Neurontin got replaced.
By desperation.
I was given a lecture by my (now former) pain management doctor that weight gain only occurred in something like five percent of all patients -- or was it a half percent? Can't remember now -- and that I shouldn't have experienced it. I told him to look at the five (or half) percent, sitting in front of him.
His response was to give up. Literally. I'm no longer under his care. Very disappointing.
He claimed there was nothing else that he could do for me and told me that I needed to go to a "comprehensive pain management program." He then kicked the ball back to my primary care doctor's office for future care.
Of course, the paperwork always gets mixed up in the transfer, and I wound up having to actually go with my wife to my primary care doctor to get the referral started. I now have an incoming patient exam scheduled for next week. That's just to see if I qualify for the program. Sigh.
In the meantime, things on other fronts haven't been much better. I had tests run to see if my gastric bypass is still working. These were done because I don't feel like I'm getting much help from it anymore. Despite that, the doctor says it's still functioning properly, so no need for a revision or anything else that insurance will cover.
Similarly, I followed the advice of two other orthopedists and saw someone about possible knee replacements. Quick backstory -- I had a bicycle accident back in 1984 that resulted in a partial tear of my left medial meniscus and chondromalacia (sp?) of the back of my kneecap. A poorly-done arthroscopy got me back on my feet, but left me with pain that has been present for almost 30 years now. The right knee just sort of developed into near bone-on-bone osteoarthritis (according to the doctor who operated on my ankles). Synvisc injections into both knees did zero to help, so I was sent by doctor #2 to a knee replacement specialist. He told me, basically, to lose 50 pounds and come back afterward, at which point he might consider doing a replacement or two.
Other things have happened that I can't talk about yet. If I can post info about them, I will. Watch this space.
Thursday, October 24, 2013
Monday, July 29, 2013
Hell in a Bottle
Neurontin.
Gods, what a monster.
This is the new pain medicine I've been placed on. This little capsule has done more to me than for me. I'm learning that I'm not alone.
First, I'm almost a chemical zombie. Without fail, this pill takes over about an hour after taking the dose. It knocks me flat for at least a couple of hours, then leaves me with almost zero energy. Getting up off of the sofa is hard as hell. Most of the time I fall asleep again, then wake up after another couple of hours. My sleep schedule
When I wake up, I'm starving. Not even the gastric bypass has broken this. My weight has gone back up to just 30 pounds less than it was when I had the operation. That's in less than a month's time. I reported weight gain to my pain medicine doctor, along with the fact that I'd looked it up and found it as a side effect on the Mayo Clinic's website. The pain medicine doctor had to call a hospital pharmacy to verify what I told him. He found that it was true.
Now, I have one dose of Neurontin left, for Monday morning. I plan on calling my pain doctor and asking him to put me on a pain medicine I've taken before - Talwin NX - and take me off of the Neurontin monster. I only hope he listens to me.
Gods, what a monster.
This is the new pain medicine I've been placed on. This little capsule has done more to me than for me. I'm learning that I'm not alone.
First, I'm almost a chemical zombie. Without fail, this pill takes over about an hour after taking the dose. It knocks me flat for at least a couple of hours, then leaves me with almost zero energy. Getting up off of the sofa is hard as hell. Most of the time I fall asleep again, then wake up after another couple of hours. My sleep schedule
When I wake up, I'm starving. Not even the gastric bypass has broken this. My weight has gone back up to just 30 pounds less than it was when I had the operation. That's in less than a month's time. I reported weight gain to my pain medicine doctor, along with the fact that I'd looked it up and found it as a side effect on the Mayo Clinic's website. The pain medicine doctor had to call a hospital pharmacy to verify what I told him. He found that it was true.
Now, I have one dose of Neurontin left, for Monday morning. I plan on calling my pain doctor and asking him to put me on a pain medicine I've taken before - Talwin NX - and take me off of the Neurontin monster. I only hope he listens to me.
Tuesday, July 2, 2013
The Toothaches of Regress
A quick follow-up to the last update:
Now, if you'll excuse me, I'm going to go off and get some liquid to take my medicines, including Augmentin now (the amoxicillin on its own was giving me the male equivalent of a yeast infection.). Urgh.
- The golf ball is out of my right knee. I still can't kneel on the floor, though both knees feel a little more "slippery." Not sure if this is a good or bad thing.
- The tooth that broke last week is no longer there. Officially, it was tooth #30, my bottom-right first molar. The doctor says it broke in half from top to bottom, and I believe him - I asked for and received the leftovers. Ugly stuff. (Don't engage your anti-Jackson-medical picture filters. I'm not uploading this. Too gruesome for prime time.) I have to go back next week to get 5 stitches removed.
- Also, the new pain medicine is only at half dosage for one more day, and as a result I'm having to deal with the fact that the relief runs out at unpredictable times. I'm sort of on a sine-wave pattern of going from relief to not much and back. Same thing goes for my sleep patterns - I get tired for about 4 hours, then I'm restless for about 4 hours, off and on, all day and all night.
Now, if you'll excuse me, I'm going to go off and get some liquid to take my medicines, including Augmentin now (the amoxicillin on its own was giving me the male equivalent of a yeast infection.). Urgh.
Saturday, June 29, 2013
The Headaches of Progress
Turns out that the Tramadol (Ultram) is what was giving me the massive headaches. Order from pain doctor: Stop taking the Tramadol. Now.
I asked the pain doctor if there wasn't something else he could give me, like Talwin NX. He said this is an "old drug" (Old? I took it as recently as 2001...) and that he needs to research it. Instead, for now I'm on a low but increasing dose of Neurontin (generic name Gabapentin). I'll say this much about it -- it knocks you for a loop. I'm dealing with said loop right now before I log off for the night, so please forgive any screwups in the text of this post.
Saw the new knee doctor yesterday and told him about the problems I have walking and climbing stairs. He injected Synvisc, a synthetic knee fluid enhancer, into both knees. I couldn't even tell he'd done anything on the left knee when he was done (the knee does feel slightly better). I could tell that he injected it into my right knee. It felt like he had injected a golf ball into my knee joint. There's still a swollen welt where the stuff went into the right knee.
