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I want to write a post exclusively about Briscoe, the GOAT dog, the ottoman, the big headed dog, a post that has nothing to do with this horrible day, nothing to do with this terrible year.  But I need to write this first.  I’m devastated, and I need to keep telling myself I did the right thing for Briscoe, even if it feels really terrible right this second.

I had to put Briscoe down today.  This sentence conveys none of what actually happened, and makes me feel terrible.  Technically I didn’t have to do anything.  I could have let them treat her ongoing chronic pain and increasingly frequent digestive issues, maybe put her on an anti-anxiety med for her sunset symptoms, and I could have given her more baths in the medicated shampoo.  But the goat dog was real sick of frequent baths and multiple medications, and over the past year she has become increasingly fragile and clearly uncomfortable.  She’s been on multiple medications for seven years, and her joint issues have been a fairly serious problem for the past five years.

In August 2014, right before her 8th birthday, Briscoe was diagnosed with protein losing nephropathy, and the specialty vet in Charleston told me that she was dying of this disease.  The vet said she couldn’t tell me any kind of time frame, that we could treat it and it might be manageable for a while, but that this disease would definitely be what killed her.

In August 2017, right before her 11th birthday, Briscoe was unable to get out of bed one morning.  I was sure she was dying, this was it, you can’t have a dog who can’t walk.  The specialty vet told me she wasn’t dying, she had a torn ACL, and it was fixable.  She had surgery and they fixed it and she was like a new dog.  Her activity level increased drastically and she lost a lot of excess weight, and her kidney disease continued to be well managed with multiple medications.

So I’ve been preparing for Briscoe’s inevitable demise for a long time.  Literally half her life.  And I really never wanted to be that person who seemed oblivious to the fact that their dog was half dead in the living room.  But recently, I’d started to turn into that person.  She was sick.  She’s been sick for a long time.  She had terrible arthritis in her front, I guess you would call them wrists?, and I’m pretty sure her other knee needed repairing.  She had a really hard time lying down, and once down, it wasn’t super easy for her to get back up.  Going up and down stairs was very difficult for her.  Despite all of these things, she seemed unwilling to accept her limitations at various times, and she very much still wanted to run and jump and romp with Ed and Jack.  But, when she did those things, she fell down, and you could tell the falls hurt her, physically and emotionally, as she’s always been the alpha where Ed and Jack were concerned.

Although she often refused to accept her physical limitations, she did seem very aware of them, and that they made her vulnerable and less able to defend herself.  This made her more aggressive, and more hyper vigilant.  She struggled to relax, and she had a very hard time in settings outside of my house, and disruptions in her routine seemed to very taxing on her.  I had to have work on my downstairs floors in May, and me and the dogs spent most of that day upstairs, and going up and down the steps several times that day and her inability to relax because she knew something was happening downstairs left her barely able to walk the next day.

We went to my parents house over the 4th of July, and she had a very hard time.  It was upsetting.

When we got back from the 4th, she was much better at my house, and she seemed to be more comfortable and I tried her on a different NSAID, and it seemed to work okay, but then last week things just started going off the rails.  She’s had several days of stomach issues, and Monday night I was resigned that the next day would be the day.  But then yesterday she was a lot better and super peppy and extra fiesty, like she wanted to prove to me she was fine.  But then last night she was sick off and on most of the night and sick again this morning.  I couldn’t get her to drink water last night, but this morning she drank water and was standing around her dog bowl waiting for breakfast, so I fixed her breakfast.  She took one look at the rice and chicken broth that I fixed for her, and promptly threw up all the water, like a pregnant person with morning sickness or a very hungover individual.

Even without eating, she continued to be sick this morning, and I called the vet and told them I thought it was time.  They said I could come in at 10:30, and they would have a room where I could come in with her. I talked to Suzy, and she told me I was doing the right thing, that it was time.

Once in the room, Briscoe ate some ice, and then she let me hold her for a while, something she would never let me do at home, but being in a new place made her feel uncomfortable enough that she was happy to let me snuggle her.  The vet was great, we’d been talking on the phone off and on for the past year about Briscoe’s various medications and trying to increase her comfort level, and I spoke to her after I got back from the 4th of July, about how I felt like things were deteriorating.  She agreed I was putting off the inevitable, and this way, we could offer Briscoe a calm relaxing end to her suffering, before things got even less manageable and we ended up in a crisis situation.  Last night felt close to a crisis situation to me, and I didn’t want to put Briscoe in that situation again – a night or a weekend where she was unable to stop being sick and I did not have a plan in place.  She has always deserved better than that.

The vet was great, and said we could do it out in the side yard that was fenced and grassy and shady with lots of trees.  It was still horrible, because telling your best friend of your entire adult life goodbye was always going to be horrible, but at this point, we were committed.  But it was intentional and thoughtful and calm and peaceful, and it wasn’t about what it felt like to me, it was about what it felt like to her.

IMG_1358

This was after they gave her the sedative, before they gave her the real drugs.  She seemed relaxed and calm for the first time in days, and I’m going to try to remember that.  It’s hard.  This was so hard.  

She was the best dog,  I hope I did right by her.  Ed the bulldog is very confused.  We are going to go watch old videos of Briscoe zooming, back when she could zoom, and imagine her zooming again in the clouds.  Hug your puppies, our time with them is so short.

The only consolation to sweating in a Halloween costume is the prospect of enjoying a balmy Friday afternoon on the Georgia/Florida coast. I woke up to pouring rain in Athens, my yoga class last night only half full.  My dogs hurried through the deserted foggy streets, throwing concerned glances towards the jackolantern scarecrow and the glowing ghost.  

The never ending summer of 2019 continues to put up a fight, and with concern, we sweat.    

