Tuesday, June 30, 2009

A General Hub-bub

Lots of activity here lately. While I am healing in bed I am surrounded by the sounds of the house being made readied for Mrs Elliott's family reunion, due at the end of July.

There are doors being re-hung, countertops being replaced, the front yard has been re-graded and landscaped with bunches of pretty plants and a nascent lawn, decks being stained, the non-windowed guest bathroom getting a Solatube, a hot water heater getting replaced, garage door opening mechanism being replaced, areas swept of rubbish so as to be made safe for toddlers, the spa being rebuilt so it works, paint going up on eves that have had new gutters installed, revealing the old paint where the old gutters once hung.

It's a fuckin' nightmare of drills and compressors and sawing.

And while all that's going in, Mrs Elliott is preparing to leave this coming Monday to San Diego for a five day conference in which she is exhibiting. Me, cripped up on one leg, unable to drive, will be relying on the kindness of my worthy son and/or Bend Taxi to provide a lift to the local supermarket should I happen to get a hankering for something like maybe a package of Hydrox cookies (sigh, better than Oreos but discontinued years ago).

We just got back from the Dr Jon Lutz, MD (infectious diseases, a delightfully quirky fellow) who confirmed that it is indeed yeast plus a soup├žon of epidermal staph bedeviling my ankle wound.

Yep, yeast -- in its myriad of varieties, some beloved for their wondrous ability to transform flour and water into bread, wheat and hops into beer; other despised for the troubles that bedevil women worldwide ... a yeastie beastie is chewing away at my flesh and possibly bone.

I will be receiving some kind of highly-technical dual isotope nuclear bone scan to detect whether the bone is involved. There are good treatments for such infections, but the worrying part is whether the bug has gotten into the holes alongside the new bolt holding my ankle together. I don't even want to think about it.

So I won't.

I got a Superman sticker at the doctor's office for being a good boy.

Back to beer. Which I deeply wish I could drink right now. But since alcohol does not mix with my meds and most certainly is not good when one has only one working leg and gets around on crutches, beers are not presently on my diet.

Thursday, June 25, 2009

Yeast? Fungus? Staph?

One of the incisions in my ankle isn't healing as it should -- I'll skip the details in case my reader is queasy about such things. The bottom line is that there seems to be an infection. The most likely candidate bug would be staph, as it turns up everywhere, even in operating rooms.

So this morning Mike Stahly, PA, took a swab to send to the lab, and sent me off to the pharmacy with a scrip for a mighty powerful oral antibiotic ($15 per tablet) to start with while awaiting the lab results which will more closely pin down the exact species of critter threatening the healing of my ankle.

This afternoon Dr. Stahly called to say that the initial lab results were -- interesting? Some kind of yeast, it seems. Or maybe a fungus? "Answer Hazy," according to the lab's Magic 8-Ball. Until they see more growth in the Petrie dishes an exact identification isn't possible.

We don't like "interesting."

We like our infections to be caused by easily-identified common beasties for which the course of treatment is well-established. Yeasts or fungi are, in contrast, more puzzling, and require more specialized knowledge.

So we're adding a powerful anti-yeast infection drug to the mix tonight.

"This is the same stuff we women take for our yeast infections," said Mrs Elliott, unhelpfully. "I guess that makes you a girly-man."

Sigh. What I have to put up with around here.

In the next few days the lab will have a better idea what's inflicting me, and on Tuesday we see a Dr Jon Lutz, MD (Bend Memorial Clinic Infectious Disease Department) who is said to be quite well-versed in your more obscure menageries of flesh-eating micro-organisms.

In the meantime, my accountant (Michael Savuto, member CPAs Without Borders, and author of Compassionate Accountancy Is Fine But How The Heck Do You Expect Me To Pay For My Daughter's Tuition When You Never Pay Me? [2009, Simon and Schuster]) warns me that we need to talk about my 2008 taxes, and we need to talk about them now.

Apparently the IRS doesn't have a form you can fill out if a limb is being gnawed away by bacteria and you could use a little delay.

