Grunting Through the Easy Stuff

Stand on your toes. Go ahead, I'll wait. You can even hold on to the couch or wall. Should be fairly easy.

Not for me.

Had physical therapy today. I learned that Bob has very strong hands as he gripped my ankle and worked on manipulating my bones. Then he had me roll my foot, like I would when taking a step. Ouch. But nothing compared to what came a bit later.

Then it was time for standing on my toes. I found myself throwing almost all my weight to the right foot. Bob decided that wasn't hard enough, so he asked me to only use my left foot. That did not work, so we moved to the leg press and tried it there.

Using both feet, with my right doing most of the work, I could press 50 pounds up on my toes and then  let my heel flex beyond the bottom of the foot brace. He had to remove all the weight before I could use just my left foot, and then I felt like I was pressing 500 pounds just to get my foot to move less than an inch. I found myself wanting to grunt like Maria Sharapova during a Grand Slam tournament. I also felt a bit pathetic, that something that should be so simple as standing on your toes is absolutely beyond me at the moment.

By the time I got home after 2 subways, 2 buses and a combined 11 blocks of walking (that was just after I left HSS), all I wanted was to put my feet up for a bit. When I got back up a but later my ankle was so stiff it hurt to flex to neutral. And I am expected to abuse myself with these and 10 other exercises five times a day!

I just keep repeating the mantra that this will be worth all the pain!

Dr. Shetty, my neurologist, called yesterday and agrees with Bob that I may have had the lack of feeling in my heel before this surgery, but because I was not walking properly I did not notice. No suggestions on how to handle the disassociation I am still having with my foot. She did order another EMG - now scheduled for late April, just shy of a year after the first one.

Someone asked me today what to do if the feeling never comes back. I don't know. I'm trying not to think like that. Hoping a positive outlook will produce a positive result. Originally everyone - Dr. Hubbard, Dr. Tsai, Dr. Shetty - kept telling me the feeling should come back in a year. It's now been 14 months and Dr. Shetty (the only one of the doctors I am still in contact with) says it could be 18 months. I couldn't find any information on the Neuropathy Association website. Seems they tend to focus on illness related neuropathy.

I have to push it back or the fear of never being able to walk normally again will overwhelm me. Bad enough that Bob has ordered me to keep the cane until my gait is a bit better - especially when my cops keep telling me I will be arrested if I start hitting people with it.

Right now it's time to do more stretches!

PT Drama and New Shoes

Today was my first appointment with my new Physical Therapist. Bob was recommended by both Dr. Ellis and Mark (my pre-surgical PT). He has over 20 years experience with a focus on feet and seems to also have experience with nerve issues.

Had a minor bit of drama at the beginning of my appointment when the therapist I had seen on my last two sessions wanted to know why I wasn't seeing him and implied that since he had done my initial evaluation I was supposed to be his patient. How does one nicely say that he was a place-holder until Bob returned from vacation and had he been the therapist I was assigned to, I'm not sure we would have been a good fit?

Nothing against the first PT, I am sure he is very competent, but he had me doing a few minor exercises like rolling my ankle, pointing and flexing my foot, and using a dog leash to pull my foot and stretch my calf - all without weight bearing. They are all good basic exercises, but he also talked about taking it slow and not doing anything more strenuous then the bicycle until the swelling in my ankle had dissipated. In contrast, Bob jumped in with two new floor stretches as well as two new bed stretches specifically designed to remind my nerves they go all the way down to my foot. He's pushing me to run through the routine at least 5 times a day.

Bob is doing what I really wanted and needed, which is treating me like one of their athlete patients. Though it was a bit disheartening to hear him say it could still be months before I would be discharged from PT. After two years, two surgeries and too many physical therapists to name, I am getting tired of the whole process!

The only complaint I have is the same one I had with Carlos, but hadn't realized until I saw Christine. Because it is a large facility the therapists see more than one patient at a time - though this seems to be two at a time as opposed to Carlos' schedule of four. But it still means the PT is jumping between patients, meaning both that my appointment doesn't begin on time (Bob didn't come get me from the waiting room until 15 minutes after my scheduled start) and that I am left alone to run through a set of exercises and then twiddle my thumbs until the therapist returns.

On the plus side, Bob could push my foot past neutral today. In fact, when Bob pushed, my left foot flexed further then my right could on it's own. He also said my heel pain, recurrent blister and calf cramps are from my foot having spent so long in the equine position - and that the pain is likely to get worse as I begin wearing sneakers full time this weekend. I am now trying coconut water to help with the cramps.