Summary: I've spent most of today in pain from the right knee. The Neurontin has numbed it for now (I go up to two doses next week). The worst part is that the inactivity forced onto me by the medicines means I have been gaining the weight back. Today's weight was 317. That is NOT acceptable, but I don't know what to do about it. I have no support system, thanks to the lousy service from the doctor that inflicted this upon me. I really do fear that I'll have to have a revision to get this fixed.
One last tangent before I log off - a tooth that recently had a filling removed and replaced has broken along the filling line. I'm on soft stuff until the Dentist can see me on Monday. Urgh.
I asked the pain doctor if there wasn't something else he could give me, like Talwin NX. He said this is an "old drug" (Old? I took it as recently as 2001...) and that he needs to research it. Instead, for now I'm on a low but increasing dose of Neurontin (generic name Gabapentin). I'll say this much about it -- it knocks you for a loop. I'm dealing with said loop right now before I log off for the night, so please forgive any screwups in the text of this post.
Saw the new knee doctor yesterday and told him about the problems I have walking and climbing stairs. He injected Synvisc, a synthetic knee fluid enhancer, into both knees. I couldn't even tell he'd done anything on the left knee when he was done (the knee does feel slightly better). I could tell that he injected it into my right knee. It felt like he had injected a golf ball into my knee joint. There's still a swollen welt where the stuff went into the right knee.
Summary: I've spent most of today in pain from the right knee. The Neurontin has numbed it for now (I go up to two doses next week). The worst part is that the inactivity forced onto me by the medicines means I have been gaining the weight back. Today's weight was 317. That is NOT acceptable, but I don't know what to do about it. I have no support system, thanks to the lousy service from the doctor that inflicted this upon me. I really do fear that I'll have to have a revision to get this fixed.
One last tangent before I log off - a tooth that recently had a filling removed and replaced has broken along the filling line. I'm on soft stuff until the Dentist can see me on Monday. Urgh.
Friday, June 21, 2013
Holding Pattern
Not much of a significant change since the last post. I'm still on Tramadol, which helps take care of the pain when it's in my system. However, I also think it's giving me migraine headaches - no idea if this is a Serotonin Syndrome red flag. All I know is that I've felt like roadkill for the past month.
The wound care specialist has declared my left ankle surgical wound healed. All that is left is a small scab, which can be dealt with by Laclotion or something similar. So, no more trips to that doctor - just a bill in dispute over the stuff he used on me to make the gaping wound fix itself -- or something like that. The next gaping wound may be in my bank account.
I did pay a visit to my regular doctor (the one who's trying to be ringleader of this five-ring circus) and talked to him about a couple of things. First, he's referred me back to an orthopedist with whom I have an established history, even if the last time he saw me was prior to 2009's disaster. He's got a much better bedside manner, compared to the...well, let's just leave it at that. Suffice it to say that he's going to get a bit of a shock when he sees the records I've had transferred to him.
The last time I did see orthopedist #2 (the one I'll be going to), he said I had bone spurs lose in my left knee. I didn't have an operation on them because I didn't have any leave to take. Now, with me on full-time medical disability, I could theoretically go in on Monday and have the surgery done on the same day. Time has little meaning for me right now (except for the times when my wife is away from the house and I'm all alone - yes, it's sappy, but it's true).
My regular doctor also had blood drawn for five different tests, including testosterone again. All of the energy I had when I was getting shots has gone pffft on me. I don't know if the Tramadol is the culprit this time or if I'm just naturally low on testosterone. Either way, I hope there's something that can be done.
The wound care specialist has declared my left ankle surgical wound healed. All that is left is a small scab, which can be dealt with by Laclotion or something similar. So, no more trips to that doctor - just a bill in dispute over the stuff he used on me to make the gaping wound fix itself -- or something like that. The next gaping wound may be in my bank account.
I did pay a visit to my regular doctor (the one who's trying to be ringleader of this five-ring circus) and talked to him about a couple of things. First, he's referred me back to an orthopedist with whom I have an established history, even if the last time he saw me was prior to 2009's disaster. He's got a much better bedside manner, compared to the...well, let's just leave it at that. Suffice it to say that he's going to get a bit of a shock when he sees the records I've had transferred to him.
The last time I did see orthopedist #2 (the one I'll be going to), he said I had bone spurs lose in my left knee. I didn't have an operation on them because I didn't have any leave to take. Now, with me on full-time medical disability, I could theoretically go in on Monday and have the surgery done on the same day. Time has little meaning for me right now (except for the times when my wife is away from the house and I'm all alone - yes, it's sappy, but it's true).
My regular doctor also had blood drawn for five different tests, including testosterone again. All of the energy I had when I was getting shots has gone pffft on me. I don't know if the Tramadol is the culprit this time or if I'm just naturally low on testosterone. Either way, I hope there's something that can be done.
Thursday, June 6, 2013
Shrinkage and Drug Games
My surgical wound on my outer left foot is now a scab. I'm hoping it'll come off by itself one day, since sometimes it itches like crazy - mainly when I'm wearing socks (guess what I'm not wearing right now). I have one more appointment with the wound care specialist left.
As far as pain is concerned, yep - it's still there. My pain management doctor decided it was time to "wean" me off of the pain medicine. He said it's probably the cause of a big drop in my bio-available testosterone, which was way below the normal healthy limit on two out of the three last tests by my primary care doctor. (He also said it was the cause of a spike in my weight, back up over 310.) The third test came after a pair of injections, which brought things back up into the low normal range. So, in response to this, the pain doctor wanted to get me off my medicine to see if my testosterone would stabilize and if my weight would drop down.
I don't know what my current testosterone level is, but I do know one other thing - my PAIN is still there. Under the previous medicine, I was limping around the house with a level between 5 and 7 on a zero-to-ten scale (zero being no pain, ten being GIVE ME THE !#$% SHOT NOW!!!). Once the medicine was completely out of my system, my range bolted up to a 7 at best and a 9 at worst, with 8.5 being pretty much the norm.