Second in the SEC East and 6-1 heading into the Georgia Florida game, we are again playing for “all the marbles,” as stated by UGA junior offensive lineman Solomon Kindley on Monday.  

Fifty years ago, on another November afternoon in Jacksonville, the Dawgs were 5-2, coming off a rainy day disaster in Sanford Stadium against Tennessee, their only other loss to Archie Manning’s Ole Miss squad earlier in the fall.  The previous weekend, the Gators had suffered their first lost, still considered one of the worst losses in Florida history at the hands of the Auburn eagletigers, in which Florida QB John Reaves, a future first round draft pick, threw nine interceptions to establish an NCAA record that stands to this day.

With 70,862 people in attendance at Gator Bowl Stadium, it would be the largest crowd the Dawgs experienced all season.  Trav Paine, a red shirt senior running back on the kickoff return team prepared to take the field and turn it loose.  With a skip.

Happy Georgia Florida everyone, I will be in Athens this weekend packing furiously to move into my new house next week.  Come visit me.  To everyone traveling to the coast, be safe, check your tires, take a fleece and some real shoes, the high is 89 tomorrow in Jacksonville, but the low on Saturday is 52, aka “freezing” on the coast.  

To everyone staying here, the nights will be in the 30s starting tomorrow, so make sure you have firewood, get started on that pot of chili, and find your puffy jacket and red gloves.  I know y’all have some red and black flannel blankets around here somewhere, get them out, there will be no more sweating. Turn it loose. 

 

GOOOOOOOO DAAAWWWGGGSSS!

 

Sic ‘EM!

Woof woof woof woof woof woof woof woof! 

 With love and bulldog affection, 

Charlsie Kate Paine

Athens, Georgia

October 30, 2019

Cover of the excellent card Becky and Nan gave me.

Monday update: I wrote this Saturday. My ability to walk in the boot has increased significantly since then, and the pain is tolerable.  I have a long way to go, but every day is an improvement. 

Waking up from anesthesia is weird. Your eyes are closed, and you know you want to open your eyes and wake up, but it’s like you forgot how to wake up and you need to remember how to wake up before you can wake up.  You also feel like there is something very important you need to remember and tell someone, but you can’t remember what it was or who you were supposed to tell.  You lie there for a few minutes, thinking about how your eyes are closed, aware of the things going on in the room, listening to the people around you, looking at the back of your eye lids.  After a while, you become aware of other things, like, whatever body part has been manhandled and cut up while you were out.  The need to wake up generally becomes more pressing at that point, because most of the time you realize that you need something urgently.  Like after my appendectomy, when I woke up DYING of thirst, like someone had scrapped the inside of my throat with a blunt object, and I thought if I couldn’t have something to drink I really might die.

On this particular occasion, I had a pressing desire to wake up because the lower part of my right leg was on fire. It felt like my right leg was being partially scalded and burned, but I couldn’t move it.  Eventually I was able to regain consciousness enough to get the attention of a nurse, who told me that the heat was from the splint they had just placed around my leg.  He wanted to know if it was warm or if it was painful.  I said it was painful. (I wanted to say, it’s hot AF, take it off!)  He said he would get me some Demerol.  Upon reflection, it’s interesting that the hot splint was painful, considering the nerve blocks.  Let’s talk about the nerve blocks.  Listen, I’ve had nerve blocks before, I had a nerve block for both of my prior ankle surgeries, and I figured this one couldn’t be a lot different.  I was very wrong.  Pre and post op they told me numerous times that I should “enjoy” the nerve block while it lasted.

Y’all, this nerve block was legit. I could not feel or move my leg from mid-thigh down.  The hot ass splint weighed about a gazillion pounds (I think it got lighter once it dried).  If I thought REALLY hard, I could make my big toe twitch for a second.  If I wanted to move my leg, I had to pick it up with both hands and move it.  Crutches were a bit of a problem, because I couldn’t operate any of the muscles in my knee.  Kate drove me straight back to Augusta after the surgery. I’m really glad we made the trip while I couldn’t feel my leg, and while I was still semi-conscious, but my decision making skills were definitely blunted.  On the way out of town, we stopped at Chick-fil-a, and I destroyed a combo #1.  Upon reflection, I realized that I was in the backseat of a car, post anesthesia, and that I might regret overeating fried foods.  Luckily, the nice people at the surgery center had sent me home with Phenergan.

Once home, Kate had to hold my dead leg while I crawled up the front steps. While I had the nerve block, I only required half doses of the Percocet about every five hours, combined with some Benadryl and Phenergan as needed.  The nerve block wore off about 4 am Friday morning.  I woke up, and my first thought was, OMG! My leg is working again! I can pick it up and…AGGGGGGHHHHHHHHH.

Needless to say, I did not go back to sleep that night, and I spent the next several days in a bit of stupor.  Narcotics make me insanely itchy, and I really cannot tolerate Percocet without Benadryl, and I don’t know about y’all, but Benadryl makes me real sleepy.  When I wasn’t passing out mid sentence, I was eating baked spaghetti and pound cake.  Does anyone need a pound cake recipe? I have a really great one.

Pound cake is really great with peaches and ice cream.

I caught up on some television.  I finally finished Billions, which I enjoyed immensely.  The passing out midsentence made my usual hour long drama difficult, and I started watching sitcoms, like Brooklyn 99 and Unbreakable Kimmy Schmitt.

I could only tolerate the Percocet for a couple days, and the doctor called me in a tramadol prescription, which is much easier to tolerate, at least for me. Kate got me a scooter, and even though Trav said I got the wrong scooter, I’ve been able to take it out on the road and see what it can do.  Here’s a video.

