questions Never Asked

Two questions it didn't occur to me to ask at the time have been bouncing through my head.

How big a scar am I going to have? This will join the three major surgery scars (or as in my knee duplicate surgery scar) on my body not to mention the numerous almost invisible ones - where I cracked my chin on the playground or where I got my finger caught in an old-fashioned folding elevator door to name two I can remember the cause of. Will this scar reach the blue heart tattoo I got on my ankle two weeks before my Dad died? Will it make slingbacks uncomfortable?

The second question is how much nerve damage will I have? Having been through leg surgery, I don't believe for a minute that some of the nerves on my foot and toes didn't lose their connection to my brain. I can already feel, or not feel as the case may be, spots between the little piggy that went to market and the little piggy that had none. I don't know what else I will or won't feel when I am out of this cast and can begin to move my foot.

I was very proud of myself this morning. I managed to do a load of laundry and scoop kitty litter. I then realized I can't get the dirty litter bag from my apartment to the trash shoot and am still trying to figure the logistics to get the laundry out of the dryer and put away, which takes away some of my pride in the moment.

I want to thank all my friends who have called, e-mailed or texted to see how I'm doing and if I need anything.  Thanks to them I now have a safe container for my used needles, though the sharps will now smell like Basil laundry detergent. I have Extra Strength Tylenol to replace the Percocet I mentioned I seem to be allergic to, and have been kept in good meals - today's lunch arrived via a local Chinese restaurant from a friend in California. (Have to remember that trick for far flung friends in the future.)

It's the boredom that is getting to me. I don't have the concentration required for the minutia of the grant proposals I hope to finish while I'm laid up, and I need more narcotics than I have available to manage to sit through one more Republican Presidential debate. Friends shocked to learn I had never seen any of "The Godfather" movies lent me the trio on DVD, I gave up about 20 minutes into the first one.

At least after my knee I had the CPM machine twice a day, which gave me some semblance of a schedule. Now it's get up when the cat's yowling starts to drive me mad, move to the couch so he can climb on my lap, try to watch tv, or play Sudoku, realize it's only 10:30am, try to watch something, check the internet, or read from the large pile of books and magazines, lunch, more of the morning activities, doze, listen to the cat cry for 90 minutes before his actual dinner time, feed the cats, write up my day while I eat dinner, answer any email's I hadn't gotten to, get my evening shot, do my nightly ablutions, go to bed, try to read, sleep and do it all again tomorrow.

And I know I need to be quiet this week so I can push it to attend a meeting Tuesday night, still trying to decide if I'll be able to bake for it and then host a meeting Thursday night. And then a week from Tuesday it's back to Dr. H to hopefully change to a walking cast. Any particle physicists with the ability to speed up time please contact me at this blog. Your gift to mankind will be greatly appreciated by this woman. 

Feeling the Love and Itching

Whatever higher power you believe in, I figure I'm blipping on the radar somewhere. A Brooklyn Priest, my Uncles in Texas and a Cousin/Priest in Louisiana have all been lighting candles and saying prayers for my recovery. Add to that a Muslim in India, a Jew on the Upper West Side and a Buddhist currently in Paris and I'm feeling fairly well covered.

The pain reached a crescendo last night and I found myself taking two Percocet instead of the one pill I had been dosing with. An hour later I found myself very itchy. I didn't see any signs of a rash this morning, but did leave a message for Dr. Hubbard and told the Recovery room nurse when she called to follow-up with me this morning. All I need, another pain med I'm allergic to.

Just getting up, washing what parts of me I could and getting dressed exhausted me this morning. I had to push myself to get some breakfast and then eat. My upper arms are sore from having to lever myself up without using my left leg. I am reminded again that it would make sense to have pre-surgery Physical Therapy / Occupational Therapy to work on all the muscles and activities you will have to do after surgery. But then again the term "health-care reform" seems to be an evil phrase in the US these days.

I continue to be utterly bored with my confinement, especially as I still don't have the attention or focus required to read any of the books and magazines piled around the couch and bed. (I have enough problems hoping these posts make sense.) I've grown tired of tv and Sudoku, but my throat is still rough enough to make me sound like I have a cold and long conversations difficult.

It occurred to me this morning that if my throat doesn't start to show signs of improving soon, I can't even go see my Primary, both because just getting out of the house is difficult and because his local office is no where near ADA compliant with a good dozen steps and no elevator. If I still feel like this in a day or two I will call my neighbor the nurse for her opinion.

In the meantime I have a scintillating schedule of watching workers on the top of the new Nets Arena and catching up on my Hulu queue.  

