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Monday, December 2, 2013

Step by Step Till Recovery

This is the sixth and final post documenting my experiences, living in Manhattan, after I missed one step on the way to the laundry room and broke a bone in my foot. First post was here: 
The Fractured Fifth - Manhattan Life with a Broken Foot

I took another walk out to the grocery store to grind coffee beans that we forgot to order pre-ground.  That was my successful mission for the day.  I still looked very awkward, and I was in pain, enough to invoke words of sympathy, "Get better!", from onlookers.  I started taking Motrin, and I think that helped the pain noticeably.

It was time for a shower.  I decided, as long as I kept the shower sleeve mostly to the side of the tub, my cast would stay dry enough if I just used ... binder clips!

They worked quite well.

I had one more day at home before needing to get back to work.  I decided to make it count, and I set a goal get a bagel, then walk to Battery Park, a ways away.  I noticed, on the way, that by not putting pressure on the cane, I was actually not doing much to support myself with it.  Bravely I tried taking a couple of steps without the cane.  It felt the same!  I had been practically walking without a cane for most of the time!  I learned that what I needed the cane for was traversing uneven terrain.  I got into the habit of stabbing the ground repeatedly with the cane, so it took the brunt of the shock of each step.  Doing this, it felt about the same as walking on even ground.

Every so often, I walked past an elderly person using a cane.  Each time, our eyes met, and better understood their plights.

It took over an hour, but, I finally made it.

There was Lady Liberty in the distance.  Liberty.  It had only been a day since I started walking, suddenly New York had returned to me.  The nightmare was coming to an end.

It was my first day back at work, and the pain was not getting any better.  I figured after a full night's rest, maybe it would, but I realized, although a long workout was a good thing, you have to also give your foot plenty of rest in between to heal.  I figured my workouts, from now on, would be just going to work, and going back.  That was it.

Progress was slow, but I found a station with an elevator near home which let me skip most of the stairs at least.  My commute to work was more than twice as long as it would have been otherwise.  I had no problem finding a seat, but the train wasn't overly crowded anyway.

At work, I found my desk and settled in.

A few people came by to say hello.  Most winced at my mention of pain.  I was mostly left alone.  It was a fairly peaceful first day back, but I largely felt like I didn't belong there.

Coming back, I didn't have the same luck finding an elevator.  Not just one, but both of the elevators I found at the station had these signs:

They couldn't just test one at a time?  I thought it weird that the handicap symbol was taped over, but I'm assuming they wanted people to be nice to not just those in wheelchairs.  Makes sense.  I also realize that the MTA (who manages NYC's subway system) is strapped for cash, always, so it's probably more economical for them to test/repair all elevators at once.  Slowly but surely I climbed three long flights of stairs.  I sure got in the way of others, but I had to assume priority.  I was suffering with each step.  I desperately experimented with my cane, and discovered that I minimized the pain, usually, by letting the cane swing naturally along with my leg, and making sure the cane hit the ground first each step.

I just couldn't wait until the weekend, where I would sleep in and just heal.  But for now, I had to go back to work.

I started to walk with more of a side to side motion.  It was either because my foot was getting better, or because I was adjusting better, but I felt a lot less pain each step.  Every so often, a misstep still sent a jolt of pain into me.  Getting onto the subway, I accidentally stabbed my cane into the gap between the subway and the platform, leaving my foot suddenly unsupported.  It hurt, but I certainly handled it.  Someone did offer me their seat, which was a relief as well.  Eventually I made it back to work and had a relatively pain morning.

People in New York are always in a rush.  They'll go out of the way to hold open doors for the crippled, but only if they see you.  Rushing out doors and around corners is very common, and when you're using crutches or a cane, they might very well plow right into you.  A couple times I had to stop short or turn fast to avoid someone, and each time, I stepped in a slightly bad way, sending throbbing pain shooting up my leg.

Another thing that caught me off-guard was in the restroom.  There was a small amount of water splashed onto the floor.  When the rubber of my angled cane touched it, I slipped.  I quickly recovered before falling, but I of course suffered more pain because of it.

I got an email from Cigna, and logged into their web site.  I hadn't looked there in a while and saw three additional claims listed since the bone stimulator.  I first looked at this:

According to that, I owe a crapload of money.  I'm eternally grateful on October 3rd, the day of my surgery, I did not log in to see this.  I may have preferred the morgue rather than the recovery room.  However, the latest item in the list was this:

Great, disaster averted, and good to know those doctors got paid.

Heading out for work, I noticed it was raining.  I had to think this through.  I was already holding a cane with one hand.  I had no room for an umbrella.  Fortunately, wool is very water resistant.  I had a leather coat on, but wool, with a wool hat, would keep me plenty dry.  I headed back up to my apartment.  On the way, given the angle I had to put my cane against the floor, it slipped, again.  Someone who was wearing clothes typical for a hospital saw me and asked if I was okay.  Aside from the mild pain, I was fine.  As we were in the elevator of my apartment building, he asked "They told you to hold the cane with your right hand?"  He explained that normally you hold the cane near the good leg, to distribute the weight.  My face went pale.  Over 3 days of using the cane for so long, the wrong way!  Why didn't anyone tell me?!

I continued on and saw the elevators were actually working.  A complete stranger saw me limping toward the elevator and excitedly shouted to me, "They're working!  The elevators are working!"  I smiled and we chitchatted in mutual exultation on the way down.

It was mostly business as usual, but the company Thanksgiving party was scheduled afterward.  I was not about to try to get food while dependent on a cane.  There was a crowd of people, some playing ping pong, some drinking and chatting.  The food would take a while to come out, and I had perfectly good food at home.  I didn't know if I'd ever be best friends with anyone there, but I certainly wasn't at the moment.

I just wanted to go home, so I did, slowly but surely.  Coming back, the elevators were already offline:

"Out of service".  That sounded worse than "Testing in progress".  Oh well.  It was good while it lasted for one morning.

I took my time on stairs.  I realized I didn't have to step on the same step with my good foot.  I could alternate pretty easily, and this allowed me to ascend the stairs at a decent pace.  Descending was still slow, but if I was careful and didn't waste time, that wasn't so bad either.

At home, I posted this silly Facebook update:

One of my friends asked "Same side like House?"

I replied "YES!! That is exactly why I was using the wrong hand. Watched too much House :(".