The dogs have been keeping me company, but they suck at bringing me drinks and snacks. Yesterday, I had my two week follow up appointment, and I got the splint off, which was absolutely amazing.  My foot looks better and worse than expected, in my opinion.  The bruising looks better than my previous surgeries, but that might be because I’m two weeks out.  The stitches are dissolvable, and the big incision is all woomped up funny. Here, I will show you – but just in case people are squeamish, I will put all the ankle photos at the bottom, so scroll down or don’t.  I don’t think it’s too bad, but I know some people don’t like to see stitches.
The resident said my ankle looked great, that I should work on my range of motion, and then I should start physical therapy in two weeks, and then two weeks after that I might be able to transition into walking in normal shoes. I got a new walking boot, and this one is significantly different from my previous walking boot.  They gave me a copy of my operative report, and I was surprised to find out that I now have two titanium suture anchors in my medial malleolus and attached to my deltoid ligament – specifically one was attached to the tibionavicular and one was attached to the “spring” ligament.  This is apparently called a deltoid ligament reconstruction, which was done to correct an anteromedial rotatory instability.

I think the spring ligament is the horizonal one to the right of the navicular bone, right below the deltoid – in the middle, not at the very bottom.

This link might be a better photo.  I also had a CAM lesion on my talus and a kissing lesion on my tibia, which were “saucerized”, which you should not google image search.  They also debrided a “large central osteophyte of the tibia.”  Google says osteophyte means bone spur.  Despite my extensive research, I’m still not entirely clear about the difference between a CAM lesion and an osteophyte, but I think a CAM lesion is a type of osteophyte.

I’m fascinated at how much more extensive the repair on the front of my ankle was, compared to the repair required on the back of my ankle in my previous surgery. It makes me wonder how long I’ve had these problems.  The only major injury I’ve ever suffered to my right ankle was a horrific ankle sprain my junior year of high school, more than 19 years ago.  The good news is that the surgical note says my ankle joint looked good, and that I didn’t have any full cartilage lesions or arthritis, which is encouraging.

My ankle is extraordinarily stiff, which has thus far inhibited my walking, but I think it is better today than it was yesterday, and hopefully, will be better tonight than this morning. The pain from this surgery has been exponentially more severe and lasted a lot longer than either of my previous surgeries.  My entire body hurts from being on crutches and climbing up stairs in a seated position.  Since about Monday, I’ve only required the occasional half a tramadol when I’ve been up on it too much.  Even more helpful than the pain medications has been keeping my foot elevated.  When my foot is down on the ground, it turns blue frighteningly quickly, but I can tell this is slowly getting better.

The atrophy to my leg is much more extensive than I was expecting, I was really hoping that the fact I was active and not in a boot before my surgery was going to translate into less atrophy.  I was hoping I would be able to immediately concentrate on rehabbing my ankle and not spend a lot of time on rebuilding my calf and thigh.  In just two weeks, my calf has wasted away.

The nurse who cut off my cast asked me if I needed a refill on my pain medication, and I told her I didn’t think I did, unless she thought my foot was going to be a lot more painful once I started walking. She laughed and said, “You know it, I will get you a refill prescription just in case.” I did not find this particularly reassuring, but so far, walking is quite painful.  Last night I was able to take a bath with my newly liberated foot, and let me tell you, it was glorious.  GLORIOUS.

Sad right leg.

My family has been great during this whole process. They’ve brought me ice packs, coffee, meals, snacks, wine, filled up my water bottles, taken care of my dog, washed my clothes, run errands for me, watched TV with me, and been generally entertaining.  My dad and I watched the first season of House of Cards.  I watched most of the first season years ago when it first came out, but then I lost interest, and I’ve enjoyed catching back up.  We’ve watched Dr. Blake Mysteries and Father Brown. I ordered T5 a tent and that has been great fun for all.

Family being entertaining

I’ve been watching Unreal and Happy Valley on my own. Happy Valley might be the most enjoyably depressing television show I’ve ever seen.  I can’t explain it, the things that happen to the people on this show are horrible, it’s gruesome and bleak, with substance abuse and mental health issues, rape, murder, infidelity, blackmail, kidnapping, family estrangement, stalking – but somehow I really enjoy watching it, and I really like the characters and the stories.  It is baffling.  You should definitely watch it.  Unreal is also pretty dark, but entertaining.

Speaking of dark, here are the ankle photos!

(disclaimer – this is a long drawn out explanation of a poorly defined, chronic problem. It is very far from the most interesting thing I’ve ever written.

My April 2015 FHL repair surgery was a breeze. Before the surgery, I had been in a walking boot  continuously since the first week of January, and I also spent about six weeks of Fall 2014 in the boot.  Because my tendon was torn, I literally could not walk without the boot.  After surgery, my foot was bandaged; I was given a surgical shoe and pain meds, and instructed to start weight bearing immediately.  I took the pain meds for a few days, with great pain control, and after a week I was back at work.  I started physical therapy in mid-June, and I was dismayed to realize how much my right leg had atrophied.  My right leg was visibly smaller than my left leg, and disturbingly weak.  It wasn’t just the ankle, it was my calf, my knee, my thigh, and my hip.  I felt like I’d had a minor stroke on my lower right side.  Keep in mind, I stayed fairly active, even in the boot.  I couldn’t work out, but I still went about my every day life without any lifestyle modifications.  The severity of the atrophy and the loss of strength came a shock.