Monday, June 22, 2009

Bend Bites Man

Yesterday was cool but pretty*, the last day of the Bite of Bend. Lots of tasties. A middlin' crowd: I was told it was a lot busier Saturday. The good thing about having a handicap plaque is that one can find close parking, but it wasn't needed yesterday: the handicap parking places on Wall were all full, but there were several choice regular ones available.

The front of Duncan's shop was still walled off by the Whole Foods booth (nice sweet watermelon!). Tooling around in my wheelchair, I had a chance to say hi to a few friends.

The voting for the board of directors Downtown Bend Business Association closed last week. I don't know when the results will be announced -- I have a few favorites who have their hats in the ring that I'd like to see get on the board 'cause I think they have some pretty good ideas for keeping the downtown healthy. I like the downtown.

Mrs Elliott's grousing about the weather, again. She misses the sunshine and the tepid climate of San Diego. I like the changeable nature of central Oregon's weather.

I was reading that some concerts at the Schwab have been canceled. Something to do with the OLCC, but I couldn't quite figure out why the promoters were pulling out, what their gripe was.

* The way I like my women.

Friday, June 19, 2009

Boot Off, Stitches Out

The folk at Desert Orthopedics removed the great big black plastic and Velcro monster pain in the ass giant Michael Jackson moon boot ankle immobilization whatsit off my leg yesterday. My skin tasted sensations of air current caresses and gentle finger touches for the first time in over two weeks and drank deeply of it.

The foot was afraid to come out, though. It felt vulnerable, afraid of being hurt. Like a little hermit crab exiting his shell or a snake shedding her skin. The big bad outside world is a little scary to a foot which has had an ankle fusion and bolts put into it and is barely on its way to healing and strength.

We washed my leg and foot, new x-rays were taken and since neither of the bolts were broken (!) pronounced good. The stitches were gently teased out, incisions taped, and I was sent home with permission to take showers without having to first seal my leg and foot in a trash bag -- now that the stupid great big black plastic and Velcro monster pain in the ass giant Michael Jackson moon boot ankle immobilization whatsit is no longer needed.

My calf has lost quite a bit of muscle mass.

I wonder whether it will necessarily gain it back -- I mean, with a fused ankle, it's not clear if the Achilles tendon will do anything worthwhile anymore, and if it's not longer employed, do the calf muscle have much to do?

That's a question for later, when I start physical therapy.

But it's nice to see progress, even if it is in the form of a slightly swollen foot with skin texture like a water buffalo's butt.

Wednesday, June 17, 2009

Whiner Takes Over Jack's Body

Hello. I'm Jack's inner whiner. I've taken over Jack's body and his blogging duties. I'm here to whine about how NOT FUN it is to be recovering from this stupid ankle fusion surgery.

One thing's for sure: Jack might experience some catharsis, but there's nothing here of worth for the average Joe. I'm not even going to try to make it interesting or well-written. Just whining. Move along, nothing to see here.

You've been warned. Erase this now.


It's now been over six weeks of acute pain and disability.

The past couple of days have been pretty uncomfortable; discouraging and depressing. I keep looking for hopeful signs that things are getting better: with less pain, more mobility. But nothing much--just more of the same tedious grind.

Wake up in pain, crutch to the bathroom, empty my pee bottle, crutch back to bed, straighten the bedding with its odor of pain-sweat and unwashed man body, arrange my pillows so I can sit up better, take my pain pills and wait for Mrs Elliott to wake up, and crutch into the kitchen to join her while she makes tea and breakfast for me (coffee and breakfast for her). Then back to bed until lunch, then back to bed until dinner, then back to bed until TV time, then into the living room for a couple hours of digitally-televised entertainment, then back to bed for sleep.

Evenings are exhausting: I run a small fever which saps me of my energy and spirit. And brains. Pain zombies have eaten my brains. It's like the last part of Flowers For Algernon when his mind is fading. It's HAL in 2001 when his higher-order brain functions are being shut down.

I can feel it happening: Sometimes Two and a Half Men is too challenging for me.

