Beware the Ides of May

Back to the OR

In no time at all, I find myself in a hospital bed, hooked up to an IV, and surrounded by some nervous-looking doctors. Blood is drawn and drugs are adminstered. I'm told I'll be in the OR as early as possible tomorrow, but I might have to wait until noon. Dr. Marcotte will do what the team around me calls the "wash-out."

The next morning finds me in waiting mode. Hilary is here with me. Finally around mid-morning I get rolled down to the OR pre-op prep room. Last time I was  here things were a bit rushed and I didn't get a god look at the room. It's long, narrow and big. It obviously  handles lots of patients a day.

My anesthesiologist today is a small, older woman who, someone tells me, is head of anesthesiology for the whole hospital. It looks like I've drawn  an all-star for this unusual noon surgery. That's good.  

This time I'm a bit more awake on my trip into the OR and , me being me, I'm looking all over and hatting with the doctors. I just hope I'm still making sense, as the d rugs are starting to kick in. I'm rolled to a face-down position on an operating table and my lights go out.

Later that afternoon I wake up in a room on either Silver 5 or 6 (I can't remember which). Hilary is there along with a nurse. She tells me the operation went well but the bad bacteria are still in me. they just lost their home. I'll be in this room for a few days, and as I get stronger I'll move to in-house rehab here. No more trips to DCMH.

Off to Real Rehab

Dr. Stineman, the lady in the power wheelchair is by again, so I guess I passed all the criteria for moving across the courtyard to in-patient rehab. She fascinating and interesting, a very impressive doctor. I hope she'll be involved in my therapy.

Later in the day, I also meet Dr. Damien Frees, the resident currently assigned to rehab. He also OKs my move.

The day passes slowly. Kristin takes me over to the on-the-unit small gym and I get a reasonable PT session there. That gym is a bit too limited for what ails me, but it's far better than lying in bed doing nothing.

Finally, just before Hilary is ready to leave, I get moved over to Ravdin 6. I get, finally, a window bed, but there's little to see. The very busy hospital helipad is just a few floors straight up. Sometimes you can see a copter. I can also see copters rising from what looks like a second, much lower pad. A few days later that mystery is solved: they are coming from Children's Hospital which is right next door.

I have a roommate, John Atkins, who is maybe 35 or 40, and unfortunately has MS. He's here because he's had trouble getting around, has been treated, and now, like me, must relearn common skills like walking. He's a big guy, 6-3 and 280, and has a stepbrother who is a reserve forward for the Sixers. John is a fanatic Eagles fan and we along great right from the start.

John's only flaw is he loves trash TV and leaves the TV on all night, I guess as a security blanket. It takes some getting used to, but it's not the worst thing in the world.

The room has a huge bathroom with a very impressive sit-down shower area.

Real Rehab, Sort of

It's my first day in rehab and it's a Sunday Insurance regulations require that I have therapy sessions seven days a week.

Around 10AM Bettina comes to take me to occupational therapy. Here we work on dressing, washing, cooking, and coordination exercise. All my sessions start with a warmup generally using 4-pound dumb bells. I do arm exercises to loosen up and maybe gain some strength. I'm shocked at how weak my arms are today. Even the tiny 4-pound weights fatigue me quickly.

After an hour or so I get pushed through the connecting door to the larger physical therapy gym. Here I meet Mary, who by chance is working here this weekend, Most weekend workers here are from other PT unit (there are maybe 6 more scattered in the hospital and in outlying locations — outpatient PT has a gym on Market Street and also a facility in Radnor. Units serving only outpatients close on weekends

Mary will be my Supervising PT the whole time I'm here. She's great, pushing me to try moves I'm doubtful about, full of great advice and techniques concerning breathing and procedure, and letting me rest when that's what's right.

Mary

PT is real work for someone in as poor physical condition as I am. When I'm done I'm tired. Nap time.

After lunch I have another shorter PT session. I'm lucky to be able to stand up into the walker from the wheelchair. My maximum, very shaky, walking distance is 30 to 40 feet. When this session is over I'm totally wiped out.

The rest of the day consists of resting, watching TV and reading. I've got a long way to go and probably no more than 3 weeks to get there. It's going to be interesting.

And Yet More New Faces

Today I meet my supervising occupational therapist, Yazmeen. My roommate, John, has worked with her and calls her the therapist terrorist. She's not that bad a taskmaster and absolutely gorgeous.

Occupational therapy, for folks like John and me, seems unnecessary, but there are skills to learn, and Yaz gives us weight work with our arms, which helps in many ways.

Yaz

After OT, I move one room over to Mary and PT. OT got me nice and loose, so I can try to do more in PT. The operative term is try. PT is real serious work without much in the way of results.

Mary puts me through the same paces we tried in the morning and I do pretty good. I'm inconsistent, a situation that's going to afflict me all during therapy.

The rest of the day passes quickly and easily. I have some neuropathic pain, virtually no back pain, and little knee pain. Therapy tires me, but doesn't increase any of my pains.

Five Days of Therapy

Days during the week in therapy all are alike. The main difference is the meal menu. This hospital has seven distinct menus, one for each day of the week, and during my stay here (from 2 September) it has been consistent. A look at the menu tells you what day tomorrow is. You get the next day's menu with breakfast, and have to select and return it right away.

The unit I’m currently residing in technically is the Piersoll Rehabilitation Unit. However, since it’s located on the 6th floor of Ravdin Hall, and everything is stenciled Ravdin 6, it is universally referred to as Ravdin 6.

Patients are encouraged to wear their own regular clothes. There's a dining area where patients can eat in a group. There's a piano there and two internet-connected PCs.

There's also a room with a washing machine and a dryer for patient use at any time, as well as a pantry with an ice maker and refrigerator (and healthy snacks).

The nurses, LPNs, and aides are all great. They're a small group and the same people take care of you 5 days in a row, This is unlike the medical units, and DCMH rehab, where the staff was different just about every day, I like this system better, although the nursing care was excellent everywhere.

I have an hour of occupational therapy every morning at 9. Physical therapy follows immediately at 10. That gives me an hour before my 12 noon antibiotic drip and lunch. Then at 1 it's back to PT. After another hour with Mary, I usually head over to OT. I'm not scheduled until 2:30, but it's easier to just sit there and wait. Afternoon OT is only a half hour.

John is a good roomie. He's big, 6-3 and 280 or so, but not near as big as his stepbrother Marc, who is 6-8 and weighs I have no idea how much. Marc is a small forward, I think, reserve on the Sixers. He's a really good basketball player and former Temple star, so he's well known in Philly. This is his first year with the Sixers, having been traded in the off-season from the Bucks. He absolutely fills the door when he comes by.