So, back to the pain doctor. Explain what's going on. Grimace while he makes me walk around without a cane. After that, he writes me a prescription for a non-narcotic pain medicine (Tramadol) and tells me to watch out for signs of Serotonin Syndrome due to the other medications I have to take (oh, joy).
The tramadol is sort-of doing its job. I don't hit 9 anymore, but I still hover around 7 when sitting. Walking any distance other than inside my house can bring on brief bouts of 8.5, so my wife is still taking care of most outside duties. This is going to be put to the test soon, when we attend an IndyCar race. Both of us love IndyCar, and we are NOT going to miss this. I'll have emergency supplies to take care of the pain (Tylenol - I can take it when the tramadol doesn't work) and the nausea which the gastric bypass STILL causes if I don't stay hydrated, or if I eat too much / not enough, or if I eat the wrong thing, or if a butterfly flaps its wings in China.
At least the weight is on its way down again, albeit slowly. It was 304 at last check, and I don't feel so bloated as I did under the low-testosterone conditions. The only thing that hasn't changed is my heart PVCs. One of them hit me while I was writing this paragraph.
Wish me luck, pick your bariatric doctor carefully, and thanks for reading!
As far as pain is concerned, yep - it's still there. My pain management doctor decided it was time to "wean" me off of the pain medicine. He said it's probably the cause of a big drop in my bio-available testosterone, which was way below the normal healthy limit on two out of the three last tests by my primary care doctor. (He also said it was the cause of a spike in my weight, back up over 310.) The third test came after a pair of injections, which brought things back up into the low normal range. So, in response to this, the pain doctor wanted to get me off my medicine to see if my testosterone would stabilize and if my weight would drop down.
I don't know what my current testosterone level is, but I do know one other thing - my PAIN is still there. Under the previous medicine, I was limping around the house with a level between 5 and 7 on a zero-to-ten scale (zero being no pain, ten being GIVE ME THE !#$% SHOT NOW!!!). Once the medicine was completely out of my system, my range bolted up to a 7 at best and a 9 at worst, with 8.5 being pretty much the norm.
So, back to the pain doctor. Explain what's going on. Grimace while he makes me walk around without a cane. After that, he writes me a prescription for a non-narcotic pain medicine (Tramadol) and tells me to watch out for signs of Serotonin Syndrome due to the other medications I have to take (oh, joy).
The tramadol is sort-of doing its job. I don't hit 9 anymore, but I still hover around 7 when sitting. Walking any distance other than inside my house can bring on brief bouts of 8.5, so my wife is still taking care of most outside duties. This is going to be put to the test soon, when we attend an IndyCar race. Both of us love IndyCar, and we are NOT going to miss this. I'll have emergency supplies to take care of the pain (Tylenol - I can take it when the tramadol doesn't work) and the nausea which the gastric bypass STILL causes if I don't stay hydrated, or if I eat too much / not enough, or if I eat the wrong thing, or if a butterfly flaps its wings in China.
At least the weight is on its way down again, albeit slowly. It was 304 at last check, and I don't feel so bloated as I did under the low-testosterone conditions. The only thing that hasn't changed is my heart PVCs. One of them hit me while I was writing this paragraph.
Wish me luck, pick your bariatric doctor carefully, and thanks for reading!
Tuesday, April 30, 2013
Almost There, But With New Baggage
The wound care doctor has pronounced my surgical wound almost completely healed. With the pronouncement, unfortunately, comes a spate of new issues.
Issue #1: Testosterone, again. A normal range for a male my age is 110 to 575 ng/dL on the bioavailability scale, according to my doctor. Mine has been in the 70s. (This is a change from what I'd posted earlier, due to a discussion with my doctor at an appointment this morning. He says it's a logarithmic scale with not much difference between the 30s and the 70s, so I still wasn't off by a significant amount.) No idea how long this has been going on. My primary care specialist put me on shots yet again, although this time every other week instead of weekly. My pain care doctor almost fell out of his chair when he heard the (old) number. His response was to start weaning me off of the Methadone pain medicine, moving me from 5mg three times a day to 5mg two times a day.
Issues #2 and #3: Headaches and irritability. I have been hit by what might be migranes several times a day for the past three days. These correspond with the end of a testosterone injection cycle, and probably have something to do with the reduced Methadone dosing.. I'm getting my T-level checked again tomorrow (2013/05/01) and should know something by the end of the week.
The last time I had shots my levels screamed past the 575 ng/dL level (new number), to something like 1280. We only did the shots because the (insert trademarked medicine name here - you've seen the ads) actually lowered my levels.
Issue #4: Heartburn. No, not me, my wife. She's suffered with it for almost all of her life, and for some reason it's coming back hard after mellowing out for a while. It interfered with what should have been a 100% memorable trip to The Salt Lick in Driftwood on Sunday. Still, 99 44/100% isn't too bad. ^_^
Anyway, all these issues have combined to make the past few days mostly absolutely horrible, not only for me but for my wife, who is putting up with all of my problems somehow (no idea how - a lesser woman would have run away screaming by now). She's also got her own issue mentioned earlier, plus that of a certain somewhat-invasive yet standard medical test for which she began a week of prep yesterday.
It's a big, hairy furball of a mess. Still, we're fighting through it, hopefully together. I just wish the headaches and the heartburn would go away.
Issue #1: Testosterone, again. A normal range for a male my age is 110 to 575 ng/dL on the bioavailability scale, according to my doctor. Mine has been in the 70s. (This is a change from what I'd posted earlier, due to a discussion with my doctor at an appointment this morning. He says it's a logarithmic scale with not much difference between the 30s and the 70s, so I still wasn't off by a significant amount.) No idea how long this has been going on. My primary care specialist put me on shots yet again, although this time every other week instead of weekly. My pain care doctor almost fell out of his chair when he heard the (old) number. His response was to start weaning me off of the Methadone pain medicine, moving me from 5mg three times a day to 5mg two times a day.
