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. 

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!

A Long Day in the ER

I wanted to talk about happy news today like the fact that I got a letter from Oxford, my insurance, yesterday stating that they had approved payment for my CPM machine, but even that was taken from me as today's mail brought a letter from Oxford dated the same day as the first, with the same reference number denying coverage for my CPM machine. And of course it is almost 5pm so the office is closed for the day. I don;t know if they will be open Sunday, or if this will have to wait until after the holiday weekend. And that just adds to my already long, crappy day.

I woke up around 5am uncomfortable from staying in one position all night and tried to get more comfortable and doze. Gave up on that around 6:30am, got up and had breakfast. While sitting on the couch I looked down and noticed that my left calf, ankle and foot were very swollen and a bit red. They had not been like this when I had my shower yesterday. The calf was sore, but I couldn't tell how much of that was after-effects of the surgery, the brace or the CPM machine versus something new. Around 7:45am I finally decided to call my surgeon's service. It took 3 calls of 5 to 10 minutes of sitting on classical hold music before I even got the service to answer the phone. I left a message and then after waiting some more called my wonderful neighbor and nurse, Lori (you may remember she supervised my nervous first bandage change). She came over and decided that I probably didn't have a blood clot, but wanted to take me to the ER anyway. After some hemming and hawing I finally agreed, so off we went to Methodist Hospital.

She dropped me off just before 9:00am at the side door closest to the ER entrance - which was locked, meaning I had to walk down the block to the main entrance and then walk the lobby, that can best be described as a perfect skate park, back to the ER. I was exhausted by the time I finally signed in. (Note to Methodist - if you want to keep that side door lock for security reasons set up a camera and a buzzer so that the ER receptionist can let people in!)

I saw the Triage Nurse around 9:30am. Told her my concerns, lifted my left sweatpants leg to show her the swelling, got an elevated blood pressure, but no temperature and went back to the low, uncomfortable chairs in the waiting room. Called into the ER around 11:45am. Another long hallway to get to my cubicle. Before I even saw a Doctor an Orderly came by to take me for a Doppler. I learned later it is the new procedure that someone - I guess the Triage Nurse can order tests so that when you see the doctor they have a better picture of your condition. (I'm guessing it will be the new thing Insurance Companies fight about.)

So just after 12:00pm I was up in Ultrasound and getting a Doppler scan on my left leg. One thing to be happy about today - no clot. Back in the ER by 12:30pm and the Resident, Dr. Hawkins, came to tell me that sometimes Doppler doesn't find the clot (enough, no clot makes Erika happy). She agreed my right calf and foot are colder to the touch then my right, but I have a pulse in my foot and could she look at my incision. She went to get more gauze and wrapping while I took off the brace and dressing. She seemed surprised that I was not expecting her to do everything for me. There was a red spot on the outside of my knee, I guess where the new ligament is located. It was hot to the touch - the only spot on my knee that was warm. She decided to have her Attending take a look at it.

At 1:54 pm (I had figured out where the tv remote was hidden and changed the channel from college football to CNN) the Attending arrived and decided that I may have an infection and gave me two prescriptions for antibiotics and sent me home.

When I got home there was a call on my answering machine from the Doctor covering for my Surgeon this weekend. He had been in rounds and finally called me back at 10:34. I had him paged. He didn't respond, so I called the service again - this time they answered. He called me back within 10 minutes.

He was happy I had had the Doppler, but was not happy the ER hadn't taken blood. He didn't think I had an infection and told me not to take the antibiotics, but to call again tomorrow if it was still red and hot.

So basically it was a very long day. I do have to say "thank you" to Lori for coming over and taking me to the hospital and Jan for coming to pick me up. My only request is that you consider lower riding SUV's for your next vehicles!