Hilary comes most evenings on her way home from work and stays through Jeopardy (at 7 PM). Then I watch lots of TV until I fall asleep.

Evening drugs are at 9, and blood sugar testing around then too. At 11 the nursing shift changes, so vitals need to be taken. At 12 I get my intravenous antibiotic, which takes an hour to drip in. I can often sleep through hook up or removal, but not always.

The neuropathic pains in my feet seem to be increasing so Dr. Lenrow prescribes a new drug called Neurontin. Patients need to start with the lowest dose and increase it every few days until the proper dosage is reached. Thus, I need to get used to these foot pains. I'm getting so many pills I have a hard time keeping everything straight. I'm not getting diclofenac sodium, because it's not stocked here (not fomulary is the hospitalese). That is not good.

Another Weekend at HUP Rehab

It’s just like the last one, except that I know what to expect. Different Eagle game, too. Same result though: the Birds beat Atlanta 23-16, in a game they unnecessarily made close.

Weekends for me pretty much follow the weekday schedule, with a slight lowering of rehab intensity and time. The main difference in the actual sessions is that the therapists are from other HUP rehab units. There’s good and there’s bad in this; the good far outweighs the bad.

The good is the weekday therapists get most weekends off. That’s good for both them and us. Also good are the different points of view, philosophies, and techniques we are exposed to. Doing the same things in different ways can only be positive, and it most certainly is in my case. Most of the techniques Mary and Yaz have taught me are the techniques I use, but I do pick up pointers on doing something a bit easier and also get more reasons for why I must do what I do. That last is important to someone as process-oriented as me.

The bad is the weekend therapist can’t know your limits as well as your regular therapist. The best notes can’t really convey where your edges are. Thus the weekend therapists, not wanting to have you do anything dangerous to you, back off a bit on how hard they push you. They push, but not to the level Mary and Yaz push.

On the plus side, I think, is the lowered intensity of the sessions. After 5 all-out days, two easier days help. The different regimes are good for both mind and body.

I believe the powers that be in HUP rehab know all that and the scheduling set up is not just a fortuitous accident.

Second Full Week at HUP Rehab

This week is marked by inconsistency. Some PT sessions go well, some go poorly. And in the middle of the week I fell, sort of. It was my bad.

I was between the two beds in the room facing the headwall. My walker was in front of me. There was something on my bed I wanted to pick up. I reached back and to my left, and got my center of gravity way outside my support base and slid down to a very awkward position mostly off, but partially on the bed. I was sort of hanging there. John offered to call for help, but I refused for fear what had happened so far would go into the books as a fall. After you fall in rehab, there are all sorts of additional restrictions on what you can do. I desperately wanted to avoid that.

After a minute or two I tried to get on to the bed and managed to slip to the floor very gently, winding up on my back. I was stuck. I wound up crying in frustration. Finally one of the male RNs, Ed, came down and picked me up as easy as could be.

I discovered the PC’s in the recreation room had high-speed Internet connections, so I started spending my evenings there after Hilary left. Felicia often tracked me down there for my 9 PM drugs. My cell phone also works in the rec room, but not in my room. That may have had something to do with the helipad a few floors up.

Final Weekend in Rehab

This is scheduled to my last weekend at HUP. My PT therapist on Saturday is a very small woman who works up the HUP outpatient facility on Market Street. That’s my likely next place to go after I’m cleared for outpatient therapy. She’s excellent and works me hard. She’s also safety oriented like all the therapists here, and strong beyond her size. I get as good a workout as Mary drives me.

Bettina handles OT and I do everything that’s on the list Yazmeen left for me.

Sunday’s PT is handled by Rene, who is even smaller than Saturday’s therapist. She’s 4-something tall, and also an excellent therapist.

Everyone skips the afternoon sessions to watch the Eagles. They lose to Dallas! 21-23 McNabb is still struggling visibly. He fumbles with 48 seconds left to shut off the Birds’ last chance.

My Last Two Days on Ravdin 6

I'm supposed to get out of here and go home Wednesday. That means I need to meet all my goals today or tomorrow as there are no sessions the day I'm supposed to leave. I won't be cleared to leave unless all goals are met.

By Monday morning I've made all my OT goals, but not my steps and distance goals in PT. The lami restrictions have hindered my progress. My inconsistency hasn't helped either. I know Mary knows I can do the distance goal, but she's not sure I can do it twice in a row with safety.

In therapy we work on the goals intensely and on Tuesday morning Mary says I've met all my goals. I'm not sure, but not about to argue.

John was discharged at the end of last week and I've been alone in the room since then. I'm still alone in the room. It's time to start saying goodbye to everyone, the nurses and techs, as well as the therapists and others involved in rehab.

However, my big toe is very painful, and Drs. Lenrow and Uleski have decided that a gout exam by specialists is in order. Since HUP is a teaching hospital, a large crew sweeps in at about 5 on Monday evening and a resident, Dr. Dennis, aspirates some fluid from the joint. The crew, doctor, residents, and students, goes off to take a look under some sort of microscope. They're back 30 minutes later, and say, yes, it's gout. We can see the uric acid crystals clearly. As they try to decide what to do about I say that the diclofenac sodium I take has always controlled the problem. I also mention that while diclofenac sodium is not formulary at HUP, it is formulary at my medical insurer and I happened to have a vial with me. They tell me I can take one now and they'll write orders that will let me take one a day with my 9 AM drugs. Thirty minutes later the pain in my toe is gone and it never returns.

The next day is my last day of PT and TO. And for once everything goes well in PT. I walk well, do all the required tests and even do well on the steps. Mary is happy with me and passes me in the morning session. The gout is gone, and I feel really good.

Home at Last, Home at Last

For such an important day, it starts totally normally. And continues that way. My personal take-home walker is delivered early. Going home weigh out is just 240. It’s a good one. No PT or OT today, and Hilary can't get to the hospital before 4:15 or so. So I pack up and wait.

Hilary shows up, and we get me into the wheelchair transportation has delivered. Unfortunately, the hospital has failed to provide a body to push the wheelchair, so Hilary does that task. It's not easy as there are three ramps to go up. We get to the car and discover we left the walker in the room. Aaargh.

I managed to get mildly, but not seriously carsick on the ride home. I haven’t been in a car since September 2nd. And Philadelphia streets are not exactly quality roadwork.