At the end of July, I spent a week with my family at Lake Rabun. My dad and I hiked down and out of the Tallulah Gorge on day, and Christy came up from the ATL for a couple nights, and we went on a fun hike.  On the way back to Augusta that Sunday, we stopped at Ingles, in Elberton.  While in the store, my ankle locked up, with blinding pain.  I limped back to the car, and had a panic attack the rest of the way home.  Something else was wrong, I knew it.  This was like the pain I had the previous summer.  I emailed the doctor, and spent the rest of the day icing my ankle with a tramadol and a very bad mood.  The doctor told me to take it easy for a few days and relax.  It did feel better after a couple of days, but it made me realize I shouldn’t push it.  In physical therapy, we spent a lot of time trying to get my ankle to bend right again.  I had very limited dorsiflexion, and myself and my physical therapist were convinced being in the boot for so long had resulted in stiffness.

Thanks to my Nike running app on my iphone, I can go back and see that I ran one mile in just under eleven minutes on June 2, 2015. I ran 2 miles on July 2, 2015, in just under 22 minutes.  As a reference, I’ve always run about a 10 minute mile, more like 9.5 if I’m in good shape, so this was sort of slow, but I was just happy to be there.  On August 10, 2015, I ran 3.1 miles in 33 ½ minutes, and after than I ran between 2.5-3 miles at about an 11 minutes pace about twice a week for the rest of the fall.  I also went back to yoga, but to shorter, less intense classes, strategically spaced out.  In October, I started going to Spin classes.  With the exception of fairly painful episode of DOMS in my right thigh lasting most of a Thursday afternoon (apparently my physical therapy had done an excellent job reconstructing my right calf, with a less thorough rehab of my right thigh), and a weird hip twinge that wouldn’t seem to go away, I was feeling good.  I was running steps, and running hills when I was home in Augusta, and I convinced my dad to buy me spin shoes for Christmas, as an added motivation to keep going to spin.  Charlotte doctor said my hip pain was piriformis syndrome and gave me some stretches.  I was still working on bending my ankle, but my range of motion had definitely improved, after a ton of physical therapy and continued stretching.

Spinning made a huge difference with my cardio, and I was back running at a pace right under ten minutes a mile by November. I went for a long run in Augusta over Thanksgiving, with a bunch of steps and hills, and I felt like I was doing something I shouldn’t be doing, and then I thought I was being paranoid.  It was six months after my surgery, and it felt like the time to start pushing myself, and stop being scared of getting hurt again.  To be clear, by a long run with a lot of stairs and hills, I mean, three miles in thirty minutes, not like, ten miles in an hour.  I had some good runs in December, but in between Christmas and Thanksgiving, my ankle got very stiff.  I attributed this to my triumphant return to high heels, but it was serious enough that I decided not to run for a couple weeks.  I went to Kona on the big island of Hawaii in mid-January, for Pete and Tara’s wedding, and I couldn’t resist going for a run along Ali’i Drive, followed by coffee and scones on the water. I made it two miles.  I haven’t run since.  I kept going to spin class, but that eventually became too much, and I dropped down to going to half of a spin class.  Eventually I was limited to riding the bike on my own for no more than 20 minutes.

I had an MRI in February, which showed some mild tendinopathy and joint effusion, but nothing interesting. The first appointment I could get with the Charlotte doctor was the end of March, so he sent me to physical therapy in the meantime, because my ankle range of motion continued to decrease.  Remember in middle school and high school, in gym class or basketball practice, when you would stand facing the wall, with your hands on the wall, with one foot slightly forward the other, and bend your knee towards the wall to stretch your calf? I couldn’t do that.  My ankle wouldn’t bend, and my heel would come off the ground.  Bassam and Justin at Physical Rehab were great – they spent a lot of time trying to make my ankle bend, with some success.  When my ankle started bending again, it hurt, A LOT.

My appointment in Charlotte was March 31st, the Thursday before the Masters, and my main goal was coming up with a plan that would let me walk around the course all week without having to wear the boot.  Dr. Davis evaluated my ankle for about five seconds, and sent me for x-rays, weight bearing, with my knee bent.  He said I had a cam lesion bone spur in the front of my ankle, causing anterior impingement, which was interesting, since my previous two surgeries had been to correct problems in the back of my ankle causing posterior impingement.  He said he had no idea why this was happening, gave me a cortisone injection, told me to give 3-5 days to kick in, and call him when it started hurting again.  He told me to stop going to physical therapy.

I don’t think I was aware of how bad a cortisone shot could hurt, but since I’d driven myself to Charlotte, I didn’t have time to wallow in the pain. I stopped at Bojangles before leaving Charlotte, because I was aware of how hungry a cortisone shot can make you (and because I felt like I deserved it) and I drove back to Augusta.  The next day, I went to the ATL to meet Philippa for the High Museum Wine Auction.  The auction was a blast, and my foot held up well, but I didn’t notice any real effects of the injection.  My ankle hurt on Monday and Tuesday of the Masters, but in a tolerable fashion.  The funny thing about my ankle pain was that it took 2-3 days to really start hurting after I overdid it, so I was expecting to wake up any morning of the Masters in debilitating pain.  To my surprise, I made the whole week on two feet with no boot!

Clearly the cortisone shot made a big difference, but about a week after the Masters the pain started to return. It’s amazing how quickly you can forget what real pain feels like once it goes away.  The cortisone shot let me continue to go to spinning and kept my activities of daily living intact, but I still couldn’t bend my ankle, and I felt like my activity level was decreasing while my pain was increasing in very small increments every day.  I talked to Dr. Davis on the phone about two weeks after the Masters, and he said he thought I needed surgery.  Surgery was scheduled for May 26th, and I had every intention of riding the bike and staying active right up until that point. The first week of May, I did something weird to my hip riding the bike, and I realized I was overcompensating because of my ankle didn’t bend right, and I decided if I couldn’t ride the bike without hurting something else, I shouldn’t ride the bike.  In the week that followed this decision, whatever remnant of the cortisone shot that was still helping wore off rapidly and completely.  Clearly I had grossly underestimated the value of the cortisone shot, but at least this new found severity of symptoms helped erase any doubts I had that surgery was a necessary course of action.