After PT I did something I haven't done in a very long time - I went shoe shopping! Admittedly it was for sneakers, but beggars and all that. Earlier this week it occurred to me that all my sneakers (by all I mean my two, possibly three, pairs) are designed for walking or cross-training, and as such they have built-in heel lifts. So today I spoke to Steve, Dr. Ellis' PA, and confirmed I needed flat sneakers - Bob actually recommended earth shoes, but not until I'm a bit further along. So I went to DSW and picked up a pair of red polka-dot Keds and gray Roxy Castaway high tops.

The negative of moving from air-cast boot to sneaker is that my walking speed - already fairly slow - will, for  awhile, become sloth-like. Always something to look forward to!

CRAMPS

Around 3:00 am I began to wake up and started to turn over when I was brought wide awake by a giant cramp in my left calf. I could not seem to move my foot in any way to lessen the pain. Finally it began to pass and I started to straiten my leg, which started everything up again. It took about 5 minutes for the cramps to finally subside. I kept my knee bent at an odd angle and finally fell asleep.

Then this morning, as I straitened my leg to prepare to get up, the cramps returned. This time, just relaxing after the first cramp caused a second. Later, trying to do my morning stretching exercises caused another round of cramps - needless to say, I did nit finish them.

Even just sitting here, I feel twinges as if my calf muscles are just waiting for an excuse.

The Psychology of Neuropathy

When the nurse removed the splint yesterday I remember looking at my foot and thinking it looked wrong. I knew it was my foot and yet felt disconnected to it. Then as I mentioned, when I felt my ankle and discovered the lack of nerve response I wanted to cry.

The disconnect continued when I removed the boot to go to bed last night. I again stared at my foot and even took cell phone photo of it.

But I felt like I had no connection to it. Later in bed, I tried to position my foot in neutral. When I looked down I could see the angle of my foot, but when I closed my eyes I couldn't have said where on the bed my foot was and if pushed would have said my toes were down almost in a ballet en pointe position. 

While the pain was less this morning, the psychological component was still there as was the lack of sensation, leading to a very nervous shower. I felt safer in the air-cast boot, as I knew my foot was tightly encased. 

With this worry in mind I played phone tag with my neurologist this morning while having my physical therapy evaluation. I also did some internet research when I got home, but could not find any articles or abstracts dealing with psychological disconnect and neuropathy. But it feels like it should be related, especially as my sciatic axonal neuropathy presents with hyposthesia (loss / lack of sensation). I will try to talk to Dr. Shetty when she gets back from her conference, especially if this emotional component continues. Just what I need, new and strange foot issues!

On the positive side, I was able to get around in the boot with just my cane while outside and no support in my apartment. I even took a bus and subway home from PT (the return of my sociology study of who offers me a seat on mass transit); stopped at Target to pick up a few items; and was able to walk the six blocks home - albeit slowly. 

The physical therapist sent me home with simple stretch exercises, though he seemed loath to start pushing me to stretch while standing until next week. Did tell me to bring a left sneaker to my next appointment. 

Relatively quiet weekend ahead as I try to balance my need to stretch and move with not over exerting myself and doing more harm than good. 

In Theory

I hurt! In theory I wanted the splint gone and with it the knee-walker. In actuality, I was very happy to cheat and use the knee walker for a few minutes this evening to feed the cats.

My foot and ankle hurt, my calf hurts, even my hands hurt. But as I explained to the guys who drove me home when I had the cab drop me off at Barclays Center so I could stop at Starbucks, I am supposed to be putting weight on the foot and walking. Heck, I even start physical therapy tomorrow.

The FDR Drive had surprisingly light traffic and I arrived at Dr. Ellis' office about 20 minutes early. I had assumed he would be running late, so I packed lots to keep me busy. Decided to finally start reading the Time Magazine cover story on health care in America. That became a bit ironic when he sent me for a sonogram to check for a blood-clot. The one amusing spot of my wait was trying to figure out why the young woman opposite me thought wearing 5" (maybe 6") platform ankle boots was appropriate for an appointment with a foot surgeon.

The nurse removed my splint and I found my self tearing up in fear. Even with the general anesthesia and the minimally invasive surgery, I couldn't feel my ankle when I touched it. And later when Dr. Ellis had me stand on my bare foot I felt like the floors were all slanted as I could not feel my heel. (I will call Dr. Shetty, my neurologist, in the morning,)

Dr. Ellis wants me up and moving ASAP to ensure that the achilles does not have a chance to tighten again. It was a bit disconcerting to hear him say he basically ruptured the tendon. He again described putting in the cuts and forcing my foot to neutral. And today when it was out of the splint I noticed it wanted to curl in and did not like when he pushed the ankle to a ninety degree angle from my leg. As I mentioned he had me stand and put as much weight as I could tolerate on my left foot and work on bending my knee.