We got home about 5:30. The first of the visiting nurses is waiting. Hilary goes in to get the kids into the backyard, and the nurse came in. Getting in was no fun. I was totally freaked by the step from the driveway to the walkway. However I made it, and it’s been easier since.

I answered paperwork questions for about two hours. The dogs came in and were all over me. I even made dinner. Tuna salad. Very difficult.

Then I went up the steps. No real problem. I was sure I could and it was easier than I expected. The first step is hard, but the physical layout makes the rest easy.

There were over 5000 messages in my email, but over 4900 were in the spam log, so I deleted them all, without even a scan. I may well have tossed mail I wanted, but there was too much, The spam log only went back about 4 days (it autoempties weekly), so I can’t even imagine how many messages went to the bit bucket since 9/2/03. Many, many thousand. Tens, maybe even a hundred K.

I spend some time answering mail, and then go to sleep in a real bed. Bliss.

Digression: How to Get IVs at Home

The course of IV therapy that the doctors decided upon to kill the staph infection in my back is a long one, 25 days. The drugs elected, Nafcillin, is too powerful to take orally. It would do more damage than cure taken orally.I need an IV with the drug mixed in four times a day; 12 midnight, 6 AM, 12 noon, and 6PM. Each IV takes an hour to drip into my veins.

In a situation like that doctors prefer a better and stronger connection than the standard IV catheter in the arm or wrist which needs to be changed every few days. The common option in my case is a PICC or Peripherally Inserted Central Catheter.

A PICC is a long, flexible tube put into a vein in your arm and threaded up into a large vein just above your heart. PICCs are used in many situations. The end of the PICC sits in a large vein just above the heart so there is plenty of blood rushing past the discharge point to dilute the drugs and get them safely into the bloodstream.

A PICC is placed by a specialist and then x-rayed to see if the end is in exactly the right place. The insertion (and removal) procedure is quick and painless. Insertion requires a small amount of local anesthesia.

Blood samples can be taken from the PICC instead of having to use a needle each time.

The End of the IV Antibiotic At Last!

October 23rd

It’s also laundry day. Going down (and back up) the basement stairs is a snap thanks to the sturdy pipe railings on each side. There are 12 steps. I start the washer right after I feed the dogs their morning meal.

I actually remember to go down for lunch early. Will wonders never cease? As I eat Penn Home Infusion calls and says someone would be by to take out my PICC just as soon as my last dose of Naficllin is over at 1:40. I’ve been taking this stuff for 25 days, 4 times a day (12,6,12,6 ; all via IV at an hour a dose). I’m more than ready to stop.

After lunch — tuna, what else? — I get all the clothes into the dryer, and start my IV. I’m now a pro at it and the procedure is a snap anyway.

As it happens, the nurse doesn’t get here until 2. The stitches are very tight, thanks Dr. Thomson, but the line came out easily and painlessly. It is 47 cm long and I am surprised to not see any traces of blood on it. After all, it had just spent the last 4 weeks inside one of my veins. I guess it’s made of a Teflon-like material.
It’s great not having the PICC line in, since the external connector caught on EVERYTHING.

I go down and pull the clothes out the dryer, then fold and bag them. Getting them up is easy using a rope and my established larger load moving techniques.

Soon it was back down again to cook a pasta dinner. As I prep dinner, Mary, Dr. Marcotte’s office nurse calls and says the doctor would like me to start increasing my Neurontin dose by adding a 300mg dose in the morning for the next four days and moving that to 600mg thereafter. I can’t say I think this will do much at all, but I have the medicine here and I’m willing to try. The neuropathy-like swelling and feelings are still bad, but I’m not sure they’re a true neuropathy effect.

I did more steps today than on any day since the operations, and while tired, feel tolerable. My feet and knees are still the problem areas.

Going to sleep without the pump on the bed or an IV in my arm is wonderful. I haven’t been free of either a lower arm IV line or a PICC since the evening of September 2nd.

Good Days, Bad Days – This One Was Good

Hilary stays home to set up her new Dell PC. It’s very nice, and very fast. It’s also surprisingly small and elegant. The door hiding the CD-RW and front side ports is a nice touch, but doesn’t seem too sturdy.

I feel pretty good. The neuropathic pains are still there, mostly in my feet. As always they are much worse when I’m lying down and much better when sitting or standing — about the same in both of thoese cases.

My knees are still awful, but I am getting stronger. I can easily stand up and balance for more than a minute unaided and can even take one or two halting steps unaided.

Sleep is aided by 600 mg Neurontin, 2 Percocets, and a 75mg Voltaren. That works fine.

Good Days, Bad Days – This One Was Bad

Last night was bad. My feet never got comfortable enough to let me sleep for much more than an hour at a time. I drank too much Diet Coke and only took one Percocet. That’s a bad combination. I wind up sitting at the computer for a few hours as that’s reasonably comfortable.

Yoko Moody sent over some wonderful sushi and Japanese salads she made, as well as some takuwan, which I could live on (if it had any protein — it’s pickled daikon or giant radish).

Quiet day. I manage to use the wheelchair to vacuum the dining room and foyer. I feel much better with all the huge amount of dog hair gone. John broke yet another small glass dish in the kitchen and naturally failed to pick up a lot of the pieces of glass. Given the choice between washing or vacuuming the floor, I choose the vacuum.

Hilary and John did the food shopping, and I put things away so they can be found. I then cleaned everything off around and on the dead microwave so we can hopefully set up the new one tomorrow. Finally.

I get some self-stick Velcro tape so I can better attach the grabber sticks to furniture and the walker. It seems to work well in the first couple of applications.

To end the day I’m watching Shogun the TV miniseries on DVD on the iMac and occasionally checking the World Series score. Doesn’t look like it’s the Yankee’s year.

Clocks are set back tonight as we go off DST.

Lots of Walking Does Me Good

Two Percocets and a heavy comforter make for a fairly comfortable night.

The morning goes quickly, as we get the new microwave setup and move the toaster oven next to it. I manage to go up and down the stairs three times.

In the afternoon Hilary and I head to Microcenter — a large computer store so she can get some things she needs and some she doesn’t. I walk a lot, and at least at the beginning fairly rapidly (with the walker). On our return I find the missing walker leg glide right outside the front door.

Followup With Dr. Marcotte

It's raining cats and dogs. My appointment is for 12:30, but the doctor's staff has warned me that Dr. Marcotte often runs quite late. They told me that if I was still using pain medication, I should bring it with me in case the wait ran real long.

