Monday, May 15, 2006

It is not clear when it exactly when it started, but in the spring of 06 I was having some soreness in my left ankle and on  a walk around Clayton, my ankle just gave out. It became swollen and I went in and had X-rays which showed some calcification, but no broken bones

Friday, June 16, 2006

We went to Justin’s Graduation at Evergreen State in Olympia Washington and then went on an auto trip through the Oregon Coast, Glacier National Park, Yellowstone National Park and then Linked up with our son Josh who was a National Park Ranger in the Grand Tetons. I had purchased good, strong hiking shoes, a stout walking stick and we scaled back some of our hiking plans, but we had a wonderful trip

Friday, December 1, 2006

During the fall and winter, I alternatively rested and used my ankle. During a trip in Nov/Dec to see Jess, my daughter in New York City, the normal rigor of walking in a big city was almost too much for me. Something had to be done so I engaged a personal trainer at the Center of Clayton and worked out with her 2-3 hours per week. The results were very promising in terms of strength, balance, endurance, etc.

Friday, June 1, 2007

One of the reasons that I had been so aggressive in the exercise is that Fran and I had decided to go on a trip of a lifetime to Israel. The trip brochure promised that we would follow the admonition of G_d to “walk this land from one end to the other.” Fran was noticing that things were getting worse, not better so off we went to our favorite podiatrist, Kurt Kaurfman, DPM, who immediately clinically made the diagnosis of a bad posterior tibular tendon. He prescribed a special brace for the ankle. Of course to get a shoe over the brace, I needed size 15 shoes and he also selected a boot and a tennis shoe that would give good support by themselves. I was the laggard of the group and it was so supportive of me that though the pain was significant at time, the whole experience was not to have been missed.

Wednesday, August 1, 2007

After returning from Israel, I was finally able to get both an untrasound and MRI of my ankle and it confirmed Kaufman’s diagnosis of a shot posterior tibular tendon - the estimate was that it was 80% gone. Kaufman had just recruited a new colleague who had just finished a rear foot surgery fellowship who felt that he could repair the damage with a tendon transfer procedure.

I decided to get a second opinion from the head of foot surgery for Orthopedics at WUSM, Jeff Johnson, MD, and during his examination he noted on the MRI that my anterior tibular tendon was missing - a fact which we had been missed by the reading radiologist! In any case I was impressed and scheduled the surgery for mid September.

Friday, August 10, 2007

Friday we went to services and I did not feel good, we had driven different cars and on the way home I started to get very sharp pain in my right (note my bad ankle was the left one) and all I could think of was the lecture on surgical risk of DVT! I was so tired, however, that I thankfully went to sleep. The next morning, Fran easily convinced me that I should go to the hospital and get an ultrasound and make sure it was not a DVT. Once I hit the ER it became clear that it was not a DVT, but rather cellulitis. Apparently the vector for the infection was that while wearing the oversize shoes, I developed a blister that had not healed and the weekend before we had celebrated our anniversary by going to a “dude farm” where there was a hot tub outside of our cabin.

This resulted in the first time that I had been hospitalized overnight in my entire life. IV antibiotics treated it well, but in my over eagerness to get back to work, I was not keeping my foot elevated and therefore the edema was not resolving and thus the cellulitis was not healing. I got strict orders from my doctor about keeping my leg elevated and my leg then healed and I began feeling well.

Friday, September 14, 2007

I went to see the surgeon 4 days before the scheduled surgery date and he was not real comfortable with doing the surgery with the recent infection history. He also was still having difficulty figuring out how to do the surgery in a single surgery, suggesting that doing two separate surgeries might be needed. But the biggest concern was that in his physical exam, he detected a peripheral neuropathy which, if confirmed would alter the post-surgical management of my case. Needless to say the surgery was postponed and a neurology consult scheduled.

