February. Waiting for the other shoe

So it’s February.  I admit, we have had winter weather blow down from the North and I’m really not enjoying it that much.  it’s in the low 40’s with a wind chill… The odd science Americans use in February to predict the weather lied!

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We have had a few 80 degree days which I’ve really enjoyed.

Honestly the end of January and the beginning of February… has been crazy. All sorts of good things have been happening and thus..I’m starting to think that the other shoe is about to drop. I did actually have to investigate exactly where that idiom came from…  I wasn’t entirely satisfied with the origin of the idiom, but it makes sense.

Given my life in the past couple of years, I kind of expect…

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So..

In late January I was notified that I was one of the lucky selected to attend a training class for the National Healthcare Safety Network, at the CDC.  I spend a lot of time engrossed with the NHSN definitions of health care acquired infections, or affectionately known by most infection preventionists as simply, “The Criteria”

NHSN is extremely frustrating in one way- you can not phone them at all, ever, about anything.  You can not email a particular person with a question, and you don’t really know what it is that goes on up in Atlanta.  If one has a question they must send it to a generic mailbox and hope that someone answers the question by email.  As you might imagine this can be kind of frustrating.  I usually get answers from them, but many many of my work colleagues have either heard no reply or have gotten “The Criteria” cut and pasted into an email.  Since Value Based Purchasing  is based heavily on the data provided by use of the criteria, it’s CRITICAL that IP’s understand how to apply the definitions – so not being able to ever talk to someone on a phone is difficult.

So, the opportunity to physically be at the CDC, learn more and discuss “the criteria” in great detail with other Infection Preventionists was very appealing to me. In addition it is AT the CDC physically, so that is super duper cool… I see they have a new exhibit up at the museum abut “Defeating Ebola” I can’t wait to see it, although it is my personal opinion that while the CDC may have done fantastic work in West Africa they did a horrendous job communicating and working with hospitals across the USA. It’s been a while since I traveled for work, and I know Ill make some great connections and friendships.  Deep down I keep hoping someone will slip me a REAL email address…or phone number.

SO Woot woot!  Atlanta Here I Come!!!!  I admit, I was slightly less enthused when I realized how cold Atlanta is compared to Florida.  I need to obtain a winter coat.

Secondly, my faithful 3 readers will recall that we have gotten a new Director at the job.  She is a firebrand. She is also, however, an overwhelmed firebrand. It would seem that they dropped so much on her that she is just running here there and everywhere.  I like her, she’s demonstrated the ability to rapidly and correctly assess situations, work with difficult personalities, show compassion and kindness, and provide support.  I had not had much interaction with her prior to my surgery, but in the past two weeks I’ve to do a lot of projects with her. I completed an analysis of one lab test that we thought was being overused. It was a huge pain.  After this I started doing observations in the OR for one of the service lines.  These types of observations are kind of tough because I sit in on cases and sometimes make people nervous.  Then, I make recommendations, which tend to upset staff, management etc.  There has been a lot of finger pointing and  I never like making recommendations because it requires some deep political finesse to get everyone to want to change things, without having them think they were being accused. My Director has several times now praised me in public and is helping me make it through those political nightmares.  It has made me feel enthusiastic to actually get up and go to work again.  I almost feel out of my chair one day because she called me Passionate about Infection Prevention….You’ll remember at my old job...So, this is good, but of course, since I am in a touchy area- the OR- I am expecting something or someone to complain.  Still it feels good to be doing good work, getting feedback that it is good, and contributing.

Thirdly- my SPINE.  I saw my Doctor in follow up a week ago.  I was actually feeling very depressed because I had had a few pain free weeks and then BAM! I had started to have very intense hip/calf and foot pain.  My X-rays look great, and he spent a great deal of time telling me that most likely I would improve over time and that the waxing and waning of symptoms was typical.  He cleared me to get a deep tissue massage, and PT which I scheduled right away. I was concerned about the massage, but it seems it really was the key.  I chose Mona the marvelous. She has so much experience, and given that I still feel freshly operated on, I didn’t want just anyone… She did a pretty short massage, and I walked out pain free.  In fact, the next day I noted that my pain in my calf was reduced and the sensation was increased to that area.  Had not really had any problems with pain since.  I’ll see her in two weeks.  I start PT on Monday and I’m looking forward to getting stronger.  I have so much more energy since I’m not in constant pain, and I am finding even the difficulties of standing for 8 hours in an OR…are not really that bad.