I call a cab around 11, very early, since cabs can be slow in coming in the rain. To my pleasure, a cab shows up promptly. I get in without getting soaked and have a nice ride to HUP.

My single walking speed — very slow — means the trip from the main door to Dr. Marcotte's office on Silver 5 takes about as long as the cab ride from home to the main door. When I get to the office the waiting room is full. After I check in and find a seat, I hear a good deal of grousing about the delays. The desk is saying 20–30 minutes and the waiting patients are saying 2 hours. Good thing I brought a good book.

Obviously the delays are standard operating procedure. At intervals a staff member walks around with a tray offering coffee, tea, water, juices and both diet and regular sodas.

After about 90 minutes I'm led to a consultation room, where I wait for another 10 or 15 minutes. Finally Dr. Marcotte comes in.

The doctor looks at my back, asks a few questions, and announces himself quite satisfied with the look of the scar. I then ask him a few questions that I've scribbled while waiting for him.

I asked:
What is my prognosis? He can't say anything about my knees, but he still expects my neuropathic pain to very slowly decrease and go away. He expects the process will continue well into 2004.
What about my lami restrictions? They're all lifted. However, I'm cautioned not to do stupid things with heavy objects.
Are there any pictures of you open back that I could use in this document? He says no; but I'll ask again when I request my medical records.

I get scripts for Percocet and Neurontin. I'm told to come back next year, in January 2004.

As I leave and head for the elevators I realize I'm on Ravdin 5! Instead of going down, I go up one floor for a visit. Both Mary and Yazmeen are there and happy to see one of their graduates. Dennis was in OT and looking really good. He says he's just about ready to go home. What the rehab unit has done for him in both condition and attitude is nothing short of miraculous.

Seeing Dennis is great for both of us. He was in bad shape when he joined the unit about a week after I did. We were often scheduled at the same time and pushed and encouraged each other.

I also thought to go look for Suma and Felicia, my two favorite nurses, but it was 3 PM, which is shift change, and when the nurses are busiest. I'll catch them another time.

It's still pouring when I get down stairs. Getting a cab is a bit tricky. The portico area is a mess and I finally head down to the street. Rain is only water.

By the time I get home I still feel really good. I make chicken piccata (I'm famous for making the world's best, by far, chicken piccata) for dinner and then I stay up for the whole Monday Night Football game (Miami beats San Diego, whoopee).

A Very Good Day

Hilary asks me to do her laundry, so I gather it up, as well as my own, get it to the basement, and started the load before breakfast. Going up and down the basement steps, is, as before, a snap thanks to the pipe railings.

I dawdle over my breakfast and feed the dogs slowly. By the time we were done and dogs have a romp in the backyard, the laundry load is done. I go down again and transfer it to the dryer.

When I get back to the first floor, I decided to clean the vacuum's beater roller. It is clogged with dog hair. I want to vacuum the whole house, but will be satisfied with the first floor K.L. Chan, my occupational therapist, calls at that moment, says he was in the area, and asks if could he come right over. I say, "Of course."

Our session is devoted mostly to Tai Chi-like balance and relaxation techniques. The positions and movements really worked my leg muscles without undue strain on my knees, and no serious fatigue. Tai Chi is good stuff for me. I think it's worth exploring further.

After K.L. leaves I go up the computer for an hour. As I am getting up to go down to lunch and the dryer, Nancy, my physical therapist calls, and comes over. I meet her outside so I can leave the dogs uncrated. We work the full hour on walking the driveway down to the street and back and up and down the sidewalks on the block. By far the hardest spot is the sloped area where the Kelly's driveway slants down over its whole length, There's no way to avoid that stretch when walking that way, except by walking in the street. I should try that.

Nancy strongly suggests that it was too soon for me to consider using the handy path that runs through the corner garden.

After Nancy leaves, I finally eat lunch. I then go down to the basement, empty the dryer, and fold and bag the clothes. Using the walker and some care, I got everything up to the bedroom.

After that I'm tired, but feeling good. I sit down and started calling to get my medical records and detailed bills from both DCMH and HUP.

Both hospital billing departments say they'll get detailed bills right out. We'll see when they actually get here.

Getting the medical records is another story. The people in medical records are very suspicious people. They keep asking me why I want them. It should be enough for me to just tell them my reasons are personal. That's the law as I understand it. That answer satisfies no one. They demand more. I have no choice but to give them some story they'll accept. My other choice is to I guess sue for access. That'd be stupid.

Both hospitals say there will be a fee for copies, but no matter how I press no one will even give me a clue what the fee structure might be. They both say it depends on the number of copies and then go mum. That may also be illegal.

A comprehensive search of both hospital's web sites comes up with nothing at all. People's rights to their own medical records doesn't exist as far these comprehensive web sites are concerned.

Both hospitals are supposedly either starting copies or getting me a quote. Both say it will take 15 days or so to get me the records, but upon further questioning neither medical record department has a clue as to how long the process might actually take. I guess they mange to discourage most people who want their own records.

After that, I did a Google search for "Medical Records." The documents will help me phrase my letters and gave me a lot of things I should ask for and terminology I should use.

Blood Sugar and Blood Infections

Wednesday 29 October

I'm a type II diabetic, and have never required regular insulin supplements. I control my diabetes by careful diet, some exercise, and glipizide, an old drug. I take 5 mg twice a day. This drug is also available as Glucotrol XL, but that's $35 monthly prescription, while the glipizide is $10 per month.

While I was in HUP, my blood sugar was tested 4 times a day. Until I came home from the hospital I never tested my blood sugar at home. I did get a kit from Aetna earlier this year, since it was free. Ever since my original diagnosis in 1993, when I tested at just over 300, my blood tests have always been in the normal range, and my long-term test (A1C) numbers have been excellent. Since I got home, I'm checking my blood sugar level at least once a day and whenever I feel light headed or get a headache.

I get up early, and take my morning pills at 6:30. By 8 AM I am so light headed that I decided to check my blood sugar. It was 72, which is the bottom of normal for many people, but very low for me. Fortunately there is enough sugar in breakfast (cereal and yogurt) to get me up to a safer level.

There was a small, or maybe not so small problem at pill time. I haven't been able to get to the store for a refill. I am supposed to take 3 Neurontin capsules, but only 1 was left.

During the morning the DCMH records people call with a quote on my records: $99.10. Good grief. They say there are 190 some-odd pages, and I was there 10 days total. I ask for a written breakout invoice, and they say they'll send one. They have to give free copies to doctors, the insurance companies, and lawyers. Only patients pay.