Day One

Who knew you could get insomnia after anesthesia. I stayed up until 8pm to give myself the first Lovenox injection and then tried to sleep. I could blank my mind, but couldn't do more than doze in fits. I would periodically check the clock and saw 9:30, 11:30 and 3:00. At 5:30 I tried rolling to my side, keeping the pillows between my legs to maintain elevation. This helped as it also allowed my left knee, which had been feeling very sore and tense, bend.

When I woke just before 8 it was time for another shot and I could finally wiggle my toes and my foot was tingly as the nerves tried to re-establish communication with my brain. Decided to take a Percocet to try to get ahead of the pain. It hasn't 100% worked, been taking one pill every 4 -5 hours, but have a low level throb that I keep thinking will ease if I can just find the right support for the cast, but is just my heel letting me know it doesn't like me much right now.

Was very proud that I managed to get up and put on clean clothes and fixing some breakfast (banana bread and a mandarin orange cup) before collapsing on the couch and letting the cats climb on me for a nap. Sat there with my brain going nowhere for a while before settling in to some DVDs followed by lunch and a doze.

Not surprisingly, no calls from the recovery nurses to check on me (though it's only 5:30 they could still call tonight).

My throat is still bothering me. It was very sore during the night and felt swollen this morning. I can swallow, but it feels rough and scratchy if I try to talk. I also noticed when I was trying to chew that my lower jaw muscles hurt too. Definitely not a fan of intubation. If I catch a cold from this I am going to be very grumpy.

The problem is that with the residue of whatever meds they used yesterday and the Percocet I'm not focusing well but am aware enough to be bored. I realized I couldn't even go check my mail, because I shouldn't risk the stairs. It's bad enough I feel like I have to take my cell phone with me anytime I go to the bathroom.

It's almost time to take another pill and feed the whining cat, then decide if I'm going to watch some more movies or go to bed, hopefully I'll sleep tonight.

Anybody Want a Cat?

My eighteen year-old cat with feline dementia wanted dinner and saw no reason why my smelling strange or having a giant thing on my foot should mean I shouldn't do my duty and get out of bed a feed him. So I'm up with my foot raised above my hip, trying to figure out how I managed to cut myself just hours before my first dose of Lovenox.

With him temporarily satisfied, dinner for me is a simple, warm and mushy chicken and dumplings as my throat recovers from the intubation.

I arrived at the surgical center bright and early, went through all the paper work and was put in a little dressing room and told to strip naked, couldn't even wear my out underwear, instead I got these cotton net things that not even a cheap stripper would wear. I always forget how repetitive the questions are as a safe-guard measure - pre-op nurse, anesthesiologist, resident, OR nurse, second OR nurse. Got my allergic to Morphine wrist band and saw Dr. Hubbard and the band of inquisitors and was led to the OR around 7:40.

Two beds in my OR so they could start me on my back for the IV and anesthesia and then roll me on to my stomach for the surgery (where I'm sure I got to show off my net undies). I commented on the 70's early 80's influenced soft rock on the OR speakers, very different then the hip-hop from my knee surgery. The resident joked they liked the quiet stuff to keep Dr. H calm. I remember the anesthesiologist putting in my IV and telling me he was adding the sleeping meds and it was going to burn. It didn't, but it did act quickly.

I now understand the term "swimming into consciousness" as that is certainly what it felt like as I opened my eyes in the recovery room to see the resident, the recovery room nurse and the anesthesiologist standing at my bed. My entire left leg felt like a dead weight and I could taste the plastic of the breathing tube in my throat.

When I could focus on the clock on the wall opposite my bed it read 10:30 - so much for leaving the hospital by 9:00. Betty said that no one told her I was out of surgery and when she finally found the ill-marked in-house phone no one gave her any info the first time.

It was a very different post-op attitude to what I've had at HSS, my Usbeckistani nurse (the woman in the next bed asked her where she was from) made not-so-subtle hints that she was over worked (as far as I could tell she was only covering two bays) and that my nit moving on her schedule was a bit of an inconvenience. I watched another nurse get huffy when a young woman who was in to "get hardware removed" needed extra Percocet for the pain and then after being discharged came back crying because she didn't feel well. My nurse told me the nausea I felt the first time I tried to stand was because I didn't sleep enough when I was moved to the recovery room. She also felt my knee-walker wasn't good enough, so provided me with crutches whose max height was 3 inches too short.

By 12:15pm I was sitting up eating a corn muffin, having managed the short crutches and showed I could use the bathroom. (Never understood the science behind needing to show you can pee and eat before discharge.) At 12:30 I got a new nurse who was entranced by my knee walker and was ready to put my clothes on and come home.

I was home and in bed by just after 2pm and happy to drift in and out of sleep with the odd sip of water to help flush my system and sooth my throat until the cat decided it was dinner time. I did take this picture wit my phone. The blob is foot shaped, so I'm assuming there is one in there somewhere.