SO… I’m just waiting for a complaint from someone who matters, or a some other thing to come rain on my parade…don__t_rain_on_my_parade_by_kiku_chan13-d4juia4.jpg

 

 

 

Checking in…

The Resolutions!

Eating is going along OK. I am struggling with my love of Pizza during College Basketball season.  Yes.. I know these kids are really not exactly students who like to play ball, but you know.. I love it anyway.

I’m consistently making better breakfast and lunch choices, but dinner…well…I am getting there.  My Oven gets repaired next weekend so I am pretty excited about that. I will then be able to broil fish and make meat balls again…

Money:  I took a quick re look at all my automated deposits and upped the IRA one.  I have a ROTH, and I have yet to contribute the full amount allowed by law.  Each year I come up with about half.  I also dropped by the bank and did a transfer direct into savings.  My bank, in order to apparently comply with some money laundering laws, limits on line transfers.  Prior to the limit, I used to go in to the online account and transfer money will nilly.  It helped me to save a lot as once my money gets into a savings account I tend to forget about it.  Now, I have to remember to go to the ATM and do it…inconvenient, and I’m never going to just pop by there to transfer 15.00.

Volunteering: I finally signed up with “Hands on Orlando” which looks like it has some activities that I can do.  Packing hygiene kits for our sizable homeless population, and sorting donations of blankets and stuff.  I was kind of torn when they asked “Are you disabled”  No, I am not disabled, but I really can’t be lifting 50 pound boxes either. I checked no, and we will see.  I don’t see anything for dates that I can do in February yet, but I hope to get some friends to join me!

SPINE/EXERCISE

I am making progress.  The slowest progress ever.  I really understand why people dislike going to the gym.  When you ‘re out of shape, it really sucks. 10 minutes on the elliptical is like an eternity.

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And the WORST part of this, is KNOWING how bad I suck at everything.  The humiliation continues in that it is January, I feel like a January-ist…

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That said. I am working at things.  My radiculopathy is still kind of nutty.  Comes and goes, but it is staying away longer, and I can do more without firing it up.  I’m starting to feel some endurance.    I do feel like I will be able to run races again. I’m still pondering what about running… What will it mean to me?   How will it be?  Will I be able to put in 40 mile weeks, or will I have to be content with 25? Will the remaining nerve problems cause big or little problems?  Could I run Comrades?  Will I be able to really LIFT weights again? It’s kind of an unusual place to be. I’ve been so worried about running again, that I never really thought beyond “Can I run”.  Now, I realize that yes that will be possible, I’m smacked with the reality that it is going to be quite different. I won’t be able to just pick up where I left off.  All that, it’s still a pretty good feeling. I find myself smiling a lot more as I feel a lot of hope.

Work.  O.M.G. WORK.  We have a new Director. She is a dynamo. This is good and bad.  I really like her, and she is pushing me (and everyone) in different directions. Often it’s a little uncomfortable. So I’ve been actually pretty stressed at work.  Add in everyone else on my team feeling stressed, and it’s a bit of a pressure cooker.  I do hope that we can move beyond the stress… but I think if I can learn some new skills, and get over the initial uncomfortableness, we might be able to achieve even better results for the patients.  So for the past two weeks I think I’ve averaged like  55 hour work weeks, which I really dislike.  The new director is a slow mover and takes her time making decisions. She clearly wants to change some things, but so far has been unwilling to do it. At this point 5 months in, I wish she would implement some of the changes as we aren’t all proverbially holding our breaths.

So… we shall see… 2016 is going to be a very interesting year. How is your year moving along?

So how are the resolutions…and my Spine coming along?

Actually pretty well.