Monday, December 3, 2007

I was referred to one of the most senior neurologists in the medical center who still conducts his practice the same way he has for many years - by conducting an extremely thorough history and physical which confirmed the orthopedist’s diagnosis of a peripheral neuropathy, but of unknown etiology. Subsequent nerve conduction tests simply confirmed the neuropathy without identifying a treatable source. One last idea was that celiac disease might lead to to neuropathy and an antibody test was ordered for that, which of course came back positive leading to the need of a small intestine biopsy.

Friday, December 14, 2007

Thankfully the prep is easier for an upper GI than a colonoscopy, but it still is the restful conscious sedation procedure which gives one a day of no driving. There was no evidence of celiac disease, but several small ulcers were noted, probably the result of chronically taking Naproxen for my arthritis and Ibuprofen for headaches, so now I have to have Nexium added to my daily medications.

Tuesday, January 15, 2008

Finally we have a surgery data and all looks good. Come in as the first case of the day, get all of the preop preparations done and off to the OR I go. The surgery goes for 6.5 hours and appears to go well. They used a cadaver tendon once they locate where my anterior tibular tendon was lost up my leg, lengthened my Achilles tendon, did a number of other tendon transfers to try and shore up the ankle. The bones needed to be fused together and they also harvested bone from my left hip and more bone from the bone bank to create an environment where it will all grow back together. This now starts a period of 3 months or so where I cannot put any weight on the left ankle. I woke up in my room on 4900 and the next day, once I was able to pee, I went home.

Friday, January 25, 2008

The first 10 days were essentially 24*7 bed-rest with my feet elevated at all times and with Fran being my angel to take care of my every need. I used crutches to go to the bathroom across the hall when necessary and a urinal at the bedside when that would work. Bed baths were divine!

When I went in for my first post-op visit at 10 days I looked very carefully at the 5 incisions on my ankle since I had been reading a lot of the surgical site infection literature recently but they were all very clean. Got a new blue cast and permission to be more mobile- primarily using my Weil Knee Walker.

Thursday, February 14, 2008

I slowly built up confidence over the next several weeks. I could use the crutches to get around the house - either to go into my office or the playroom. I could use my crutches to go out to the car by myself and since the cast was on my left ankle, I could drive myself anywhere. Once there I was able to get my knee walker of of the back of the car, get it assembled and zoom off to a store, or more importantly to my office. Apart from a couple of days where the elevator in the underground parking garage stopped working, life was great. I could get to meetings from one end of the campus to the next and be a conversation piece for everyone concerned. It was nice to feel like I was getting connected back into the life of the medical center.

Friday, February 15, 2008

I was doing so well that I went over to Shriner’s where most of the Biostat facilities are for a reception for the certificate in the GEMS program. It was good to see many folks and I headed off to return to my office going the outside route. Unfortunately, when I went down a curb cut, I hit an indention in the road and was catapulted over the handlebars of the knee walker and hit my head on the pavement. I had a big bruise on my head, but I went directly to the garage and foolishly drove home. My son Josh, the EMT directed me to go back to the ER - I did have health insurance, after all.

The Barnes-Jewish ER is a 62-bed facility which is always busy, but a weekend evening is worse. I got in quickly and they started taking care of me, but were ignoring my facial wound and more concerned about my neck. After a CAT scan to rule out brain damage and a regular x-ray of my neck, they were still not sure what was going on, but had immobilized my neck through all the transfers from stretcher to x-ray table and back. Of course there was great competition for access to staff and equipment with all of the trauma and other events coming in. Finally they decided that I needed to have a CAT scan of my neck and when that was finally read, it revealed a crack in C2 - I had done what every mother has warned her son about - I had broken my neck! Now a C1-C2 break is very high and if there is neurological damage - it is extensive - think of  Christopher Reeve. It was now very early in the morning, it was clear that they were going to admit me and I sent Fran, my every present partner home to try and get some sleep.

