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!

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!