The horror.

That's pretty much been the drill. I have to keep the ankle elevated so bed's the place and bed is a fucking boring place to stay, even with being able to stay in touch with my business and customers and vendors through the miracle of web-based communications.

The pharmacist said that ankle fusions are among the worst in terms of pain and slowness of recovery, a fact that is both validating and depressing: At least I'm not the only one who has found this experience to be pretty awful. But I want to be better now! (waa, waa.)

Doc is cutting back on my pain meds. The plus is that I'm in less of a pain-killer fog all the time, the minus is that there are these AMAZING new pains and aches.

And it's really frustrating to always have to ask Mrs Elliott for everything I need.

My ass is sore from being sit on all the frickin' time.


Monday, June 15, 2009

Movie Review, "The Hangover"

We laughed a lot.

You want more than that? Look elsewhere: I'm not a movie critic.

Sunday, June 14, 2009

KPOV's Bday Party, Beatles Sing Along

Last night's Beatles Sing Along at the Old Stone Church -- a fund-raiser for KPOV 106.7 Community Radio, as well as the station's fourth birthday -- was a complete success by all measures.

Mrs Elliott co-chairs KPOV's fund-raising committee. In addition to taking care of me, still bedridden and crutch-powered, she put together over a dozen goodie baskets for the event's silent auction.

Each basket contained anywhere between $100 to $300 of gifts and gift certificates donated by local businesses including:
Angel's Thai Food, Applicance Doctor, Aveda Salon, Azu, Backporch Coffee, Bambini, Beauty Bar, Bellatazza, Ben & Jerry Ice Cream, Bend Brewing Company, Bond Street Barber Shop, Camalli Books, Caitlin Goodwin Personal Trainer, Chris Huffine Guitar Lessons, Christmas Valley Golf, Cosmic Depot, D&D Grill, Devore's, Flatbread Community Overn, Greg's Grill, Ina Louise, Jackson's Corner, Joolz, Kobra Corp., Lava Lanes, Local Joe's, Bend Distillery, McKay Cottage, Mother's Juice Cafe, Nature's, Newport Market, Parilla Grill, Paul the Computer Guy, Powell's Candy Store, Ranch Records, Richard's Donuts, Rival's, Riverside Golf, Strickly Organic, Suds and Shine, The Brew Shop, Thump Coffee, Victorian Cafe, Wild Birds Unlimited, Zydeco, 7-11 Stores third street, and others.
Mrs Elliott has done fund-raising for many, many years in SoCal. She's used to hitting up businesses for contributions, and has learned to expect some to contribute and some to decline.

What she learned here is that Bend is truly a community: everyone here said "yes."

The turnout at the Old Stone Church had the same feel of community: despite the terrific downpour of last night's thunderstorms the event sold out. It was packed. Old folk and young, the frail in their wheelchairs (me included), and the highly energetic, the cool and the unhip. The musical acts as well were diverse and whacky and quirky, and their willingness to put together a few Beatles tunes and show up in a rainy Saturday night to perform them for no pay was met by the crowd's enthusiastic singing and applause.

It was a 60's love-in replete with old hippie guys and chicks dancing.

KPOV's Michael Fischer (as "Sgt. Pepper" and sporting a genuinely atrocious British accent) and Strictly Organic's Rhoda Jones ("Lucy In The Sky With Diamonds") were the masters/mistresses of ceremonies, and both did a great job keeping the show going.

Everyone had a great time. I had primo seating in the aisle and, being the old hippie that I am, I sang and clapped along with everyone else.

Rick Miller, president of KPOV's board of directors, said that, "I heard people saying that this was the best event they had been to in a long time.....maybe ever! There was one lady who stood by me during a song, she was maybe 80 years old, and said, "Isn't that song on the Help album?" as she was swaying to the song. I think we truly touched the community last night."