Issues #2 and #3: Headaches and irritability. I have been hit by what might be migranes several times a day for the past three days. These correspond with the end of a testosterone injection cycle, and probably have something to do with the reduced Methadone dosing.. I'm getting my T-level checked again tomorrow (2013/05/01) and should know something by the end of the week.
The last time I had shots my levels screamed past the 575 ng/dL level (new number), to something like 1280. We only did the shots because the (insert trademarked medicine name here - you've seen the ads) actually lowered my levels.
Issue #4: Heartburn. No, not me, my wife. She's suffered with it for almost all of her life, and for some reason it's coming back hard after mellowing out for a while. It interfered with what should have been a 100% memorable trip to The Salt Lick in Driftwood on Sunday. Still, 99 44/100% isn't too bad. ^_^
Anyway, all these issues have combined to make the past few days mostly absolutely horrible, not only for me but for my wife, who is putting up with all of my problems somehow (no idea how - a lesser woman would have run away screaming by now). She's also got her own issue mentioned earlier, plus that of a certain somewhat-invasive yet standard medical test for which she began a week of prep yesterday.
It's a big, hairy furball of a mess. Still, we're fighting through it, hopefully together. I just wish the headaches and the heartburn would go away.
Wednesday, April 24, 2013
Case Closing, I Hope
The wound care doctor has managed finally to get my surgical wound on my outer left ankle to heal to the point where I can get it wet, wear socks, and do my normal stuff without help from my wife (she is rejoicing, yes). He went to using a "long acting" collagen with a different dressing. I still had to keep it dry during showers, but I didn't need a re-wrap afterwards. I'm still experiencing pain to the touch above it - something I will explain to my Pain Management doctor when I see him this morning - and I'm still taking Methadone 3 times a day to keep it and all of the other pain under control, be it from the fractures or from other arthritic conditions. Two more appointments and I should be done with the wound care.
That allows me to approach other problems not caused by the fall. First up will be my left knee, which I screwed up badly in a bicycle accident in the early 80s. I won't bore you with the details - suffice it to say that I had the knee scoped back when arthroscopic surgery was still relatively new, and the doctor who performed it was not much of a specialist. I've got arthritis, bone spurs, damage behind the patella, and other aches & pains that I've lived with since the operation. To this day I can't kneel, even with a pillow. I'd say that makes it an extremely good candidate for surgery.
Even that won't be the end of it. I've got arthritis in my right knee with bone-on-bone on the medial side, and I can't lean or kneel on it either. I need to fix this, get the rest of the hardware implants removed from my right foot, and see if something can be done about the arthritic symptoms I've had in the lower spinal vertebrae.
Next update will hopefully be a continuation of what happened to get my ankles into the shape they're in right now. We shall see.
That allows me to approach other problems not caused by the fall. First up will be my left knee, which I screwed up badly in a bicycle accident in the early 80s. I won't bore you with the details - suffice it to say that I had the knee scoped back when arthroscopic surgery was still relatively new, and the doctor who performed it was not much of a specialist. I've got arthritis, bone spurs, damage behind the patella, and other aches & pains that I've lived with since the operation. To this day I can't kneel, even with a pillow. I'd say that makes it an extremely good candidate for surgery.
Even that won't be the end of it. I've got arthritis in my right knee with bone-on-bone on the medial side, and I can't lean or kneel on it either. I need to fix this, get the rest of the hardware implants removed from my right foot, and see if something can be done about the arthritic symptoms I've had in the lower spinal vertebrae.
Next update will hopefully be a continuation of what happened to get my ankles into the shape they're in right now. We shall see.
Friday, April 5, 2013
Limping Ahead A Bit
Here's where we stand (or sit) at the moment. All of the hardware has been removed from my left ankle. That ankle hurt the worst, despite other treatments. It took two operations, since the doctor didn't want to have to haul out the hammer and chisel to pull out certain screws. He also didn't want to remove a syndesmosis that had developed over a ligament. The hammer and chisel were removed during the second operation that happened in late 2012.
Since then, I've had hell getting one of the incision wounds to heal. (The first person to use the word "diabetic" in a response is going to get hit over the head with a very large and ripe banana. My A1C is 5.1 and my fasting glucose is 84, so I'm in "diabetic remission.") Removal operation #2 required incisions on both sides of my ankle, so the ortho doc went in through my already existing scars. I don't know what he did wrong, but I don't like it.
The scar on the inside area (the medial area? Correct me if I'm wrong) eventually closed up with fibrous material and a nastier scar. The scar on the outside area (lateral?) has never closed up. The ortho doc had no idea why it wasn't healing, and I damn near scared my primary care physician to death when I showed it to him during an appointment for a different malady.
I was referred to a specialist in foot wounds in December 2012. He has since poked, scraped, suction bagged, and medicated the outer wound site, with no joy. The latest thing he tried involved a "procedure" of some sort which was close to an operation, but not exactly - I was heavily sedated, but not knocked out. During the procedure, he did a curettage which scraped out all of the fibrous (fibrous == bad) material. He later told me that it extended all the way down to the bone. He sent samples from the procedure for infection testing, but no word on those yet.
After the Big Dig (left outer ankle version), he injected a newly approved fluid which he said contained placental and amniotic fluid material. He told me that it was "sort of" a T-cell injection, and believe it or not, it's working!
Or at least, it was.
So, here I sit, almost 7 months after the second hardware removal, still having to have my wife irrigate, pour collagen flakes into and then bandage my left foot since the wound is in an area I can't reach. The good news is that I've grown a lot of granular "beefy" material (doctor's words, not mine), which is a sign that the wound is healing. The bad news is that it seems to me like it has hit a plateau.
I have another appointment with him on Monday. Watch this space for updates.
Since then, I've had hell getting one of the incision wounds to heal. (The first person to use the word "diabetic" in a response is going to get hit over the head with a very large and ripe banana. My A1C is 5.1 and my fasting glucose is 84, so I'm in "diabetic remission.") Removal operation #2 required incisions on both sides of my ankle, so the ortho doc went in through my already existing scars. I don't know what he did wrong, but I don't like it.
