Ankle Update 20240513

I saw the orthopedic surgeon this morning and there is potential bad news. It is difficult to see but it appears that I am losing bone from the tip of one of the screws in my foot. I made a composite of photos I took of x-rays.

There is definitely more bone in the April picture and just a shadow from this morning. The surgeon wants me to get a CT scan for a clearer image. He also went to consult with the other foot/ankle surgeon in his office, and both are uncertain what it could be. He did suggest Charcot Foot, which would fit since I am diabetic, but why so much change in three weeks? I was told to stop physical therapy until after he sees the CT scan.

If the bone is indeed deteriorating, one solution is to remove the bottom screw from my foot. We need to make sure that the ankle is properly fused to the metal rod. That would require another surgery, but it would be relatively minor and require much less recovery. Still sucks though.

Ankle Update 20240505

*https://www.cabrini.edu/blog/2020-2021-blogs/a-closer-look-at-cinco-de-mayo*

Happy Cinco de Mayo!

I have three weeks of physical therapy left. My therapist went on vacation this week, so another therapist helped me with massages and workout. I do feel there have been major improvements over the past five weeks, but it still bothers me a lot to walk. I can walk without a visible limp, but pain comes pretty quickly to my heel. Therapist said I need to put more weight on the front of my foot when I walk.

Unfortunately, the ankle seems to be permanently swollen. The surgeon said the swelling is normal, but for how long?

Ankle Update 20240427

This is the lates x-ray image from April 22nd. My primary surgeon said it looked fine. Initially he wanted me to keep wearing the walking boot after I told him my physical therapist said not to wear it. However, he changed his mind and gave me an ankle wrap. It is a lot less bulky, and I feel it does help support my bad ankle a lot.

After four weeks of physical therapy, I can definitely feel more flexibility in my ankle, but overall movement will be very limited since the entire joint is fused. I can walk further than before, but there is still soreness in the ankle and calf muscle, and some pain and numbness in the heel. I am still wearing a travel compression sock on my right foot and using a special pillow to raise my lower leg when sleeping. I have four more weeks of physical therapy left. I hope I can walk longer distances without pain and without crutches.

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I do think the surgery has aggravated my peripheral neuropathy. I am experiencing much more pain when I lie down, especially if I sleep on my side. I have finished all the Norco prescribed during the ankle surgery, and I find that the oxycodone does not have any effect, even though it is supposed to be a more potent painkiller. Luckily, I found a vial of Norco prescribed to my mom back in 2020. It has long since expired, but they are still able to dull the neuropathy pain. Since I do not have a current prescription, I am using it sparingly on the most intense nerve pain attacks. I should ask my endocrinologist for a refill since she offered to prescribe me gabapentin previously.

Pacific Crest National Scenic Trail

*https://www.pcta.org/discover-the-trail/maps/overview-maps/*

The Pacific Crest Trail is a 2,661 mile trail that stretches from Mexico to Canada, and goes through the states of California, Oregon, and Washington. My sister and friends started hiking this trail last year, and they are hiking this weekend as well. I believe they started at Warner Springs yesterday morning and they will hike until Monday noon. Here is their progress so far:

I am tasked with picking them up Monday from a random dirt lot near the junction of highways 74 and 371, very near Paradise Valley Cafe, next to the town of Anza. I will have to charge up my car fully and drive four hours round trip. I think my Model X has enough range for this.

The Pacific Crest Trail is part of the national trail system. Here is a map of all the hiking trails.

*https://www.pcta.org/our-work/national-trails-system/*

Worst Neuropathy Pain Ever? (updated)

I have wondered how it would feel if I got a really bad neuropathy pain attack while wearing a cast? Luckily, even though I did experience a few attacks while wearing a cast, none were too bad.