I did have some un-planned issues with the knee walker. I had thought through the 4 steps in my hall and left the crutches for easy access once I got home, but I didn't think of the difficulty of getting in and out of the car. Just figuring out what to brace on to hop off the curb gave me a couple worried moments. Also elevators are not great as the wheeler has the turn radius of a bus. I wound up having to back out of my galley kitchen and I haven't even tried to take it in the bathroom yet. But I do feel steadier on it then on the crutches, especially around the cats. We'll see how the relationship progresses. I have decided what it really needs is a bicycle bell, or one of those reverse horns. Betty thinks it needs a flag to tie to my heel like one of those truck long load notifications. For now, I'm going to use it to go back to bed.

Shh...I Think the Foot's on to the Plan

As if to remind me I'm doing the right thing, my heel has been periodically twinging and my ankle swelled impressively yesterday.

Friday I kept wishing it was Sunday and I was getting it over with, today I'd like to add some extra hours to the day - 120 should do! I thought I was basically ready until I wrote up a full "to do" list last night. None of the tasks will take very long, except for baking the banana bread, but seeing a sheet of paper filled with things to do in the next 20 hours feels overwhelming. Add that to the general stress of surgery and I'm ready to crawl back into bed and pull the covers over my head.

I'm also waiting for the final word if I have to scramble and find a back-up to pick me up from the surgical center tomorrow. The friend I had lined up to pick me up has a family crisis which may throw both our schedules out the window. As I started trying to find a back-up plan Friday I had to wonder, what happens to those who can't pressure spouses, lovers, parents, siblings or children into being our "responsible adult" escort? Are you banned from ever having surgery? Do you have to live in the hospital?

It is especially hard for those of us who live alone and don't like asking for help at the best of times. For me a hospital pick-up (and this is my fourth since October 2009) is a delicate procedure. Finding someone reliable, whose schedule can be changed without worry I immediately rule out friends with office jobs or young children. Some of my freelance friends may be in the middle of a project. Other friends may agree to do it, but will make me feel they are doing it under duress or that I owe them for their generosity. Ex's are always tricky with all the relationship baggage and possible false expectations. I often get to the point where I have to wonder if it would be easier to simply call an escort service and book the fantasy of being taking home from the hospital.

For now, it's time to start working my "to do" list and not stress over anything until I have to. 

Ouch

I have spent most of the week preparing my world for surgery. I ordered a knee walker and a shower stool; stocked up on supplies (both food and entertainment); re-arranged the loft to be more crutch and walker friendly; and caught up with meetings and editors.

I've been busy checking things off my list, trying not to think about the actual surgery. Until I got hit with logistics in a one, two punch. First came in the mail, the letter authorizing my surgery. A simple line in the Requested Services Summary, Description of Service Code(s). The first description I expected "Repair of achilles tendon". Strait forward explanation of what this surgery is for. It was the second description that threw me, "Part removal of ankle/heel". It made it sound like some sort of amputation, like I would wake up and all the bone under my tattoo would be gone. Not a phrase to inspire the belief that everything will be fine and I will be up and running quickly!

Before hyper-ventilating and calling Dr. H. (not a completely unreasonable reaction considering some of the strange dreams I've been having about this surgery - I don't remember any prior to my knee surgery.) I decided that he actually meant shaving the Haglund's deformities and the bone spur. (You can see both on the photo of the x-ray below.) But still, bad wording.

The second came in a phone call from Dr. Hubbard's office. My surgery is scheduled for 7:30 am, which means I have to be at the surgery center at 5:30 am. Sit and do the math and that means I have to get up at 3:30 ish to be showered and awake enough to get to Union Square. Does it even make sense to go to bed?

On the plus side, they predict I'll be ready to go home by 8:30 - 9:00 am (which doesn't make 100% sense if the surgery lasts an hour unless they are wheeling me straight from the OR to the car) and I have to believe I'm the first surgery of the day. Dr. Hubbard's assistant said I should be happy it's early, because it means I won't be hungry like later patients.

The doctor is still waiting for insurance authorization to put me on a blood thinner, Lovenox, to prevent possible blood clots with my leg being immobilized for so long. I had been told that the PA would be talking to my hematologist and was expecting a blood thinner. Then I went on-line - from drugs.com "Lovenox can cause a very serious blood clot around your brain or spinal cord if you undergo a spinal tap or receive a spinal anesthesia (epidural)..." Didn't even get to the websites partial list of side-effects before emailing Dr. H., my pre-surgery packet says that my surgery uses an epidural instead of general anesthesia. 