The scar on the inside area (the medial area? Correct me if I'm wrong) eventually closed up with fibrous material and a nastier scar. The scar on the outside area (lateral?) has never closed up. The ortho doc had no idea why it wasn't healing, and I damn near scared my primary care physician to death when I showed it to him during an appointment for a different malady.
I was referred to a specialist in foot wounds in December 2012. He has since poked, scraped, suction bagged, and medicated the outer wound site, with no joy. The latest thing he tried involved a "procedure" of some sort which was close to an operation, but not exactly - I was heavily sedated, but not knocked out. During the procedure, he did a curettage which scraped out all of the fibrous (fibrous == bad) material. He later told me that it extended all the way down to the bone. He sent samples from the procedure for infection testing, but no word on those yet.
After the Big Dig (left outer ankle version), he injected a newly approved fluid which he said contained placental and amniotic fluid material. He told me that it was "sort of" a T-cell injection, and believe it or not, it's working!
Or at least, it was.
So, here I sit, almost 7 months after the second hardware removal, still having to have my wife irrigate, pour collagen flakes into and then bandage my left foot since the wound is in an area I can't reach. The good news is that I've grown a lot of granular "beefy" material (doctor's words, not mine), which is a sign that the wound is healing. The bad news is that it seems to me like it has hit a plateau.
I have another appointment with him on Monday. Watch this space for updates.
Monday, December 31, 2012
Getting Back On Track, Again
A kind soul on Facebook finally gave kick in the seat of my pants that I needed to get this blog going again. Let's see, where were we...ah, yes! The nightmare during surgery.
I've been trying to figure out that dream for a couple of years now, but a description still eludes me. Suffice it to say that I dreamt, either during surgery or in recovery, that I was being operated on in a wood-paneled room in something that seemed like a room in, of all places, Hell!. I can't remember if I was in hell, going there, or if World War III had just broken out and everybody was headed there. Either way, I dreamt that I was trying to warn the surgeon (in mid-operation) that he shouldn't be operating on me with the end of the world imminent.
My wife says I really did say this next part during recovery. Apparently, I told a nurse that I had accidentally created a MIDI controller (musical device for non-techheads) that would launch all of the world's missiles if someone programmed it to play a certain song. Don't ask me what the song was - I can't remember.
The whole hallucination was probably due to the length of the operation. I was under for two or three hours. Not long when compared to an organ replacement, but plenty long when you consider just how much ankle hardware the doctor had to insert in order to repair bimalleolar fractures with complete dislocation on both feet.
Suffice it to say that I was under for more time than I've ever been. I also woke up in EXTREME pain.
Not to end the story, but just a quick status update: I'm now on long term disability leave from my job due to a laundry list of problems that keeps getting longer. I have a heart condition called PVC (Premature Ventricular Contractions) that can strike without warning, and the electrocardiology specialist who verified these (along with another heart problem) says there's nothing he can do, mainly due to the operation I had which put the Greenfield mesh filter into my vena cava. I won't go into the other problems since they're most likely not due to the gastric bypass, but next update I will go into the real hell that is called Spending Time in a Crappy Hospital.
Watch this space for the next installment, and thank you for reading.
Thursday, February 17, 2011
But First...
I'm still having some problems getting my thoughts sorted out on the nightmare mentioned in the previous post; just thinking about it brings up some degree of post-traumatic stress. So, until I can deal with those demons, I figured I would put this online for your perusal.
What follows is the text of the Operation Report from December 17th, 2009, the day on which my ankles were fixed. I just received this after asking for a copy of it during a follow-up appointment I had on Tuesday. Certain portions have been omitted to keep swarms of lawyers from descending on my family. Also, a few reformats have been done here and there to make it more readable, and I've added a few explanations of some of the more technical terms, trying to limit those so that I don't defeat the goal of improving readability.
Here we go:
The aforementioned nightmare happened either during the operation or during recovery. I'll never be sure which, but from what my wife tells me I'm guessing it happened in recovery.
I promise it'll be up soon. It scared me, but it might give you a good laugh once you've read it. Go ahead, if you can't laugh at the walking wounded, who can you laugh at? (Hawkeye Pierce, M.A.S.H., if memory serves.)
What follows is the text of the Operation Report from December 17th, 2009, the day on which my ankles were fixed. I just received this after asking for a copy of it during a follow-up appointment I had on Tuesday. Certain portions have been omitted to keep swarms of lawyers from descending on my family. Also, a few reformats have been done here and there to make it more readable, and I've added a few explanations of some of the more technical terms, trying to limit those so that I don't defeat the goal of improving readability.
Here we go:
OPERATION: 12/17/09
PREOPERATIVE DIAGNOSIS:
1. Left bimalleolar ankle fracture.
2. Right bimalleolar ankle fracture.
POSTOPERATIVE DIAGNOSIS:
1. Left bimalleolar ankle fracture.
2. Right bimalleolar ankle fracture.
OPERATION:
1. Open reduction internal fixation (a.k.a. ORIF - fixing a fracture after incision into the break site - ed.), left bimalleolar ankle fracture.
2. Open reduction internal fixation, right bimalleolar ankle fracture.
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
50.
COMPLICATIONS:
None.
DRAINS:
None.
TOURNIQUET TIME:
Left 25 minutes and right 27 minutes.
INDICATIONS FOR PROCEDURE:
The patient is a 46-year-old male who suffered significant bilateral ankle fractures after a fall 5 days prior. He was eventually medically cleared and due to the displaced subluxed (dislocated - ed.) ankle fractures bilaterally was indicated for ORIF. He understands risks and benefits of surgery and consents for the procedure.
SUMMARY OF OPERATION:
Following successful induction of general anesthetic, both ankles were prepped simultaneously. Ancef 1 g (an antibiotic - ed.) was administered prior to start. Calf tourniquets were applied. The left side was done first.
Following exsanguination (I assume this means either free bleeding or some removal of blood from the site - ed.), toruniquet was inflated on the left. Lateral incision was made through skin and subcutaneous tissue. The fibula was dissected down to and underwent reduction. There was minimal comminution (breakage into a number of pieces - ed.) but somewhat softened bone.