I’m eating more correctly. Not perfect yet, but it is improving.  The trick for me with the sweet tooth and sugar is to decrease it gradually until I stop craving it. So, I’ve been doing things like drinking chocolate milk as “dessert” at work. 15o calories, sweet and is milk with calcium which I desperately need for my spine fusion. Lots of salad, i’ve even “cooked” two crock pot meals so I’ve eaten at home a lot more this week, an even brought some left overs to work, so I’m pretty pleased.  I’m going to do another meal in the crock pot this week, and I am thinking about branching out into trying to make a carrot ginger soup.  So, feeling pretty good about this one. I’m not ruling out sweet all together, I just found a coupon for buy one and get one free sundae at Culvers, sooooo yes I’m going to take advantage of that with a friend.

Exercise is coming along well. We’ve had a cold snap so I have stopped any pool walking.  It’s too cold, and it wasn’t that great exercise anyway.  I’m feeling stronger and am seeing improvement in my heart rate and stamina. I was smart enough to take a complete rest day this week as we had hospital inspection week so I was standing and walking ALL day…and so so tired.

I have not done a thing about my Money, but I did finally stop by the club house to discover that they had issues with printing the coupon books for the HOA, so NO one got their coupon book.  So not late on that payment at all. I am going to the bank tomorrow and I’m going to at least move some more money into saving accounts.

Volunteer:  have not done a thing.  Must investigate.

And return to running.

My back/leg is improving. It isn’t perfect at all, but it is slowly getting better. the symptoms I have are more manageable.  It gets a bit crazy from time to time, but I do see it improving.  I am starting to think more and more and more about running…and wondering what running will look like for me after all of this.  People who don’t know me well have asked “Are you glad you did it”  HA ha ha Ha.  Those that watched me deteriorate weekly after injury have never asked this question.  But yes…. I AM glad I had the fusion done. I can walk now for hours…take care of relatively simple house tasks, and sit around and chat with folks for hours.  I am still struggling with not being able to bend much, or lift much, but my life is dramatically improved.

Hope everyone else has had a positive, calm start to the New 2016. Keeping your resolutions or have you pitched them to the wind?

 

New Year’s Resolutions

Have you made your New Year’s Resolutions?  Are they the same ones you make every year, or….are you branching out in 2016?

The lady is IRRITATING, but… Interesting ideas here.

I do like to make resolutions and then see where I end up 365 days later (we get an extra day this year too in February!!!)  But this year, I kind of struggled.  I want to make some athletic goals, but I’m really still in the early stage of healing and so most of those goals can’t really be implemented. In addition, life is happening while I am healing so, I need something to focus on in the meantime.

So here are a couple of goals for 2016.

My MAIN goal is to set myself up to return to running.  Oddly one would think I was doing this already but in reality, i think I was so hopeless when the surgery happened and the aftermath I was very nervous in the immediate recovery period, that I tried really hard not to think about it, and as a consequence…I am currently not ready to ru never if I was 100% healthy.  So what goals go under this?

  1. Eat correctly.  I have a super sweet tooth.

stock-illustration-15279384-sweet-toothSo this is going to be really hard for me. Like many people, I eat well for a few months and then settle into a pattern of take out…some junk food and what not.  When I prepare food that I like it’s pretty easy to avoid the junk… I just have to actually prepare it.

2. Do the exercise I can do…within moderation.

I was recently cleared to use the elliptical and the stationary bike as long as my knees don’t come up high. I started on the bike and increased from 10 minutes daily… My quads…my quads have been burning. After a few days, I added in the Elliptical.  So by the end of this week I was doing 10 mins of elliptical, 20 mins on the bike, 50  minutes of walking on the treadmill and 30 minutes of pool walking every day.  One day my legs just started to hurt.  I need to adjust somewhat because none of this moderate exercise will get me in great shape.  Doing too much does irritate the nerve which is still healing.  So in support of my L5 nerve, I’m going to support it by doing a little less. A delicate balance.

3. Manage my Money better.

I’m not crazy with money management, but I have a tendency to get very disorganized and to have late payments not because I was lacking money but because I put off sending the payment in.  Already this year, I seem to have lost an entire coupon payment book.  (I’d do it electronically but there isa  14.00 fee for electronic payment!).

