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!