Fracture site was irrigated of hematoma and a curette was used to remove any loose bony fragments. It was then reduced anatomically with a bone-holding clamp, and a single compession screw AP (anterior/posterior - ed.) was placed to hold the reduction. A 6-hole 1/3 tubular locking plate was bent to conform and placed along the lateral aspect. Initially, 2 compression screws, cancellous (i.e., into spongy bone material - ed.) was placed distally (at the far point - ed.) and cortical (dense bone - ed.) placed proximally, followed by 3 locking screws of appropriate length.
We then moved to the medial side and made a small curvilinear incision over the medial malleolus. Opened the deltoid ligament to identify the fracture, irrigated it, and reduced it anatomically and held in place with a bone clamp. Two 50 mm 3.5 partially threaded screws were then placed in parallel through the medial malleolus obtaining good compresion and good derotation (stability - ed.).
X-rays confirmed good hardware placement and anatomic ankle mortise reduction on AP and lateral images. The limb was then wrapped snugly with an Ace wrap and the tourniquet deflated.
We moved to the right side and performed a similar procedure after tourniquet inflation; first the fibula and then the medial malleolus in similar fashion. We used a 7-hole 1/3 tubular locking plate laterally with a single AP compression screw for this similar short oblique fracture. Anatomic reduction was achieved on both sides. Final X-rays confirmed good hardware placement, screw length, and mortise reduction.
Both ankles were then irrigated thoroughly and closed with 0 Vicryl (absorbable sutures - ed.) for the deeper tissues including the deltoid ligaments medially followed by 2-0 Vicryl for the subcutaneous tissue. The wounds were then dried, Mastisol (an adhesive - ed.) and Steri-Strips were applied to all 4 incisions, Xeroform (gauze - ed.) and sterile dressings followed by a soft roll and boots placed bilaterally.
The patient was then reversed from general anesthesia and taken to recovery in stable condition.
The aforementioned nightmare happened either during the operation or during recovery. I'll never be sure which, but from what my wife tells me I'm guessing it happened in recovery.
I promise it'll be up soon. It scared me, but it might give you a good laugh once you've read it. Go ahead, if you can't laugh at the walking wounded, who can you laugh at? (Hawkeye Pierce, M.A.S.H., if memory serves.)
Monday, January 31, 2011
More Omens and More Operations
So, here we are, four days following my re-admission to Hospital X. According to my wife, I've since had several pints of blood transfused, had several more pints of other fluids and nutrients infused, and now have a piece of titanium permanently wedged into a major blood vessel to keep clots from killing me. The internal bleeding appears to have stopped and my blood pressure is up a bit, so I'm finally out of ICU and am being given morphine for the pain. Meanwhile, both my ankles have been somewhat re-set after sustaining both dislocations and multiple fractures and are now wrapped, awaiting an operation to put everything back in its proper place.
Things would appear to be getting better, right? Well, you've probably guessed it - another bad omen popped up earlier in the week, this time involving the doctor scheduled to fix my ankles. He had a death in the family and had to go out of town for the rest of the week, meaning his associate would be performing the surgery. (Someone upstairs apparently took notice and showed a bit of mercy, though, as my employer told my wife on the same day that the company was willing to put me on FMLA leave until I was physically able to return to my job.)
The ankle repair surgery took place Thursday afternoon. It was supposed to last around three hours, but after a four hour wait my wife has still not heard from the surgeon. She says she got someone to call and check on me at that point and was told that I was already on my way back up from the recovery room. The surgeon didn't even bother to stop by and talk to her about the operation. I heard about this from her later on, and she was supremely pissed with the whole situation. Our relationship with this doctor would not improve until much later (after I'd left the hospital, in fact).
Up to this point I'd been going in and out of consciousness and lucidity, thanks to my physical condition and/or whatever drugs or anaesthesia was being used on me at the time. Aside from feeling goofy at times and at other times thinking that I was in Austin instead of Dallas (see the previous update for info on the latter), I hadn't had anything disturb me mentally other than the sheer pain of the situation. Something different happened during the ankle surgery, though - I don't know if it was in the operating room or in recovery - but I had some kind of dream that scared the hell out of me for a while. It was disturbing enough that I apparently felt the need to describe it to the recovery nurses, who then told my wife so that she could have a good laugh at my expense.
I'll describe what I saw in the next update and let you be the judge.
Things would appear to be getting better, right? Well, you've probably guessed it - another bad omen popped up earlier in the week, this time involving the doctor scheduled to fix my ankles. He had a death in the family and had to go out of town for the rest of the week, meaning his associate would be performing the surgery. (Someone upstairs apparently took notice and showed a bit of mercy, though, as my employer told my wife on the same day that the company was willing to put me on FMLA leave until I was physically able to return to my job.)
The ankle repair surgery took place Thursday afternoon. It was supposed to last around three hours, but after a four hour wait my wife has still not heard from the surgeon. She says she got someone to call and check on me at that point and was told that I was already on my way back up from the recovery room. The surgeon didn't even bother to stop by and talk to her about the operation. I heard about this from her later on, and she was supremely pissed with the whole situation. Our relationship with this doctor would not improve until much later (after I'd left the hospital, in fact).
Up to this point I'd been going in and out of consciousness and lucidity, thanks to my physical condition and/or whatever drugs or anaesthesia was being used on me at the time. Aside from feeling goofy at times and at other times thinking that I was in Austin instead of Dallas (see the previous update for info on the latter), I hadn't had anything disturb me mentally other than the sheer pain of the situation. Something different happened during the ankle surgery, though - I don't know if it was in the operating room or in recovery - but I had some kind of dream that scared the hell out of me for a while. It was disturbing enough that I apparently felt the need to describe it to the recovery nurses, who then told my wife so that she could have a good laugh at my expense.
I'll describe what I saw in the next update and let you be the judge.
Saturday, January 1, 2011
Extremely Silly Walk Not Attempted
As I mentioned, my wife took a photo of my feet while we were in the ER. The doctors had not yet worked on them in any way when she took that photo.