If you ask an administrator why that's the case, you generally get mumbles for answer. It looks like the real answer is something along the lines of: patients who request their own personal, but not so private records, are probably looking for an reason to sue us. So we'll make the records as expensive as possible and make the patient jump through hoops to get them.

Maybe I should ask to just look at my records at the hospital. I wonder if they'll allow that. I tend to doubt it. I should be able to see my records without cost. The costs of creating and archiving those records were paid by, guess who, ME (via my insurance company). No matter who paid, DCMH already got their money.

When I get to see my records, I'll be looking for any account of what Dr. Stevens ordered and did in regard to my back wound. What did he order in regard to looking at the wound? Did he order sterile precautions? Did he have to order that or is that standard protocol? Did the orders change after the nurses first noticed the blood and then the pus and serous fluid oozing? Did the nurses record those very obvious facts? Was there an order written telling the nurses to clean the wound when changing the dressing? Or, again, is that standard protocol? After the bleeding and oozing started sometimes the wound was cleaned with sterile solution when the dressing was changed and sometimes not. When the oozing started was it regarded as normal, or was infection considered and rejected?

Is there anything in the records that indicates someone at DCMH inpatient rehab saw and documented the infection before my wife literally forced the nurses to acknowledge that the wound was probably infected? Did they think the infection would go away by itself? How in heaven could this have happened?

I have no problem with the fact that the wound infected. Well, I do if the cause was touching it without gloves as did happen, but leave that for now. Infections happen, especially in hospitals. Not being able to see the infection for days after it started, and not really admitting the facts in front of them, is plain wrong. Had antibiotics been administered as soon as an infection was suspected, it might have been stopped in its tracks. As it was the first antibiotics I received were after I went back to HUP. I was in DCMH for better than three days after my wife asked if the wound was infected. And apparently no one did anything.

The result was another operation, an operation that never should have happened. For me operations, with general anesthesia are a major risk, and a long recovery. All progress made to date was lost.

I'd like to see my white blood count levels for my entire stay in DCMH rehab. I'm sure blood was taken. I know that blood was taken every day. The WBC could not have been normal towards the end. I wonder in what format the results were in. In many formats the results are given, as well as the normal range. Results outside normal are usually flagged. Did no one actually look at the blood test results. I suspect not. The whole atmosphere may have been that laid back. The blood results just get put into the chart -— another piece of paper.

What happened was not a necessary accident.

Why Pain Meds Are Good

Last night I was out of Neurontin, so I tried an experiment: I skipped the Percocets I had been taking, and also skipped the 75 mg Voltaren (diclofenac sodium) I've been taking at night. I wondered if I could make it without pain meds.

I should have my head examined. At the least. What exactly did I think was going to happen? I sure don't know, even now,

By 2:30 AM both knees are screaming in pain and the neuropathic pains in my feet are getting to intolerable levels. I still soldiered on. Idiot that I am.

At 3 AM I stagger to my feet, just barely avoiding a fall. I painfully head to the other end of the floor, where the drugs are. Once I get there I slump into the computer chair and take two Percocets. Percocets are not fasting acting, at least in my body. They take a minimum of 45 minutes and sometimes as long as 75 minutes to have any substantive effect. However, they are all that I had. I would kill for an MSContin (small dose time release morphine). I also take a diclofenac sodium, but that would only help relieve my left knee.

Tonight of course, the Percocet. take 75 minutes to have much effect. At that point I go back to bed and manage 2 full hours sleep.

When I awake my feet, lower legs, and knees feel swollen and painful; about a 7 out of 10.

I get up and get through dog feeding and breakfast. Sitting up is less painful than lying down, and standing feels best of all. However talented I am, I still haven't mastered sleeping all night standing or leaning against a handy wall. I can't stand unaided for even a minute, although I'm close to that.

Nancy, the Penn Home physical therapist comes at 10:30. It's very quickly obvious I'm struggling to do anything and after a few minutes we decide to cut the session short. That's a great plan.

As the day progresses I try to do as little moving as possible. That may not be the best plan, but I feel improvement by afternoon, and don't have too much trouble preparing dinner.

Hilary picks up my Neurontin refill on her way home and I take the evening dose before I went to bed. Falling asleep is much easier.

Halloween

Can it really be the end of October, with early sunsets and cold weather around the corner? This whole thing started in the spring.

My morning doesn't start that well. I'm really stiff and sore when I first get up. A trip down the stairs to feed and run the dogs, and then a trip up to take my pills, which today includes one Percocet, helps a lot.

The day passes quickly. I do remember to eat a big lunch, because I'll probably stay close to the door during trick or treat time, which should be, at the extreme 4 to 8:30PM.

My set up starts at 3. I move my wheelchair to the foyer, and load the basket with assorted candies and packaged cookies. I'm still not sure what to do about the dogs. Ideally they'd be gated off upstairs with Hilary as in past years, but I don't think that's in the cards this year.

At 4 I crate the boys, and count on the wheelchair blocking the girls. Picking up my book du jour, I sit by the door. Hilary calls and says she needs to stop at Acme. I think we have enough candy, but all the chocolate is already gone (thank you, brother-in-law John). I ask for two more small bags.

The first trick or treaters don't show up until 5:30PM. I've already passed on dinner. This first batch includes Vincent's (across the street neighbor) three and Vincent as chaperone. Only three more groups show up by 6:30M. One of the groups is three well-mannered male teens, including one in an absolutely spectacular ghoul costume.

I'm patient and I sit at the door until 7:30PM, but the group at 6:30PM was it this year. Every year has had a decreasing number of trick or treaters. That's sad. I enjoyed the holiday as a child, and I enjoy just as much on the older, giving out end. Anyway, I'm getting stiff sitting there, so I turn off the outside lights.

After a quick light bite, it's upstairs, some TV, and an early bedtime

Starting HUP Outpatient PT

I get up at 4:30AM so I can take care of the dogs and be ready to leave with Hilary at her normal leaving time of 7. While 'm feeding the dogs I hear Hilary, very faintly, call for help.

I go upstairs as fast as possible, without taking stupid risks. It is the fastest by far, that I've ever climbed the steps since the knee blew out. I expect to find Hilary injured or on the floor or worse. Instead, she is in her bathroom trying to hold up the door to her medicine cabinet which is a very heavy glass piece mirrored front and back. The top hinge has come adrift and the door would fall and undoubtedly shatter without her support. We manage to secure it.

Hilary drops me right in front of the outpatient therapy center at 7:30. There's an 8- to 10-foot wide gravel strip between the curb and the sidewalk. Walker and gravel landscaping are a poor mix.