Dr. E says stretching is my top priority. He wants me working on the foam angle in my bare feet tonight and starting physical therapy three times a week as soon as possible. Since no billionaires decided they needed an unlimited supply of triple chocolate double toffee cookies, I am starting PT at the HSS rehab center tomorrow morning. My pre-surgical in-hospital physical therapist had recommended someone in that center who supposedly has 20 years experience specializing in feet. He is on vacation, but I should be able to start with him as soon as he returns. In the meantime, I have an evaluation with someone else at the practice. Not looking forward to my long commute (car service tomorrow, but eventually one to two subways and a bus each way) three days a week, but, if at the end I can walk, it will all be worth it.

Dr. Ellis is pushing me forward quickly. I only get the air-cast boot for a week before he wants me in sneakers and I see him again in three weeks. Since the pads of my hands hurt from gripping my crutches tightly, both before and after I was allowed to put weight on my left foot, that seems like a herculean challenge. I'm just trying to figure out if I can get to and from PT tomorrow with just my cane.

For now it's all about putting one foot in front of the other. 

Achilles Seeks PT Sugar Daddy

I spent the weekend talking myself out of texting my last Physical Therapist. While I was sure my saying thank you would be appreciated, I didn't think interrupting her weekend was the best way to do it.

"Physical therapy is important" is a phrase I have heard from both of my current surgeons and my neurologist. My neurologist adds "especially for you," referring to my neuropathy and the hope that proper PT will help my nerves reconnect to my brain.

I am aware of how important physical therapy, and the right physical therapist, is to recovery. After all it was a year ago this week that Dr. Hubbard put me in a cast for 11 days after I possibly pulled my achilles seven weeks after my first surgery, when my physical therapist at the time had me use the BAPS board. After my knee surgery, my recovery improved greatly when I changed physical therapists.

Six months after my first achilles surgery my health insurance stopped paying for physical therapy, saying they  didn't see improvement. After my open letter to Beth Israel, the hospital began to cover the cost of my PT. Eventually Dr. Hubbard recommended I see a physical therapist who had worked at Beth Israel before starting her own practice. I only saw Christine for two months, but discovered having a therapist who specialized in feet and spent an hour one-on-one was very beneficial. I didn't even mind traveling to midtown twice a week and had finally trained the local Starbucks baristas on how to make my Chai. I will never know if seeing her from the start could have saved me from Achilles 2.0, but she was the therapist I wanted to text this weekend as I began to realize how important the strength and balance exercises she ran me through were helping me maneuver through my daily activities in the week after my surgery.

I was hoping to return to Christine for my physical therapy after this surgery, until my insurance shot down that idea. Which is where my need for a Sugar Daddy comes in. Christine does not take my insurance and my insurance will not cover any of the cost if I go out of network. I could argue that Beth Israel should continue to pay, since some of my need for physical therapy is still related to my neuropathy, but I'm not sure that is a fight I would win outside a courtroom.

I realize that much as I liked Carlos, I need a therapist who has a real focus on feet and achilles and someone who will work with me without getting pulled to other patients during my appointment. Ideally, I want that person to be Christine, but simply can not do math that allows me to spend $400 - $600 a week and feed the cats or myself.

I am hoping that when I see Dr. Ellis tomorrow he will let me exchange this hot, annoying splint for an air-cast boot and some walking around. If so, we will discuss my return to physical therapy.

If it ups the incentive, for the money to see Christine, I'll bake at your beck and call.

Is WebMD a Bad Invention?

Been trying to decide since 9:30 pm last night if I should call the Resident on call and ask if they think I have a blood clot in my calf.

I have had some localized pain in my calf for the last two days and last night had a horrifically bad cramp (not fun when you can't move your ankle or massage your calf muscle). I did manage to get my fingers an inch or so down the back of my splint and my calf felt hot.

All of these can be explained away by surgery and being in a splint, or according to the internet, be symptoms of a blood clot in my calf. With no way to do a physical inspection I can't tell if my calf is more swollen then the first few day post-surgery, or how the skin color looks.

I also discovered that I am on less Lovenox then I was last surgery (Blogs are good). My first achilles surgery I was on 30 mg injection twice a day, this time I am on a 40 mg injection once a day. Does this make a huge difference?

And it's not like I can just go to my local ER as they may need to remove the splint to examine my foot, and I'm not certain I would trust them to get it replaced in a way that would make Dr. E happy.

Last night I held off calling because I simply didn't want an answer that might involve my having to go to the hospital that late at night. But with my history of clots, this is not something I should ignore.

I finally decided to leave a message with his service for the Resident on call. Will update later with the outcome.



