Spiffy Percocet side-effect du jour: nightmares

I've slept about 4 hours total since Saturday. Last night, the Percocet simply kept me wide awake all night. Tonight, I eventually drifted off to sleep, only to be jolted awake by vivid and truly frightening nightmares. Now I'm tired, but afraid to go back to sleep.

The Best Laid Plans

The idea behind an early October surgery was that I would not have to deal with snow while hobbling around on crutches. This appears to have been an invalid assumption.

Recently, I had been sleeping quite well. Until tonight. I woke up around 2am, and it's now almost 6am. I was in pain (same old incision soreness) so I took the prescription-strength ibuprofen and a percocet. That mostly took care of the pain, but I'm still wide awake. Since tomorrow isn't a work day, I seriously considered going for the oxycontin, and just completely checking out. I've been working hard at this, getting exercise and being extremely vigilant with the wound care, but I feel like I'm making no progress.

I'm not ready to say that I regret this, since I am only 3 weeks post-op. And, in theory, I should be better off in the long run. But these last few weeks have been no picnic, and someone less stubborn than myself would probably be in dire straits. I'm pretty sure that I'll continue to have some level of pain until the stitches come out in 2 weeks. Getting them out will probably be as much fun as a root canal, and I'm sure it'll be sore for some time after that.

It doesn't help that working with CIGNA and the Cleveland Clinic is like working with the DMV. CIGNA seems to be utterly unable to comprehend that I went back to work earlier than I had originally estimated. And the Cleveland Clinic never responds to my emails any more. I requested a transition to an intermittent leave, so that I can basically work whenever I'm feeling up to it. My employer is completely fine with that, but I apparently blew CIGNA's mind with that one. I understand that these people need to have all sorts of documentation in order to prevent fraudulent claims, but I think there should be an express lane for someone like me.

My wife taught me never to complain exclusively. Always think of at least one thing you're thankful for. Well, the cat (Hiro) is back. Despite his walking on me at various times during the night, it's nice having him around. I have also established a dialogue with a professor at Clarkson University who is engaged in bionics research. Apparently he is very keen on getting me into his lab to help them develop terrain-adaptive ankles. As both a software engineer and a BK amputee, this sort of thing is fascinating to me. (Although, honestly, the reason there hasn't been much energy spent on developing BK bionics is because the existing carbon-fiber prosthetics are so good. Unlike losing a hand, which is extremely disruptive, a BKA is generally considered not to be particularly disabling. Unless the only parking spot available is a handicapped spot -- then I consider it to be very disabling!!!)

I am also grateful to my wife for putting up with this whole ordeal, and for not allowing me to sit on the couch and eat bon bons all day.

I guess I should also mention that I'm grateful for insurance. See my previous post. I cannot imagine facing a bill like that without insurance. I know it looks like that's my situation, but actually the claim is under review, and my out-of-pocket expense should be considerably less than what's shown.

Dang.

Three Weeks!

Tomorrow (Thursday) is the 3-week mark. Then, it's just a little over 2 weeks until the stitches come out. I don't know if the incision needs to be completely healed before they can be removed, and at this point I really don't care. I still have a few areas along the incision that continue to drain (not much at all, but enough so that the gauze soaks it up, dries, and then becomes stuck to the wound.) This is the source of my pain, and it warrants a percocet. Hopefully removing the stitches will eliminate this pain.

In any case, I may have found a solution. By first laying down a thin layer of bacitracin ointment, then Adaptic (a petroleum-impregnated dressing specifically meant to be non-adhering) and then covering all of that with gauze, I seem to be getting some relief. I'm a bit concerned that these areas haven't shown any signs of progress over the last week, but maybe I have unrealistic expectations. Maybe keeping the incision moist and covered is actually prolonging the healing process, although I always believed that wounds heal faster when they're kept moist.

Day 18

I'm glad I didn't throw away the percocet, after all. I have very localized pain coming from the medial aspect of the incision. I don't know what the problem is, but it's been fairly consistent over the last several days. I'm pretty sure I have excellent nutrition, I'm washing the incision and changing the gauze every day, and I'm applying bacitracin ointment. I don't necessarily care if the incision takes a long time to heal, I just wish it would do so without throbbing pain. I don't understand the point of this pain -- what is my body trying to tell me? It's not like I'm going to forget that my leg was sawed off. Maybe it's just mad that I did that, and this is revenge.

