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.

The Operation

The gastric bypass operation took place on Friday, December 11, 2009.  Pre-op was pretty uneventful.  They put an IV in me, and I told the anaesthesiologist about problems I'd had before with nausea and with surpressed breathing response during recovery.  My wife came into the pre-op room and checked on me, then the nurses wheeled me away.

I don't remember anything about the operation, and I don't remember much of the recovery room.  I remember being groggy, and I remember having a urinary catheter and some other tubes sticking out of me.  Everything else is a blur, until some point later in the day when I found myself in my hospital room.

The uneventfulness continued through Saturday until a couple of hours before my discharge from the hospital.  I was still in pain, but I didn't feel like it was unusually bad pain.  I remember telling a nurse that I felt like I was about to have an anxiety attack.  They gave me something for it, and I calmed down shortly afterward.  No one thought that anything out of the ordinary was going on.

The problem is that something very bad was happening inside of me.  Things would get much, much worse within the next 24 hours.