Maybe medical internet research IS a bad thing! In the meantime I'm left with four days to worry and obsess.

Countdown Begins

 I have started my pre-op "to do" and shopping lists. Top priorities are making the apartment crutches friendly and stocking up on entertainment. Other jobs have included replacing the padding and grips on my crutches and stocking up on easy, healthy food. Even though I have the list well in hand, somehow a week doesn't feel long enough.

I also realize I'm much more afraid with this surgery then I was with my knee. It's not that I don't have faith in my surgeon, but that this surgery seems to have the ability for more complications. Plus everyone seems to want to tell me a horror story - not helpful!

I think it's also the idea of not being able to weight bear for two weeks. With my knee I started passive PT immediately and could at least use my foot (with some pain) to maneuver around and get up from a seat, etc.  This time I ordered a medical shower seat and have been thinking about trying to borrow a wheeled office chair to scoot around the apartment for the first two weeks. At one point Dr. Hubbard had mentioned the possibility of a knee walker. (see my favorite picture from a testimonial page of rentakneewalker.com)

I don't know if my insurance would cover it, and all the images show that the weight point is directed to the knee - the one thing I have never been able to do since my first knee surgeries 25 years ago is kneel without pain. But it certainly looks like a safer and steadier option to crutches - especially around the cats. Will email Dr. Hubbard or his PA, Marco, and call my insurance Tuesday. (With the knee walker, I might even be able to bake for Precinct Council.)

I am probably going over-board in all my preparations, but I'd rather discover I don't need something I have then try to figure how to get it afterwards.

And Maybe an Ankle

You sometimes forget how your body is related, or maybe now that I'm 40 everything is just falling apart. Anyway, about a year ago I tore my Achilles. I didn't realize I had injured it and now believe the tear to be caused by tightening of my calf muscle after surgery. Once I understood the tear could be the feeling of a simple pop at the back of your heel I could find a vague memory of the event.

It wasn't the actual pop that sent me to the doctor, but the continuing and increasing pain as I tried to maintain my schedule and routines during the following months. The morning I woke up and couldn't walk to the bathroom I decided to call the doctor. I bypassed my primary and went strait to Dr. W. who fit me in and sent me for a sonogram, put me in a short immobilizing boot and ordered physical therapy.

When the pain did not dissipate, Dr. W. decided I needed a foot and ankle specialist. He recommended a few at HSS. Only one took my insurance and he had a nine month waiting list, which became six when I said Dr. W. had recommended me. That seemed ridiculous in a city like New York, even with my less then amazing health insurance, that it should take longer to see an orthopedic specialist then it does to see my gynecologist.

As the pain began interfering with my ability to take assignments and the PT wasn't working I started scouring lists of top doctors and cross-referencing them with my insurance. I found Dr. Hubbard at Beth Israel and sent an impassioned e-mail through his website.

When I saw Dr. H. in June he changed my brace to a knee high contraption with built-in air pockets that could be inflated and deflated for a perfect fit. He also showed me an x-ray of my heel and pointed out both the spur where the Achilles had tried to reattach and the Haglund's deformity bumps that were making it difficult for my body to repair itself.

The hope was that with rest in the brace and continued physical therapy, my heel would find a way to mend. But, we're talking about me, so simple and easy wasn't an option. After a month in the boot it quieted some, but would periodically flare, especially during photo shoots. and somehow, simply ignoring it didn't really help.

I worried about my knee as my gait changed and began to change my activity level to baby my heel. After one flare Dr. H. sent me for an MRI and shortly after my right knee put it's two cents in and Dr. W. sent me for an MRI as well.

I continued to have low-level heel pain, but figured that was simply part of my life. Everyone I had spoken with talked about how they took over a year to recover from any Achilles issues. As December arrived the pain increased, but I tried to work through it. I certainly knew I couldn't wear the brace to meet with editors to discuss future assignments. The ankle swelled so badly my Primary sent me to the hospital for a Doppler for a blood clot and the pain increased to the point that my heel would throb while I was in bed.

I put the brace back on and called to see Dr. Hubbard. I got to celebrate my birthday in his office, being told that my two options were surgery or coming home from every big assignment and going into the brace for two weeks. Neither sounds particularly appealing, but after much soul searching, discussion and research I've gone with option A.

So the doctor's office works on my insurance and I am tentatively scheduled to get my Achilles cut and the spur and bumps shaved down. Two weeks in a no-weight cast, three in a walking-cast and then a month back in my boot. Nine weeks of severely limited mobility and four to six months before I am fully recovered.

Terrified seems the emotion of the moment. I'm spending my time trying to get any outstanding work done and get the apartment back into a crutches friendly zone. Now if I could just get Lowe's to finish installing my new washer and dryer.