After I sign in I sit down to wait. Just about 8, the time of my appointment, I'm called over to the desk and told my therapist is actually at Weightman Hall, the new PT facility down by Franklin Field. Oops. I can either go there, wait at the place I am until 9:45 when they have an opening, or reschedule. I elect to get myself down to Weightman. It's four long blocks east and three long blocks south. I haven't been able to walk that far yet, but I might try except for two factors. It's all down-slope, and that's far difficult than level ground with a walker. Also, although I might have made it, I wouldn’t be much good for much physical therapy when I got there.

So being city bred, I took a cab.

I got there and checked in, and met David, my therapist. He seems able and competent. The facility at Weightman isn't big, but it's brand new and seems to have adequate equipment. It only went into service this past Monday.

David does a good evaluation, and we do some exercises I can also do at home. Given the state of my legs and feet from mid-thigh down, some of these won't be easy.

We do e-stim, and he tells me to continue using my e-stim machine at home. It's drizzling when leave, so I just catch a cab home. I'm not ready for a lot of hill walking (HUP is on a slope) or public transportation just yet.

I'm well tired out by the time I arrive home and do computer work the rest of the day. My left leg feels like I overworked the hamstring — maybe a slight pull. My right knee is a mess, painful and a bit swollen I think. I'll sleep with the CryoCuff tonight.

A Lot of Exercise: Power, but Not Speed

I overslept. But I had an excuse: I spent 3 to 4AM reading the day's news on the Net. I got up at 6:15, and managed to wash, dress, feed the dogs, and be ready to lead with Hilary by 6:55.

Physical therapy (at 8) is great. I ride the bike for 10 minutes without pain. These are interesting bikes. They're made by Star-Tac and do not use an external source electricity for the display panel. The rider generates the power. So if you want a display and timer, you pedal fast and you keep pedaling. That is definitely an incentive for me.

Next up is the leg lift type machine. First, David set it to the lowest position, and my efforts are mostly isometric. I get some lift with each leg, but not much. Then the start position is changed so that my legs start at a 45 degree angle rather than the 90 degrees of the first exercise. For reasons I don't quite understand, although David does, this exercise is harder for my right leg and much easier for my left.

After I really get warm with the leg lifts, we go to table exercises. I do knee pushdowns, Theraband exercises to work my hips, pillow squeezes for the same reason, heel lifts, and squats. Since squats were simply impossible earlier in therapy, I was really pleased with my performance today. I did 20 deep squats, for the most part without touching the walker or anything else. I'm really getting stronger and my balance is improving daily.

After PT I walk to the Penn Bookstore. The walk takes a lot of effort, but I haven't been in a real, brick bookstore since early May. I miss that a lot. I wander all over the store and find a couple of cooking magazines and books. There's also an ATM with a very low fee, so I get some cash. After that it's a cab home.

John and I get all the trash out during the afternoon. Then Hilary and I go to Acme at 6 PM. She waits in the car, while I shop, incredibly slowly. We don't get home until almost 8. I've walked far more today than any day since the knee injury. Progress is slow, but steady. I'm encouraged.

To top off a good day, the Eagles pull out the Monday night football game 17-14 with a miraculous touchdown with only 27 seconds left. McNabb was brilliant when it counted most, and so was the offensive line. It's really Tuesday now, but I can go to sleep happy.

Exercise Hurts More the Next Day

I'm so wired by the Eagle win that I stay up until 2:00 AM. And then get up at 5:30. I was sore. The therapy and walking yesterday, which felt so good then, caught up with me.

The soreness didn't slow me down, but the lack of sleep did. Not much happened all day. I did do a series of squats and toe rises in the afternoon.

Sleep Would Be Nice

Another ugly night. I kept waking up every 60 to 90 minutes, and at 2:30 get up and read the online editorials for an hour or so.

Physical therapy this morning. Since David is quite busy I manage to sneak in a few extra sets of reps on the leg lift machine. I still can't pedal the stationary bike fast enough to keep it powered up (remember that the rider generates the power to run the display).

For a change I come straight home, and plug away on the computer for several hours. My legs feel almost like they're not there from my knees down. However, the only thing that hurts is my knees and only while standing up from a sitting position. I'm not at all clear why, but sitting down is painless.

My balance is getting much better, If I'm real careful I can walk a few jerky steps without any assistive aids, not even walls or furniture, which in my world, are major assistive aids. I can stand almost 5 minutes, again free of any aids.

As my balance improves, my confidence is growing by leaps and bounds. Now I need to watch out for overconfidence and doing something really stupid. So far, I'm managing that well.

Another Terrible Night

Last night I finally wandered off to bed around 12:15, fully intending to read for an hour or so, or at least until the increase in neurppathic pain that always accompanies my lying down decreases. My plan seems to work work: the neurppathic pain becomes tolerable quickly and any pain in my knees is well controlled,

As I read, I start to hear very odd noises coming from the direction of my office. Knowing that Charley is up here and quite awake, I manage to foolishly ignore the noises for 20 minutes or so. Finally my brain gets the message to me that the noises are way in excess of normal dog wandering and not slowing down.

So it's back to my office. Charley has knocked over and thoroughly explored a large trash bag, but found nothing he wanted to eat apparently. He then knocked over the large green plastic trash can. He's deep into it — all that's visible is his rear end when I come on the scene. Charley backs out, clearly startled, but immediately assumes his "I'm totally innocent" look. It takes me a full half hour to restore order. He really outdid himself.

It' s around 2 AM before I head back to bed. Now my feet really hurt and so do my knees. Even with the grabber stick I did far too much bending and lifting. The cold front has also passed through and the winds are starting to really come on to blow. The barometric change downward surely doesn't help.

Although there's no absolute reason to get up early, I arise at 5:30 and feed the dogs. I feel awful.

Fortunately, I have nothing pressing on my schedule, and by afternoon I feel a lot better, By late afternoon, I was able to straighten the kitchen some and prepare a chicken piccata dinner.

After dinner we take Charley to TED (his vet, whom he adores; TED is dogspeak for the The Evil Doctor). The trip goes great. Charley behaves and charms everyone he meets, except maybe the cat in the crate who was less than thrilled with him.

I made a major discovery on this trip. I didn't want to put the walker into the backseat with the dog, so I got it in front of me in the passenger seat. Not only was it easy to get in, but is stays more or less off my body and is comfortable. It seems safe as the wheels hold it down low. Having the walker up front makes it much easier to get in and out, not to mention much faster. The process is no longer a production.