Winner of Quirkiest Act goes to Canaan Canann. Cutest Sight was her mom filming the whole performance, grinning ear to ear.
Winner of Chunkiest Tune goes to Kousefly for their performance of I am the Walrus.
The Longest Guitar Tuning Ever award goes to David Bowers who apparently had a tuner failure and took, like, forever tuning his guitar by ear. It was a nightmare moment for him -- as he put it, like one in which he finds himself onstage, naked. Anastacia, who dueted two songs with David, killed time by telling jokes. "What does the snail riding on the turtle's back say? Whee!"

The little kids loved it.

Mrs Elliott worked super hard. She got me, all the silent auction baskets, and several dozen cookies she'd baked to the gig. In a heavy downpour. She looked cute onstage. She got us home. And withing a half hour, was sound asleep on the couch.

Today is her rest day.

Monday, June 8, 2009

A Pain-Free Operation Morally Wrong

According to this, anesthesia during surgery was considered "morally repugnant" in the 19th and early 20th century.
"Before 1846, the vast majority of religious and medical opinion held that pain was inseparable from sensation in general, and thus from life itself. Though the idea of pain as necessary may seem primitive and brutal to us today, it lingers in certain corners of healthcare, such as obstetrics and childbirth, where epidurals and caesarean sections still carry the taint of moral opprobrium."
I had no idea.

Much More Pain, as Promised

Yep, with the removal of the Pain Pump on Sunday morning, the formerly-blocked nerves have cheerfully returned to their regular duty of relaying pain messages from my leg and ankle to my brain. And they have a lot of traffic, apparently.

Last night was very, very uncomfortable. I didn't get a lot of restful sleep, and Mrs Elliott's sleep was also disturbed second-hand by my groaning and moaning and struggling to get comfortable.

We're trying to figure out the right timing for the pain meds to minimize the aches and stabbing pains. Feels like my freakin' ankle is in a bench vise.

Dr Askew has written new prescriptions for painkillers, at lower dosages than the last. The goal here is to keep the pain level tolerable while reducing the risk of dependency.

Tonight should be marginally better than last night. And so it should go: a little less pain that the previous day until the pain becomes a vague, nearly forgotten memory.

Until then: whimper, whine.

Sunday, June 7, 2009

Winner of Best Wife announced

Mrs Elliott won Best Wife category this morning, by
  • Pulling eight inches of the infusion line for the now-empty Pain Pump out of the back of my knee, this despite being totally queasy about blood and stuff (amateur video showing it being done here - warning: gross),
  • Helping me wrap and tape my leg and its dressings into a plastic garbage bag so I could take a shower -- my first since last Tuesday, the day before my ankle surgery,
  • Changing the sheets on our bed while I was in the shower,
  • Giving me love and kisses and wifely affection after the shower,
  • Vacuuming the bedroom -- singing the whole time -- while I was dressing, and
  • Making a great breakfast for the two of us.
When I described to her everything she did for me this morning, she said, "You're right - I'd want me for a wife!"

We Were Told There Would Be Balloons

I got a "day out" yesterday. Mrs Elliott rented a wheelchair with a leg lift for me from Norco Medical (and Welding) Supplies in Bend. I don't know how medical and welding supplies make sense together as two halves of a business -- large metal bottle of gases? -- but it's not as oddly disquieting as "Sickroom and Party Supplies" businesses.

Being as it was my first day out after the surgery, we went over to the Old Mill for the Balloons over Bend event Something cheap, cheerful, and festive seemed called for.

There were the usual booths selling tchotchkies, treen, and outdoor events foods. I bought a couple of tie-dyed t-shirts from the two Burns kids who own the We Dyed For You booth.

But there were no balloons. Not in the morning (we can see the Old Mill area from our house), not while we were there, not in the evening.

I've never taken a balloon flight and don't quite get the attraction; I've seen the brochures and what I gather is that you go up, you drink wine, you go down.

Yet balloons are festive, and it's fun to see them up, so I'm sorry they didn't fly.

Even without them, though, it was a pleasure to get out -- even if I had to be pushed about in a wheelchair. Little kids eye wheelchairs with great curiosity.

Friday, June 5, 2009

There Will Be Pain

The PainPump went dry sometime in the night.