I watched practically every episode of House, so I thought his awkward, leaning walk was normal.  The people who decided how House should walk justified it as an acceptable way to use a cane.  Most done, but some do.  However, it seemed more dangerous.

With further experimentation the next day (Friday), I realized that there was a benefit to both.  It was definitely too risky to use the cane on the bad side when traction was questionable, but when the ground was dry, using the cane near the bad leg would better alleviate pressure.  I found while I was more stable using the cane near my good leg, every so often, I could switch to the other side for a break, especially when my foot was hurting too much.

On that Friday, my foot was hurting just as much as the past three days, but I realized I'd have a chance to rest my foot thoroughly that weekend, and hopefully it would have a chance to heal.  Although I didn't resort to taking out my knee walker, I did manage to mostly avoid using my foot much at all.  When I did move around, I used the cane on my bad leg, keeping most of the weight off it.  I hopped a bit, and sat down a lot.

Monday came around.  Elevators were again operational, and a mechanic at the station saw my cane and made sure to let me know this.  From work, I headed back to the doctor's.

Dr. La Puma's assistant first removed the cast, and then did what she could to scrape off some of the dead skin.  I couldn't wait until I could take a simple shower.  The doctor examined me, asked for me to do "figure-8" movements with my foot, and then delivered news I didn't expect.  I was being granted "freedom", in Dr. La Puma's words.  No more cast!  I'd now be able to wash my foot!  No more shower sleeve over my foot!  Finally!

He warned me not to let my foot stay in water for more than a couple minutes.  I figured it was to keep the scab on my surgical wound intact, which I had no intention of messing with.  He only put a bandage on me (which he was using for just the outer layer of my cast), and I was to replace it after each shower.  There was no hole for the bone stimulator on the bandage.  I could just take it off and put it back on each usage.  However, the cast just removed had a hole, so I had an area of skin swollen in that spot which was covered up.

He recommended an ACE bandage, which I've not used before but he instead gave me a cloth bandage I could use instead.  He admitted it wouldn't be as good, but good enough.  Free is better, right?

He suggested I could also try walking around home with a sneaker for 15 minutes a day, and if it was working out well, I'd be gradually shifted into a sneaker over the course of the next week.

It was a short week, due to the afore-celebrated Thanksgiving.  Just two and a half days.  I was happy I'd have more time to rest my foot.  Upon returning home that night, I tried on a sneaker for the first time in so long.  The sneaker for my good foot had been overused so much that it was breaking down, but the right sneaker was still in very good shape.

The sneaker felt different, but surprisingly comfortable to stand in.  With my first steps in the sneaker, I immediately noticed the shock absorbency.  It was a major problem I was having with the cam boot.  I was desperately trying to use the cane to avoid that initial shock with each step.  This seemed like a solution.  I texted Dr. La Puma about this, not wanting to use the cam boot with its awful hard bottom and velcro straps.  The sneaker was more comfortable!

The doctor replied with strong reservations, saying how it was very early.  He suggested I'd have to be very careful.  He mentioned the possibility of a "surgical shoe" I could wear, providing a middle-ground.  For now, I was going to try the sneaker.

In bed, I noticed my foot was a bit more sore than I'd have liked.  I worried that I did something to my foot while wearing the sneaker.  I then remembered about the puffy area of skin being pushed down by the bandage.  I remembered this being more severe the night before my surgery.  However, this time, despite my foot feeling sore, the bandage was thin enough where the discomfort wasn't that bad.  If it woke me up, I could just loosen or even remove the bandage.  It didn't.

The next day, I woke up early to take my first shower with my foot fully exposed.  I first took off my bandage to use the bone stimulator.  More dead skin fell from my foot.

I then carefully entered the shower, still using the stool, and not stepping on my bare foot.  I rinsed my foot and applied a layer of soap, then easily rinsed the soap off.  Then I scraped my foot with my fingernails, trying to remove most of the dead skin.  I washed between the toes multiple times.  No longer did I have to live with the idea of having a foot that hadn't been cleaned well since the surgery.

Still not perfect, but it was looking more human.

I wrapped the foot in a bandage and wore the sneaker.  I was very careful with it on my way to work.  I would only take small steps, restricted by the still throbbing pain in my foot.  I made sure to only step on even ground.  With the sneaker, I was able to move with more ease, because the top edge of the cam boot was no longer there to dig into my leg each stride.

By the end of the first day in a sneaker, my foot was still in significant pain.  I figured I was exercising more muscles and tendons, and breaking up new scar tissue.  Even if it was alleviating the pain I had before, there would no doubt be more pain with the additional freedom of movement.

I finished the short work week and then I was home.  I was able to just relax, finally, for four full days.  Each night, I was able to sleep in, and each morning, my foot felt better.  I walked more naturally.  I noticed a tendon around my ankle felt strange, but I eased up on it and the next day, it felt fine.

I actually had the confidence to try stepping on my bare foot.  I took three steps as a test.  It felt a bit less comfortable than with the sneaker, but it mostly felt fine.  I tried walking around, very carefully, with bare feet, but as my bad foot got sore, I switched back to the sneaker.  I decided there wasn't much reason to rush, as walking around with a sneaker, not even with the laces tied, was at worst a minor inconvenience.  I did notice though, when my foot touched the cold floor, that my foot was incredibly sensitive to temperature compared with my good foot.  The dry bathroom tile floor actually felt as if it was wet with cold water.  Just like a painful tooth becomes less sensitive as nerve endings recede from the surface, so would my foot.  It actually felt refreshing.

I was able to stand on both feet in the shower, however, and it not only felt fine, but it was much safer than carefully balancing myself when I needed to stand.

It was difficult to apply the bandage evenly over my foot, probably because it was slightly too short in length.  When taking off the bandage for a shower, I noticed how my foot retained the imprints of the bandage, looking irritated.  It wouldn't stay on when I put my foot into the sneaker anyway.  The bandage would slide off the heel, riding up onto the ankle.  I decided, after a shower, to try just a sock, if for nothing else than to protect the scab on the wound.  I didn't think the slight support a thin bandage would offer was worth worrying about anymore, especially since I was indoors for the next couple of days and being very careful.  It turned out not to be an issue and protected the scab just fine.

On the third day, I didn't even need the cane anymore.  I couldn't walk around for too long without a cane, but using the cane would only be necessary outdoors.  I was able to carry things with two hands again.  I was able to take out the trash.  I was able to hold my affectionate cat with two hands.  I began to feel liberated.  I noticed the skin on my knees was chaffed, from all the crawling on hands and knees.  Those days were over.