I went back to Charlotte on May 19th, for a pre-op visit, and Dr. Davis said he felt confident he could fix the problem.  I told him I was happy someone was willing to at least try to fix the problem, and that I had low expectations, because any improvement would be appreciated.  The surgery was May 26th.  The morning of the surgery, they had me sign a piece of paper that said Dr. Davis was going to perform an anterior ankle arthroscopy with possible tibia/talus saucerization, whatever that means.  Once I had my surgical gown and cap on, Dr. Davis stopped by to draw on my foot.  He told me he was going to make sure he fixed everything this time, because he did not want to see me back there. The anesthesiologist stopped by and told me he was going to give me a nerve block in three of the nerves in my leg – with an injection on the outside of my knee, and another one on the inside of my thigh.  Then they wheeled me back to another room so the anesthesiologist could use the ultrasound to find my nerves.  They also gave me 2 mg of versed, and about ten minutes after that, they gave me another 2 mg.  I remember them telling me I would go back to the first room after the nerve block, but I don’t remember the nerve block, and the next thing I remember is waking up.

Hello, Friends.  Here I am, back at my parents house, convalescing after ankle surgery #3 last Thursday, May 26, 2016.  I’m in a splint, non-weight bearing, until at least June 10th, when I get the splint off and get my new walking boot, which I will be enjoying for the rest of June and part of July. Until June 10th, it’s me, my crutches, and the scooter against the world.

 

In the eighth grade, we read Alas, Babylon and Lord of the Flies. These books taught me that in the event that I became stranded on a desert island or the apocalypse, I would quickly, if not immediately, be a burden and liability to those around me.  Why? Because I was blind without my contacts or glasses.  My contacts would only last so long and let’s face it, my glasses would get broken. Even with my contacts or glasses, I would suck at boar hunting and crab spearing, these visual aids did nothing for my impaired depth perception.

 

Eventually, I got my eyes lasered, and I can say without doubt that getting my eyes fixed was one of the greatest things that ever happened to me. Visually, I am now ready for the apocalypse.  I’m not sure if you’ve noticed, but the apocalypse has been a hot topic for most of my life.  There was a period of time when I gravitated toward dystopian literature, when the Hunger Games was first published and I had to convinced my tween cousins to read the novels, when Jennifer Lawrence was a tween somewhere in Kentucky.  After a while, the dystopia was difficult to escape.  A quick look at my Goodreads list reveals a distressing trend of nightmare wasteland settings, with heroes and heroines fighting through the jungles of what was once Chicago/Baltimore/Sacramento.  The last two straws were The Handmaid’s Tale and The Fifth Wave.  These books were HORRIBLE.  I can’t believe anyone thought the Handmaid’s Tale was worth publishing, much less recommending to others.

Around this time, I developed a chronic ankle problem. The only thing worse than imaging District 12 in the hunger games is imagining yourself as a young cripple in District 12.  I decided I would stop reading dystopian novels.  Except…a lot of novels don’t tell you they are going to deteriorate into a dystopian nightmare on page 450. Maybe I need to research the books I read, and maybe the problem is that most fantasy involves a dystopian lean, but as a PSA, novels with dystopian aspects you might pick up at the airport:  11/22/63; The Bone Clocks; 1Q84; The Circle; Night Film.

I enjoyed four glorious years of being ready and able for the apocalypse, but since 2012, my right ankle has replaced my vision as the top concern for why I won’t survive dystopia.  If you would like to read more about initial injury to first surgery, this post does a good recap from the initial injury in 2012 through March 2015, with links to the posts about the first surgery in October 2013 and the recovery.  Then you can read about my adventures with Ortho #4 and the second surgery here and here.

It’s interesting for me to go back and read these posts, because sometimes it hard to grasp how long I’ve had this problem, and how many doctors I’ve seen, and how many times I was told to “wait and see.” I’ve been reflecting on whether or not I could have handled this differently, if I could have been more aggressive in advocating for myself.  I’ve also been reflecting on how lucky I am that this problem manifested itself at a time when I was gainfully employed by the federal government in an extremely sedentary job, which has provided me with the best group medical healthcare available; the sick leave necessary to take the time off for my numerous surgeries, doctors appointments in cities 3 hours away, and extensive physical therapy; the ability to continue working despite my inability to ambulate effectively; and the sort of work that can be handed to a coworker during my absence without placing an enormous burden on myself or my coworker.  Plus, I’m not responsible for miniature humans!  While this has been a serious problem resulting in significant limitations in my activities of daily living and vocational restraints, I’ve been extremely lucky in my circumstances.  Next post, Surgery #3!

 

 

 

 

 

 

 

 

Me: You never responded to my text message about the Canadian mystery crime novel I’m reading! Where the victim gets electrocuted at the community curling match on Boxing Day after the maple syrup pancake breakfast?! 

Robyn: I definitely thought I dreamed that, and that if you did send me that text that you made this novel up to pick on the Canadian. 

Me: I’m serious! Everyone got a new toque for Christmas! And I even knew what that word meant! It was a fun read. There was hockey and bacon and snow and art and tons of French words, it was awesome, you would love it. 

Surgery 2.0

I would have preferred to have my ankle fixed before the Masters, but that did not happen.  The Masters is a week where no one is allowed to complain, and I wore my giant CAM boot the entire week.  The CAM boot kept my ankle from hurting, but it threw off my gait just enough and weighed enough to make the rest of my body hurt.  I found muscles I never knew existed while climbing the hills at the Augusta National in my boot.  I was also surprised to see how many other people were at the tournament in boots, and scooters, and wheel chairs.  The random comments of strangers was entertaining.  A lot of people told me they were “proud” of me.  I found this to be the most amusing comment.

