Saturday, May 30, 2009

Possible misdiagnosis?

One thing about this blown ankle is that it feels like the ligaments and tendons surrounding the ankle are inflamed. The orthopedist who injected the cortisone into the joint says it's not possible, that it is the joint itself that is causing the pain. But he doesn't know how this ankle feels.

In the case of tendinitis, treatment includes cooling the tendons. In the case of osteoarthritis--the diagnosis the doctor is sticking to--treatment includes heat on the joint.

We've been putting heat on the joint with no improvement, in fact the joint felt kinda crappy afterward. So this afternoon we tried a bag of frozen corn, and my ankle liked it. At least it seemed to: hard to say for certain because the level of painkiller meds fluctuates throughout the day between pills.

Also, tendinitis presents with a lot of swelling of the tendons, and swelling is something my ankle surely has.

So I'm wondering whether this surgeon has the right diagnosis. I'll be seeing another ankle man next week for a second opinion and I'm not going to tell him about the first dx, I'll just give him history and let him examine the ankle and see what he comes up with.

Back from Spain, Ankle completely blown

One week after getting that cortisone shot in my old, battered ankle (see May 1, 2009 entry), I had to have my son take me to the ER at St. Charles. I was running an elevated temperature and my ankle was swollen and so painful that I couldn't put any weight on it.

I was attended to by two fine doctors, one of them a joint specialist. They tapped my ankle to see if the joint was infected -- it wasn't; they confirmed my elevated temperature; they drew blood to check for signs of inflammation, which they found. They had no idea what the problem was and sent me home with Keflex (an antibiotic), and some meds for pain.

(This is going to sound odd, but that was the best ER experience I've ever had, and as a father of two kids and a survivor of a pretty nasty auto accident, I've had plenty of ER experiences. To a person, the staff at St. Charles were friendly and helpful, I got prompt attention, and felt well taken-care of.)

Anyway, I contacted Dr Holmboe (the guy that gave me the ankle injection), wondering why I wasn't warned that this massive inflammation might be a possible outcome. If I had been warned that this could happen I would not have gotten the injection, which was supposed to make my ankle less painful, not so painful that I was on crutches. His nurse said that bad reactions to cortisone injections are so rare that it's not considered a likely outcome. In fact, they've never seen one go sour.

Well, Mrs Elliott had cashed in all her air mileage points earlier in the year and scored two steerage-class round trip tickets for an 11-day vacation in Spain. I've always wanted to visit Andalusia, the southern portion of the nation. We had hostel rooms booked in Toldeo, Seville, and Granada.

But was I going to heal up enough to make the trip? I certainly hoped so but signs of improvement were slight and possibly imaginary. Nevertheless, we've had to cancel two previous vacations, and Mrs Elliott wanted a break from her workaday world and I vowed that I would do everything in my power to keep us on track.

So we went. And my ankle did not improve. And those hilltop cities like Toledo are impossible for crutches. So we bought a wheelchair. And the lovely Mrs Elliott pushed me around in that damn wheelchair in those handicapped-unfriendly medieval towns, up and down narrow cobblestoned streets, over steps in cathedrals and museums, over curbs to restaurants and through our hotels. We managed the Alhambra.

Bathrooms were a constant frustration: if they were not up or down a flight of stairs, they were out of paper. Or the seats were missing. Or there was water on the floor. Water on a marble floor provides exactly as much traction to a crutch tip as does ice. I fell once going into a restaurant when my crutch tip caught the lip of a step, bringing me down with a hearty crash and nearly tipping over a table where diners were seated. A great hub-bub ensued with waiters and spectators trying to pick me up off the floor.

Not one of my proudest moments.

It was very difficult for both of us. If I was not in pain -- aching, burning hot pain -- I was partially doped up on painkillers.

That's me at the top of this post at the Prado museum -- Europe's largest collection of paintings -- asleep after a long day of looking at some of the world's finest art, and wiped on painkilling meds.

I saw Goya, Velázquez, Zurbarán, El Greco, and Sorolla, among many many others.

That said, if I ever again see another painting of a saint or a Mary with their eyes rolled up in their sockets, glistening like wet mushrooms, gazing up at the sky like mind-numbed nitwits, it'll be too soon. It's a pity the 15th, 16th, 17th, and 18th century painters didn't have the freedom -- or imagination -- to paint more than suck-uppy portraits and religious claptrap.

The Sorolla exhibit was incredible -- absolutely astonishing.

We got home to Bend yesterday morning -- landed at RDM where a warm breeze greeted us, and the sweet smell of junipers suffused the air.

I saw my doctors immediately: my family doctor and Holmboe. He said he's never had one single cortisone shot go bad like this, and suggested that what might have happened is that when the cortisone initially started working, I started doing more weight bearing on the ankle, and may have simply damaged it. Just a guess. No one knows. My primary care doctor shook her head and said pretty much the same thing: bad reaction or self-damage.

Anyway, I got a prescription for a wheelchair so we can bill the insurance company; paperwork to take to the DMV for a handicap sticker for the car; modifications to my painkillers to reduce the risk of liver, kidney, and stomach damage; and a general agreement that my ankle is now and forever blown. Ankle fusion surgery is in my near future.

The cobblestones just about shook that poor wheelchair apart under the load of my chunky-butt. Bolts rattled out, the thing just made it home and I'll attempt repairs.

Monday, May 4, 2009

May Gray, June Gloom

Coastal San Diego county does this weather thing every year where you never see the sun for the second half of spring. Six to eight weeks of gray overcast, day after day, week after week. A few miles inland the damp onshore breezes can't overcome the basic desert (low desert: glary and dusty) climate and the skies are sunny. But if you're looking for picture postcard image of sunny San Diego beaches, don't go in late spring. It's gloomy, damp, and chilly.

But do get there before the Santa Ana's start blowing in late August to late October.
Today is shaping up to look like a May Gray day, but one thing I can count on is that this one, single, weather pattern will not persist until July.

Friday, May 1, 2009

Owie - Ankle Shot

My poor degenerating right ankle has reached the point where it's nearly bone on bone. It was trashed in 1980 in an auto accident and I've lived with the limited range of motion and chronic pain since then. Nearly three decades.

Anyway, Dr Holmbue at The Center took one look at the X-ray and declared it the most messed-up ankle he's seen in a long time. Offered to either open me up and fuse the ankle bones together or shoot in some cortisone to reduce the inflammation and the pain.

I selected the latter.

Got the first shot today. This x-ray picture was taken while the needle was right in the ankle joint (the syringe is points up from about the 7:30 position). Yeah, it's gross.

Ow. It hurt a bit, but he expects a reduction of pain. I hope he's right. The shots can't be given more than every three or four months or so. I'll stick with this until they no longer work, then consider that ankle fusion.
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