Well, one of the worst attacks just started about twenty minutes ago. Unfortunately, the location is in my right foot, near the top of my inner sole. The pain level is probably nine on that pain scale. It is at the “involuntary screaming” level, and I have experienced that a few times before. However, in the past, my entire lower leg was not swollen and sore from physical therapy. I tried using a percussive massage on the location and of course, I can barely feel the massager. Even worse, the pain attacks are coming in fast, sometimes every ten seconds. I already took an oxycodone pill, and it is not helping at all. Other than lying down and screaming several times a minute, I do not know what else to do.

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So, it has been almost three hours and I have not been able to sleep. The oxycodone pill did nothing for the pain; I think it has gotten worse. Additionally, another two locations on my right foot are starting to experience pain.

What is worse than super painful neuropathy? Super painful neuropathy in three locations.

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I have tried to massage the pain spot so much that I have broken the skin, and I am now bleeding. The wound is pretty small, but I still had to put a bandage on it. The pain intensity has not decreased in the past four hours.

Fuck.

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In the past, sometimes I would shake 0r swing my lower leg vigorously, and that would alleviate some of the pain. I think it gets more blood into my lower leg and foot, though I am unsure why that helps. Today, when I tried to do the same thing, my lower leg and ankle would swell up due to my ankle injury. My entire foot is numb now from the constant nerve pain. I am still unable to sleep or even feel tired. I also do not know how long I have to wait before taking more painkillers. In addition to the worst neuropathy pain ever, I may get addicted to opiates too.

Fuck. Fuck.

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My right calf is so swollen and sore right now.

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Updated: Saturday, April 20th, 2024

I ended up falling asleep around 3:00 am Tuesday and woke up at 6:00 am. The pain was still there but more muted. Throughout the week, I would get occasional flare ups at the same spot, which has not happened. This evening, six days later, the pain came back in the same spot, though around a six or seven on the pain scale. I had finished taking all the Norco I was prescribed for my ankle operation, so I tried taking 5 mg of Oxycodone. Even though it is supposed to be stronger than Norco, I really do not feel any difference in pain afterwards. Maybe I need to take Tylenol at the same time? It has been two hours since I took the pill, and again, I cannot sleep. At least the pain is not as bad as Monday’s attack.

Ankle Update 20240415

Happy Tax Day! Today is also my first day back to work after taking a twelve-week medical leave for my broken ankle.

After two weeks of physical therapy, my ankle is still very swollen. My physical therapist has been adding weight and new exercises each time I go into the clinic/gym. I can walk short distances normally. but the ankle swells quickly and becomes quite sore. I am still not wearing the walking boot, but I am carrying my crutches in my car.

I have an appointment with my orthopedic surgeon on April 22. That will be after three weeks of physical therapy so hopefully everything is on track.

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I bought a lot of travel compression socks while I was on dialysis and I am wearing them again, if only just on my right foot. I feel it does help keep the swelling down, and give some support when I walk around slowly.

Supplemental Short-Term Disability

I may have mentioned this before, since I have been on disability and medical leave so many times. Our company provides some supplemental benefits via The Hartford insurance company. My understanding is that the benefit is two-thirds of weekly salary, up to a $1,600 maximum. The maximum is also affected by what I receive from the State of California for short-term disability. Previously, California provided up to $1,357 per week so I received several hundred dollars per week. However, the state cap is now $1,620 per week so even though I filed a claim with The Harford, I pretty much ignored the process after finding out the maximum benefit was less than what the state offered.

Today, I received a call from The Hartford asking to confirm my disability end date. I provided it but asked why it mattered. The customer service representative (CRS) said I should have received some checks. While she was still on the phone, I checked all the unopened mail and found about $450 in checks. Strange. I looked at the statement closely and discovered that there is a minimum benefit of $50 per week. Even though I was paid more than the maximum benefit, the minimum benefit must still apply. It is not a lot of money, but it is better than $0.

Ankle Update 20240404

I started physical therapy this past Monday, which is April Fool’s Day. The clinic signed me up for three sessions per week for eight weeks. I hope it does not last that long.