I returned to Charleston on Monday, only to leave again on Wednesday afternoon.  Robyn was sweet enough to drive me to Charlotte, and to let Kate and me stay at her house in Charlotte. Although Dr. Davis told me that I would be able to weight bear immediately, the post-surgical people at OrthoCarolina called me on Wednesday and told me that the doctor had ordered a knee scooter for me for three weeks.  This freaked me out, but I was able to contact Dr. Davis’s nurse, who re-assured me I would not be non-weight bearing, and that I did not need a knee scooter.   When I mentioned this freak out to several close friends, they all responded with something along the lines of, “It would be terrible if you had to be non-weight bearing, but it would be awesome and hilarious if you had a knee scooter.”

Thursday morning, Kate and I got in the car, and drove to the wrong OrthoCarolina surgical center.  I was vaguely horrified by the traffic in Charlotte.  Once we found the right surgical center, around 9 am, thirty minutes late, everything was exceedingly pleasant and easy, with the exception of the ankle fellowship resident who came in and told me that I would be non-weight bearing for at least three weeks following surgery.  I had another freak out, and I told him that Dr. Davis told me I would be able to walk on my foot immediately, and the resident said he was under the impression I would be non-weight bearing.  I hate that I kept having mini panic attacks about this, but my house is not in the least bit cripple friendly, and I was only planning on being incapacitated in Augusta for a week.  Also, why is everyone telling me something different?

Eventually Dr. Davis came in and told me that I would be able to walk on my foot immediately and that he wanted me to move it as much as possible after surgery.  He said that I would be in a surgical shoe for a week, with my foot in a bandage, and that after a week I would be able to take the bandage off and wear regular shoes, and that I would not have to wear the boot again.  After my last surgery, I had to sleep in a boot for a week, so not having to wear the boot at all is blissful.

The surgery took about 45 minutes, and I woke up from anesthesia feeling like a bazillion dollars.  Dr. Davis said that my FHL tendon was torn, and that he cleaned up the tear and removed all of the scar tissue, and that the tendon would grow back on its own and that it wouldn’t bother me anymore.

Kate took me back Robyn’s house, where I was piled up on the couch with pillows and ice and percocet.  Robyn had to go back to Charleston, but Kate and I spent a lovely evening watching television with Whole Foods lasagna and salad.  I was able to walk in the surgical shoe by Thursday afternoon, and I slept like a professional sleeper Thursday night.  Friday, we returned to Augusta, and I’ve been happily recovering all weekend, and the dogs are taking good care of me.  I’ve been able to taper down the narcotics, and increase my activity.  Fingers crossed the worst is over, and that I will be able to return to the regular scheduled programming soon.  Dr. Davis said I would be able to play tennis three months from now, but I have to admit that I don’t actually believe him, and that I’m going to take things slow.  I would never play tennis again if it kept me from having this problem ever again.  I’m going to try to trust his professional opinion.  I’m so excited about being able to run, hike, swim, ride bikes, and go to yoga.  I am also looking forward to being back in Charleston in a routine and being a normal person again.  I will keep y’all posted on my progress!

OrthoCarolina

My long anticipated appointment at OrthoCarolina in Charlotte. was for 1:30 on Monday, March 23.  I was battling a cold and terrible allergies, and Susan-Elizabeth and crew stayed with me over the weekend.  I woke up Monday morning feeling terrible, but nothing was going to stop me from making my appointment in Charlotte.  I met my mom, Kate, in Columbia, and rode with her to Charlotte.  I left my insurance card, of course, but other than that, the visit went off without a hitch.  Dr. Hodges Davis met with me and watched me walk, and examined my ankle, testing the range of motion and the strength, and asking me questions.  Dr. Davis pulled up MRI and showed us the one slide that showed a tear in my Flexor Hallucis Longus Tendon, and that the tear would not have been visible during my previous surgery because of the location and the surgical approach.  Dr. Davis said that tendons tear like a rope frays, and that once it gets frayed, it will get stuck in the tendon sheath and not move correctly. Dr. Davis said that when my big toe seemed to get stuck, and when my ankle seemed to be stuck in a certain position, that it was actually the tendon tear getting stuck in the tendon sheath.

Dr. Davis said that he could fix the tear with arthroscopy, and that I would be in a boot for three weeks, and then I would be able to go back to my regular activities, with maybe a couple weeks of physical therapy.  This sounded too good to be true, but I was happy to have a doctor who was confident in what was wrong with me and in their ability to fix the problem.

I drove home from Charlotte pleased with the result of the visit, but generally not feeling very well.  When I got home, I had a fever of 102.2.  I spent the next three days in bed.  My surgery was scheduled for April 16.

Remember that time I thought my foot was broken, and then it wasn’t broken, and I had unexplained ankle pain for about a year before anyone could tell me what was wrong, and then one of the doctors decided he knew what was wrong, and they took out the extra bone in my foot and got mostly better and I did fun things???  Well, as of January 2015, I was pretty much back where I was in January 2013, just with a more complicated treatment history.

I had ankle surgery in October 2013, and in Spring 2014, once I started running and working out again, I played two tennis matches because my tennis team needed someone to play.  I did okay for not having played in a year and a half, but I didn’t feel great about it, and I figured I would sit out the summer and be all well and rested for fall tennis. I ran about ten miles a week in June and July, and did yoga a couple of times a week.  I had some tweaks of pain on occasion, but I was thrilled by this level of activity, as a year previously I had basically resigned myself to the fact that I might never run more than a mile again.