The photo is NOT FOR THE SQUEAMISH. It includes an angle that is not normally seen in nature, at least not on the human body.
If you are absolutely certain you wish to see that photo, click here. It has not been photoshopped at all. The black spot is from a magic marker and indicates the foot has been injured. More on this in a moment.
You will note that the left foot doesn't look too bad when compared to the right foot. That is true, until you consider that it has been snapped off and is now lying at a 90 degree angle to the rest of my leg. Believe me, it's not supposed to point that direction on its own.
My wife says the doctors and nurses kept walking past the end of the gurney and bumping one foot or the other, not realizing that both had been broken. They did this several times, and each time she says I would let out a blood-curdling scream of pain. Eventually, someone got the idea to tie red tape around both of my feet so that everyone would know that both were off limits. That worked better than nothing.
The worst part about the situation is that the doctors could neither operate to fix my ankles, nor could they give me morphine for the pain. If you'll remember, my blood pressure was 60/20. I was bleeding internally, and until they could stop it there was a huge risk that a blood clot would break loose and enter my lungs, killing me. As a result, all they could do was wrap my feet in gauze, put Fentanyl patches on me, and move me to the Intensive Care Unit so that they could try to find the source of the bleeding.
I don't have much memory of what went on in ICU. I remember a lot of pain, and I remember a terrible thirst because I couldn't drink anything due to the stomach bleeding. My wife brought in ice chips made from a zero-calorie fruit drink and slipped them to me when the nurses weren't looking. I also remember having IV tubes stuck in me several times until the doctors finally decided to give me a PICC line (one line that led toward my heart and had three connectors hanging out of my left arm). I saw at one point that they were feeding me through the IV, again since they couldn't put a tube into my stomach.
All this while, for some reason I guess I will never understand, I thought I was in Austin. Don't ask me why. I just thought Austin was outside, waiting for me once I got better. There were a lot of other strange things that happened, like me demanding my wife hand me my cell phone so that I could call in sick (my boss asked if I could come in to work in a wheelchair - the doctors nixed that), and me asking the doctor how many days I would be out of work (he said it would be weeks, not days). Again, my wife says she will not fill me in on the other blank spots in my ICU amnesia. Based on what I do remember, I guess I should be grateful.
To continue, my wife says they ran all kinds of tests on me while in ICU but never found the source of the bleeding, despite eight different doctors being assigned to me all at once. Nevertheless, the bleeding stopped on its own after about three days in ICU. At that point a pulmonologist decided to put something called a Greenfield Filter in my vena cava. The filter is essentially a titanium mesh umbrella which is designed to catch and stop clots headed to my lungs. (I still have that filter implanted in me.) Once the filter was in, the doctors were finally able to operate on my ankles, and I was able to begin a whole new series of hospital nightmares.
Stay tuned. The ankle operation was anything but routine.
The photo is NOT FOR THE SQUEAMISH. It includes an angle that is not normally seen in nature, at least not on the human body.
If you are absolutely certain you wish to see that photo, click here. It has not been photoshopped at all. The black spot is from a magic marker and indicates the foot has been injured. More on this in a moment.
You will note that the left foot doesn't look too bad when compared to the right foot. That is true, until you consider that it has been snapped off and is now lying at a 90 degree angle to the rest of my leg. Believe me, it's not supposed to point that direction on its own.
My wife says the doctors and nurses kept walking past the end of the gurney and bumping one foot or the other, not realizing that both had been broken. They did this several times, and each time she says I would let out a blood-curdling scream of pain. Eventually, someone got the idea to tie red tape around both of my feet so that everyone would know that both were off limits. That worked better than nothing.
The worst part about the situation is that the doctors could neither operate to fix my ankles, nor could they give me morphine for the pain. If you'll remember, my blood pressure was 60/20. I was bleeding internally, and until they could stop it there was a huge risk that a blood clot would break loose and enter my lungs, killing me. As a result, all they could do was wrap my feet in gauze, put Fentanyl patches on me, and move me to the Intensive Care Unit so that they could try to find the source of the bleeding.
I don't have much memory of what went on in ICU. I remember a lot of pain, and I remember a terrible thirst because I couldn't drink anything due to the stomach bleeding. My wife brought in ice chips made from a zero-calorie fruit drink and slipped them to me when the nurses weren't looking. I also remember having IV tubes stuck in me several times until the doctors finally decided to give me a PICC line (one line that led toward my heart and had three connectors hanging out of my left arm). I saw at one point that they were feeding me through the IV, again since they couldn't put a tube into my stomach.
All this while, for some reason I guess I will never understand, I thought I was in Austin. Don't ask me why. I just thought Austin was outside, waiting for me once I got better. There were a lot of other strange things that happened, like me demanding my wife hand me my cell phone so that I could call in sick (my boss asked if I could come in to work in a wheelchair - the doctors nixed that), and me asking the doctor how many days I would be out of work (he said it would be weeks, not days). Again, my wife says she will not fill me in on the other blank spots in my ICU amnesia. Based on what I do remember, I guess I should be grateful.
To continue, my wife says they ran all kinds of tests on me while in ICU but never found the source of the bleeding, despite eight different doctors being assigned to me all at once. Nevertheless, the bleeding stopped on its own after about three days in ICU. At that point a pulmonologist decided to put something called a Greenfield Filter in my vena cava. The filter is essentially a titanium mesh umbrella which is designed to catch and stop clots headed to my lungs. (I still have that filter implanted in me.) Once the filter was in, the doctors were finally able to operate on my ankles, and I was able to begin a whole new series of hospital nightmares.
Stay tuned. The ankle operation was anything but routine.
Wednesday, December 29, 2010
Triage Two-Step
At some point on Sunday, just one day after being released from Hospital X, I returned to Hospital X's emergency room entrance. My wife quickly procured a wheelchair and either wheeled me inside or had me wheeled inside; I'm not quite sure which. In either case, my job from that point on was simply to sit in the wheelchair, hold onto my walking cane, and wait to be called back for triage.