The PainPump "...is designed to deliver medication directly to the surgical wound site or in close proximity to the nerves associated with the surgical area for post-operative pain management. The pain pump infuses the medication at an hourly flow rate or combination of an hourly flow rate and controlled bolus doses."

It was expected that it would be empty this morning, and I already had an appointment at Desert Orthopedics to get it refilled.

"Heck," I said over breakfast, "this thing has been empty since before I woke up at 5:30. I don't feel any pain from my ankle. Maybe I don't even need to get it refilled!"

"Let's go anyway," said Mrs Elliott, and handed me my crutches.

While I was gimping back to the examination room to get the pump refilled with another two-day's supply of meds, Mike Stahly, PA, said that it takes about 12 hours for the Pain Pump med to wear off and the pain block to be lifted.

Dashing my hope that the pain level wasn't going to be all that much.

This pump is only approved for four day's usage, beyond which the chance of infection goes up. So when it goes dry again on Sunday, I am to remove it and discard it. And sometime around Sunday evening, the nerves will begin sending their signals, unimpeded, to the brain.

"Will there be pain?" asked Mrs Elliott.

"Oohhh, yeah," he said.

Thursday, June 4, 2009

Sun, Rain, and Hulu: a Proper Recovery

In bed, watching a fine vintage It's Always Sunny in Philadelphia on hulu.com; outside the open sliding glass door the sound of rain falling onto the little deck outside our bedroom, while the sun shines and big puffy cumulus clouds drift across the sky. It's truly lovely.

Dr. Askew's office just called to check up on my recovery.

Cheese, crackers and an apple are at my bedside. Mrs Elliott is too good for me.

Surgery Goes Swimmingly, Pain Level Zero

Yesterday I had the ankle surgery at Bend Surgical Center. It went just swell. As I've written earlier, I've had plenty of orthopedic procedures done for broken bones:
  • Right ankle fracture, open reduction (which means that the doc cuts you open to try to get things to fit back together), 1980
  • Right hip fracture, open reduction, got a giant lag bolt in there, 1980
  • Left knee broken at top of tibia and bottom of femur -- "floating knee" it's called. First open reduction January 1980, didn't heal (no union), second open reduction August 1980, that one took, but it eventually wore out with bone-on-bone, so:
  • Left knee total knee replacement with titanium wonder knee, 1998.
Now this -- the old ankle finally wore out.

As mentioned in previous posts, I first saw a Dr. Holmboe who suggested an ankle fusion, or for a possible temporary fix, a cortisone injection, which I elected to take because Mrs Elliott and I had a vacation in Spain at the end of May. His plan for the ankle surgery was three night in the ho$pital, six weeks in a cast, then another six or so weeks crutching about with physical therapy (PT), while the ankle strengthened.

But his bedside manner sucked, and his staff wasn't real friendly. The ankle blew out seven days after the injection and I was in a wheelchair for our vacation. The pain was intense and needed to take more pain meds than was safe just to keep from slashing my wrists.

When we got back from Spain we saw another recommended ankle doctor, Dr. Askew, who totally blew us away with his helpful, interested, and open manner, his friendly (and good-looking) staff (even Mike, his nurse practitioner was good-looking and I'm not gay), and his plan: outpatient surgery, a "PainPump" box for five days t0 block pain from the femoral nerve (which carries most of the pain), my ankle fixed with a boot for six weeks to immobilize it, and then the usual crutching stuff with PT.

Hospital stays are super-expensive, outpatient surgery is much less expensive.

So we elected to get surgerized by Askew. It was a no-brainer.

As the title to this post says, it went just fine. Into the center at 6:30, the usual paperwork (releases, agreement to pay, etc.) to sign, stripped down to undies with an open-back gown totally eliminating any sense of status or control, IV plugged in and saline drip started, ankle prepped, chat with anesthesiologist, rolled into surgery at 7:40, more interesting drug pushed into drip . . . then I woke up in the recovery room, teeth chattering from cold and low blood pressure. Warm blankies were draped over me, there was pain, pain meds given, pain pump turned on, and within a half hour (I think), Mrs Elliott was helping me into the car and I was pain-free.

