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.

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!

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.

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.

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.

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.

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.

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.