I guess I should have stayed home an extra week before going back to work.

I ran this by my surgeon, but he thinks it sounds pretty typical.

Time to celebrate my 32nd birthday with percocet!

Back to Work

2 weeks + 1 day post-operative, and I'm cleared to return to work full time on Monday, my birthday.

Also cleared to shower without entombing my leg in plastic, which should make that whole process easier.

CIGNA = clowns

My employer uses CIGNA as the FMLA/disability approver, and WOW do these people FAIL at their jobs. Today, CIGNA told me that they have received nothing from me or the Cleveland Clinic. This, despite the fact that I sent them everything a solid month ago via US Mail. The nurse from the Cleveland Clinic also said she had sent everything well before my surgery.

Today, I told the CIGNA rep that I had faxed her another form, and she pointed out that I was using the wrong fax number. I said, "Well, I'm using the fax number that this form says to use." She actually copped an attitude, and said, "Well, that's an old number, and I don't know where that goes." Because someone who just had his leg hacked off deserves attitude over something as inane as this.

So, the Cleveland Clinic probably faxed everything right into outer space, since CIGNA uses outdated forms. I told the CIGNA rep that the Cleveland Clinic probably faxed everything to the old number, and she advised me to get in touch with the Cleveland Clinic and straighten it all out. Seriously? You guys screw up, and the onus is on me? It still baffles me that they never received the forms I mailed them. Undoubtedly the mailing address they provide on the forms is invalid. What an unprofessional and disorganized outfit.

This is really terrific that I've got to coordinate all of this stuff. What exactly are these people being paid to do, besides make my recovery as exasperating as possible?

Also, who doesn't use email to conduct business these days? Apparently, CIGNA. I asked the rep if she had an email address, so I could more easily keep in touch. She said, "I do, but I don't give it out." Great. Thanks for that.

The other annoying thing is that CIGNA reps have extensions, but there's no way to actually contact them at their extension. The automated phone system will only transfer you to a rep of its choosing. Then, I have to say, "Uh, could you transfer me to this extension?" Seems a little amateurish to me.

IPOP

Here is a picture of my RRD (rigid removable dressing) which is also known as an IPOP (immediate post-operative prosthesis.) It's not a prosthesis, so RRD is more accurate. Its purpose is to keep the knee extended (thereby preventing flexor contracture of the hamstring) and to protect the leg as it heals. If I catch a crutch and bite it, this should protect the stump from injury.



Dressing changes are now a breeze, and the incision looks very good. A blister that was worrying me (and was present after the first dressing change in the hospital) has finally cleared up. Basically, it's now just a waiting game until Nov 14, when the sutures come out.

In the meantime, maybe it's not too early to start looking at prosthetic options. I wasn't aware that a BK amputee was on Survivor, and he used the Freedom Innovations Renegade foot:

This is probably ridiculously expensive, but it sounds like it can handle anything.

Random Thought

Next time I see a self-absorbed male cyclist with shaved legs, I'm going to go up to him and say, "I shaved my leg once, too..... RIGHT BEFORE THEY CUT IT OFF."

Back in NY

We are back in NY, and I'm attempting to go completely off oxycodone. We've been steadily increasing the intervals between doses, and I'm up to 24+ hours now since my last dose. I have no pain at all, but I'm still taking ibuprofen for the anti-inflammatory effect.

Off to get some exercise, and watch Corrine shop for groceries.

One Week

One week ago at this time, I was prepping for surgery.

I forgot to mention that when I was sitting in the pre-op staging area, I overheard two nurses talking about a surgery on the previous day that apparently ran into some major complications. They were talking about blood having to be mopped up, and hearing "tone" twice. I'm guessing "tone" is the alarm from the vital signs monitor. In any case, this is not something I wanted to hear moments before major surgery.

Healing is a slow process at the macro level, but it's remarkably fast at the cellular level. After only one week, my incision looks a lot less angry. There is virtually no drainage, and I have far less soreness than even a couple of days ago. The sutures won't come out for another month, but I'm feeling very confident about the progress already.