My last shower for the weekend resulted in part of my scab falling off.

I  really hope readers will forgive the ugliness, but I want people going through the same thing to know what to expect.  Anyway, compared to before, I don't think this is ugly at all.  I can see the uncovered section at the top healing almost perfectly.  There's a small remnant of the scab hanging on to show you where the scab stretched to previously.  To think, someone sliced very deeply into my foot, and the wound could heal this well, just two months after.

I was itching to go for a walk on Sunday, and Aliona and I went to a restaurant in Tribeca, Sarabeth's, a mile away.  Usually, because of Aliona's high heels she wears, she is the slower walker, but this time it was me.  I felt mostly comfortable, but I still had an obvious limp, and needed my cane each step.  Occasionally I walked without the cane, but only for short stretches on an even surface.  The food was exquisite:

In the picture is a giant shrimp, lobster sausage, two scallops, and this sweet bubbly sauce that I can't identify.  There was a type of pasta (herb garganelli) and a "tomato ragu" as well.  Such a normal experience.  I did have to ask for a chair to prop my foot up on.  I noticed, while walking for a bit, my foot was understandably sore, and it wasn't feeling better while sitting on the ground.  If I rested my leg on a chair and suspended my foot, the soreness would fade away, just like when I used the stool at work.  I didn't know how long it would take before this soreness would stop, but I was improving by leaps and bounds (figuratively) and I certainly was happy with my progress.

On the next day, my foot felt great.  I definitely still did not need the cane walking around my apartment.  After my shower, I decided to take a bit of the cloth bandage and cover my wound with it, just so the doctor would not fuss too much about me just using a sock.  I also didn't mind a little protection for my scab, so it wouldn't be rubbed at unnecessarily.

I certainly took the cane on my way out, but after two weeks of returning to my feet, I was walking much more comfortably, and faster.  I was still offered a subway seat, but people weren't very concerned to move out of my way.  It seemed like New York knew I'd be just fine, and they were gently reverting accordingly.  When I got back to work, my foot was still a bit sore, however.  I propped it up once again on my stool.

It was time to go back to Dr. La Puma.  I do acknowledge he would have never wanted me to go so quick to using the sneaker so much, and certainly not stepping on my bare foot for a while.  However, I was using even a slightly sharp pain, or significant soreness as a guide for what not to do.  I had to live.  It's been almost three months of dealing with this injury, and I was certainly out of the woods, even almost done with it.

I walked over to Foot Care of NY with much more ease than just a week ago.  Although I was using the cane, I felt it was mostly getting in the way.  You can't just use a cane while maintaining a natural stride.  The motion to put weight on the cane breaks the natural movement.  I every so often walked without using the cane, still limping a bit, but it felt weird to not use the cane that I was holding.  Eventually I started to walk as if I was using the cane, but I was putting no weight on it, so the effect it had on my stride was negligible.  It was good to have the cane in position for safety, although I was conscious of the possibility that the cane might get stuck on something and indirectly cause me to trip.  Now, because stairs were responsible for my initial injury, I've been very careful navigating them, but I made a point of moving a step up and down each step.  I realized it was certainly easier to use the stairs just with the handrail, without the cane.  It was a little awkward descending steps, feeling the stretch on my heel, but by angling my feet 45 degrees, it wasn't too bad.

When I entered the doctor's office, I soon had X-rays taken.  Dr. La Puma came in, saw that my bone was still perfectly straight, then he asked how I was doing.  I told him the whole truth, and nothing but the truth.  He acknowledged there was no need for a surgical shoe, and that I was way ahead of schedule.  I told him about the restaurant I went to a mile from my home.  He exclaimed, "You walked a mile?"  I nodded.  In retrospect, I realized I actually walked back as well, so that was two miles.  He sprayed some Biofreeze on my foot:

It basically just made my foot feel cold, supposedly relieving pain.  My foot was elevated, so there wasn't much soreness, but it's the thought that counts.  He suggested I continue to use my bone stimulator for another two weeks, and then looked at the scar on my foot.  He suggested in the future, he would have me massage "vitamin-E gel" into the scar, which should "break it up".  He added, however, that it was mostly the massage that mattered.

He took the further liberty to wrap some bandage over just the front part of my foot with the wound.  He added that he was comfortable not seeing me again for a month.  I figure the next day, I wouldn't even use my cane.

Ladies and gentleman.  It's been three months since the injury, two months since the surgery, and two weeks since I started walking again.  I consider this story over.

Thursday, November 21, 2013

Hurdles in the Homestretch

This is the fifth post documenting my experiences, living in Manhattan, after I missed one step on the way to the laundry room and broke a bone in my foot. First post was here: The Fractured Fifth - Manhattan Life with a Broken Foot

After I got back from the doctor's getting my bandage fixed, I had the renewed confidence that my cast did not have to be just right, adjusted only by professionals.  I could adjust it myself, so I could get some sleep.  Therefore, later that night, I practically undid the fix that I made the last "emergency" trip out for.  Here I was, serving out the next two weeks with a really shoddy looking cast.  But it was comfortable, and it held the fiberglass splint close enough to my foot.

Those two weeks were relatively uneventful.  No slips.  Used the bone stimulator twice a day.

My boss had begun stopping by my apartment building each Thursday, likely at the suggestion of his boss, to discuss my work.  I didn't see him much during the short time I worked on site, so it was nice that he could stop by.

He initially had me focus on configuring something called "Jenkins", which was what tests and compiles software automatically, as changes are made.  Plenty to learn, and plenty to do.

I eventually ran out of my calcium supplements.  I viewed this as a milestone.  I didn't want to get more, because even the doctor wasn't convinced they'd be beneficial, but still, the last one represented a certain amount of days since I started taking them.

Another thing I was concerned with was how long the stitches would be in my foot.  I looked around the internet and I hadn't seen anyone keep stitches in for longer than 14 days, and mine were going to be in for 20 days when they're taken out at my next appointment.  If stitches are left in too long, the healing might not happen properly, and the scar might end up with a "railroad tracks" look.  I thought about trying to come in a little earlier, but decided to trust the doctor's judgement.  He certainly came through on my surgery.

Fortunately, my ride to the doctor at the three-weeks-post-surgery mark went smoothly.  I got to see my naked foot, with the skin looking a lot better than it did a week after surgery.  However, the foot was disturbingly swollen.