I've been totally pain-free since. This little pain pump really works, and I gotta say that after nearly four weeks of make-a-grown-man-cry ankle pain and massive amounts of pain meds, being pain-free and off heavy medication is a wonderful thing.

I've got long haul ahead of me, and I expect I'll grow bored writing about my healing as it becomes part of the daily routine. It will be a while before I'm out and about, a while before Jack can go back out on the town, but we work with the cards we are dealt. I can continue my work since I work out of the house.

Dr. Askew -- recommended.

[Gory details follow in layman terms. If you're the queasy type then you've read as far as you need to. Skip the next paragraph]

So what Askew and team did to fuse this ankle is go into it arthroscopically and rough up the edges and surfaces of the joint bones with a Dremel-like tool, and modify the bones as needed for a good fit with the ankle adjusted to where it's meant to go. Then they cut a chunk of bone out of my right knee -- one of the bony protrusions that don't really do anything for a living -- and grind it up in a food processor to make a nice paste filled with happy little bone cells just itching to grow into strong bone, then packed that paste into and around the joint. Then a couple of deck screws (square drive? Torx? I forgot to ask) were run down through my leg bone, one through the fibula and one through the tibia to affix the ankle bone to the leg bones. The combination of rough-up edges and eager little bone cells fools the body into thinking that I've got a fracture that needs healing and tells them to get to work. The screws keep things together so the bone union process has a chance to glue everything nice and tight. Such procedures work about 95% of the time. There's a 5% chance that the ends don't form a union -- that happened with my left knee in 1980. In that case, they'll zap the joint with electricity and use other magic methods to try to activate the growth process. But 95% is pretty good odds.

Tuesday, June 2, 2009

Going Under the Knife

I have been focusing on my ankle problem for nearly a month now, for good reason: it's horribly painful. And crutches are a poor form of locomotion.

Mrs Elliott and I saw another orthopedist yesterday: Dr. Aaron Askew of Desert Orthopedics. Askew got an emphatic recommendation by Dr. Biggler, MD, at High Lakes Health Care. Desert Orthopedics is an Official Medical Provider to the US Ski & Snowboard Teams. Which puts them pretty much at the cutting edge of medical paste-em-up technology.

Askew does ankles and feet and that's about it.

We liked him a lot.

He'll be doing my ankle arthroscopically, using a Dremel tool to roughen up the bone surfaces to make the bones think they are broken; re-shaping them for straighter alignment (the 1980 open reduction left my ankle pretty crooked; packing in magic healing pixie dust to help the bones fuse (actually he'll be using ground up bone taken from my right knee (ground up bone is packed with baby bone cells that are just itching to grow into new bone); and running a couple of stainless steel deck screws down through my tibia and fibula to clamp everything together.

It will be outpatient surgery, not three nights in the ho$pital like a certain other doctor whose name I will not mention here though it starts with an "H" and who has been mentioned previously, and whose cold "it sucks to be you" bedside manner totally annoyed me.

The plan then is to send me home with little drug pump gadget plugged into my leg which works like an epidural block, keeping a nerve center behind my knee infused with a numbing agent on a timed basis. It also has this cool "I hurt now" button for an extra jolt of numbing goodness. This pump is good for four days. I'll have on an ankle-support boot to spend a couple days in bed followed by 6 to 8 weeks on crutches, then on to physical therapy.

I like this plan a lot more. I've been in casts before. I don't recommend it.

Askew sent me home with a different kind of painkiller, Lyrica, which works just peachy, and a topical anti-inflammatory gel for my ankle. It's called Voltaren.

(I forgot to ask if it was the best of all possible gels.

Candide? Voltaire?

Forget it. If you have to explain a joke, it's not funny.)

So I'm going under the knife tomorrow morning at 7:30 am. I'm not looking forward to it, I've had plenty of surgeries. They are never as much fun as one would hope.
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