Saturday, February 16, 2008

In the morning, I met the rest of the neurosurgical team headed by Eric Leuthardt, MD, who verified that there was no evidence of any neurological damage. I had two choices - they could fit me with a halo-collar to stabilize my neck and hope that over a 2-3 month period that my neck would heal ok. The probability of an acceptable heal were quoted as being above 70%. The alternative was to operate on my spine and to use screws and posts to stabilize C1 & C2 together. If I had the surgery, and  all went well, then I would “only” have to wear a Miami J collar while it healed. I quickly opted for the surgery and they worked at trying to find a slot in the OR schedule when they could do the surgery - probably Tuesday or Wednesday.

It quickly dawned on me that the floor  where I was hospitalized (10500) was the same floor that Amanda Feeler had worked on - now Amanda had been my daughter Jessica’s best friend since kindergarden. Sure enough, my first hospital visitor was Amanda with both a wonderful flowers and some candy! She was very reassuring about my neurosurgeon and although she no longer works there, was very calming.

Monday, February 18, 2008

There was a cancellation of a surgery scheduled for Monday, so I lucked out and got to be the first case. Had a great discussion with the anesthesiologist who wants me to work on some of his data!  The surgery went for 4.5 hours and from all indications went well. Going through surgery is, for me, easy - I sleep through it all and wake up and it is all over! Not so easy for those like Fran who have to wait for it, worrying about all of the things that could go wrong. None of the rare, but serious complications happened and I was back in my room by early evening. A long day for the surgeon, however, as it was 2330 before he came around to my room to make sure everything was still fine.

Thursday, February 21, 2008

My left knee started swelling, getting red and getting really sore. This got some real attention from the doctors and the orthopedic folks came over and extracted about 65 cc of fluid from my knee and scheduled me for emergency surgery in case it was infected. By the time I got down to the preop area and they were getting me ready for another surgery, the lab results came back and it was gout, with no infection. I have never previously had a diagnosis of gout, and of course it usually presents in the big toe. We started some medication and it seemed to be getting better. Thankfully, my primary care physician, Mary Kiehl MD, is a rheumatologist, so she knows all about it its treatment. She explained that gout can occur after surgery, apparently as a result of some of the fluid imbalances that occur. Subsequently ultrasound exam of my legs also revealed that I had DVT in both legs, but seemed confined to below my knee.

Friday, February 22, 2008

Next my right ankle started getting sore and red. Again, they removed fluid, we started for the OR but thankfully again, no infection, but gout again. I am now not in great shape since I need my right ankle and left knee to work to make it around on crutches. Everyone is worried about how I will get home and navigate all of the stairs in our house. Not only have I been in bed for a week, the gout is going after the joints I need for crutch navigation.

Monday, February 25, 2008

Given the concern about how well I could navigate stairs with crutches at home, the decision was made to transfer to the Rehabilitation Institute of St. Louis, a separate institution on our medical school campus. The have a whole inpatient floor for folks with spinal cord injuries and similar orthopedic problems. While here I got at least 2 OT and 2 PT sessions a day as well as standard acute nursing facilities. The therapists were great and while here I made substantial progress on the crutches and while everyone was nervous while I was on crutches, especially on stairs, it has gotten progressively better each day. I also did a lot of leg exercises to try and recover some of the loss of strength which I suffered while in the hospital for the spine surgery and then the gout episode. They also arranged for an electric wheel chair for me to use while at work and a manual chair just does not work going from one end of campus to the other and back again frequently, especially with the concern about using the shoulder muscles which are connected to my neck.

Saturday, March 1, 2008

On Saturday I was released. Fran came to pick me up and we went to fill the discharge prescriptions and then went to our synagog for special services and lunch. Seeing all of my friends and being welcomed back was inspiring and in mid afternoon we actually arrived home to be greeted by all of our 4-footed housemates. It was great to be home, to have home cooked food (some brought by friends) and sleep in my own bed! On Monday, I went into the office and had the electric wheelchair delivered so I could actually make it across campus for a meeting.

I feel good, if somewhat tired and need to plan ahead a great deal when going from one place to another, but am on the road to recovery.