We are slowly extending the time intervals between my oxycodone doses -- I'd like to get off of it as soon as possible. I can't say for certain that I'd be fine without oxy, but I think the Motrin is helping me more.

I picked up a pair of weightlifting gloves to spare my palms from the abuse of crutches. The plan for today is to walk around at Presque Isle -- fresh air never hurt anybody.

Day 5

I was sent home with one-month supplies of extended-release oxycodone, percocet, and Motrin, but I really think I'd be OK with just the ibuprofen at this point. The pain is really not bad at all. Donning the shrinker sock continues to be a chore, but today wasn't nearly as bad as the first time.

I had a legitimate shower today, which was extremely refreshing.

Corrine and I walked 0.4 miles around the neighborhood, which is about as much as I can do comfortably at this point. We walked 0.2 miles yesterday. Part of the problem is that I don't have "crutch palms" yet, so they're extremely tender & on the verge of forming blisters. They'll toughen up, along with the rest of me.

Daily, I'm taking 1360 mg of fish oil, 5000 IU of vitamin D, plus my usual multivitamin. I'm usually a camel when it comes to water, but I've been drinking a lot lately. I blame the oxycodone for that (and I blame it for lots of other unpleasant side-effects.)

I had some questions that I emailed to Dr Clair this afternoon. He wound up giving me his personal cell phone number, and offering to work me into his schedule tomorrow if I thought it would help (but I declined.) I am continually impressed by his professionalism and dedication to the patient.

Visit from the prosthetist

The prosthetist from Hanger stopped by this evening, ostensibly to measure me for my leg brace. What I wasn't counting on was being placed into orbit by the pain from rolling on a shrinker sock. I was relaxed and settled in for the night, and he knocked on the door at about 8:45pm. We had a nice discussion about how I will be so much better off with the Ertl, and how Dr. Clair is probably the best Ertl surgeon in the country. That was very reassuring.

Then he unwrapped the shrinker sock, and started to slide that on. I could feel my sutured-together bones flexing, and the sutures being tugged as that stupid thing went on. Hopefully that doesn't have to happen again. Between this and the physical therapy, I don't see how all this abuse is going to promote healing. I wish there weren't so many people involved in rehab, but I guess that's Modern Medicine™ for you. Hopefully I'll see Dr. Clair tomorrow before being discharged (if discharge is still the plan for tomorrow.)

Pain Update

No longer needing IV fentanyl or morphine! Down to just Motrin and Oxycodone. Discharge tomorrow is possible, but Monday is probably more realistic.

Done!

I went into surgery around 3:30pm yesterday, and my understanding is that the procedure was relatively quick (no more than 2 hours.) I vaguely remember being wheeled back to my room, where I have been recovering ever since.

I created a minor stir in the OR when I told the nurse anesthetist that I did NOT want to do the epidural, after all. They recommended that I have it, but they said ultimately it's my decision. I insisted that I would be able to manage the post-op pain with medication. Maybe I would have been better off, but I just don't like the idea of needles going into my spine.

Dr Clair said he's very happy with the procedure. He was able to suture a good piece of bone in place, and he said I have excellent blood supply. The dressing is very bulky, but I'd say he removed about 6 inches. If this heals properly, I should have a far more functional limb than before.

For pain, I'm taking oxycodone, percocet, and intravenous fentanyl. Fentanyl is great stuff, but it makes me completely useless and loopy. Overall, my pain is not excruciating, but I think I've got several days of persistent pain ahead.

The good news is I've got a single room, with a nice big TV!

Too tired to say much more for today. There's a chance I might be discharged on Sunday, but I think it'll most likely be Monday.

I can has phlebotomy?

"I'm a student, and I'll be doing your blood work."

That actually didn't concern me. I figured a rookie at the Cleveland Clinic would be pretty good. However, two pieces of evidence suggest otherwise:

(1) I'm a male, and she asked me if I have ever been pregnant (skipping over the box that said "N/A patient is male")

(2) I wound up with a nice, big bruise

The procedure

Here is the actual surgical procedure: http://www.ampsurg.org/html/bb1/bb1printsegmented.html


This is supposedly considerably more complicated than a standard BK amputation, but it sounds like the really important stuff (nerve ligation and myodesis) is common to standard and Ertl-esque TTA procedures.