During yesterday’s session (#2), the therapist told me to not wear the walking boot next time, and to put more weight on my right ankle. Each session so far has consisted of a calf massage, a foot/ankle massage, and several exercises, usually three sets of ten repetitions on each leg. After each session, my right lower leg and ankle would swell a lot. I think that is normal since physical therapy works the non-fused bones and muscles. Both my legs and my right ankle are quite sore. Due to neuropathy however, I do not know if I am putting too much weight, or if the exercises are too intense.

The Worst Neuropathy Pain Ever

I had the worst neuropathy pain I ever felt during the last hour. My physical therapist told me to not use the walking boot anymore, and just wear regular shoes on my right foot. After the session, my ankle was pretty swollen, but it felt okay. However, when I tried to go to sleep earlier, about four to five attack pointes appeared on each foot. For almost an hour, I was in constant neuropathy pain; it was about level seven or eight on the pain scale. I was about to get out the oxycodone I received for surgery pain.

Since then, the pain has subsided. Both my feet are still sore and numb, and there are still attacks but more spread out. I also skipped dinner so I will probably eat a snack, and reconsider if I need to take the narcotic painkiller still.

Weight Update 20240326

I was finally able to update the weight goal in Omada, so I am setting a new goal of 200 lbs. I have been home for about six weeks and have been able to maintain my weight despite doing zero exercise. I am glad I was able to lose thirty lbs. over the past 9 months; life with crutches would be much harder with the extra weight.

I have not used any other features in the Omada app. I will try to start tracking food and drinks to see if it is beneficial.

Ankle Update 20240325

I went to see my orthopedic surgeon today. Even though I got a CT scan last week, he took more x-rays today. The good news is that I did not damage my ankle by falling off my knee scooter last week. From the CT scan, he said I am about 60% to 70% healed. That is good enough to schedule physical therapy next week, and I can start putting weight on my ankle, but only up to 50% of my weight. Not sure how I am supposed to know that.

I asked my church friend, the other foot/ankle surgeon in the same practice, for recommendations and he suggested this place:

I will need to go two to three times a week for six to eight weeks. This is going to suck.

Ankle Update 20240324

I feel like such an idiot. I get that feeling a lot now that I am old, but this was really stupid. I sometimes get sweaty under the cast, and it is a terrible feeling. With the boot, I am able to take it off for showers and sleep. Last Tuesday, after returning from an eye doctor’s appointment, I took off the boot to cool off my leg. I then managed to fall off my knee scooter and banged up my right leg. My knee scooter is cheap and comes with hard plastic tires. On that day, I ran over a small rug and the scooter came to an abrupt stop. My body kept moving so I slid off the scooter “seat” and onto the hardwood floor. I managed to skin my knee again, but also banged my toes hard.

Re-injuring my knee really sucked since I kneel all the time on scooters, walkers, and also climb stairs. Worse, I think I did some damage to the ankle because it seems more swollen than before. I wrote a message to my orthopedic surgeon asking for advice. Since I managed to schedule a CT scan of my ankle the same day, I am going into his office tomorrow. The CT scan was ordered before my fall so he can see clearly how well my ankle has healed. I am hoping that my fall did not do anything to my ankle, and I can start physical therapy as soon as possible.

Ankle Update 20240317

I have good news and bad news.

The good news is that I do not have a cast anymore. My orthopedic surgeon agreed to switch me to a boot instead of giving me another cast. This means I can take it off to sleep or to take a shower. I took a shower yesterday, the first one in almost three months. Since we have a shower chair in the house, I used it to be extra safe.

The bad news is I am no allowed to put weight on my foot yet. The surgeon said the X-rays look good, but he wants to be 100% sure. There is too much metal in my ankle so he ordered a CT scan of my ankle to make sure it is fully healed. My next appointment is April 1st so I will still be using crutches until then.

I did take the boot off to try driving. Even though I cannot move my ankle, the remaining flexibility in my foot allowed me to drive easily. It is definitely easier than using my left foot to drive. Also, since the boot is much larger than a cast, there is a lot less room in the car footwell if I keep the boot on while driving.