90 minutes after my message with the service I got a call back from the doctor on call. He didn't feel I needed to worry about the cramping and pain, but said I know my body best and if I get too concerned, or start to have breathing issues, I should go to my local ER. He thought the ER doctor could do a doppler behind my knee without removing the splint. He also said the efficacy of 40 mg lovenox once a day vs. 30 mg twice a day is the same. (So why would any doctor prescribe two shots a day?)

So I sit and mentally note every periodic twinge, or pain in my body. And I definitely need to get my lovenox refilled today!

New Series

To amuse myself (and avoid the heavier work that is waiting for me) I have begun taking a daily photo of my cats interacting with my foot. I have entitles the series 'My Left Foot with Cat'. Paes will be making the majority of appearances as he tends to consider my lap his rightful nap spot.

I thought about Photoshopping my foot into some of my existing photos, but if I'm going to do that much work I might as well be focused on the projects I should be doing.

So here are the first five days

Cat, Odd Pain & Boredom

Day Three. Happy to discover that I have at least one pair of jeans with a cuff wide enough to fit over the bandages. Psychologically it helps to be wearing something other then sweatpants. I have spent most of the last two days on the couch with my foot elevated and a cat on my lap.

Remembering my knee-walker experiences last year, I expected to push forward faster. Instead I have been stymied by a new, sharp pain on the outside of my leg where the muscles attach to my shin or knee. I kept thinking that a hard part of the brace under the bandages was digging in, but the pain is located above the top of the bandages. I mentioned it to the nurse who called to check on me Sunday, but her only recommendation was to take some Tylenol and it would go away. It hasn't. Though it only starts to hurt when I am on the knee-walker, it makes using the knee-walker for more than necessities very uncomfortable.

While I do have my crutches, the problem then becomes the cat. He keeps getting under the knee-walker and I am forever trying to get him to move so that I don't run him over. I fear that he would be just as bad if I were on crutches, only I would not have the stability to stop and maneuver to avoid him. I do not need or want an ER visit because the cat tripped me and I went splat.

So I sit on the couch surrounded by books, magazines, DVDs and my computer and slowly go stir-crazy. On the plus-side, with the probability of rain and snow the next two days, the world outside my windows won't look quite so inviting! 

Achilles 2.0 - New Surgeon, New Hospital

So today was S-day. My surgery was scheduled for 9:30 am, so of course I had to be at the hospital by 6. If you have never ridden an uptown 4 train at 5:00 am on a Saturday morning, I highly recommend it for it's theater alone. My favorite was the rough-housing women being yelled at for waking up the homeless person. I did have one man tell me he had been on a knee-walker too as I was carrying it up the stairs at the 68th Street subway station.

Spent the first half of my pre-op preparation listening to a querulous woman complain that she needed her pain meds before surgery and say some rather racists things about the nursing staff. Her surgeon arrived as she was reaching her crescendo of obnoxiousness and told her that the hospital staff were there to help her, but if she didn't want that help it was her decision. She shut up. I did not applaud, but wanted to. I understand nerves (I had plenty of my own) but that is not an excuse for being rude and derogatory.

Eventually I was wheeled into my operating room and climbed onto the table. I remember the anesthesiologist giving me a sedative and then disjointed memories from the recovery room where I could hear people talking to me, but could not open my eyes as my brain seemed to flash random thoughts and my right toes were cold.

I eventually woke up to my left foot looking like this.

My surgeon performed a minimally invasive procedure where he made three 2mm incisions through my skin, nicking my achilles and then forcing my foot into neutral. He said he could hear and feel things pop and pull, but even with the cuts couldn't get past neutral. They then designed an open plaster mold (see above) that holds my ankle in neutral and forced my foot to stay that way until the plaster dried. 

Dr. E is hopeful that I can go into the aircast boot when I see him on March 14th and begin putting weight on my foot. He says the issue is not putting me in the boot too soon and risking me popping my achilles vs. leaving me immobile for too long and having the achilles tighten again.

On a side note: I like Dr. E, he seems to have a sense of humor, gets my dry sarcasm and is willing to laugh - not something Dr. H seemed capable of.

So by noon I was awake, with Betty called and on her way to get me enjoying a tuna sandwich and cookies, hoping to get the plastic taste of the breathing tube out of my throat. And a little after 1:00 pm Betty & Steve were driving me home and picking up my new batch of Lovenox. 

I am now ensconced on the couch with a cat on my lap (who I do have to admit is less then impressed with the smell of plaster, iodine, etc coming from my foot, nor does he seem to be a fan of the pillows needed to elevate) looking forward to some home-made matzo ball soup and trying to stay awake until it's time to feed the cats and take my motrin and lovenox. I am not in any pain, so no Tylenol needed.

Hmm, what did I put on my Hulu queue?