I knew a large purpose of the cast is to compress the foot to reduce the swelling.  The fact that I've been wearing a makeshift loose cast for so long was the obvious reason for my foot to freely swell up like this.  However, the doctor was unconcerned, so same with me.  I got the gist that controlling swelling was only really important before surgery, not after.

I also noticed callouses forming around parts of my foot.

I generally know what a callous is and have had it before, but I quickly recognized the white mesh over the hard parts of my skin because of the callous that formed before on my other foot, when I was balancing too much on it.  The other foot was fine by then, once I became more diligent using the knee walker and not balancing so much.

Dr. La Puma went to work with two metal tools, removing my stitches.  I didn't actually see what he was doing, because his hand was blocking my view, but I sure felt it.  I was a little concerned about skin sticking to the stitches, but after a quick reality check, I figured medical science must have come up with a teflon-style material for stitches that would slip out safely.  I was right, but I still felt a sequence of stings.  I forget how long it took him, but I think he was done within two minutes.  I managed to get a decent picture, but I'm glad I didn't hesitate.

Then, I could see the cut on my foot free of stitches.  The insides of the foot did not pour out of a gaping wound, so I figured the healing went well.

Dr. La Puma told me the blackened skin would just flake off at some point, so I should not be concerned.   My wound did look disgusting still, but comparing it to my last picture, it looked like it was only getting better.

 An X-ray of my foot was taken, and it showed the healing process was going fine so far.

That's the computer that I got copies of my X-rays from.  To the left is the X-ray machine that I had gotten used to at that point.  Whenever I got on the thing, the assistant taking the X-ray complimented me on being a "pro at it".  In fact, they said that about me using the crutches too.  It's good training, and made me feel good for the first couple of compliments, but afterward it was something I no longer cared about being a "pro" at.

The doctor went to work on putting the splint and cast back on me.  The theme of the day was "comfort of the heel".  Here was the start of the pillowy cushion he was building around my foot.

My next appointment was two weeks later, and when I got home, weeks four and five began.

One thing I was very nervous about was running over the cat with my knee walker.  I nearly did once, rolling around in the dark, but she made a cute noise and got away in time.  Cats are fast.  They're also silly.  Normally cats nuzzle your legs when you're about to feed them.  Here's Luna nuzzling my knee walker.

I had one more issue working from home.  The neighbor across the hall has a door directly facing ours.  They recently got a new noisy dog.  Aliona and I heard whimpering and barking echoing throughout our apartment, with nowhere to hide from the sound.  The fact that I was working at home all day did not help at all.  I would have walked over to have a chat with them, but being on one leg makes it awkward.  Sheepishly, I relayed a complaint to management.  It didn't stop, however.  On the third complaint, I saw there was a letter left at my door.

The neighbors pleaded for patience, saying their dog was working through "separation anxiety" and he never had this problem before.  It would be overcome, but would not happen overnight.  They left an email address.  They also included a photo of their dog, which I recognized as a Boston Terrier:

Look, while I'm totally a fan of cats, obviously, I grew up a dog person, and was not about to push for this canine to be kicked out.  However, I knew there were some unfortunate but reasonable options that could be pursued.  I was shuddering at the idea of a "shock collar", but I discovered there are "citronella collars", which spray the dog with something unpleasant for each bark.  I was thinking something along those lines.

I emailed the owners and expressed my sentiment, saying all I wanted to know is that they're doing everything they can, and they promised they were.

I got a call from the head of HR at my workplace.  She was suggesting, because I had crutches, I would be able to start coming into work, and I should call to discuss my options.  I told her I could not do that, because I could not rely on using crutches safely enough.  She requested a doctor's note.

At this point, I got the impression they were considering putting me on short term disability.  I worried about that, because as far as I understood, that'd mean a week with no pay, followed by 60% salary.  But my rent would not be 60%.

I wanted to talk it over with them.  I figured maybe I could come in a couple times a week for important meetings.  No one was telling me anything though.  My email inquiries were largely met with silence.  I had to assume that because the company generally bills employee time to clients, they were getting weary of paying my salary on their own dime.

My boss, on his next visit, explained exactly that, and suggested I'd not be put on disability right away, but they were leaning that way.  I told my boss that I likely would only have three and a half more weeks left.  At most they'd probably save two weeks, and losing 1.4 weeks' pay would be much more of a hardship to me than the company's hardship.  I was doing hard, valuable work for them remotely.  I was given no reassurance though.

The HR representative got back to me, saying they received a doctor's note, but unfortunately it did not say I absolutely needed to stay home, so I should call to discuss my options.  I replied with:

"This is not a joke"

and proceeded to briefly explain that the reason I needed surgery was because I had slipped twice already, and I was not going to chance doing that again.  I added that I'd get another doctor's note that has the language they're looking for.  She readily agreed.

Luna had been oblivious to all of this.  She just knew I was home a lot, and took advantage of it.

The doctor then followed up the next week with this:

Sure enough, soon I was contacted by HR, saying that I'd need to fill out forms if I wanted short term disability.  I would have two more days on the job the next week to wrap up my work.  I was thinking I'd potentially have three vacation days, a personal day, and a sick day, and could borrow five vacation days more.  I first learned I had a lot less than I thought, because the online "employee gateway" inaccurately reported my remaining sick time (I didn't get the full year of sick leave right away), and the last three sick days I took were vacation days instead.  Sure, the exact policy is in the employee handbook, but I checked their system to make sure of everything I did.

However, I figured I still could borrow vacation time, to cover the week of waiting for the 60% pay to start.  The HR rep at first said I could not do that, but after checking, it appeared I could.  I followed up by saying I wanted to take the one personal day I still had first, and also would like to use any vacation days I accrued while I was out.  I also figured out that if I had two days off available, I could get full pay on a 60% pay week.

In the back of my mind was the realization that I was being forced to burn all my time off.  I was hoping to get married, and have at least two weeks for a honeymoon.  When Aliona got her US citizenship, we were also hoping to visit her family in Belarus, seeing them for the first time in over 7 years.  This all seemed financially impossible now.

Work ended.

