Anybody Want a Cat?

My eighteen year-old cat with feline dementia wanted dinner and saw no reason why my smelling strange or having a giant thing on my foot should mean I shouldn't do my duty and get out of bed a feed him. So I'm up with my foot raised above my hip, trying to figure out how I managed to cut myself just hours before my first dose of Lovenox.

With him temporarily satisfied, dinner for me is a simple, warm and mushy chicken and dumplings as my throat recovers from the intubation.

I arrived at the surgical center bright and early, went through all the paper work and was put in a little dressing room and told to strip naked, couldn't even wear my out underwear, instead I got these cotton net things that not even a cheap stripper would wear. I always forget how repetitive the questions are as a safe-guard measure - pre-op nurse, anesthesiologist, resident, OR nurse, second OR nurse. Got my allergic to Morphine wrist band and saw Dr. Hubbard and the band of inquisitors and was led to the OR around 7:40.

Two beds in my OR so they could start me on my back for the IV and anesthesia and then roll me on to my stomach for the surgery (where I'm sure I got to show off my net undies). I commented on the 70's early 80's influenced soft rock on the OR speakers, very different then the hip-hop from my knee surgery. The resident joked they liked the quiet stuff to keep Dr. H calm. I remember the anesthesiologist putting in my IV and telling me he was adding the sleeping meds and it was going to burn. It didn't, but it did act quickly.

I now understand the term "swimming into consciousness" as that is certainly what it felt like as I opened my eyes in the recovery room to see the resident, the recovery room nurse and the anesthesiologist standing at my bed. My entire left leg felt like a dead weight and I could taste the plastic of the breathing tube in my throat.

When I could focus on the clock on the wall opposite my bed it read 10:30 - so much for leaving the hospital by 9:00. Betty said that no one told her I was out of surgery and when she finally found the ill-marked in-house phone no one gave her any info the first time.

It was a very different post-op attitude to what I've had at HSS, my Usbeckistani nurse (the woman in the next bed asked her where she was from) made not-so-subtle hints that she was over worked (as far as I could tell she was only covering two bays) and that my nit moving on her schedule was a bit of an inconvenience. I watched another nurse get huffy when a young woman who was in to "get hardware removed" needed extra Percocet for the pain and then after being discharged came back crying because she didn't feel well. My nurse told me the nausea I felt the first time I tried to stand was because I didn't sleep enough when I was moved to the recovery room. She also felt my knee-walker wasn't good enough, so provided me with crutches whose max height was 3 inches too short.

By 12:15pm I was sitting up eating a corn muffin, having managed the short crutches and showed I could use the bathroom. (Never understood the science behind needing to show you can pee and eat before discharge.) At 12:30 I got a new nurse who was entranced by my knee walker and was ready to put my clothes on and come home.

I was home and in bed by just after 2pm and happy to drift in and out of sleep with the odd sip of water to help flush my system and sooth my throat until the cat decided it was dinner time. I did take this picture wit my phone. The blob is foot shaped, so I'm assuming there is one in there somewhere.

I did have some un-planned issues with the knee walker. I had thought through the 4 steps in my hall and left the crutches for easy access once I got home, but I didn't think of the difficulty of getting in and out of the car. Just figuring out what to brace on to hop off the curb gave me a couple worried moments. Also elevators are not great as the wheeler has the turn radius of a bus. I wound up having to back out of my galley kitchen and I haven't even tried to take it in the bathroom yet. But I do feel steadier on it then on the crutches, especially around the cats. We'll see how the relationship progresses. I have decided what it really needs is a bicycle bell, or one of those reverse horns. Betty thinks it needs a flag to tie to my heel like one of those truck long load notifications. For now, I'm going to use it to go back to bed.

Shh...I Think the Foot's on to the Plan

As if to remind me I'm doing the right thing, my heel has been periodically twinging and my ankle swelled impressively yesterday.