Around 30 minutes passed, according to my wife, and I had yet to be seen by any of the ER staff. I realized at that point that I was going to have to use the restroom if the wait stretched out any longer, so my wife wheeled me over to the nearest one. The bathrooms near the ER at Hospital X are of the unisex one-person-at-a-time type, and I learned by trying to open the door that the one I wound up at was in use and its door was locked at the time.
I remember my wife saying, "It's locked," followed by the sensation that she had moved me slightly away from the door. For some reason that I do *not* remember, I felt the need to get out of the wheelchair and try the door handle again. I stood up with the help of my walking cane, determined once more that the door really was locked, and then turned away with the intent to move out of the path of the current restroom occupant once they were finished with their business.
Now, if you've ever experienced the sensation of blacking out while still being aware of things that area going on, you might partially understand how I felt in the seconds that followed. However, you'd also have to understand what a tree probably feels and hears when two of its major branches break off in order to fully comprehend how I felt. In any case, my vision suddenly went to black and I had a sensation of falling, accompanied by the *feeling* of a snapping, cracking sound moving through my body to my ears.
The next thing I remember is being on the ground and hearing my wife gasp in horror:
"Oh my god! His ankle's broken!"
Close, but not exactly right. Both of my ankles were broken.
I had apparently slumped against a wall behind me and fell, just like a tree, to my left. As I fell, both ankles snapped as if my shoes had been glued to the floor. Unfortunately, neither my wife nor anyone else saw exactly what caused me to fall, so no one really knows if I passed out and fell on my own or was knocked over by the man and his 4-year-or-so-old daughter who had exited the bathroom as I was turning away.
I passed out before I could hear my wife yell at the man to hurry and get help. I regained consciousness only long enough to hear a nurse call, "Rapid response to ER...Rapid Response to ER," over the hospital intercom, then blacked out again until someone started moving me around. I remember knowing that I was in intense pain at the time, but my mind had disconnected itself from the sensation to the point where I don't remember what the pain felt like. My wife tells me that I'm lucky on this point.
During another brief moment of consciousness, I recall being moved onto a body board. I also remember someone cutting off my pants so that they could get to my legs for an examination. I somehow gathered up enough brainpower to crack a joke about needing to go shopping for new pants again, since they were cutting off a pair I'd just purchased a few days earlier.
The last sequence of events I remember in the hallway began with a nurse telling a doctor that my blood pressure was 60 over 20. Normal blood pressure is usually near 120 over 70, so 60/20 meant I was losing blood, and losing it badly somewhere. The doctor got her to re-check, and she still came up with 60/20. He thought for a second and then flew into action, ordering up IVs of fluids and blood. When the nurse asked what flow rate she should use, he told her to "flood" me since I was obviously running several pints low.
I have no memory of what happened from this point until I woke up in the Intensive Care Unit. Again, my wife tells me I'm lucky and that she has no intention of refreshing my memory on the matter. She *did* take a photo of my badly broken ankles while in the ER, though. When a nurse asked her why she did that, she said that I would want to see what they looked like.
Damned right. Anything that would cause as much trouble as they would absolutely required documentation.
Around 30 minutes passed, according to my wife, and I had yet to be seen by any of the ER staff. I realized at that point that I was going to have to use the restroom if the wait stretched out any longer, so my wife wheeled me over to the nearest one. The bathrooms near the ER at Hospital X are of the unisex one-person-at-a-time type, and I learned by trying to open the door that the one I wound up at was in use and its door was locked at the time.
I remember my wife saying, "It's locked," followed by the sensation that she had moved me slightly away from the door. For some reason that I do *not* remember, I felt the need to get out of the wheelchair and try the door handle again. I stood up with the help of my walking cane, determined once more that the door really was locked, and then turned away with the intent to move out of the path of the current restroom occupant once they were finished with their business.
Now, if you've ever experienced the sensation of blacking out while still being aware of things that area going on, you might partially understand how I felt in the seconds that followed. However, you'd also have to understand what a tree probably feels and hears when two of its major branches break off in order to fully comprehend how I felt. In any case, my vision suddenly went to black and I had a sensation of falling, accompanied by the *feeling* of a snapping, cracking sound moving through my body to my ears.
The next thing I remember is being on the ground and hearing my wife gasp in horror:
"Oh my god! His ankle's broken!"
Close, but not exactly right. Both of my ankles were broken.
I had apparently slumped against a wall behind me and fell, just like a tree, to my left. As I fell, both ankles snapped as if my shoes had been glued to the floor. Unfortunately, neither my wife nor anyone else saw exactly what caused me to fall, so no one really knows if I passed out and fell on my own or was knocked over by the man and his 4-year-or-so-old daughter who had exited the bathroom as I was turning away.
I passed out before I could hear my wife yell at the man to hurry and get help. I regained consciousness only long enough to hear a nurse call, "Rapid response to ER...Rapid Response to ER," over the hospital intercom, then blacked out again until someone started moving me around. I remember knowing that I was in intense pain at the time, but my mind had disconnected itself from the sensation to the point where I don't remember what the pain felt like. My wife tells me that I'm lucky on this point.
During another brief moment of consciousness, I recall being moved onto a body board. I also remember someone cutting off my pants so that they could get to my legs for an examination. I somehow gathered up enough brainpower to crack a joke about needing to go shopping for new pants again, since they were cutting off a pair I'd just purchased a few days earlier.
The last sequence of events I remember in the hallway began with a nurse telling a doctor that my blood pressure was 60 over 20. Normal blood pressure is usually near 120 over 70, so 60/20 meant I was losing blood, and losing it badly somewhere. The doctor got her to re-check, and she still came up with 60/20. He thought for a second and then flew into action, ordering up IVs of fluids and blood. When the nurse asked what flow rate she should use, he told her to "flood" me since I was obviously running several pints low.
I have no memory of what happened from this point until I woke up in the Intensive Care Unit. Again, my wife tells me I'm lucky and that she has no intention of refreshing my memory on the matter. She *did* take a photo of my badly broken ankles while in the ER, though. When a nurse asked her why she did that, she said that I would want to see what they looked like.
Damned right. Anything that would cause as much trouble as they would absolutely required documentation.
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