I went in for my five week-post-surgery appointment, and I explained the situation to the doctor, saying I was really hoping to be cleared at the seven week mark.  He said he'd check the X-ray, but didn't seem convinced I might not be ready to walk after just five weeks recovery.  I felt a glimmer of hope.  Could it be?  Well, the doctor came back saying that my healing was going great, but he was unsure of the top of the bone being fully healed.  He claimed he was 95% sure that I'd be done at my next appointment.  I never was that convinced five weeks was probable, so I didn't mind playing it safe anyway.

No surprise solution to my woes, however.  My cast was still very comfortable, and Dr. La Puma, for the first time, did not build a new one.  I did not get to see my foot's progress.  Fortunately, I was plenty safe from rush hour traffic and had a pleasantly uneventful ride home.  I realized that I could move my next appointment to 8am, and, assuming I could walk again, I could start work that very day, which would save me more.  While my vacation time would be lost, at least I would lose very little pay.  The HR rep agreed that it would be fine.

When I arrived, I had only domestic responsibilities.  Luna gave my recovering foot a comforting hug.

I don't like being out of work.  I feel I have a lot of technical expertise to offer a company, and I feel my talents were being absolutely wasted during this time.  But I still stayed busy.  The editor for a short film, entitled Sky Paradise, that I directed back in the spring was revving up progress on it.  She was doing really great work, and inspired me.  I decided to aim for the Tribeca Film Festival deadline a few weeks away.  From past experience, I've learned that film festivals do frequently reject the work of amateurs, so I wasn't getting my hopes up, but I figured I had a small chance, and I had fond memories of Tribeca Film Festival.  Why not?

Working with the editor only takes so much time, however.  I'd get a new version of the movie sent to me, then would comment on it, and wait more.  I had extra time.

I decided to get serious about a social networking web project I was working on, which used a lot of fun technologies that I now had time to learn about.  I was a computer programmer since the age of 7, so it only came naturally.

As my time at home continued, the noisy dog was still having noisy moments, including weekends.  I decided I'd have to contact the owners again.  They suggested they were home during the times when I said the dog was barking, and it was being confined while wearing a shock collar, so it couldn't be their dog.  They did ask whether or not the dog was barking on the weekend.  I said I was pretty sure it was barking on and off.  I got a reply saying "Aha! Then it could not be our dog!" and proceeded to explain that they took their dog to Vermont.  I replied saying the weekend included Veteran's Day, and I was thinking the on and off barking was likely on that Monday.  I said that either way, next time I'd make sure I knew where it was coming from.

Sure enough, the next morning, the dog was barking again.  I took out my phone and recorded it, and sent it to her.  The dog went silent.  I don't like the idea of a shock collar, but if you bring a noisy dog into a Manhattan apartment, you have to do something.  Your neighbors are paying a lot of rent, and the least they could ask for is to be spared the ambiance of a dog pound.

Aliona and I were visited by my friend Zack for the second time since my surgery.  We had pleasant conversation over sushi.  Zack's hard to be too spontaneous with, but he makes a point to include all his friends on his schedule, and I appreciate that!

We later also went to an expensive restaurant across the street.  I wasn't going out much, so I figured I'd make it count.  It was mostly uphill and farther than I'd have liked to get there, but I did get there.  I was given the red carpet treatment for a business nervous about how to accommodate a crippled patron.  A waitress exclaims "Oh wow!" as she spots me and hurries to put chairs in different positions.  I was in no way needing to use the restroom, but they insisted on telling me where the elevator was that I could use to get there anyway.  People overreact a little, but it's better than underreacting.

The food was very nice, and we spied on someone sitting alone at another table, wearing noise-reducing headphones and reading a book of poetry.  It had poems focused on "beasts", as in animals.  I ordered a Ketel One dirty martini, one of my favorite drinks, and it very much hit the spot.

One thing that was on my mind at the time was the fact that my birthday is November 17th, and I was not going to be walking until at least November 20th.  I had the foodie-style idea of touring Manhattan with others, tasting the best knishes available.  Last year I did pizza.  But I was barely able to get to a restaurant, let alone "quest" anywhere.  I invited my friend Russ, who has the same birthday, to stop by for a beer and a movie.  He seemed up for it.  But my parents called, suggesting they were going to drive into the city for my birthday, and I could choose a restaurant.  The only real option I figured suitable was the Italian restaurant at the bottom of my building and had food that would work for everyone.  I suggested Russ and his wife Anita, who happened to be my cousin, could join us.  Zack emailed me, suggesting he could stop by also, and bring cake.  Looks like I was going to have a decent one-legged birthday after all.  Aliona suggested a frozen yogurt cake, and Zack was very accommodating.  He made sure he knew what flavors I liked, and would also put Russ's name on it.

I got the latest version of my short film.  The editor was making improvements that made me so happy.  Would I actually make it into Tribeca Film Festival?  I'm sure I'm biased, like a mother's opinion of her child's beauty, but it's at least a ton better than I ever expected it could be.  Everything seemed to be falling into place just right.

Over the course of the week, I experienced some soreness in the knee of my good leg.  This certainly worried me.  You become much more anxious about anything going wrong with a leg... when it's your only leg.  I think it was because I was hopping around too much, and perhaps extended my knee a bit too much.  I made a point of not hopping, nor fully extending my knee, which also felt uncomfortable.  Within two days, it felt better.

The weekend arrived, and a realization set in.  If the doctor was 95% sure I'd be walking again on Wednesday, what are the chances he'd think I was perfectly fine on Monday?  I texted the doctor and he said I could certainly come in on Monday.  I would be walking two days earlier, and could save another day of vacation time!  It's ironic that, the day right after my birthday, I could finally walk again.  Nice belated birthday present.  Maybe this is a sign that I should have been born one day later.

On that note, it was time for my birthday.  We cleaned the place up, and I did my best to remove some cat hair from Luna's hangouts.  First, Aliona surprised me with a few gifts:

From upper left to lower right:

  • A toilet mug
  • A piggy bank shaped like an ass, that makes a wet fart when you insert a coin.
  • A card that makes cow noises when you press buttons. You can play cow songs using the five cow notes.
  • A pig that lets you grow its grassy hair, similar to a chia-pet, but more punk.

Things were looking up.  My family arrived and I showed them and Zack my short film so far.  They seemed to like it, so I'm hopeful it might be well-received at a film festival.  We had our family-style Italian meal with lots of pasta, chicken, veal, and salmon.  Since this was the first time Zack got to meet my parents and brother, he asked them a ton of questions, at times drifting toward awkwardness.  Conversation was interesting and energetic though, so I overall had a good time.  Zack suggested he wanted to go on a cruise with friends and we should join him, and it sounded great, but I didn't know how to possibly have any vacation, let alone another that additional one.