Friday I kept wishing it was Sunday and I was getting it over with, today I'd like to add some extra hours to the day - 120 should do! I thought I was basically ready until I wrote up a full "to do" list last night. None of the tasks will take very long, except for baking the banana bread, but seeing a sheet of paper filled with things to do in the next 20 hours feels overwhelming. Add that to the general stress of surgery and I'm ready to crawl back into bed and pull the covers over my head.

I'm also waiting for the final word if I have to scramble and find a back-up to pick me up from the surgical center tomorrow. The friend I had lined up to pick me up has a family crisis which may throw both our schedules out the window. As I started trying to find a back-up plan Friday I had to wonder, what happens to those who can't pressure spouses, lovers, parents, siblings or children into being our "responsible adult" escort? Are you banned from ever having surgery? Do you have to live in the hospital?

It is especially hard for those of us who live alone and don't like asking for help at the best of times. For me a hospital pick-up (and this is my fourth since October 2009) is a delicate procedure. Finding someone reliable, whose schedule can be changed without worry I immediately rule out friends with office jobs or young children. Some of my freelance friends may be in the middle of a project. Other friends may agree to do it, but will make me feel they are doing it under duress or that I owe them for their generosity. Ex's are always tricky with all the relationship baggage and possible false expectations. I often get to the point where I have to wonder if it would be easier to simply call an escort service and book the fantasy of being taking home from the hospital.

For now, it's time to start working my "to do" list and not stress over anything until I have to. 

Ouch

I have spent most of the week preparing my world for surgery. I ordered a knee walker and a shower stool; stocked up on supplies (both food and entertainment); re-arranged the loft to be more crutch and walker friendly; and caught up with meetings and editors.

I've been busy checking things off my list, trying not to think about the actual surgery. Until I got hit with logistics in a one, two punch. First came in the mail, the letter authorizing my surgery. A simple line in the Requested Services Summary, Description of Service Code(s). The first description I expected "Repair of achilles tendon". Strait forward explanation of what this surgery is for. It was the second description that threw me, "Part removal of ankle/heel". It made it sound like some sort of amputation, like I would wake up and all the bone under my tattoo would be gone. Not a phrase to inspire the belief that everything will be fine and I will be up and running quickly!

Before hyper-ventilating and calling Dr. H. (not a completely unreasonable reaction considering some of the strange dreams I've been having about this surgery - I don't remember any prior to my knee surgery.) I decided that he actually meant shaving the Haglund's deformities and the bone spur. (You can see both on the photo of the x-ray below.) But still, bad wording.

The second came in a phone call from Dr. Hubbard's office. My surgery is scheduled for 7:30 am, which means I have to be at the surgery center at 5:30 am. Sit and do the math and that means I have to get up at 3:30 ish to be showered and awake enough to get to Union Square. Does it even make sense to go to bed?

On the plus side, they predict I'll be ready to go home by 8:30 - 9:00 am (which doesn't make 100% sense if the surgery lasts an hour unless they are wheeling me straight from the OR to the car) and I have to believe I'm the first surgery of the day. Dr. Hubbard's assistant said I should be happy it's early, because it means I won't be hungry like later patients.

The doctor is still waiting for insurance authorization to put me on a blood thinner, Lovenox, to prevent possible blood clots with my leg being immobilized for so long. I had been told that the PA would be talking to my hematologist and was expecting a blood thinner. Then I went on-line - from drugs.com "Lovenox can cause a very serious blood clot around your brain or spinal cord if you undergo a spinal tap or receive a spinal anesthesia (epidural)..." Didn't even get to the websites partial list of side-effects before emailing Dr. H., my pre-surgery packet says that my surgery uses an epidural instead of general anesthesia. 


Maybe medical internet research IS a bad thing! In the meantime I'm left with four days to worry and obsess.

Countdown Begins

 I have started my pre-op "to do" and shopping lists. Top priorities are making the apartment crutches friendly and stocking up on entertainment. Other jobs have included replacing the padding and grips on my crutches and stocking up on easy, healthy food. Even though I have the list well in hand, somehow a week doesn't feel long enough.

