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!

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. 

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.

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.

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.