The staff started singing "Happy Birthday", but we soon realized it was for another table.  My Dad shouted out to them that it was my and Russ's birthday as well, so we eventually got our comeuppance as well.  They brought the cake out, creme-brulee flavored, and there was thankfully only one candle on it.

My next shower, that night, was hopefully the last with the cast and shower sleeve.  When I came out of the shower, I noticed there was a decent lot of water in the shower sleeve.  Parts of the cast were soaked.  There was tear in the seam.  I was about to throw away the shower sleeve, but decided to just let it dry out, and worry about it later.

I woke up at 9am on Monday and quickly scheduled my appointment for 1pm.  95% chance I'd be walking again after that appointment, that Monday!  In less than 4 hours!  I was served disturbingly steamy coffee in my toilet mug, and then I used my bone stimulator for hopefully the 98th and last time.

It took quite a bit to get to my appointment, because lots of road were blocked off, but I give myself way too much time anyway, so I was still early.  The doctor checked X-rays as I nervously waited.  He came back saying that yes, my cast could come off.

After 4 weeks of not seeing my foot, there it was.  The skin was dry and flaky all over.  Certainly there was no swelling.

I promise, no more gory pictures.  It's just interesting to see how my scar's healing was progressing.  There was still black skin there, and the doctor was very much unconcerned.  Also, my foot felt weird underneath.  It felt as though the skin on half of the sole was hardened.

Dr. La Puma offered me a "treat", and soon my foot was immersed in a warm whirlpool bath.  I was worried about getting the wound wet, as if there would be a scab that could fall off, but he was unconcerned.

I couldn't see the skin flakes, and the skin all felt normal after that.  He then applied moisturizer, all around the foot, including over the wound.  I didn't feel any irritation.  It was as though there was no wound.  It was just discolored.

He broke the news to me that I would still be using the bone stimulator, and wearing a soft cast, but only for two weeks hopefully.  I could either buy a new shower sleeve there for $25 or so, or fix the one I had so that it lasted two weeks.  I decided to save the money.

After he put the soft cast on me, I then got to try standing.  I tried with crutches first.  The more I put weight on my right foot, the more pain I felt.  I did not expect severe pain!  I only expected some discomfort and a lack of balance due to atrophy.  But there was no way I was going to keep using crutches.  I was done with crutches.  I asked for the cane.  It was bearable, and my rehabilitation was firmly in my control, for once.  Dr. La Puma was nice enough to store my crutches somewhere, but the cane would be enough.

I headed toward Grand Central Station.  At first, progress was very slow, but then I realized, the less pressure I put on the cane, the more easily I was able to walk.  I reached the subway, then was able to walk a while longer all the way to home.  I felt I had gotten my freedom back.  There was New York again.

I folded up my knee walker and posed for a Facebook pic.

Sunday, October 13, 2013

I Love Propofol

This is the fourth post documenting my experiences, living in Manhattan, after I missed one step on the way to the laundry room and broke a bone in my foot. First post was here: The Fractured Fifth - Manhattan Life with a Broken Foot

I had a horrible time getting all the appointments necessary so I could be approved for surgery.  I was told that I had to get an EKG and a chest X-Ray to my primary doctor so he could give a final thumbs up clearing me for surgery -- especially the general anesthesia.  In my last post, I detailed just how messy it was getting, and let's just say it got worse, although I thought I made the necessary arrangements.

I got a quick taxi ride to a nearby hospital for a chest X-Ray.  Despite my repeated, crystal clear, detailed explanation, they thought I was having surgery in that hospital.  Essentially I ended up waiting unnecessarily, but eventually people who were out to lunch started showing up and they came to their senses.  The fact that I nearly did have surgery at that hospital (see my first post) didn't help, because other X-Rays were already made for that.  They checked the records and told me that they already did the X-Rays and sent them, but then I reiterated for the tenth time that this was a different X-ray, to clear me for surgery at ANOTHER hospital.  You can guess that there were significant language barriers, plus they just weren't paying attention.

Later that Monday, I was going to the cardiologist for my EKG.  I was scheduled to see this very compassionate cardiologist.

A different cardiologist appeared, but the assistant assured me he was compassionate too.  He was a nice guy.  He regretted not being able to give me a stress test, because it'd be difficult for me to hop along on a treadmill until my heart was racing.  He tried to scare me into eating healthier, by saying I had 0.12 cm of cholesterol in my corrodid arteries, as opposed to a normal 0.10cm.  I asked how bad the extra 0.02 was, and he dodged the question.  I eat fairly healthy and will continue to, so I don't think I'm going to worry about it.  He said sans-stress test, he was taking a "risk", but he was going to clear me for surgery anyway

I was under the impression that my primary doctor had to look over the X-Ray and the EKG results, in combination with the blood test he already had, and was supposed to clear me.  But my podiatrist's assistant was already asserting that the cardiologist's clearance was enough.  I asked her why I needed the chest X-Ray then, because no one looked at it yet.  I made the requests to have everything sent to my primary doctor, and to send clearance to my podiatrist.  Eventually the doctor called and assured me that everything was set.  I'm not sure if the chest X-Ray was ignored or not, but I gave up worrying about it.

I had a discussion with my retired parents, now that I knew the surgery was on.  My mom initially suggested sleeping on my couch, helping me to the hospital and taking care of me during the first couple of days afterward, since Aliona had to work.  I didn't like the subpar accommodations for my mom, but couldn't argue that I could absolutely use some help.  I got another call later, then suggesting I instead stay with them in New Jersey.  They even offered to give up their master bedroom, since it was on the first floor, which was important for me.  My mom stressed that the bed had a vibrating feature too.  Although living with parents is not my first choice, how could I say no to being attended to, 24 hours a day by people who cared about me?  They would even bring my knee walker along.

The day before my surgery, I had one more appointment.  The doctor mainly wanted to make sure I was going to start fasting after midnight, including water, which he told me could cause me to drown.  Here's the X-Ray of my foot that, as I mentioned in my previous post, I fractured twice.  You can see the break doesn't look as clean as in the X-Ray I added to my first post.