As for physical therapy, I will find out more after I am approved to put weight on my right foot. My lower right leg is definitely a lot thinner than my left leg. I also scrubbed my leg and put on a lot of lotion to try and get rid of the dry skin.

Ankle Update 20240328

I have got good news and bad news. The good news is that everything still looks fine, and my ankle is healing well. The bad news is that the ankle is not at 100% so I will need to keep wearing a cast, at least for another two weeks. I was hoping that I would be able to switch to a walking boot today, but the surgeon said we would do so during the next appointment. They did replace the cast today:

Ugh, that looks horrible. The skin is very dry and flaking off my leg. They did wipe my leg down with alcohol, but I am sure my skin has dried out again. At this point, I did not care about the cast color, so they gave me a blue one again. The next appointment is in sixteen days instead of twenty-one, so I saved myself five days of misery.

On the way out of the office, the elevator broke. Since the office was on the second floor, and there was only one elevator, we had to wait for the elevator repair person. Soon, there was a line of people on crutches, walkers, and wheelchairs waiting to go up and down. The office had no choice but to call the fire department, and they came within ten minutes. I was the first patient in line, so they put me in a chair/dolly and rolled me down two long flights of stairs like a refrigerator being moved.

The new cast. I asked for more room at the bottom so I can wash my toes easier, and Larry (the cast guy) also put more padding at the top since I told him I was climbing stairs on my knees.

Ankle Update 20240223

There is really nothing to update. I mentioned before that there was a three period between the last appointment on February 7th and the next appointment on February 28th. Well, despite thinking I would never survive the three weeks without a nervous breakdown, I only have five days to go. I am hoping that my ankle is healed enough to switch from a cast to a walking boot. Even if I need a few more weeks of healing, I want to ask the surgeon for a boot, and I can continue to keep the weight off my right leg. That would allow me to take the boot occasionally to put on lotion and scratch itches.

As for living at home alone, I have gotten a lot better at climbing the stairs on my knees. Two weeks ago, I had to rest on each landing on the staircase because I was exhausted. Now, I can climb up non-stop and hardly break a sweat. I still try to minimize the number of times I need to go up and down, but it is no longer an issue. I also have lots of food with the recent Factor 75 prepped meal delivery, and the remaining Costco family meals.

The amount of work I have to do has dropped off even more. I still offer to help, but I only “worked” for four hours the past two weeks. Due to being on medical leave, it is all unpaid except for disability, but I am okay with helping.

Ankle Update 20230212

It has been only five days since my last update, but since I am now at home instead of my sister’s house, I thought I would share the experience so far.

Living solo at home with a non-weight bearing cast has been more difficult than I expected. I have plenty of equipment, with a knee scooter (thanks Doug) and a (cheap) walker upstairs, and a fancy walker with a seat for the first floor.

Finally, in the garage, I have a pair of crutches, another knee scooter I bought, and a wheelchair. I get around okay, but going up the stairs several times a day is very tiring.

My routine starts in the morning. I have a stash of pre-made protein shakes upstairs and I usually drink one for breakfast. I try to avoid going downstairs until lunch. I would also bring down trash, empty containers, or dirty dishes, one step at a time. After lunch, I would climb upstairs, usually on my knees, and stay until dinner time. Then I would repeat the cycle, bringing up stuff one step at a time too. Of course, stuff comes up during the day, so I end up going downstairs more than just for lunch and dinner.

I expected that climbing stairs would be difficult, but making meals, even if just microwaving, has been taxing too. I did not think about how I would transport hot plates and bowls using one hand since I still needed to steer and hold on to the chair/walker. I used to eat upstairs before the surgery, but now I just eat in the kitchen nook. Even going to the dining room is too far and precarious.

The best scenario is the surgeon letting me use a boot instead of a cast after the next appointment. The appointment was schedule three weeks from last Wednesday and I already survived five/six days out of twenty-one.