So… What I have done is take 12 envelopes for the coupon payments, write 12 checks, dated appropriately and addressed and stamped them all.  Each month I need to grab one and mail it at the appropriate time. This SHOULD be easier than making the time to write the check out each month and look for an envelope and stamp, right?  We’ll see.

In 2015 I upped my automatic contributions to both my savings and retirement accounts. I didn’t up them very much, so I seem to still not be contributing the MAX to the Roth. This year, I will try to contribute as close to the MAX as possible. This may be a bit tricky as I am also trying to finish furnishing the home.

4. Volunteer

Since I hurt my back I’ve not done any volunteering at all.  None.  Zilch.  I did serve the community as I gave fairly generously to the food bank in November and also adopted an older lady from the tree at the gym and provided her with bed linens and a comforter and a new outfit.  I tried to volunteer several times.  Each time I relayed the information that my back was bad, and EVERY SINGLE TIME I was asked to do something insane for a healing back- like “Set up tents” or “Rake the field for long jump”.  So at this point, I really have to be careful about volunteering and I suspect if I sign up for something like helping a kid with homework, I might have a better chance of success.

5. One totally time specific goal…

 RUN The TURKEY TROT In November 2016.  I might be visiting my parents, but there is ALWAYS a Turkey Trot.  The Turkey Trot in Carlisle PA was my first running race that I remember doing. It was an untimed race and  I was so overwhelmed by the entire experience I never even looked at the clock when I crossed the finish.  In truth I’d prefer to be in Florida and run the race where I had a massive PR and got to run with a bunch of running buddies, but… we’ll see where I am.

6. I should have some work goals.  My Goal for work is to survive through 2016.  That’s it.  I did a ton last year- I was published, I served on committees that I didn’t want to serve on, I volunteered for a lot of stuff that I regretted.  So… Here’s to getting through 2016 with a job.

SO, let’s all go “Kill it” in 2016.

 

Spine Update

I am ready to close the book on 2015… forever.  It was not a fun year for me. I had surgery in February, didn’t totally recover and then had surgery again in November. I’ve had enough of 2015.

2016 has started out better than 2015 I think.

As noted in my other post, my neurological symptoms had started to improve.  They have continued to improve for the most part.  I’m now starting to note that some things I do actually set the nerve off and cause me more radiculopathy… The only thing that consistently disturbs me is a noxious sensation in my toes.

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just imagine this, except it’s my first big toe and second toe.  All the time… when I exercise or put pressure on it, it gets “tighter”…

To my great surprise, on New Year’s Eve at about 4:30 or so I was hopping out of the pool. My phone started to buzz and I didn’t recognize the number, but I was on call so I answered it.  It was my surgeon. He apologized for missing my appointment, and asked how I was doing.  I was standing there wrapped up in a towel on the pool deck utterly surprised.

So I told him I had improved greatly in the last 2-3 days but that my toe remained difficult.  He queried me was it numbness or pain.  I was stumped… and finally just told him… its like rubber bands.  I personally do not care if I have altered sensation forever, I just want any kind of burning, heat, crushing etc pain to go far far away.  I told him I thought the toe thing was permanent.  He disagreed and explained that it takes forever long for a nerve to heal.  He feels that if I have no improvement at 6 months post op we can talk about permanency.

After this, I asked him about the few things that his PA had said I could do.  As I suspected, the PA was wrong on certain activities.  The surgeon said he really didn’t want me treading water as that sort of movement would be terrible for a healing spine. (Score one for trusting my own instinct and not doing it!) He then explained that many people do return to some sort of running at 90 days, but its mostly jogging slow.  He said, “for the kind of running you were doing, and want to go back to, it really will be a year”  This was a little disappointing but also kind of reassuring that I had not mis-heard him in the past.

I told him that I understood that my injury occurred so long ago that perfect function was probably not going to be possible.  He surprised me by saying he felt it might happen as long as we can support the nerve in healing.

So, I got off the phone feeling encouraged.  This healing is a very slow process, but it seems to be headed in the right direction.