The doctor drew me a sketch of what his plans were for my broken metatarsal.  He said if he didn't think the titanium plate with screws were enough, he'd wrap the bone in metal coil and pull it tight, like pictured in the lower right.  On the upper right, you can see all the post-surgery instructions I could expect to have to follow.

I asked about possible nerve damage.  One of my favorite things in life is the feeling of bare feet sliding under a cool blanket.  I wanted to feel that again.  Dr. La Puma nodded, saying there is some risk as there's a nerve there, but he'd do his best to avoid it.  He made me a new soft cast out of tight bandages, to wear just until surgery, to reduce inflammation as much as possible., That night, I went home, and made sure I rubbed my toes into my blanket.  It's common knowledge you should try to get good sleep the night before surgery.  I slept maybe 5 hours, which was pretty good considering.

My surgery was at Interfaith Hospital.  I've been going with Go Green Ride for car service, rather than taxis, so I don't have to risk trouble hailing cabs on crutches.  They didn't have availability to take me to the hospital at 6am on a Thursday, for whatever reason.  Upon asking them for a recommendation, they managed to squeeze me in.  Dr. La Puma told me to arrive at 7am, but then the surgical coordinator called me and requested I arrive at 6:30am.  I arrived at 6:20am and ended up waiting outside the hospital on crutches for 10 minutes, because I was locked out and no one was around to let me in.  Eventually someone saw my crutches, walked over, and gave me a cold stare.  He opened the door, asking me if I was there for surgery, then finally let me in.  I just wanted to have a good experience leading up to the surgery.  I did not need to be treated like you'd expect in the bad part of Brooklyn that I was in.  But I trusted Dr. La Puma and his staff, and I didn't have much choice at this point.  I needed the surgery.  So I entered the waiting room.  It was after 6:30am, but the one lady at registration told me to wait, and eventually left.  I wanted to get the paperwork started, but there I was, in the waiting room, about to be forced unconscious and hacked into by mostly strangers.

Twenty minutes later, she did return and I was registered, then told to wait in front of the nurse's office.  15 minutes later, she did arrive, and registration began.  There was a bit of a language barrier, but the questions were very standard.  No, I did not have diabetes.  That sort of thing.  The nurse went into explaining what the procedure was exactly.  I was pretty well-informed already, and suggested it was going to be an "open reduction internal fixation", which I learned on the internet means cutting into me and leaving something inside me to hold the bone in place, as opposed to other alternatives.  The nurse replied with a "wow" and decided to move on.

I was then escorted off to another room where I got to meet Dr. La Puma's residents.  They were a fun bunch.  I often like to make jokes in the form of silly situations I'd pretend to be true.  The chief resident  totally got my humor without missing a beat, and I suggested he had a knack for improv comedy.  He admitted he did try that at one point years ago.  My main goal was to make the doctors laugh.  My belief was, if the doctors liked me, they'd be more careful not to kill me.  Each of them had a separate conversation with me, all asking the same questions.  No, didn't have diabetes.  They were just being absolutely sure, which I appreciated.  One resident looked at my record and was suggesting to be careful of my cholesterol level.  I replied, "Oh, you mean the 0.12 cm of cholesteral build-up in my corrodid artery?"  I wasn't trying to impress her, nor the nurse, but she was similarly impressed anyway, and I hoped that would make her even more careful not to kill me.

The anesthesiologist introduced herself.  I ask her up front, "So, how are YOU feeling?"  Bewilderment struck the faces of those around her, and one doctor mentioned that it was a first for me to ask HER that question.  The anesthesiologist, however, completely understood, telling me how she had a great night's sleep and she was feeling really good, with no reservations.  That's exactly what I wanted to hear.  She slept better than I did anyway.

I changed into a hospital gown and robe, putting all my possessions in a plastic bag, including my cell phone.  They let me keep my glasses.  I got back on crutches and followed the staff into the elevator, and into the operating room.

The operating room was not as big as I'm used to seeing in Gray's Anatomy or House.  It also had walls packed with all sorts of medical supplies.  It looked clean enough where it was believably sterile.  My filmmaking side told me that sterile rooms had more of a cold blue color cast.  This was just a normal looking room with lots of medical supplies, and a table in the middle.  The table was long enough for me to lie on.  There was something black with straps lying on the head area, which I imagined with be later strapped around my head, holding a breathing device in place.  Again, general anesthesia (specifically propofol) stops you from breathing on your own, so a machine keeps you alive instead.  There were also skinny little side supports for my arms, one pointing directly to where the anesthesiologist was sitting.

Dr. La Puma and his staff gathered around, and one placed my injured foot on a hard block of some sort.  I imagined it as a butcher's block.  An IV was inserted into my left arm.  I didn't feel very nervous, but you can't fool an anesthesiologist with a stethoscope.  My heart rate was over 100.  Without any warning, I felt a very pleasant cool stream flow into my arm.  It felt very nice, but I wasn't feeling any effects of drugs, so I wasn't sure if it was the anesthesia yet.

Then... I felt the propofol.  It was such a wonderful sensation.  I exclaimed out loud how I was very happy and relaxed now, and they didn't have to worry about me.  The anesthesiologist complemented whoever she was overseeing, saying that starting with a test dose was exactly the right way to do it when the patient is nervous.  I saw another guy join the crowd, joking around a little and doing a little dance.  I never met him and probably never will, but I didn't mind some energy in the room.  That was the last thing I remembered before the surgery began.

Upon awakening, I was in the recovery room, and it was about three and a half hours later.  The nurse was there, asking me if I was up for seeing my parents.  Sounds fine.  My mom described how ugly I looked as I was being rolled into the recovery room.  The funny chief-resident stopped by and described how nasty the fracture actually was.  The anesthesiologist visited next, and told me a few things, including emphasis on keeping my foot above heart level when it feels painful.

Dr. La Puma was the next in the procession.  He told me flat out that everything went beautifully.  I asked about the nerves, and he said my nerves are absolutely fine.  So much relief.  He did also say how the break was uglier than the X-ray showed.

There was apparently a section of bone that had "flipped off to the side", and they had to put that back in place as well.  But as planned, they were able to secure all the bones with one "main" screw.  Then the plate plus the smaller screws were additionally installed to further hold everything in place.  In this X-ray, you can see the big screw, along with the long plate and the five additional smaller screws protruding from it.

My hospital wristband, almost matching my blue shirt and jeans, and gauze covering the spot where they stuck the IV.  In the recovery room, I was given my belongings back.  I changed in the bathroom and texted Aliona with my phone, to let her know I was fine.