New Insulin

Last week, I wrote about having a reaction to my Humalog injections. It turned out that the NP at my endocrinologist’s office prescribed me an alternative fast-acting insulin pen. However, she did not send a reply, so I only found out when my local pharmacy called me to pick it up.

The new medication uses the same pen and has the same active ingredient, but their website says it has additional ingredients when compared to Humalog. Lyumjev is supposed to work faster so I should inject when I start eating, instead of fifteen minutes beforehand. It feels like the medication is more “effective” since I am getting much more low blood sugar events than with Humalog. Unfortunately, I still have a lot of Humalog pens and cartridges so if I keep using Lyumjev, all the Humalog in my refrigerator will need to be tossed.

I am also getting a lot of low blood pressure events, like right now as I type. Is this related to using Lyumjev instead of Humalog?

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Ha! I totally forgot to discuss the reason I was prescribed Lyumjev. I am still getting the hot flashes or flushing, but it definitely feels less severe. There is also a big difference in temperature between the two floors of my house, so I need to test my “allergic” response more.

New Weight Loss

Since I was staying at my sister’s house post surgery, I was not able to weigh myself on the connected scale. I did so today and was somewhat surprised at the result. I did have a few people say that I have lost weight, but it is hard to tell if you are just looking at yourself in the mirror every day.

The first drop is from the SPR program, which I posted about several months ago. The recent drop is from the surgery and recovery. There are no datapoints in January, so the chart just interpolates a straight line. So, since this summer, I have lost about 20 pounds from the SPR diet and exercise program, and another 10 pounds from basically not eating much, or all the muscle loss in my right leg.

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Hmm. People cannot see my leg inside the cast. So, if they think I have lost weight, it should be from my face or upper body.

First Day Home

It has been miserable. I underestimated how hard it is to climb up and down the stairs on your knees. I end up winded and sweaty after each climb up. That is okay except that I am sweating inside the cast too, and it is really irritating my skin. The cast is tighter too so I need to keep elevating my leg. Otherwise, the gauze is pressed tight and further irritates my skin.

It is 5:18 am and I have not slept at all today. It has been an entire day of trying to set up my house for a non-mobile person and it is very difficult. Since my sister moved back everything I brought over to her house, including a mattress, I think it will be hard for me to move back. I guess I need to stick it out for the entire three weeks until the cast comes off again.

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I have already made a big misstep and almost fell. Unfortunately, in order to regain my balance, I had to step down pretty hard on my right foot. I know the surgeon said it was healing well but I do not know if my big step messed anything up. Also, since I am moving around a lot more, it is very hard not to put a bit of weight on my right ankle. I hope I did not trade familiarity of living at home for more weeks of recovery.

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My right knee is taking a beating. There is still a piece of scab left from my roller-skating accident, and it is quite thick. That means it hurts when I kneel on it. If it becomes too painful, then I will not be able to use the knee scooter too.

Ankle Update 20240207

Today is also my sister’s birthday.

I had my second follow-up appointment with the orthopedic surgeon today. After sawing off the cast, the surgeon said it look good healing-wise, and sent me off to get some x-rays.

I think they took four x-rays and it confirmed that my ankle is healing well. The surgeon even told me that I may switch to a walking boot during the next visit. I am not setting any expectations.

I got a nice new blue cast this time. The surgeon even got some alcohol pads and wiped down my lower right leg. It has been in a splint and cast forever so the skin was dry and probably stinky.

During the same appointment, I also brought up that my leave form has not been completed. The surgeon said he would take care of it and the entire mess was resolved later this afternoon. In addition, I was informed by our leave administrator that I would receive $1,620/week in short-term disability. That works out to $40.50/hour, which is a lot of money for me to sit around. Our work also provides supplemental short-term disability, but it caps at $1,600. Someone forgot to update the cap amount.

Right after the appointment, my sister-in-law packed all my stuff at their house and moved me back to my house. We had discussed this previously. If the prognosis was good, I would move home. I guess I did not think it would be within the hour. Oh well, I was going to get thrown out sooner or later, and I am fine with right now.