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?

Adding Another Voice

11 days to surgery. Today was a visit to my primary for my pre-op physical. I knew the tests, came ready to have blood drawn and pee in a cup. What I wasn't expecting was for my primary to say "Everything is fine, but I want you to see a Cardiologist."

The problem is that a small sinus arrhythmia showed up on my EKG. Not a huge issue, until you combine it with general anesthesia. So my doctor wants to get a second opinion from a specialist.

This brings the number of doctors involved in this surgery up to six (not counting my primary and previous foot surgeon). My new surgeon has been consulting with my knee surgeon, anesthesiologist, neurologist, hematologist and now cardiologist. Luckily only two will be in the operating room, or it would be very crowded.

And I am left with six days to fret over this finding until my appointment with the cardiologist next Monday. Bright side is that my primary shares an office with a cardiologist, so I was able to make an appointment quickly.

I guess it's back to moving furniture to make my apartment more knee-walker friendly.

Happy Valentine's Day, I Want to Break Up

How do you break up with your doctor? Type that into Google and you get over 71,000 results. The few I looked at tended to be overly general, some simply said you should listen to your instincts without giving a real answer.

I did it by voice mail. I was ready to speak to the Office Manager, but instead I got her message. So I simply said "I have decided to switch to Dr. ___. Please forward my files to his office and needless to say I will not be coming to my appointment next week."

It's been coming for a while. This is, after all, the doctor who has had helped make the last year miserable. Thirteen months after my achilles repair surgery I still don't feel much of my foot and I have what my knee surgeon and new foot surgeon refer to as an "equine" walk.

If I'm honest, my new surgeon is the one I wanted to see two years ago when my achilles first tore, but I did not feel I could handle his nine-month waiting list for new patients. I only got to see him now because my foot issues were starting to impact my knee and my knee surgeon did not want his hard work to be for naught. He called the new surgeon and got me a jump in the queue.

So, now I have a new foot doctor, who on our first appointment scheduled me for an achilles lengthening surgery on March 2nd. He answered all of my questions, showed he had a sense of humor, and let me know he would be in contact with both my knee surgeon and my neurologist, before sending me to meet with an anesthesiologist to discuss how to ensure this surgery does not have an adverse effect on my already damaged nerves.

I have two weeks to get the house ready for the return of the knee-walker, stock supplies and get all of my pre-surgery tests and authorizations. This has to go better then the last time. If I'm honest, I'm terrified. I now have an awareness of all the things that can go wrong.

The new surgeon refused to openly criticize the old surgeon. The consulting anesthesiologist said the old surgeon should have told the old anesthesiologist immediately when I first complained of not feeling my foot. (Something the old anesthesiologist had also said.)

So I have broken up with my old foot surgeon and already started a new relationship. As with all new relationships you look forward, with high hopes and positive energy. Happy Valentine's Day.

Health Care in America: An Open Letter to Beth Israel Medical Center

I have sciatic neuropathy down both sides of my lower left leg. For me that means I don't feel my foot from my ankle down. I've likened it to my foot being asleep, only the nerves never wake up.

I can pinpoint exactly when this started, Monday, January 23, 2012. The day I went in to Beth Israel Medical Center in Union Square to have outpatient achilles repair surgery. I had spent much of the previous year trying to stay out of the operating room. I had been diagnosed with micro-tears and had been in severe pain for a few months before I was finally able to schedule an appointment with a foot and ankle surgeon (I won't go in to the hoops involved in simply finding a specialist who takes my insurance). I had done everything I could to keep from going under the knife, I had heard stories from many people about how long the achilles can take to repair, however, no one had mentioned neuropathy as a side effect.

After being in severe pain over Christmas and spending my birthday at the doctor's office I finally conceded the need for surgery. So very early on the morning of January 23rd I found myself taking the subway to Union Square with my rented knee-walker and checking in for surgery. That morning I met the anesthesiologist who told me he would put me to sleep and then give me a popliteal sciatic block, otherwise known as a nerve block behind my knee. And the trouble began. 

I wasn't in much pain post-surgery, which probably should have been a sign. On my post-surgery diary I begin commenting on numbness in my leg on January 30th and had emailed my surgeon's PA. By February 7th I was referring to it as neuropathy and commenting that my surgeon was "surprised". It continued to be one of my top concerns at post-surgery appointments until March when the surgeon finally conceded to my seeing a neurologist. He recommended one at Beth Israel - I made an appointment with one at Hospital for Special Surgery.

It was fifteen weeks after surgery when the surgeon finally said I could start to transition out of the walking boot into sneakers with a lift. I was ecstatic until I discovered another side effect of the neuropathy. Since I can't feel the ball of my foot I roll my ankle as my brain searches for a position that feels secure. The end result is that my ankle is constantly swollen and in severe pain and my gait has become so slow tourists in Times Square move more quickly then I can. I continue to be fearful of causing damage, but when I emailed a photo to my surgeon and asked about wearing some sort of brace I was told that he did not want me constricting the ankle. So my mobility and ability to live my daily life has been severely compromised as even simple things like walking to the kitchen to feed the cats causes pain and my ankle has taken to permanently resembling a softball. 

And here we are, I have had an EMG (Electromyogram) showing definite neuropathy (an MRI of the lower sciatic nerve is scheduled for later this week). Both the surgeon and the neurologist have said that the best case scenario is that the nerves re-establish feeling in a year. And the only treatment option - physical therapy (PT).

So, why this letter? What do I hope to accomplish? My physical therapists office is reporting that my insurance is beginning to limit and deny the number of sessions I can have. While I am one of the fortunate self-employed who can afford insurance, being self-employed and limited in my ability to work when I can barely walk means I do not have the money needed to pay for PT and other treatment options out of pocket. 

I have had many people tell me to sue, I may be naive, but I don't like how litigious our society has become. It bothers me that people seem to think they should get rich because someone else screwed up. I am not looking for some huge payout. I simply want enough to cover my out of pocket expenses related to trying to care for and rectify this injury created during my surgery. 


I am not looking for compensation for pain and suffering or even lost income. I have made, have been forced to make, the decision that my primary job for the next year is working to convince my nerves to find a path to connect my foot to my brain. I need to make every effort to insure that this is not a permanent disability. 


I want the opportunity to discuss this with someone. I have left multiple messages with the Beth Israel Patient Representatives Office, but never heard back, leaving me to write this letter in hopes that someone will finally respond.


Thank you.


Erika Clark