It was pretty difficult to slide my jeans over my very padded cast, which consisted of a fiberglass splint underneath my calf and foot, plus lots of gauze.  I knew I'd have to switch to sweatpants.  As my parents helped me to the car, the nurse told me how lucky I was.  I was able to comfortably stretch my legs over the back seat.  My next worry was my parents navigating out of Brooklyn successfully.  It wasn't easy, but we made it.

Upon arrival, I settled into bed, with the intent of getting as much sleep as possible.  My mom showed showed me the bed's remote control, and pressed a button.  It vibrated fiercely.  I was waiting for her to leave so I could turn it off.  She realized that it was weird and just turned it off for me.  But it did elevate the head/feet for me, which was really nice, considering I was supposed to keep my foot elevated, and would be spending a lot of time sitting up in bed.

The most important pill pictured below was the small pill, oxycodone.  I was told not to wait for the pain to start.  Just take one pill every 4 hours for the first couple of days.  My foot was sore enough to keep me from sleeping easily.  My mother suggested a system where I would state my level of pain from 0 to 10, where 10 was me screaming horribly.  In general, the pain never got more than a 6, and maybe briefly a 7.  One thing I didn't like about the oxycodone is that it made me feel "blah", and I was very sluggish.

My mom did her best to cater to my iffy appetite.  I pictured the wonderful fruit that Aliona inspires me to eat often, and I realized I was very much in the mood for it.  Mom went shopping and soon I was presented with my first snack. 

A lot of my time was spent watching Netflix episodes of this 2004 sci-fi series called "4400".  It was not very good, but good enough to stay interested.  I watched one episode after another during my moments of awakedness, and slept otherwise.  It helped me avert any boredom, which I was worried about.

Along with my brother, I was visited by some of my friends from New Jersey, Paul, Mike, Leigh, and Scott and Christine Miller with their baby Kathleen.  We had a wonderful time talking and they admired the ingenuity of my knee walker.  Mike brought a few board games, and we played the one that required as little intelligence as possible, at my request, since my brain was still a bit under the influence.  I won one round, so I think it fit that requirement fine.

The weekend was ending, and my mother wanted me to stay, but I knew I had to get back to work.  I would have an appointment in a couple of days, and wasn't about to want to go in from New Jersey.  Plus, I missed Aliona and my cat.  I was already reducing my use of oxycodone.  The pain was mostly gone, which amazed me.  Early Sunday, we left, and I was back on the bed, with Luna by my side by early afternoon.

My boss stopped by the morning of my appointment and we talked a bit about upcoming work.  I was back in the swing of things.  My boss told me about how he neglected rehab after his arm injury, until he almost needed to have surgery again.  I had no intention of slacking off when I got to start rehab, however.  I made it to my doctor's appointment later that day, and the massive padding was taken off my foot.  The first thing I noticed was that the skin on my ankle was in bad shape.

 Dr. La Puma applied an ointment to it, which hopefully is helping as I type.  The gauze around the wound was of course flooded with dried blood.  There was this one piece of gauze that was stuck to my wound.  I imagined the nasty stitches that lied in wait behind it.  I didn't worry too much about me being squeamish, but I hoped it wouldn't look too horrible.

Dr. La Puma poured fluid over the gauze, allowing it to be cleanly pulled off.  Needless to say, the wound did look pretty ugly, but I can imagine it easily being worse.  Dr. La Puma was happy, saying how I'd have such a nicely thin scar.

He made me a new cast using the same fiberglass splint, and I worried about it being too tight again.  It felt a bit tight but okay at the moment, but I worried about having to pay for another round trip to the doctor if I needed it adjusted.  One thing I liked was the doctor cut on the lower part of the splint, allowing me to use the bone stimulator again, which hopefully should help me heal faster.  Dr. La Puma also told me that although I'd still need to come in for regular appointments, I would do my rehab at home, which suits me just fine.  If anything, my apartment building has a very nice gym that I'd get to make better use of.  I'd prefer just walking around New York for fun though.  I miss that.

Sure enough, that night, I had a severe burning sensation in my heel.  The doctor told me to come in the next day, and for now, just reapply the bandage making up the cast a bit looser.  I continued to work, with my clumsy bandaging staying intact.

The next day, I went back to the podiatrist, after 4:30pm, and his impression was that the job I did reapplying the bandage was fine, since it was holding well.  I regretted making another trip out there to hear that, but he did apply a new layer of bandaging over my foot, and gave me plenty of spare bandaging in case I needed to adjust it myself.  I felt pretty confident I could do so again if need be, so that helped.

The problem was getting home.  I don't know how long my appointments would last, so Go Green Ride told me to request a "ride now" after my appointment was done, and they'd be there in 10 minutes, or 20 if it was rush hour.  Well, I tried that, and they had no availability for at least as long as the doctor's office was staying open.  I knew I had no chance of hailing a cab, and there was no way I was going to try going into the subway.  I was left high and dry, and made a mental note to replace my favorable Yelp review of that car service with an angry one.

I tried out "Uber", having previously created an account with them and having the app on my phone.  They have a cheaper service where, I believe, non-professionals can give rides requested through the app.  During rush hour, they'd charge 50% more.  I didn't have much choice, so I went for it.  Albert in a Toyota Avalon was supposedly on his way, and I could see on a map that he was already pretty close.  Pretty impressive.

I saw he was approaching, and went to the street.  No one was there.  I got a call from him, saying he was one block away, and was asking me to go to him.  I told him I was on crutches and I'd rather not, but I'd wait until he arrived.  20 minutes later, I see a Toyota go by and wave at it.  The driver nods and pulls up.  Finally I'm going home.

But on the way home, I get a call from Albert saying he just arrived.  I realized I got into a car that illegally accepted a street hail.  The driver, in his very sparse English, reassured me that he was a good Christian, and he was usually a normal car service.  He showed me his driver's license.  He showed me a cane next to him, saying how he had quite the experience himself recovering from an injury, and how he only recently was able to drive again.  He gave me another "hang in there" story, half in Spanish.  I shrug and just decide he's a good dude.  I did my best to navigate him to my home, and it worked out fine, and I paid him around what Go Green Ride would normally have charged me.

I made it to the weekend and finished watching 4400.  In 10 days, I'll have my stitches taken out, and hopefully a month after that, I'll be able to walk again.