In August 2014, I decided I was ready to start playing tennis again.  I even took a couple clinics.  Being out on the courts felt good, even though I was still a little leery of my foot.  The last week of September, I ran three miles on Monday, took a tennis clinic on Wednesday, and played my first tennis match of the season on Thursday.  My tennis opponent made swift work of me, and ours was the only match that was finished by the time it started raining.  I was relieved that it was over, because I didn’t feel good about my ankle, but I didn’t feel any worse than I did during the spring matches, and I figured it was all in my head.

Friday, Saturday, Sunday are normal days.  Sunday night, I get a hankering for Jestine’s.  Jestine’s is just over a half mile from my house, and if I don’t want it bad enough to walk a mile for it, I probably don’t deserve it.   Plus, it always tastes so much better, and Briscoe likes to walk.  Briscoe and I happily and successfully make it to Jestine’s and almost back to the house with no trouble.  Half a block from my house, mid step, my ankle locked up and each step resulted in blinding pain.  If I had been more than half a block from my house, I would have required rescuing.  As it was, I hobbled home in near tears, and stumbled up my stairs, collapsing on the couch in the worst pain in recent memory.  I dug through my medicine cabinet and found some pain killers from my surgery, but when I woke up the next day I was still in pretty serious pain.  I dug out the ole trusty walking CAM boot, and tried not to scream in frustration.

I made an appointment with my Augusta surgeon, and with the ankle guy at MUSC.  Augusta Surgeon could see me Friday, MUSC said I was in luck, that their Ankle guy could see me December 15th. Augusta Surgeon was completely nonplussed by my regression.  He said that it’s not uncommon for scar tissue to break up about a year after surgery, and that I should wear the boot until I didn’t need to anymore, and call him back in six weeks if it was still painful.  I went back five weeks later and he fitted me with a lace up brace, and ordered an MRI.  I had an MRI thanksgiving week. The MRI showed some swelling and inflammation of my FHL and PTT tendon, but nothing was torn or broken.  I went back to Augusta Surgeon the week after the MRI, and he told me I should just be patient, that inflammation like this can take 3-4 months to heal, and that I should try to take it easy until January.  He said he felt sure it would be better by January.  I asked him what would happen if it wasn’t better by January.  He said that if it wasn’t better by January, it meant there was something else wrong with the ankle that the MRI didn’t show.  Great.

I was able to transition from the CAM boot to a lace up brace.  Before I knew it, it was December 15, and I was able to see the MUSC ankle guy.  I was told that most people wait six months to see the MUSC ankle guy, and I was lucky I only had to wait 2.5 months.  Dr. MUSC said that he wanted to review my MRI with his radiologist and that he would contact me after he came up with a treatment plan.  Dr. MUSC’s PA called me on December 31, and asked if I could come in that morning for an ankle injection.  Dr. MUSC said that he believed that there was something wrong with my FHL tendon, but that his radiologist disagreed.  Dr. MUSC injected my posterior tibial tendon sheath with ropivocaine.  This was an interesting experience, as the doctor took x-rays with this x-ray arm thing while he was injecting my foot.  I was instructed to go out and do whatever I would normally do that day.

“Normally” is such an interesting thing.  What is normal?  Seeing as it was New Year’s Eve, I wore heels.  I had not worn heels in months.  The injection made my foot feel infinitely better, and I was able to wear heels all night NYE, and I was able to go to two yoga classes the next week – on Monday and on Friday. I was at about 70% for the yoga classes, but I was so happy to be active, I had forgotten how much I enjoyed working out and how much I had missed it.  I returned to MUSC on Monday, January 12, 2015, and Dr. MUSC injected my ankle joint with ropivocaine, to see if injecting the ankle joint would also result in improvement.  The actual injection did not hurt, but a few hours after the injection, the pain increased drastically.  By Tuesday morning, I was unable to walk.  Dr. MUSC said he performed hundreds of injections a year, and that he could not remember the last time an injection had increased a patient’s pain.

It is my belief that I further injured my ankle wearing heels and going to the two yoga classes, and that the ankle injection just happened to be at the same time. I was prescribed mobic and ultram, but I only took the ultram at night because it made me feel weird. The pain was severe enough the second and third week of January that Dr. MUSC put me in a hard walking cast for three weeks.

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Dr. MUSC took my cast off on February 22, 2015, and told me that he was not confident enough about my diagnosis to operate, and he referred me to OrthoCarolina for another opinion.  I had to wait until March 22 for an appointment, and the pain forced me to continue wearing the boot.

Twenty-Fourteen was a great year overall.  Twenty-Fifteen needs an attitude adjustment.  I know I promised to write all the blogs I missed in 2014, and I actually have a great one that I am almost finished with, but 2015 is so loud right now that I’m unable to focus on the past.

Tuesday, January 20, 2015, the day after MLK holiday.  Sunny dry conditions.

Downtown Charleston.

My work desk at home overlooks a residential street that borders a more commercial area.  I live where the slate sidewalks end, and I spend my days watching College of Charleston kids ride by on skateboards and bikes.  I observe my neighbors on their routine to and fro, with or without their children and dogs.  There is the greyhound who wears a jacket when it is cold, and he seems to skip with delight when wearing the jacket, either from the cold or from the sheer pleasure of being stylish.  I like to people watch, and I’ve never been able to resist attaching make believe characteristics to people I see every day but know nothing about.