I also realize I'm much more afraid with this surgery then I was with my knee. It's not that I don't have faith in my surgeon, but that this surgery seems to have the ability for more complications. Plus everyone seems to want to tell me a horror story - not helpful!

I think it's also the idea of not being able to weight bear for two weeks. With my knee I started passive PT immediately and could at least use my foot (with some pain) to maneuver around and get up from a seat, etc.  This time I ordered a medical shower seat and have been thinking about trying to borrow a wheeled office chair to scoot around the apartment for the first two weeks. At one point Dr. Hubbard had mentioned the possibility of a knee walker. (see my favorite picture from a testimonial page of rentakneewalker.com)

I don't know if my insurance would cover it, and all the images show that the weight point is directed to the knee - the one thing I have never been able to do since my first knee surgeries 25 years ago is kneel without pain. But it certainly looks like a safer and steadier option to crutches - especially around the cats. Will email Dr. Hubbard or his PA, Marco, and call my insurance Tuesday. (With the knee walker, I might even be able to bake for Precinct Council.)

I am probably going over-board in all my preparations, but I'd rather discover I don't need something I have then try to figure how to get it afterwards.

And Maybe an Ankle

You sometimes forget how your body is related, or maybe now that I'm 40 everything is just falling apart. Anyway, about a year ago I tore my Achilles. I didn't realize I had injured it and now believe the tear to be caused by tightening of my calf muscle after surgery. Once I understood the tear could be the feeling of a simple pop at the back of your heel I could find a vague memory of the event.

It wasn't the actual pop that sent me to the doctor, but the continuing and increasing pain as I tried to maintain my schedule and routines during the following months. The morning I woke up and couldn't walk to the bathroom I decided to call the doctor. I bypassed my primary and went strait to Dr. W. who fit me in and sent me for a sonogram, put me in a short immobilizing boot and ordered physical therapy.

When the pain did not dissipate, Dr. W. decided I needed a foot and ankle specialist. He recommended a few at HSS. Only one took my insurance and he had a nine month waiting list, which became six when I said Dr. W. had recommended me. That seemed ridiculous in a city like New York, even with my less then amazing health insurance, that it should take longer to see an orthopedic specialist then it does to see my gynecologist.

As the pain began interfering with my ability to take assignments and the PT wasn't working I started scouring lists of top doctors and cross-referencing them with my insurance. I found Dr. Hubbard at Beth Israel and sent an impassioned e-mail through his website.

When I saw Dr. H. in June he changed my brace to a knee high contraption with built-in air pockets that could be inflated and deflated for a perfect fit. He also showed me an x-ray of my heel and pointed out both the spur where the Achilles had tried to reattach and the Haglund's deformity bumps that were making it difficult for my body to repair itself.

The hope was that with rest in the brace and continued physical therapy, my heel would find a way to mend. But, we're talking about me, so simple and easy wasn't an option. After a month in the boot it quieted some, but would periodically flare, especially during photo shoots. and somehow, simply ignoring it didn't really help.

I worried about my knee as my gait changed and began to change my activity level to baby my heel. After one flare Dr. H. sent me for an MRI and shortly after my right knee put it's two cents in and Dr. W. sent me for an MRI as well.

I continued to have low-level heel pain, but figured that was simply part of my life. Everyone I had spoken with talked about how they took over a year to recover from any Achilles issues. As December arrived the pain increased, but I tried to work through it. I certainly knew I couldn't wear the brace to meet with editors to discuss future assignments. The ankle swelled so badly my Primary sent me to the hospital for a Doppler for a blood clot and the pain increased to the point that my heel would throb while I was in bed.

I put the brace back on and called to see Dr. Hubbard. I got to celebrate my birthday in his office, being told that my two options were surgery or coming home from every big assignment and going into the brace for two weeks. Neither sounds particularly appealing, but after much soul searching, discussion and research I've gone with option A.