After we get home I call my aunt and read the news. Naturally about 9 PM I wake up and start writing. I only work until midnight because PT is scheduled at 8 AM tomorrow and we have to leave a half hour early due to Hilary's normal Friday work schedule.

Thanksgiving

The day dawns nicely. Boomer calls me down for his walk and breakfast at about 7 AM. As far as Boomer is concerned I'm a voice-activated feeding and back door machine. Actually, all the dogs want their run and food, but Boomer is the spokesdog. Breakfast is a big hit as I made plenty of fresh rice at dinner last night and still have Papa John's Special Garlic Sauce to spice it up.

I feel pretty good today. After my breakfast the dogs run again and then head to their nap places. Morning is nap time . Night time is for exploring and guarding. About 11:30 I need to start dressing for Thanksgiving dinner at Aunt Kathleen's. I have no idea what fits anymore. I only know that there are clothes in the closet that didn't fit before the accident that do fit now. I'm pleasantly surprised at what I can get into.

Hilary is off on the West Coast so John's girlfriend, Liz, who has a large and comfortable car, will take the three of us. On the way, remembering past holiday meals at Kathleen's retirement community, we look for a quick fast food filler. Fortunately all are closed, even McDonalds.

The meal turns out to be wonderful and quite filling. The portion sizes are normal restaurant sizes and everyone could choose up to five sides, each ample in itself. Even the coffee quality was excellent. The company is as good as the food. Besides the three of us and Kathleen, her sons Stephen and Bill are there along with Bill's wife Nancy and daughter Lavonda. We sit at the dinner table so long that my knee becomes totally stiff.

Later in the evening Catherine explains exactly how easy it is to edit QuickTime movies, I feel so stupid.I've been looking the interface and never saw the small markers, nor read the right part of the help file, It also did not help, even a bit, that I started to edit files in .mpg format, where QuickTime wants files in .mov format.

By late evening I become sure of what I've thought for the last few days. The nerve damage, which seemed constant for so long, is either being better controlled by an unchanged dosage of Neurontin or I'm getting so much better I can feel and see the changes. Lying down is still the worst position, but even there I feel improvements. The incontinence seems to be receding as well. For that, I give much thanksgiving.

Is the Day After Thursday Monday

Another good night and good morning. I'm getting a strong feel for how long my new morning routine will take. The routine includes personal grooming and cleaning, making and having my breakfast, running the dogs in the back yard, and, most important, giving the dogs their food and pills.

Each dog gets a chondroitin and glucosamine pill, Boomer also gets a Tagament and an 81mg enteric coated aspirin, while Charley gets two 81mg aspirin and a 0.2mg thyroid pill. My meds are easier to prepare and take than theirs. Anyway, all of that is consistently taking within a few minutes of 90 minutes. That's great, at least by my lights.

This morning I'm a bit slow — still getting over dinner — and I take 95 minutes. Since I have no plans at all today, that's just fine.

Most of the day is spent cleaning and working on the computer and thinking I need to get the garbage out because tomorrow is Tuesday. I can't shake the that feeling.

I manage to eat really well all day, keeping on or below diet goals, but getting enough nutrition and hydration. John isn't too happy with dinner as I'm enforcing portion controls now. All he can eat in quantity is plain salad with minimal dressing on it.

My workouts and NMES sessions go well. The 10-lb dumbbells are seeing their last days as my basic weight. The 12's should start next week. After I think I should buy dumbbell bars and plates as I really don't want a dozen unused dumbbell pairs around here. I want to get to at least 30 pounds in the next few months.

I do have to be careful of my lower back. I lost tone in the muscles there as well as everywhere else, and I feel the exercises I'm doing in that area. No strains or constant pain, but reminder twinges now and then.

November Is Already Over

I'm walking more without aids. Always with a hand or two out for balance and light contact with a support (anything will do — wall, chair, anything). It's not pretty. I lurch, reel, and wander. My stiff right knee is hard to move normally. But I'm walking. And better each time. I also walked up the steps normally on Sunday — that is, one foot on a step, not both on each step as is my new normal. It was much harder than the way I've been doing it, both feet on each step, but I think it was faster.

The Night Problem

My morning sugar test is well within normal, yet I had another fairly bad night. All the nights recently have been fairly bad.

Last night I went to sleep at midnight and got up at 3, 5:30 and 7:30AM to urinate. At least on those three occasions I made it to the toilet without very much leaking at all. That was a pleasant surprise. The total I urinated far was more than I drank since yesterday afternoon. I have no idea where it all comes from.

And last night was a good night in my recent big picture.

Why Do I Dither?

It's seems pretty clear to me that the infection of my back wound while at inpatient rehab at DCMH was the result of inelegance. Sure infections happen, and they happen through bad practice, bad luck, or some combination of events.

My concern is not the infection occurred. My concern is the staff non-reaction to it. When I arrived I had a dry, healing wound. A few days later it began to ooze fluid and blood. A few days later the fluid was clearly pus, and from what I'm told (I could not see my back) the wound was an ugly and obviously infected site.

It turns out, as is usually the case in these postop infections, the worst of the infection was hidden, a layer or two of skin down. It was also growing rapidly in all directions including towards my spinal cord.

During the period of roughly six days from when the infection first made itself visible to the final stage of a serious and rapidly spreading dangerous infection, the only care I received was twice a day dressing changes and every now and then cleaning of the surface with sterile solution prior to the new dressing being applied. In most cases it was off with the old and on with the new.

The result of the failure to deal with the infection was another operation under general anesthesia, probable further nerve damage in my spinal cord, and an extra 4 to 5 weeks in a hospital. The extra month has made my knee rehabilitation, which was halted so my back could be repaired much more difficult. The back that my back was opened a second time has certainly at best hugely slowed the recovery of the nerves in the affected area and has possibly caused permanent damage to my lower legs.

The prognosis for nerve recovery varies depending on to whom I talk. I suspect some of the "diagnoses" I get may be an attempt to deflect me from what has happened. I have no idea who I could go to for a completely honest assessment, as everyone, when they hear what happens, wants to be far from my situation as they can get.

I've not yet spoken with a lawyer. I don't know why not, expect that I have such negative feelings about tort lawyers. I believe for the most they do not seek justice for their clients (and don't get it either), and fail to realize that their personal fortunes and money are not the best solutions to the events they rail against.