4 pm, I’m sitting at my desk at home, furiously trying to finish a project before a 5 pm meeting.  I hear tires squeal and a crash.  I momentarily consider walking down stairs and investigating, but with my walking air cast boot (See Part II) and my impending deadline, I decide to fight the ADHD and stay at my desk.  I finish my project and take Briscoe outside around 4:45, at which point I discover that not only was there a car wreck, the car wreck involved my parked car.  I peer pressured Briscoe into hastily finishing her business, and I whisked her back upstairs.  Briscoe did not appreciate her afternoon stroll being cut short, and headbutted my knee and pretended like she might bite me once we got back inside.  I called Philippa to tell her I was unable to drive to our Florence Crittenton meeting, and she was nice enough to come pick me up.

Back out on the street, I see that the gold jeep liberty that hit my car is entirely stuffed with, including a piece of luggage spilling into the cab from the backseat, along with a tall boy aluminum can wrapped in a paper bag in the console.  The airbag is visible on first glance, but the responding office told me that it was a pillow, as he pulled numerous curious objects from the front seats of the car.  These objects included a panhandling sign that said – HOMELESS – OUT OF WORK – ANYTHING HELPS, numerous empty 24 ounce cans of Four Lokos and Icehouse, empty liquor bottles of what appeared to be gin or vodka, along with numerous needles and a black dish that was about the size of an ashtray.  I took a few pictures because I have no self control and I’m an interested party.

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The driver was still in the car when the police rolled up, and he was in the back of the cruiser by the time I got there.   I literally could not, because I had somewhere to be, so I gave my driver’s license and insurance card to the responding officer, who promised to put the accident report and my driver’s license in my mail box, and I hopped in the car with Philippa.

After two hours of meetings, and then a decompression dinner with wine, I arrived home around 9 pm to find that there was no accident report or license in the mailbox.  A few phone calls later, the responding officer tells me that he is at the hospital with the driver, that things are crazy, but that he will bring me my license and the accident report within the hour.  10 pm rolls around, and I start to get a little concerned.  I texted my new police friend at 10:15, and he tells me he is on the way.  10:30 pm finds me on my front porch, in my pajamas, talking to a police officer about how the man who slammed into my car tried to hide his drugs where the sun doesn’t shine, and how they had to take him to the hospital for x-rays and extraction.  The good news was that the driver hit the stop sign, and possibly a few other things, before he hit my car, and that this was his fourth DUI, so he would be in jail indefinitely.  The other good news was that it was his girlfriend’s car, and that they thought she had insurance.  The bad news that they had no current location on the girlfriend.

This was all a lot to process, and these sorts of things are always better left to worry about tomorrow.  The following day I had my car looked at by various body shops, and I discovered that the name of the car owner was incorrect on the accident report.  After an inordinate amount of back and fourth with Allstate, and a conversation with my new police friend, I learned the owner girlfriend’s actual name, and I discovered that yes, she did have insurance at some point in time, but that her policy was cancelled in October 2014 for non-payment.

My insurance claims man acted like the fact that the policy had been cancelled in October was the greatest news ever, because he was convinced that if the girlfriend DID have insurance, that allstate would deny the claim because the accident was in the commission of a crime.  And if there was NO insurance, I could use my uninsured motorist coverage, with a $200 deductible, but if it was denied because it was in the commission of a crime, that I would be forced to use my collision insurance, which has a $1000 deductible.  Just to be clear, my undergraduate degree is in Risk Management and Insurance, and I went to Law School, I am a member of two bar associates, including the state where this accident happened.  All of this was news to me, along with sounding unreasonable, totally insane, and confusing.  I pretty much just nodded and smiled and acted like I understood.  South Carolina, if it is in fact true that my uninsured motorist coverage is not triggered in the scenario of my car being damaged by an insured crime committing moron whose coverage is invalidated by his crime, then I don’t understand the policy reasons for uninsured motorist coverage.  Isn’t every uninsured motorist committing a crime?  Isn’t having valid liability insurance required by law?  If this is true, I call bullshit.  If I had the time or the effort available I would do some case law research to discover the validity of my insurance company’s claim.  However, since this loophole did not actually apply to me, and because I have a lot of ridiculousness to worry about right this second, I’m going to leave this question to the professionals.

Since this time, my car has been delivered to the repair shop, and I discovered that the driver’s girlfriend got a DUI in early January 2015, but since it was her first offense, she got out fairly quickly.  I have spent a lot of time thinking about these people. One insurance person that I spoke to said that she would be FURIOUS if this happened to her.  I thought this was interesting.  Because I’m not furious.  I’m really not even mad.  I would be mad if I had to pay $1000 deductible, but I don’t.  I’m disappointed that my fairly new car has lost value, but it’s a car, and that’s what insurance is for, right?  More than anything, it just makes me sad.  It makes me sad that this idiot would stand on a street corner, playing on the heart strings of the privileged but feel guilty about it, only to turn around and use the money to buy drugs and four loko and get behind the wheel and endanger the rest of us.  At 4 pm on a Tuesday afternoon.  But I’m even more sad for whoever is on the receiving end of the phone call they make from jail.

I remember one time in Athens, Christy and I were sitting outside of the Globe, eating hamburgers and enjoying our drink of choice (Christy was probably drinking rum and diet coke with no ice and I was probably drinking a tall paulaner), and she gave a panhandler $5, and I said, “Christy!  You know he’s just going to go buy booze!” and she said, “Yeah, but that was what I was going to do with it, so whatever.”  Christy had a really excellent point, and since that time I don’t begrudge a panhandler spending some of his money on booze.  But I’m deeply troubled that incredibly intoxicated individuals are driving cars through my neighborhood at 4 pm on a Tuesday afternoon.   4 am on a Friday is one thing, 4 pm on a Tuesday is a whole different beast.

Next thing you know I’m going to be standing on my front porch with a shotgun yelling at kids to get the hell off my lawn.