I’m Still not a Radiologist

Wow.  I know a lot about X-rays, spines, and medical stuff, but I actually know nothing about all three combined.

So Monday I had my follow up.  It really started out badly. My appointment was at 3 pm.  At 1:30 I got a call from the office.  As soon as I saw the number I was a little alarmed. It was the Medical Assistant telling my that Dr. H. has been called into a big emergency surgery.  I was super annoyed, but really I mean, can you argue with that?  It was a big surgery and several surgeons were involved, so I took a deep breath.  emergency_surgery_cartoon.jpg

They offered me a phone call, a visit with the PA, or reschedule.

Normally I’d reschedule, but my brace was SO irritating that I said, “Can the PA get rid of my brace?”  The MA checked and verified that yes the PA could. So I said, keep the appointment.  It’s Christmas week, and appointments are sometimes hard to come by. Plus, some part of me knew I was being a wee bit unreasonable.  Typically surgeons aren’t on call during clinic hours, but things do happen, and it surely wasn’t personal.

So 3 pm came and I arrived, and found myself still being a wee bit unreasonable. I was upset that the PA was someone I’d not met, knew nothing of my surgery, and I think honestly I was feeling very irritated.

I heard the receptionist discussing it with the PA, the walls are thin.  The PA has a booming voice, his name is Patrick.  He basically said well let’s try and if she isn’t satisfied we can schedule another appointment with the Doctor.  To me this seemed rather reasonable.

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I’m sure he felt like that guy above.

As it turned out… The PA was pretty good.

I determined that I would be nice to him and act human. He in turn came in and was very nice to me.  He explained he hadn’t been present for my surgery because he wasn’t here working for the hospital at the time.  It seems that my surgeon had enjoyed working with the PA so much in his former job that he pretty much hired this guy and moved him to Florida. Once I realized that, it kind of changed EVERYTHING. I mean, I trust the Neurosurgeon.  He clearly trusts this guy….so I felt I could too.  Patrick showed me my old X-rays and my new ones. and indeed they look alike.  The text book photos & X-rays shown to patients with fusions are pretty misleading.

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Most don’t really look this picture perfect.  (and I’m a little unsure of this example because the bone looks like there isn’t enough disc space between vertebrae)

We compared films from the day of surgery and my most recent ones and I felt extremely reassured regarding this.  In addition, he told me that Dr. H. had looked over the films with him and said, “Her films look great”  I bust out laughing because I knew this had to be true.  Whenever we talk about X-rays or scans Dr. H always says “The films look great” or “your studies looked not great”….

It was a bit frustrating as he didn’t really know my history or my surgery very well, but to his great credit he really listened to me.  He did give advice on slowly decreasing wearing of the brace, and cleared me to use a stationary bike and elliptical in a limited way.  He actually assessed all of my strength and discussed in great detail my goals for the fusion.  To my great distress he explained that what I was looking at on the film was bone, but it wasn’t the fusion and that there was no signs of fusion. Apparently there is usually no sign of fusion and they only get the 6 week X-ray to make sure the hardware is in place and not migrating.  He was kind enough to show me where they will be looking for signs of fusion, so I will be able to better assess things in the future.  LOL I am SOOOO not a radiologist.  I still have pain in my leg and pins and needles and burning sensations…they are reduced, but I imagine if someone else started to have these symptoms, they probably would go to a Doctor about them…we talked about it and my expectations for the future…and how to manage them. He suggested Neurotin, and I had to tell the tale of how that particular medicine makes me loud and difficult… so we agreed no Neurotin for me….