So the doctor's office works on my insurance and I am tentatively scheduled to get my Achilles cut and the spur and bumps shaved down. Two weeks in a no-weight cast, three in a walking-cast and then a month back in my boot. Nine weeks of severely limited mobility and four to six months before I am fully recovered.

Terrified seems the emotion of the moment. I'm spending my time trying to get any outstanding work done and get the apartment back into a crutches friendly zone. Now if I could just get Lowe's to finish installing my new washer and dryer.

Just call me Half-Awake Hobbles

Right now the knees not really hurting, but I do have that spacey feeling when you're not quite awake. I got home after ten pm last night and was up at 3:30 this morning to be at the hospital by 5:45 so that I could be Dr. Williams first patient of the day at 8:00 am.

No epidural this time, just a little something in my IV and I began to wake up in the OR as they were wrapping my knee and remember looking at my anesthesiologist and asking if we were done - no loud music in the operating room this time. Just after 9 (Regis and his guest host were still doing their opening banter on the tv over my bed) I was wheeled into recovery and offered a mediocre tuna sandwich and a ginger ale. By 10 am I had gotten out of bed and peed and they were ready to send me to "Phase 2" recovery and send me home.

I never even got to see Dr. Williams after my surgery, though Melissa came and told me everything went smoothly and gave me some post-op care rules. Nor, did I ever get my screws! (May that be the worst part of this operation!)

Mitch picked me up and took me to the pharmacy for my pain and anti-inflammatory prescriptions before dropping me off at home. Where I immediately collapsed on the couch with an ice pack and made a few phone calls and getting some time with one of the cats. When I found myself in some pain and waking from a doze in a position bound to give me one heck of a neck cramp, I took my crutch and hobbled to bed and passed out for two hours. Which brings us to now and this fuzzy headed feeling.

As for post-op rules - one crutch and light weight bearing for the next 24 hours at which point I can remove the bandages wrapping my full knee and just band-aid the surgery scar. I have to keep it dry for the next 10 days (so it's back to plastic wrap in the shower!) but should be able to move the knee normally. Though we did discuss I may have re-plan my Saturday as my currently scheduled photo shoot may have me on my feet too much.

Right now I'm just going to drink some juice and go back to bed. Melissa is supposed to call tomorrow to check on me, we will leave it until then.

Blood work

Yes, it's been awhile. My life has been more about bringing in a paycheck then obsessing on my knee. Though I have been getting a bit of pain lately. I have decided it is my knee preparing to lose the screws.

I am happy to report that procedure is scheduled for a week from tomorrow (if I finish and post this by midnight). I went to the hospital today for my blood work - an hour on the subway each way so they could spend less then a minute drawing 2 vials of blood. I figured it was still better then last time when my primary sent the blood to a lab that doesn't take my insurance and so we had to rush labs the morning of my surgery.

I also had to do a bit of scrambling today when the person who was originally scheduled to pick me up at the hospital had to cancel. Fortunately, I was able to find a new person. It seems ridiculous that I have to have someone at all, it's not like I'm having them move into my apartment to take care of me. Especially since this is supposed to be such an easy procedure. I asked if I could just have someone meet me downstairs at the hospital entrance, but no, Melissa insists they have to come up to the Recovery Room. Again, if all they are doing is driving me home what is the point? I can almost guarantee that whoever comes to pick me up next Wednesday is not the person I would call for help if there is a post-surgical complication!

Maybe that should be my new career - hiring myself out to people who need someone to get them out of the hospital so they can go home and be sick in peace!

In all seriousness, I just want to know that this final part will be easy and that it will mark a turning point in getting my life and my career back on track! I have been somewhat forced by the surgery into a stagnation that I neither wanted, nor was really prepared for. The thought of having to pause my life for another nine months to have the other knee done scares the crud out of me.

I want nothing more then to jump on a plane with my camera bag and just go! I have tried for some projects closer to home, but have been having funding and permission problems. I don't know maybe my life just makes more sense when I'm looking through a camera lens - or maybe it's almost midnight and I just need to go to bed!