It seems clear to me that I've suffered damages and that the damages were caused by negligence. However, I don't know who is responsible or most responsible or jointly responsible. I fear that a suit would spread a net so wide that many innocent people and parties would be drawn in and that those responsible would escape or get away very easy. That's not fair and that's not justice and that would not please me even a little bit. That's so, even if I were to get a lot of money as a result. I know that fairness and justice are not one and the same in our legal system. I wish that was not the case but it clearly is the case.

However, the damage is ongoing and does impose financial costs on me. I did not cause the damage. Indeed, if my wife had not seen the infection and forced the issue, I doubt if I'd be writing these words now. The infection very nearly got into my spinal cord. If it had, death was an clear option and very severe disability the most likely prognosis. I'm very lucky to have escaped that fate.

I did get the name of lawyer who does not handle malpractice, but would listen to me and tell me what he thought and provide names. He’s a friend of a friend of one of Hilary's coworkers. I never called him.

I've looked at the ads in papers for tort attorneys and since they're ads, some of them seem reasonable.

At heart I don't like the idea of a shark, but a part of me says, rather strongly, not to do things half way. If I decide to sue, I should go for the best.

Still the question nags me: what's the best? Do I want a lawyer who will try to get some huge settlement or do I want some sense of restraint. I've seen very many doctors, and very many medical practices. I don't want every last one dragged in just because it might enhance the settlement.

I have a hard time putting a price on my damages. It's not breathtakingly huge, but it's tiny either. I strongly suspect that some of my problems — problems that developed in the course of my medical care since May 15th — will bedevil me for the rest of my life. No matter how long that may be. My problem is trying to figure out what portion of those problems was caused by the failure to see and treat the infection until it required the severe intervention it wound up requiring. I accept that who and what caused the infection can never be determined and never will be known.

Am I entitled to anything for th what DCMH did or didn't do? What happened not only could have killed me, but would have killed me, had not there been a fortuitous intervention by a third party (my wife, Hilary) who by chance was present when a nurse changed my dressing. I'm very aware of that. I don't have nightmares over that, but those facts are towards the front of all my thoughts. I've never been much of a diarist, but I feel driven to write this account. It certainly is good for my mental state.

I don't know how long I can wait to make a decision. Certainly I'm well within the allowable time frame. I really should talk to a lawyer, even if it costs me money, I need to define my options better. When I actually have better facts I can make a better decision.

Right now I think I'll decide to sue, if I can find a lawyer who doesn't offend me too much. But I won't be happy about it.

[Postscript 2012] A lawyer eventually looked at the records the hospitals deigned to provide and informed me that in his opinion I could not show enough damage had been done to make a suit worthwhile. With relief I thanked him, paid the small fee requested, and simply let the issue go away. I've never had a moment of regret at not suing anyone.]

Pleasures of the Night

Seven days before Christmas, 3AM or so

No, this is not what you probably think tis post is about.

It’s about quiet. The house is quiet. Everyone else is asleep, and if they’re snoring away (even dogs snore), they’re too far too quiet for me to hear them.

It’s quiet.

When John is awake and not talking loudly on the phone or to himself, he now whistles constantly. Annoying doesn’t begin to describe it. Intolerable comes close. Hilary says he probably doesn’t even know he doing it (the whistling and the talking), and she may be right. She says her mom whistled constantly too.

During the day, and always on weekends, the noise level here is simply (at least to me) bizarre. I know that many folks, who have grown up in large families and different environments than I did not only find constant noise acceptable, but necessary. My roommate in HUP rehab needed to have the TV on all the time (and that included all night). That takes a bit of getting used to, but it was more predictable noise and easier to deal with than the random changes and oft-times extreme volume of John’s noise.

I need to say that the John’s hearing is very poor and getting worse. He will, I afraid, be deaf one day not all that far in the future. He has VA-supplied hearing aids and he hates them. I think he hates them because they’re relatively large (although not the old huge over the ear type). Anyway, he often refuses to wear them in the house, which makes talking to him loud and sometimes impossible.

After he came back from an otherwise excellent six-week posttraumatic stress syndrome treatment course at a VA facility, he pretty much refused to wear the hearing aids at home. I think part of his instruction there lead him to believe that it was better for him not to wear the hearing aids at home. It was an empowerment issue. That’s what he seemed to indicate in conversation. However, he may have just been trying to please and agree, which he usually does.

So that was about John, and not really why I am up tonight and many other nights. The primary reason I’m up is my bladder made its common demand to be emptied. It’s indicates; I act as fast as I can.

I probably wouldn’t have stayed up except (1) the neuropathic pains in my feet are particularly bad tonight. My left foot is really painful when I lie down, and (2) it was an exceptionally and constantly noisy day in the house. John and dogs took turns.

I simply don’t understand my neuropathies. They are more severe when I’m prone. Sitting up is usually quite comfortable, although I’m aware of the neuropathic pain in my feet. Standing up is best of all; almost always painless.I'm told things are not supposed to work lie that. I should be most comfortable prone, and least comfortable standing.

All but one of my doctors have ascribed the neuropathy to my diabetes. Dr. Lenrow, my rehab and physical medicine specialist, disagrees. He thinks that for the most part my diabetes is very well controlled. He’s right. My sugar numbers are never excessive, and sometimes too low. Dr. Lenrow also doesn’t think I’ve been diabetic anywhere near long enough to have neuropathies as severe as mine.

My understanding of diabetic neuropathy is highly incomplete. However, I believe it’s largely a circulatory dysfunction. That being the case, if my neuropathy was diabetes caused, I’d expect that the prone position would be the easiest on circulation and thus the best. It may be that this is the case, but simply doesn’t feel like. It may be that when I’m prone my circulation is better (of course it is) and the increased circulation lets me feel pain better.

I don’t think that’s what’s happening though. My feet have better feeling when I’m sitting or standing. Prone is when I feel the worst. Or so my senses tell me.
To be honest, I don’t know what is happening.

I can see two strong possibilities: (1) My nerves were so damaged or traumatized in the T10-T11 thoracic area which was operated on, that they are permanently damaged. (2) There’s another choke point in my spinal cord that has yet to be found. That’s a possibility because the T10-T11 flaws don’t do much to explain the ongoing urinary incontinence. I wonder if there’s not something neuropathic or possibly carcinogenic happening in my lower torso. I need to find out who I should see to best explore that possibility.

Isn’t modern medicine great? I keep coming up with more questions and fewer answers.

The Story Continues

Thus ends Chapter One. Life goes on, and my medical problems cause lifestyle changes. We move to Paradise. 

New problems and long-term complications and joys from Boomer's tackle and my reaction are at The Second Back Operation.