The only thing that was rather not so great about this visit was some very confusing messaging about running and swimming.  Per Dr. H. I understood I’d be cleared to swim at about 12 weeks, or when I show some signs of fusion.  I would be cleared to run at one year.  Patrick the PA said, oh yeah after 3 months you can just start running, we’ll let you loose… I said, uh, I was told a year?  He looked surprised and kind of looked at my films again… and I said, well… no matter. I will see the surgeon hopefully on February 1… at 12 weeks and we will reassess.  I feel like the PA did an adequate job for a follow up, but given that he essentially started at the hospital 2 weeks after my surgery…he wasn’t exactly up to date on My situation in particular.  To his credit he listened well, and appeared genuinely interested in me as a patient and a person…which was a real step up from the other office, I honestly still would have preferred to see the actual surgeon. So hopefully on February 1…I will see the surgeon. I don’t think I’d mind seeing the PA either, but I actually want to plan to be the plan…

I think since Monday I’ve had a wee bit of a decrease in burning and aching, but… it’s hard to tell.

 

I’m not a radiologist

So, yesterday I went FINALLY to get my 6 weeks follow up X-ray.  It’s the end of the year and people have met deductibles so everyone is trying to fit in scans and other expensive tests. I waited 2 hours for films.  I am amazed and very proud that I was very adult and never asked about the wait and did not complain about it to anyone.  Waits happen.

I was hoping I’d be able to see some fusion on the film, essentially at this stage it would be fluffy white speck or something, but of course I’m not a radiologist.  Not at all.

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So this is what I saw.  Once I looked at the image a little more carefully (these are not the best images, because I snapped them with my phone when the technician wasn’t looking, though she did say they were my images so I’m sure she knew what I was doing…)

CWjC2UtWoAArnwk (1).jpgIt would appear there is a lot of fluffy white stuff between the screws, If you look at the vertebrae above there is a huge black gap and below there is a lot of fluffy white stuff.  So, it could be the start of fusion.  I’m not a radiologist, however, so it could be anything… Christmas Snow?

What did kind of alarm me, and also make the technician raise her eyebrows a bit was this film.

CWjDBj6WoAAwcRc (1).jpgWe both kind of looked at it and simultaneously tilted our head to the right… (If you didn’t tilt your head, let me know, because everyone I show it to does…) I said, well that looks odd.  She said, “Well I don’t know what the surgeon intended.”  I never saw my original post op front view films, the Doc told me they looked great. So I really have nothing to compare to, plus as mentioned before, I’m not a Radiologist.  This could be entirely due to the way I was positioned on the table, or it could be where the screw needed to go, or it could be that I bent the screw which would be amazing, considering I’ve not been doing ANYTHING.

So I drove home.  I’ve been having a large amount of radiculopathy (Right leg pain) and it’s been hard to manage it, so I was thinking, if it is caused by that screw, they can move it and that would be nice.  Then I started to think of the expense and time off work for another procedure….and then I just got very overwhelmed.  I mean, it isn’t the end of the world, but I’m really over my Lumbar spine controlling my life.

We have a nifty thing with our hospital system. It’s called the patient portal.  Once lab tests or X-ray reports are uploaded into the system, the patient can access them, with a handy bar that says (low/normal/high).  When I got home, I jumped on the patient portal to find that my X-ray was read as “Normal Post-operative changes”  I saw the Radiologist was using films from the day of my surgery (done after the surgery) as a comparison.    Because of this, I think I can assume that my former X-ray looked about the same.  I also am not 100% sure that the patient portal contains EVERYTHING on a report, just because I can not access my reports from anything done while I was inpatient, and I can’t access my operative reports. That said, from having to read a lot of radiology reports, the Rad guys and gals usually will mention if something appears to have moved/migrated/relocated from the comparison study.  Plus, if s screw moves, usually there is a dark portion around the screw. I don’t see that.

I’ll see the Doctor on Monday, and while he isn’t a Radiologist, he is a Neurosurgeon, and he is more than qualified to interpret things.

In the meantime, I am thinking about what kind of shoes I’m going to need next year for running.  Something with a narrow instep and a wide toe box… going to be tough to find, but I have a few ideas….A company that could send me out a few different styles to try would be welcome.  I know I probably can’t stay in the Saucony because every time I use them for walking they aggravate the damage to my foot… so something with a bigger toe box to minimize my big toe’s contact might do the trick…

I am excited for Monday…. I do think the X-ray shows beginning fusion, but that one screw has me kind of thinking a little bit too much about the whole thing!!!!

Wish me Luck!